Low Back Pain Treatment
Epidural Steroid Injection
Epidural steroid injections are most commonly used in situations of radicular pain, which is a radiating pain that is transmitted away from the spine by an irritated spinal nerve. Irritation of a spinal nerve in the low back causes pain that goes down the leg. Epidural injections are also used to treat nerve compression in the neck , referred to as cervical radiculopathy, which causes pain.
Treating Lower Back Pain: How Much Bed Rest Is Too Much
Back pain is one of the most common reasons why people visit a health care provider. The good news is that the pain often goes away on its own, and people usually recover in a week or two. Many people want to stay in bed when their back hurts. For many years, getting bed rest was the normal advice. But current studies recommend no bed rest at all and stress that staying in bed longer than 48 hours not only wont help but it may, in fact, actually delay your recovery. Heres why:
Staying in bed wont help you get better faster.If youre in terrible pain, lying down for a day to help ease the distress may seem like a good idea, but moderating your activities and staying active in a limited way is a more effective way to control your symptoms. Research suggests that if you can find comfortable positions and keep moving, you may not need bed rest at all.Research shows that:
- Lying down longer than a day or two day isnt helpful for relieving back pain.
- People can recover more quickly without any bed rest.
- The sooner you start moving, even a little bit, or return to activities such as walking, the faster you are likely to improve.
Who needs bed rest?Almost no one! The only people who might require time in bed are those with unstable spinal fractures awaiting surgery.
When should I see a health care provider?You should see your health care provider right away if:
- Heat or ice
- Ultrasound
- Manipulation
Check with your health care provider before starting an exercise program.
Ways To Treat Chronic Back Pain Without Surgery
Back pain is considered chronic if it lasts three months or longer. It cancome and go, often bringing temporary relief, followed by frustration.Dealing with chronic back pain can be especially trying if you dont knowthe cause.
Back pain rehabilitationspecialistAndrew Nava, M.D., offers insights into common chronic back pain causes and nonsurgicaltreatment optionsand advises not to give up hope.
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What’s New With Neurofeedback
Central Sensitization
The pain research community has been doing a considerable amount of work on central sensitization. The Institute for Chronic Pain defines this as: a condition of the nervous system that is associated with the development and maintenance of chronic pain. When central sensitization occurs, the nervous system goes through a process called wind-up and gets regulated in a persistent state of high reactivity. This persistent, or regulated, state of reactivity lowers the threshold for what causes pain and subsequently comes to maintain pain even after the initial injury might have healed.7
Central sensitization has two main characteristics:
- allodynia that is, a tendency to experience pain with stimuli that are not normally painful
- hyperalgesia in which a painful stimulus is experienced as much more painful than it normally would.
Central sensitization can also lead to excessive sensitivity to light, sounds, and odors as well as cognitive deficits.7
Central sensitization can be associated with the following medical conditions: stroke, spinal cord injury, chronic low back pain, whiplash, chronic tension headaches, migraine headaches, rheumatoid arthritis, osteoarthritis of the knee, endometriosis, injuries sustained in a motor vehicle accident, postsurgical pain, fibromyalgia, irritable bowel syndrome, and chronic fatigue syndrome.8
Neurofeedback Use for Specific Chronic Pain Conditions
Protocols vary but tend to fall into two major categories.
Ii What Are The Causes Of Lower Back Pain
The vast majority of patients experience back pain because of mechanical reasons. They strain a muscle from heavy lifting or twisting, suffer a sudden jolt in a car accident, experience stress on spinal bones and tissues resulting in a herniated disc, or suffer from osteoarthritis, a potentially painful degeneration of one or more joints. Common causes for low back pain are as follows:
- Mechanical or Functional Injury
- Inflammation
- Neoplastic
- Referred Pain
To choose the safest and most effective therapy, doctors need to consider the full spectrum of possible underlying issues, such as inflammatory conditions, fracture, infection, as well as some serious conditions unrelated to the back that radiate pain to the back.
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How Can You Prevent Lower Back Pain
While you cant stop aging or change your genetic makeup, lifestyle changes can help manage and prevent lower back pain. Having a healthy lifestyle may make you less likely to suffer an accidental injury, too.
Improve your physical fitness. People who are not physically fit are more likely to develop lower back pain because strong core muscles help support the lower back.
Stay active. People who lead sedentary lives may be more likely to injure themselves when they do exert themselves. As far as back health is concerned, its better to do a smaller amount of physical activity most days of the week than to sit all week and over-exert yourself on the weekends.
Lose weight if necessary. The more you weigh, the more pressure you have on your lumbar vertebrae. Being overweight or obese can put stress on the back and lead to lower back pain.
Lift heavy objects the right way. Be sure to squat while lifting so that your hips and knees do much of the work. Keep the load close to your chest while you lift.
Your legs, not your lower back, should be the main driver when you’re lifting something heavy.Make your workspace as ergonomic as possible. If you sit at a desk, make sure your chair has plenty of low-back support and your hips are at a right angle to the floor.
Dont use tobacco products. In addition to all the other health problems tobacco use causes, it can restrict blood flow and oxygen to the discs, causing them to degenerate faster.
