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.
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.
Identifying Subgroups Of Patients More Amenable To Specific Treatments
A recently published randomised clinical trial found that patients with acute or subacute low back pain had significantly better functional outcomes when they received a matched treatment compared with an unmatched treatment. The authors examined all patients before treatment and assigned them to one of three groups thought most likely to benefit the patients. Patients were subsequently randomised irrespective of this subgroup assignment towards one of the three interventions groups with the same treatments. The analyses were focused on matched versus unmatched treatment according to their baseline subgroup assignment.
Up to date evidence for clinicians regarding benefits and harms of treatments for a variety of disorders including low back pain
Cochrane Back Review Group The activities of the review group responsible for writing systematic Cochrane reviews on the efficacy of treatments for low back pain
Cochrane Collaboration The organisation responsible for writing systematic reviews and meta-analyses on the efficacy of treatments which are published in the Cochrane Library
European Guidelines The recently issued European guidelines on the prevention and treatment of low back pain
A patient’s perspective
Mrs Mooren-Baars, aged 76 years, Breille
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Is This Information Right For Me
This information is right for you if:
- You have low back pain
- Your low back pain is not caused by:
- Injury or pressure on the nerve roots in the spine
- A high-speed injury
- Cancer, an infection, problems with your nervous system, a broken bone, or certain types of arthritis
How Is Lower Back Pain Diagnosed
Your provider will ask about your symptoms and do a physical exam. To check for broken bones or other damage, your provider may order imaging studies. These studies help your provider see clear pictures of your vertebrae, disks, muscles, ligaments and tendons.
Your provider may order:
- Spine X-ray, which uses radiation to produce images of bones.
- MRI, which uses a magnet and radio waves to create pictures of bones, muscles, tendons and other soft tissues.
- CT scan, which uses X-rays and a computer to create 3D images of bones and soft tissues.
Depending on the cause of pain, your provider may also order blood tests or urine tests. Blood tests can detect genetic markers for some conditions that cause back pain . Urine tests check for kidney stones, which cause pain in the flank .
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What Specifically Makes The Chirp Wheel The Best Back Pain Relief Solution
The Chirp Wheel is patented and designed specifically for back pain relief and muscle relaxation. It can also be used to reduce tension headaches and relieve neck and shoulder pain. Every other solution is not cost effective, does not specifically target your back where it needs to, and can’t be easily stored.
How Does Rfa Work
The procedure will be performed in a specialized procedure suite under the guidance of a fluoroscope, a specialized type of x-ray. You will lie f dwn n n x-r tbl and the skin over your low back will be sterilized with a cleaning solution. The injection area is then numbed with a local anesthetic to minimize any discomfort during the procedure.
Using fluoroscopic guidance, your pain doctor will advance a small needle to the small facet joints of the spine, which often develop arthritis and cause pain. Th specialized type of x-ray allows your back pain dtr to watch th ndl placement n rl-tm to ensure optimal placement of thermal energy and nerve inactivation.
Your physician will perform several tests to confirm that the needle is not near any nerves that perform important functions, such as strength or sensation. Only pain generating nerves are targeted. Once optimal needle placement is confirmed, the area is numbed with a local anesthetic and thermal energy is delivered. Thermal energy inactivates the nerves transmitting pain signals from the facet joints to provide long lasting pain relief. Because the area is numbed, you may feel some pressure but will experience very minimal discomfort.
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Team Approach To Pain Management
For some, an integrated team of specialists may be best suited to manage the chronic lower back pain from degenerative disc disease. A team will usually comprise some combination of the following health professionals:
- A pain management specialist, such as a physical medicine and rehabilitation physician or anesthesiologist focused on pain management
- A physical therapist or physiatrist focused on rehabilitation
- A psychologist and/or psychiatrist for co-existing mental health issues, such as depression and/or difficulty sleeping
- An occupational therapist to assist with functional rehabilitation
In addition, a specialized nurse case manager or another health professional may work with the team to coordinate the care needed to treat depression, disability, and chronic pain.
Sometimes the combination of treatments is more effective than individual treatments. For example, the use of cognitive behavioral therapy has been shown to improve the benefits of physical therapy3 and reduce sleep problems.
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Lower Back Pain: What Could It Be
Do you have lower back pain? You are not alone. Anyone can experience lower back pain at any time, even if you dont have a prior injury or any of the risk factors. It is not always serious and can often get better on its own. But in some cases pain is your bodys way of telling you that something isnt right.
Learn more about lower back pain and what causes it from rehabilitation physician Akhil Chhatre, M.D., who specializes in back pain in the Johns Hopkins Department of Physical Medicine and Rehabilitation.
Can I Prevent Lower Back Pain
You cant prevent lower back pain that results from disease or structural problems in the spine. But you can avoid injuries that cause back pain.
To reduce your risk of a back injury, you should:
- Maintain a healthy weight: Excess weight puts pressure on vertebrae and disks.
- Strengthen your abdominal muscles: Pilates and other exercise programs strengthen core muscles that support the spine.
- Lift the right way: To avoid injuries, lift with your legs . Hold heavy items close to your body. Try not to twist your torso while youre lifting.
