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What Is The Best Treatment For Chronic Lower Back Pain

How Effective Are Conservative Treatments In Chronic Low Back Pain

Chronic Low Back Pain : Understanding lower back structures and treatment approaches

That exercise and intensive multidisciplinary pain treatment programmes are effective for chronic low back pain is supported by strong evidence. Some evidence supports the effectiveness of behaviour therapy, analgesics, antidepressants, nonsteroidal anti-inflammatory drugs, and back schools and spinal manipulation. No evidence supports using other interventions . For most effective treatments, the effects are usually only small and short term. Unfortunately, many commonly used interventions lack sufficient evidence for clinically relevant long term effects.

Chronic Low Back Pain: Evaluation And Management

ALLEN R. LAST, MD, MPH, and KAREN HULBERT, MD, Racine Family Medicine Residency Program, Medical College of Wisconsin, Racine, Wisconsin

Am Fam Physician. 2009 Jun 15 79:1067-1074.

Most primary care physicians can expect to see at least one patient with low back pain per week. Acute episodes of back pain are usually self-limited. Patients with persistent or fluctuating pain that lasts longer than three months are defined as having chronic low back pain. Patients with chronic low back pain are more likely to see a family physician for their pain compared with orthopedists , physical therapists , and chiropractors .1 The economic impact of chronic low back pain stems from prolonged loss of function, resulting in loss of work productivity, treatment costs, and disability payments. Estimates of these costs range from $12.2 to $90.6 billion annually.1


Acetaminophen and NSAIDs are first-line medications for treating chronic low back pain.

Clinical recommendation

Imaging, such as lumbar spine radiography, should be delayed at least one to two months in patients with nonspecific low back pain without red flags for serious disease.

Evaluation of psychosocial problems and yellow flags are useful in identifying patients with chronic low back pain who have a poor prognosis.

Herbal medications

Trade-off between benefit and harm

Muscle relaxants

Antiepileptic medication for radicular symptoms

8, 36, 37

Home Remedy Treatments For Back Pain

A massage, whether performed by a massage therapist or by a loved one,can help relieve back pain.

The following home remedies are appropriate for anyone who is suffering from back pain due to tight, aching muscles or a strain. However, if you are experiencing pain, weakness, or numbness in the legs, or a loss of bowel or bladder control, see a doctor without delay.

Dont take it lying down. Conventional wisdom once held that several days or even weeks in bed were the best cure for a sore back. However, a growing number of doctors today encourage patients to get up and around as soon as possible and to avoid bed rest entirely if possible. Thats because mounting research shows that lying down for an extended period not only fails to speed up relief of low back pain but may make it even worse. If you feel you must rest your aching back, the best position is lying flat on your back with two pillows underneath your knees. Never lie facedown, since this position forces you to twist your head to breathe and may cause neck pain. Make an effort to get up and move around, slowly and gently, as soon as possible. Any more than three days of bed rest could weaken the muscles and make them more prone to strain.

Get some sleep. Getting sufficient rest at night is important when your back muscles are strained. Its best to lie on your side, with the knees flexed and a pillow between them. If you lie on your back, place a pillow under your knees.

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What Is The Source Of This Information

This information comes from a research report that was funded by the Agency for Healthcare Research and Quality, a Federal Government agency.

Researchers looked at 156 research studies on noninvasive treatments for low back pain. The studies were published before April 2015. Health care professionals, researchers, experts, and the public gave feedback on the report before it was published.

What Are Some Common Lower Back Pain Causes

Homeopathy treatment for chronic low back pain

The causes of lower back pain are sometimes viewed as being mechanical, organic or idiopathic. Sometimes spinal conditions are congenital or acquired meaning the disorder develops later in life.

  • Mechanical lower back pain is often triggered by spinal movement and involves spinal structures, such as the facet joints, intervertebral discs, vertebral bodies , ligaments, muscles or soft tissues.
  • Organic lower back pain is attributed to disease, such as spinal cancer.
  • Idiopathic refers to an unknown cause.

These are some of the things your doctor might look for or rule out when you schedule a visit for back pain.

The common symptoms of lower back pain.

Sprains and strains. Ligament sprains and muscle or tendon strains are the most common causes of lower back pain. Theyre often related to overuse.

Degenerative disc disease. While the name sounds worrisome, it just means you have a damaged disc causing pain. Over time, discs become thinner and flatter due to wear and tear. That leaves them less able to cushion the vertebrae and more likely to tear .

Herniated disc. The protective covering on intervertebral discs can tear over time. When this happens, the soft inner disc tissue may push through the outer layer. A disc that bulges or slips out of place is known as a herniated disc, bulging disc, or slipped disc. The herniation may press on nerve roots, leading to symptoms such as pain, tingling, numbness or weakness in the area that the nerve serves

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The Best Supplements For Back Pain

Blog Supplement Ingredients

Occasional back pain can be uncomfortable and inconvenient. But if you live with chronic back pain, you quickly learn how debilitating it can be. In fact, back pain, especially lower back pain, is the leading cause of work absence around the world. While chronic back pain can stem from an injury, inactivity, or even stress, it may also signal an underlying condition such as spinal degeneration, skeletal irregularities, or osteoarthritis. In this article, youll learn ways to relieve back pain naturally and be given a list of supplements for back pain that you can use.