Vii Fractures And Lower Back Pain
Fractures of the spine are often very difficult pain problems and indicate the possible presence of osteoporosis . In patients with severe osteoporosis, spinal fractures can occur with no early warning and no significant trauma the patient does not have to fall to fracture a vertebrae.
Patients with spinal compression fractures experience spasms and very high pain levels.
In patients with low back pain where the cause is difficult to determine, especially for elderly patients with osteoporosis, a fracture in the sacrum may be the cause of the pain. A standard X-ray or bone scan may not show a sacral fracture. Imaging techniques such as CT scan or MRI can often reveal these fractures.
It is very important that patients with acute lumbar compression fractures be tested for osteoporosis. A bone density study is needed, unless the patient has no other osteoporosis risk factors and has had a very high impact fracture. Studies have shown that many patients with fractures in the U.S. are discharged from hospitals with no plans for management of their bone density problems, which then are left to worsen.
Although pain can be very intense, it is best for patients with lumbar fracture to resume activity as soon as possible. This is especially true for elderly patients, who can too easily become weakened, and develop other complications, if mobility is reduced for too long. might be needed for pain control, for a brief period.
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Nerve Irritation And Lumbar Radiculopathy Causes Lower Back Pain
Nerve irritation: The nerves of the lumbar spine can be irritated by mechanical pressure by bone or other tissues, or from disease, anywhere along their paths — from their roots at the spinal cord to the skin surface. These conditions include lumbar disc disease , bony encroachment, and inflammation of the nerves caused by a viral infection . See descriptions of these conditions below.
Try To Find A Back Whisperer Or Try These Three Exercises From One
Ramin, the journalist and author of Crooked, makes a compelling argument for seeking out a specialist who deeply understands the back to tailor an exercise program that targets your specific pain.
These back whisperers come from many different backgrounds: doctors of physical therapy with an orthopedic clinical specialist certification, personal trainers with a degree in exercise science, physical therapists.
They are able to observe how you walk and sit and stand, and grasp what your posture and gait say about your muscles, tendons, and ligaments, she writes in Crooked. Generally, they focus on functional training, prescribing exercise regimens that are non-pain-contingent , quantitative , and high-dose .
One renowned back whisperer isspine biomechanics professor Stuart McGill, of the University of Waterloo in Canada, who has treated everyone from Olympic athletes to professional football players. He spends several hours watching his patients move, and identifies the specific motions, postures, and loads that trigger their back pain. He then tailors exercise programs that build a foundation for pain-free activity, so that those triggers no longer result in pain.
McGill has a set of spine-stabilizing exercises the McGill Big Three, which Ramin does daily based on research in his lab that are targeted at people with chronic back pain.
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What Home Remedies For Lower Back Pain Actually Work
Unless youve had a major injury, such as a fall or car accident, you probably dont need to rush to the doctor for back pain. You may want to try these simple self-care strategies first.
Avoid bed rest. When lower back pain strikes, people often think complete rest will relieve back pain. However, a review of many clinical studies found that patients who retreated to bed actually experienced more pain and recovered more slowly than patients who stayed fairly active
Use ice and/or heat. Many people find that using ice or cold packs for periods of up to 20 minutes at a time helps reduce pain and swelling. Always wrap ice or a cold pack in a thin towel before putting it on your body so you dont injure your skin. You may also find that heat, such as a heating pad or warm bath, eases pain. Ice is recommended in the first 48 hours after injury then you can try a combo of ice and heat.
Try over-the-counter remedies. Short-term use of OTC pain relievers, such as the nonsteroidal anti-inflammatory drugs ibuprofen and naproxen, may ease your lower back pain. Also consider OTC creams, gels, patches, or sprays applied to the skin. They stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain.
Were Treating Lower Back Pain All Wrong Heres How To Do It Right
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Low back pain is the most common cause of disability worldwide, with eight in 10 people reporting the problem at some point in their lives, according to doctors.
But a new study on Wednesday found that people arent often getting the care they need to address their back pain.
The best cure for most people? Exercise. Regular movement is the best way to help with the vast majority of cases of low back pain, according to Doug Gross, a co-author of the study and a professor of physical therapy at the University of Alberta.
Although many people believe that bed rest or medication is what you should do when you have back pain, We know that the best management is just the opposite: you dont rest, you dont become immobilized, said Gross.
READ MORE: Chronic back pain? New guidelines call for exercise, heat pads painkillers a last resort
We tend to view back pain as something serious, he said, and so assume that rest and medication are the answer. And if it doesnt get better, patients get x-rays or MRIs or get referred to orthopedic surgeons. Ultimately most of those things are ineffective and they dont reduce the long-term disability that is associated with back pain.
Although he recognizes that the pain might limit your movement somewhat for a little while, you should not cut back on all your activities. And, he says, you should be confident that you will get better and not hold back on activities out of fear.
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Rub On Medicated Creams
Skin creams, salves, ointments, or patches may help when your back feels stiff, sore, and tense. Many of these products contain ingredients such as menthol, camphor, or lidocaine that can cool, heat, or numb the affected area.
