A Recent Study On Chiropractic Care For Low Back Pain
A 2018 study published in JAMA Network Open is among the latest to weigh in on the pros and cons of chiropractic care for treating low back pain. Researchers enrolled 750 active-duty military personnel who complained of back pain. Half were randomly assigned to receive usual care while the other half received usual care plus up to 12 chiropractic treatments.
After six weeks of treatment, those assigned to receive chiropractic care:
- reported less pain intensity
- experienced less disability and more improvement in function
- reported higher satisfaction with their treatment
- needed less pain medicine.
While no serious side effects were reported, about 10% of those receiving chiropractic care described adverse effects . Five percent of those receiving usual care had similar complaints.
Back In Action: Updated Treatment Recommendations For Lower Back Pain
That dull ache when you go for your morning jog. A sharp pain when you lift a heavy box. For some people, back pain is just an annoyance that comes and goes. For others, it can be a devastating hindrance to everyday life.
Back pain affects 80 percent of people at some point in their lifetime. Each year, lower back pain causes about 149 million lost days of work in the U.S. and costs $100 billion to $200 billion mostly in lost wages and productivity.As The New York Times reported in February 2017, the American College of Physicians and the American Pain Society have released updated back pain treatment guidelines that are similar to the evidence-based approaches weve used at UT Southwestern for many years. Many people expect their pain to be treated with a doctors visit and a prescription for medication. But we know thats not how back pain works. And with an opioid epidemic ragingin America, prescribing medication as a first-line treatment for back pain is not the safest approach for patients.
Lower back pain often can be resolved by staying active without pain medication. But there are times when thats not enough. Lets discuss when you might need to visit the doctor and when back pain is manageable at home.
Tips To Use Topical Medication To Relieve Sciatica Pain
Sciatica pain originates in your lower spine and travels down your sciatic nerve into your thigh and leg.
- When you use topical medication, apply the cream/gel or lidocaine patch to your rear pelviswhere your sciatic nerve roots are located.
- Treating this area, rather than your thigh or calf where the pain may be more, will help control and numb the pain at its origin and also calm the nearby nerves.
When you experience pain relief after using topical medication, try to perform simple lower back stretches. Stretches and targeted exercises can help prevent sciatica from recurring, by relieving the sciatic nerve compression, strengthening your tissues, and improving the flexibility in your lower back.
Also Check: How To Get Rid Of Period Back Pain
Look Into Getting A New Mattress
How old is your bed? You may be surprised to learn that the average life span of a mattress is less than 10 years. Theres no hard-and-fast rule, says Sean Mackey, MD, PhD, chief of the division of pain medicine at Stanford University, but if your mattress is sagging significantly or is more than six to eight years old, Id think about getting a new one.
Something else to consider: A firm mattress may not do your back any favors, says Carmen R. Green, MD, a physician at the University of Michigan Back & Pain Center. A number of studies over the years suggest that people with lower back pain who sleep on medium-firm mattresses do better than those with firm beds, she says.
Low Back Pain: What Role Does Medication Play In The Treatment Of Non
Painkillers are only recommended in addition to active treatments such as exercises and movement for example, to relieve severe back pain or to help you start moving more again. Because of the associated risks, though, they shouldn’t be used over a long period of time.
Low back pain usually goes away on its own after a while. In most cases it’s not clear what’s causing the pain. It is then called “non-specific” back pain. If low back pain lasts a long time or keeps returning, it is often difficult to treat. Good-quality studies have so far found that only few treatments help. Staying active and moving enough are among the most effective things you can do yourself.
The medications used include over-the-counter and prescription painkillers, muscle relaxants and antidepressants. Because medication can have side effects especially when taken over longer periods of time it shouldn’t be taken continuously, but rather only for a short while, for example when the pain is especially severe. What’s more, painkillers only have a limited effect in the treatment of non-specific low back pain.
Recommended Reading: How To Help Lower Back Strain
When Opioids Are Appropriate
If you have moderate to severe back pain or neck pain, have exhausted all other viable medication options, an opioid may be an effective treatment for you. Before your doctor prescribes an opioid pain reliever, he/she will likely evaluate your current medical condition by performing a physical and neurological examination. The assessment focuses on your painincluding the location, intensity, frequency, and treatments youve tried.
Get Back Pain Treatment
Most people suffer from back pain at some point in their lives. Its one of the most common reasons people miss work or go to the doctor. Its also a leading cause of disability. Back pain isnt a disorder rather, its a symptom of an underlying problem. Luckily, most cases of back pain can be treated at home without the need for surgery or other invasive treatments.