Did you know? While an acute case of back pain can temporarily sideline your life, chronic back pain, defined as lasting for 12 weeks or more, can be agonizing and may prevent you from enjoying the activities you love.

In an effort to find pain relief, many people reach for over-the-counter non-steroidal anti-inflammatory drugs like aspirin, ibuprofen, or naproxen. Yet taken routinely, these drugs can cause gastrointestinal issues, as well as kidney and liver injury. They can also increase the risk of heart attack and other cardiovascular problems. Fortunately, there are safer options for relief from back pain.

What Do Guidelines Recommend

In many Western countries, clinical guidelines have been issued for the management of low back pain. In general, recommendations are similar across guidelines. Box 2 summarises the main recommendations for diagnosis and treatment for acute low back pain from 11 countries. For chronic low back pain, far fewer guidelines are available. Box 3 shows the recommendations from the recently issued European clinical guidelines for chronic low back pain. It must be noted, however, that these recommendations are made by a single guideline committee.

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What Is Low Back Pain

Low back pain may be dull and aching or sharp and stabbing. The pain may be mild or severe, and you may feel tingling or burning. You may also have pain in your legs.

You may feel stiff, and it may be hard to stand up straight or move your lower back. Low back pain can make it hard to do your daily activities.

  • Acute low back pain lasts for 4 weeks or less
  • Subacute low back pain lasts between 4 weeks and 12 weeks
  • Chronic low back pain lasts for 12 weeks or longer

Often, it is hard to know the exact cause of low back pain. There are many possible causes. One possible cause is a strain or tear in the muscles or ligaments that support your back. Low back pain can also be caused by a muscle spasm in your back.

Your health care professional may talk with you about your history of low back pain and may do a physical exam. Both can help rule out any serious conditions that may be causing your low back pain .

What Are Some Less Invasive Or Noninvasive Back Pain Treatments

Lower Back Pain Relief – The Best Chronic Pain Exercises and Home Remedies

Your doctor has a wide range of treatments that may help your lower back pain. In general, expect your doctor to take a stepped care approach. That means starting with simple, low-cost treatments and moving to more aggressive approaches later. Keep in mind that many treatments take time to reach their full effect.

Medications. When over-the-counter pills and topicals dont do enough to relieve back pain, your doctor may recommend a prescription drug. Examples include:

  • Antiseizure medication, such gabapentin or pregabalin, for nerve-related pain
  • Muscle relaxants, such as baclofen or carisoprodol
  • Prescription NSAIDs, such as celecoxib, diclofenac, or fenoprofen
  • Opioids, such as oxycodone or hydrocodone, on a short-term basis.

Physical therapy . PT for lower back pain involves passive and active therapies to help the patient build core muscle strength, improve spinal flexibility and range of motion, correct posture and more. Your physical therapy sessions may include:

Injections. An epidural steroid injection or a selective nerve block may provide short-term pain relief when lower back pain causes sciatica symptoms, such as leg pain.

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What Should I Know About Back Pain

Back pain is a very common problem and will affect many of us at some point during our lives.

The good news is that in most cases it isnt a serious problem, and it might just be caused by a simple strain to a muscle or ligament.

As far as possible, its best to continue with your normal everyday activities as soon as you can and to keep moving.

Being active and exercising wont make your back pain worse, even if you have a bit of pain and discomfort at first. Staying active will help you get better. Taking painkillers can help you do this.

The Real Difference Maker For Chronic Pain: Active Physical Therapy

Many people with chronic back pain are under the impression that they have two options: live with pain and try to minimize it, or have surgery. But for most back pain sufferers, theres another option a better option for providing long-term relief: active physical therapy.

Active physical therapy or targeted therapy involves exercises aimed at building up the specific muscles that support your back.

Also Check: How To Relieve A Tight Lower Back

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.

Imaging For Back Pain

chronic lower back pain treatment program

The issue of medical imaging X-rays, magnetic resonance imaging and computerised tomography scans for back pain is controversial. A survey of GPs found that about one-quarter of patients with lower back pain were sent off for imaging, yet these sorts of tests are costly and rarely useful for diagnosing the source of back pain or suggesting the best treatment.

Expert guidelines advise caution in ordering tests for presenting back problems, unless there’s some indication or ‘red flag’ suggesting something more serious major trauma, unexplained weight loss, unexplained fever, history of malignancy, inflammatory conditions or neurological issues, for example. Such cases account for only a small proportion of people presenting with new back problems.

Research has found that for uncomplicated lower back pain, the risks from imaging radiation may outweigh the benefits, as it doesn’t improve the outcomes of treatment, may result in high doses of radiation and may result in inappropriate treatment.