Put on creams right where you hurt. Ask someone to apply it if you have trouble reaching the spot.
âIt’s not going to be a mainstay at providing significant relief, but it can calm things down,â Ray says.
What Is The Prognosis
In general, the clinical course of an episode of acute low back pain seems favourable, and most pain and related disability will resolve within a couple of weeks. This is also illustrated by the finding that about 90% of patients with low back pain in primary care will have stopped consulting their doctor within three months. Croft suggests that in many patients low back pain symptoms fluctuate over time.w5 Most patients with back pain will have experienced a previous episode, and acute attacks often occur as exacerbations of chronic low back pain. So recurrences are common. Pengel et al estimated the cumulative risk of at least one recurrence within a 12 month period to be 73% .w2 The severity of these recurrences, however, is usually less and does not always lead to a new visit to the general practitioner., Only a small proportion of people with an acute episode of low back pain develop chronic low back pain and related disability.
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When To Contact A Medical Professional
- Back pain after a severe blow or fall
- Burning with urination or blood in your urine
- History of cancer
- Loss of control over urine or stool
- Pain traveling down your legs below the knee
- Pain that is worse when you lie down or pain that wakes you up at night
- Redness or swelling on the back or spine
- Severe pain that does not allow you to get comfortable
- Unexplained fever with back pain
- Weakness or numbness in your buttocks, thigh, leg, or pelvis
Also call if:
- You have been losing weight unintentionally
- You use steroids or intravenous drugs
- You have had back pain before, but this episode is different and feels worse
- This episode of back pain has lasted longer than 4 weeks
What Is The Outlook For People With Lower Back Pain
The outlook depends on the cause of pain. Most people with back strains and sprains recover and do not have long-term health issues. But many people will have another episode within a year.
Some people have chronic back pain that doesnt get better after several weeks. Older people with degenerative conditions such as arthritis and osteoporosis may have symptoms that get worse over time. Surgery and other treatments are effective at helping people with a range of injuries and conditions live pain-free.
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How Is It Diagnosed
The diagnostic process is mainly focused on the triage of patients with specific or non-specific low back pain. Specific low back pain is defined as symptoms caused by a specific pathophysiological mechanism, such as hernia nuclei pulposi, infection, osteoporosis, rheumatoid arthritis, fracture, or tumour. A study in the United States found that of all patients with back pain in primary care, 4% have a compression fracture, 3% spondylolisthesis, 0.7% a tumour or metastasis, 0.3% ankylosing spondylitis, and 0.01% an infection. Non-specific low back pain is defined as symptoms without a clear specific causethat is, low back pain of unknown origin. About 90% of all patients with low back pain will have non-specific low back pain, which, in essence, is a diagnosis based on exclusion of specific pathology.
Summary points
Most episodes of acute low back pain have a favourable prognosis, but recurrences within a year are common
Diagnostic triage focuses on excluding specific pathology and nerve root pain
Imaging might be indicated only in patients with red flag conditions
Evidence mostly favours active compared with passive treatments in acute and chronic low back pain
Evidence based guidelines for the management of low back pain are available in many countries, but implementation needs more effort
The main challenge is the early identification of patients at risk for chronicity and subsequently preventing the chronicity from occurring
Red flags
Indicators for nerve root problems
Know Your Otc Medications
Nonprescription pain relievers can help with muscle aches and stiffness. The two main types of over-the-counter options are nonsteroidal anti-inflammatory drugs and acetaminophen. NSAIDs include aspirin, ibuprofen, and naproxen.
True to their name, NSAIDs help lower inflammation that can lead to swelling and tenderness. But acetaminophen does not relieve inflammation. You can reach for either type of pain reliever for occasional back pain. NSAIDs may work a bit better, Hemani says, if you have arthritis of the spine or other inflammatory conditions.
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What Are The Common Causes Of Chronic Back Pain
Most of the time, chronic back pain is age-related as it is normal for the spine to degenerate with the years. However, it can also be a direct result of a past or current injury. Injuries that occurred because of trauma, improper lifting, years of bad posture, and even obesity. These are general causes but it is important to note that not always can people determine what initiated the pain. This does not mean that it should be ignored. When experiencing back pain for a prolonged period of time, you should seek medical attention.
Getting medical attention is vital because chronic low back pain may also be a sign of a serious condition or disorder. Radiculopathy occurs when a spinal nerve root is injured. Apart from the back, this injury may send pain signals to other areas of your body. This injury might be provoked by a herniated disc or spinal stenosis that compresses the nerve. Similarly, sciatica may also cause chronic low back pain. If the sciatic nerve is pinched or compressed, you may feel pain and muscle weakness from the lower back to the legs.
Skeletal irregularities may also produce chronic low back pain. Scoliosis, an abnormal curvature of the spine, is one of the most common of these irregularities. Scoliosis usually starts right before puberty, but pain may not be experienced until later in your adulthood. Although this condition cannot be cured, there are treatments that can help manage the pain, for instance, chiropractic care.