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Risk Factors For Low Back Pain
Anyone may develop back pain, even children and adolescents. The following factors may put you at risk for back pain:
- Age Back pain is more common after the age of 30 or 40 and when you start aging.
- Not exercising. Weak and inactive muscles in the lower back and abdomen may cause back pain.
- Overweight. Excess body weight creates more pressure on your back.
- Diseases some types of osteoarthritis and cancer can cause back pain.
- Heavy lifting in an inappropriate manner Using back instead of legs when lifting objects can lead to back pain.
- Mental conditions It seems that people with depression and anxiety are more likely to develop back pain.
- Smoking also, smoking reduces blood flow in the lower part of the spine, causing your body to fail to deliver nutrients to your back discs. Smoking also slows down the healing process.
- Fear of low back pain has been reported in recent years as an effective factor in the continuation of pain and in fact the transfer of pain from acute to chronic.
What Should I Think About When Deciding About Treatment
You and your health care professional can discuss what might be best to treat your low back pain. Here are some things to think about. Be sure to share your thoughts with your health care professional.
- How does your low back pain affect your daily life?
- What are your goals for treatment?
- Which treatment feels like the best fit for you?
- Which possible side effects of treatment concern you?
- How might the cost of treatment affect your decision?
- How much time do you have to spend on treatment?
Ask your health care professional
- Which treatment do you think may be best for me? Why?
- What may help my low back pain in the short term?
- What may help my low back pain in the long term?
- Might medicine help my low back pain? If so, which one?
- What side effects should I watch for? When should I tell you about them?
- Might nonmedicine treatments help my low back pain?
- How long might it take for the treatment to start working?
- Is there anything else I can try?
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Xv Useful Links And References
, Hospital for Special Surgery, Hector Lozada, PT, DPT, OCS, Robert Turner, PT, OCS, MS, Theodore R. Fields, MD, FACP, January 19, 2017.
Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health. Reviewed, July 26, 2003.
Deyo RA, Weinstein JN, Low Back Pain, N Engl J Med, Vol 344, No. 5, Feb 1, 2001, pp 363-370.
1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health
How Is Low Back Pain Diagnosed
A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.
Blood tests are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.
Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluids pressure in the disc will reproduce the persons symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.
Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:
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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.
When To See A Doctor
There is not always an obvious cause of lower back pain, and it often gets better on its own. Resting, trying hot or cold therapy, taking OTC pain relievers, and gently stretching may help speed up recovery.
However, a person should see a doctor for lower back pain that is severe, does not seem to be getting better, or occurs alongside other concerning symptoms, such as tingling or numbness down the legs.
People with lower back pain should seek immediate medical attention if they also have any of the following symptoms:
- difficulty walking or moving the legs
- loss of bowel or bladder function
- loss of sensation in the legs
- very severe pain
A doctor can help a person identify potential causes of lower back pain and recommend appropriate treatment.
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Diagnosis Of Lower Back Pain
Your physiotherapist or GP will usually be able to diagnose lower back pain from your symptoms and by examining you. A physiotherapist is a healthcare professional who specialises in maintaining and improving movement and mobility. You may want to go straight to see a physiotherapist if a self-refer service is available in your area. If its not, you can see your GP who can advise and refer you.
Usually further tests wont help. But if you have other symptoms, your GP may recommend tests including:
Is It Possible To Prevent Low Back Pain
Avoiding injury to the low back is a method of preventing low back pain. Additionally, conditioning exercise programs designed to strengthen the lumbar area and adjacent tissues can help to minimize risk of injury to the low back. Specific programs to relieve and prevent back pain can be designed with the help of physical therapists and other treating health care professionals.
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What Are Other Uncommon Causes Of Low Back Pain
Infection of the cartilage and/or bone of the spine
Infection of the discs and bone is extremely rare. These conditions lead to localized pain associated with fever. The bacteria found when these tissues are tested with laboratory cultures include Staphylococcus aureus and Mycobacterium tuberculosis . TB infection in the spine is called Pott’s disease. These are each very serious conditions requiring long courses of antibiotics. The sacroiliac joints rarely become infected with bacteria. Brucellosis is a bacterial infection that can involve the sacroiliac joints and is usually transmitted in raw goat’s milk.
Aneurysm of the aorta
In the elderly, atherosclerosis can cause the weakening of the wall of the large arterial blood vessel in the abdomen. This weakening can lead to a bulging of the aorta wall. While most aneurysms cause no symptoms, some cause pulsating low back pain. Aneurysms of a certain size, especially when enlarging over time, can require surgical repair with a grafting procedure to repair the abnormal portion of the artery.
What Research Is Being Done
The mission of the National Institute of Neurological Disorders and Stroke is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health , the leading supporter of biomedical research in the world.
As a primary supporter of research on pain and pain mechanisms, NINDS is a member of the NIH Pain Consortium, which was established to promote collaboration among the many NIH Institutes and Centers with research programs and activities addressing pain. On an even broader scale, NIH participates in the Interagency Pain Research Coordinating Committee, a federal advisory committee that coordinates research across other U.S. Department of Health and Human Services agencies as well as the Departments of Defense and Veterans Affairs.
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