Imaging is not recommended for these reasons.

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What Is The Role Of Invasive Procedures In Chronic Low Back Pain

A recently published review summarised the available evidence about the efficacy of surgery and other invasive interventions for low back pain and sciatica. A number of interventions, including facet joint, epidural, trigger point, and sclerosant injections, have not clearly been shown to be effective. No sound evidence is available for the efficacy of spinal stenosis surgery. Surgical discectomy may be considered for selected patients with sciatica due to lumbar disc prolapse that do not respond to initial conservative management. The role of fusion surgery for chronic low back pain is under debate. Recent randomised clinical trials comparing fusion surgery with conservative treatment showed conflicting results.- Recommendations that fusion surgery should be applied in carefully selected patients are difficult to follow because no clear and validated criteria exist to identify these patients in advance.

Box 3: Recommendations in the European clinical guidelines for diagnosis and treatment of chronic low back pain



RecommendedCognitive behaviour therapy, supervised exercise therapy, brief educational interventions, and multidisciplinary treatment, short term use of non-steroidal anti-inflammatory drugs and weak opioids.

Meet Physicians Neck & Back Center: A Leader In Active Physical Therapy Programs

Your active physical therapy program needs to be intensive and specifically designed to strengthen and condition your back and core. And early on, you need specialized equipment that can help you target those specific muscles. Thats where Physicians Neck & Back Center can help.

We opened PNBC nearly 30 years ago, and weve worked with more than 200,000 patients in that time.

Our active physical therapy program for back pain focuses on spine strengthening. Through this program, youll start by doing an intake with a doctor or a physical therapist who specializes in spine care. Theyll work with you to determine your best treatment plan. Then youll start working one-on-one with a physical therapist who specializes in helping people heal chronic pain.

Want to learn more about PNBC? Watch this short video.

Your therapy will happen at one of our facilities that features state-of-the-art medical exercise equipment. Programs range usually from six to 12 weeks, but it all depends on your progress and your goals. Youll learn about what chronic pain is and how the brain processes it. Youll also focus on body mechanics such as proper lifting, standing and sleeping all the things that can contribute to back pain but you may not think about.

Since our programs are intensive and last for several weeks, its a good time to use your Flexible Savings Account dollars or your insurance .

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Pain Medications To Treat Back Pain

A wide range of medications is used to treat both acute and chronic low back pain. Analgesic medications are specially formulated to relieve pain. They include over-the-counter acetaminophen and aspirin, as well as prescription opioids such as codeine, oxycodone, hydrocodone, and morphine.

Nonsteroidal anti-inflammatory drugs can also be used to relieve pain and inflammation. Over-the-counter NSAIDS include ibuprofen, ketoprofen, and naproxen sodium. Several others, including a type of NSAID called COX-2 inhibitors, are available only by prescription.

There are also many topical creams or sprays that can dull and soothe low back pain. These are applied to the skin and thus stimulate localized nerves to provide feelings of warmth or cold in order to dull the sensation of pain. Topical analgesics can reduce inflammation and increase blood flow.

What Are Some Complementary Alternative And Emerging Treatments For Lower Back Pain

Top 5 Exercises For Chronic Low Back Pain

In some cases, doctors suggest therapies that are not considered standard of care. They probably wont be covered by insurance, but they may be worth considering. Examples include:

Platelet-rich plasma . PRP treatments use a small sample of your own blood that has concentrated amounts of blood building blocks known as platelets. Your doctor then injects the PRP directly into a damaged disc. The theory is that PRP injections use your own healing system to accelerate improvement of injured tendons, ligaments, muscles, and joints. PRP treatment has a longer track record in knee osteoarthritis, but a recent review article in the Journal of Spine Surgery suggests it may have a useful role for back pain, too. PRP needs a lot more research before it can be considered a proven technique.

Stem cells. In this emerging treatment, your doctor injects stem cells harvested from your hip into the intervertebral disc or discs causing your pain. Doing so may lessen pain and the degenerative effects of aging, though, like PRP, more research is needed before stem cells for lower back pain could eventually become the standard of care.

Acupuncture. Your doctor probably doesnt perform acupuncture , but may support you trying it as a complementary therapy. Acupuncture involves careful insertion of fine, sterile needles into specific points on your body. This may stimulate the release of your natural pain-killing chemicals.

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Invest In An Ergonomic Workplace Chair

Slouching onward while operating at a workdesk places excessive stress on the discs in your reduced back and can create issues, such as disc degeneration occurring or further damage. Assistance the natural contour in your lower back by:

Using an ergonomic chair that helps you straighten and sustain your back and also thighs appropriately

Positioning a small rolled-up towel in the tiny of your back for additional support

Using a standup workdesk, when possible for at least part of the day

It is handy to establish a timer for every single 50 mins to an hour on your phone to advise on your own to inspect your stance, stroll for a couple of mins, as well as stretch your lower back as well as leg muscular tissues.


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