Recommended Reading: What Can You Do For Sciatica Back Pain
The Best Medication For Chronic Low Back Pain
by Health Professional
Medications are the most frequently recommended treatment for low back pain. Research has shown that 80% of primary care patients with low back pain were prescribed at least one medication when seen by the primary care provider more than one third were prescribed two or more medications.
The most commonly prescribed drugs for low back pain are nonsteroidal anti-inflammatory drugs such as Motrin and naproxen, muscle relaxants, and opioid-based pain killers. Other medications regularly prescribed for chronic low back pain include benzodiazepines such as Valium, cortisone-type drugs, anti-depressant medications and anti-seizure medications. Of course, many patients use over-the-counter medications such as Tylenol, aspirin, and NSAIDs such as Advil.
A challenge to many health care providers involves the choosing of the safest and most effective medication for a given patient. A more disturbing thought involves the possibility that many of the medications physicians prescribe may have little benefit. Thanks to a recent review by the American Pain Society and the American College of Physicians, published in the October 02, 2007 edition of Annals of Internal Medicine, there is a little more statistical certainty behind the decision to treat with a particular medication.
It will still be the case in many cases that the “best” treatment is the one that works.
Treatment For Acute Low Back Pain
Learn about the first aid steps you can take when you first get back pain, such as using heat or ice, taking medicine, and not resting too much.
If your pain is very bad, your doctor may recommend short-term use of a muscle relaxant. Some people consider epidural steroid shots.
Answers From an Expert:
“Stay as active as you can. Doctors used to say to rest, but it turns out that this is not the case. The more active you are, the better you will be, and the faster you will heal.”âDr. Robert Keller
- Low Back Pain: Should I Have Spinal Manipulation?
If over-the-counter medicines combined with these treatments have not helped, your doctor may recommend another medicine. In some cases an antidepressant such as duloxetine can help. If pain is very bad, your doctor may have you try a week or two of an opioid pain reliever such as tramadol. Be sure to discuss the risks and the possible benefits of all medicines with your doctor.
Don’t Miss: What Can Cause Pain In Lower Back Right Side
How Effective Are Back Braces
For low back pain, the research is mixed as to the exact degree of pain relief provided by back braces. Some studies have found that back braces can significantly augment other care mechanisms such as corsets while other studies have led to inconclusive results, or found that back supports and education did not result in meaningful improvement in cases of low back pain .
Studies show that back braces are especially helpful for reducing spinal curvature in cases of scoliosis when combined with exercise . Younger patients with scoliosis in particular tend to prefer bracing to surgery, as back braces can potentially improve spinal alignment enough that the need for surgery is eliminated .
Braces also appear to be helpful for those suffering from back pain due to manual labor. Lumbar supports inhibit flexion-extension movements, which make them useful for treating pain for workers whose occupations involve lifting heavy objects .
Some doctors recommend back braces after surgeries such as decompression or spinal fusion for spinal stenosis . Doctors may also suggest a specific type of spinal brace called a corset after a surgery like microdiscectomy, in which a surgeon operates on a painful lumbar herniated disc . Research indicates that corsets provide comparable relief to spinal manipulation, massage therapy, and electrotherapy in cases of subacute low back pain .ââ
What Happens When I Visit A Back Doctor
We gather a full medical history of your back problems and perform detailed physical examinations, said Dr. Guo. That includes checking for tenderness, spine range of motion, strength, sensation, and reflexes. Depending on your symptoms, we may perform provocative tests to find out what triggers your pain. We may order imaging studies, such as X-rays, MRIs, or CT scans. We may order electromyography and a nerve conduction study, which assess whether you have muscle and/or nerve problems that may cause your symptoms. We use all the information to help identify the cause of your back pain and associated symptoms, and provide the most appropriate treatments for you.
Also Check: What Causes Lower Back Hip And Knee Pain
Get Active To Treat Chronic Lower Back Pain
If the pain persists, we recommend scheduling an evaluation from a physical therapist. A physical therapist can teach you how to do special exercises to stretch and strengthen the spine, which should help relieve the pain.
Nonspecific Low Back Pain
This is the most common type of back pain. The majority of cases of sudden-onset low back pain are classed as nonspecific. This is the type of back pain that most people will have at some point in their lives. It is called nonspecific because it is usually not clear what is actually causing the pain. In other words, there is no specific problem or disease that can be identified as the cause of the pain. The severity of the pain can vary from mild to severe. This type of back pain is discussed further below.
Recommended Reading: Which Tempurpedic Mattress Is Best For Lower Back Pain
Will My Doctor Prescribe Pain Medications
Many doctors prescribe pain medication for the first time back patients. Any kind of pain medication comes with potential side effects, but recently the FDA changed the risk profile of Advil . The research they reviewed indicated that even a few weeks of use could significantly raise the risk for serious health conditions such as heart attack.
Sadly, many doctors give narcotic pain relievers right off the bat, even to their patients with mild, self-limiting pain. My opinion is that such practitioners are doing a serious disservice to these people because of the increased risk for addiction associated with taking narcotics.
A systematic review published in the May 2016 issue of the Journal of the American Medical Association found that while the ability of opioid analgesics to relieve acute low back pain is unknown, there is no evidence of a meaningful effect on chronic non-specific lower back pain. One of their big reasons for this was that opioids may yield a bit of short-term relief, but thats about it.
How can you extrapolate JAMAs findings on opioids for chronic back pain to your acute situation? You might consider this from risk to benefit angle. Taking narcotics for acute back pain may mean that youll risk becoming addicted to just a small amount of overall pain relief.
Not only that, its possible that opioids are over-kill, providing much more power than is actually needed to keep pain managed during that initial healing period.
Whats The Role Of Chiropractic Care
Some doctors refer back pain sufferers to a physical therapist right away. But many people with back pain see acupuncturists, massage therapists, or a chiropractor on their own. Experts disagree about the role of chiropractic care, and there are not many high-quality studies to consult about this approach. As a result, there are a number of questions regarding the role of chiropractic care: Should it be a routine part of initial care? Should it be reserved for people who dont improve with other treatments? Are some people more likely to improve with chiropractic care than others?
The answers to these questions go beyond any academic debate about how good chiropractic care is. Estimates suggest that low back pain costs up to $200 billion a year in the US , and its a leading cause of disability worldwide. With the backdrop of the opioid crisis, we badly need an effective, safe, and non-opioid alternative to treat low back pain.
Read Also: Why My Lower Back Is Hurting
Less Common Causes Of Low Back Pain
Inflammation of the joints of the spine sometimes causes back pain. Osteoarthritis is the common form of arthritis and usually occurs in older people. Ankylosing spondylitis is another form of arthritis that can occur in young adults and which causes pain and stiffness in the lower back. Rheumatoid arthritis may affect the spine but you are likely to have other joints affected too.
Various uncommon bone disorders, tumours, infection and pressure from structures near to the spine occasionally cause low back pain .
The rest of this leaflet is mainly about nonspecific low back pain – the common type of low back pain.
What Are The Best Natural Ways To Treat Lower Back Pain
Turmeric is a popular natural remedy for lower back pain. The roots anti-inflammatory properties may reduce joint pain and inflammation. Use caution if you’re taking prescription medications known to thin blood. They could interact with this supplement. Another natural treatment is applying ice directly to the affected area to reduce swelling.
Recommended Reading: How To Sleep With A Sore Lower Back
Oral Steroids May Reduce Sciatic Nerve Root Inflammation
Oral steroids, such as methylprednisolone and prednisone help reduce inflammation. Doctors may prescribe oral steroids to treat acute sciatica due to an inflamed spinal nerve root.5 Steroids are generally prescribed for short bursts of therapy.
For chronic sciatica, doctors may prescribe antiepileptic and antidepressant medications, which have shown to improve nerve pain. To reduce the risk of potential side effects, treatment is typically started with a low dose and increased gradually to determine the lowest effective dose.2,6
Sciatica typically resolves in 4 to 6 weeks without long term complications.7 Medications are an effective option to reduce acute sciatica pain and are usually recommended for short term use. Your doctor can help select which drug is appropriate for your specific underlying cause of sciatica, age, and general health and tolerance. For long term pain relief and to prevent recurrences, talk to your doctor about more specific treatments for the cause of your pain, such as physical therapy, manual manipulation, and massage therapy.
Read more about Sciatica Treatment
What Else Do I Need To Know
Braces are a relatively low-risk treatment method for several musculoskeletal conditions. They can provide short-term back pain relief, lumbar support, posture improvement, and muscle spasm relief, and can help alleviate lower back pain. Your doctor may offer medical advice such as pairing back brace usage with physical therapy, considering orthosis for other parts of your body, or specific exercises to strengthen your back muscles.
If you choose to use a back brace, take care to find the best fit, design, and style for your needs. Keep in mind that overuse of your brace can lead to muscle weakness, which could ultimately compound your pain, so be sure to use the brace as directed by your healthcare provider.
Read Also: What To Do If You Pull Your Lower Back
Chronic Back Pain What Options Are Available
If you are struggling with back pain in Central Pennsylvania, youre part of a vast group. Around 80 percent of adults, at some point in their lives, experience back pain. Its one of the most common contributors to missed work days and job-related disability, according to the National Institute of Neurological Disorders and Stroke . The Orthopedic Institute of Pennsylvania provides chronic pain treatment options at our eight locations, including conservative methods and surgical procedures if needed.