When Surgery Is Necessary
When conservative treatment for low back pain does not provide relief or neurologic symptoms are worsening or severe, surgery may be needed. Candidates for surgery present any of the following:
- Reasonably good health
- Back and leg pain limits normal activity or impairs quality of life
- Progressive neurologic deficits develop, such as leg weakness, numbness or both
- Loss of normal bowel and bladder functions
- Difficulty standing or walking
- Medication and physical therapy are ineffective
If surgery is recommended, neurosurgeons have a variety of options available to help relieve pressure on the nerve roots. If several nerve roots and discs are causing the pain or if degeneration and instability exist in the spinal column, the neurosurgeon may choose: a minimally invasive approach a more open decompression or fusing the vertebrae together with bone grafts and stabilizing them with instrumentation, including metal plates, screws, rods and cages, depending on the extent of disease. After such surgery, patients may gain restored mobility in the back, including the ability to bend over. In addition, patients may require postoperative physical therapy.
The benefits of surgery should always be weighed carefully against the risks. Although a large percentage of patients with low back pain report significant pain relief after surgery, it is not guaranteed that surgery will help.
How Do You Get Rid Of Back Pain Fast
The quickest way to get rid of back pain is with over-the-counter medications such as NSAIDs, like as ibuprofen and aspirin. If your back pain is due to a new injury or inflammation you can apply light pressure with ice to the area until you are able to seek medical attention. This will reduce the swelling and pain until further treatment is available.
One Back Pain Treatment You Probably Dont Need
Back pain can be incredibly frustrating, and going under the knife may seem like the quickest, easiest fix to bring relief. But the truth is, many people dont need surgery for lower back pain management, Dr. Park says.
If your back pain is musculoskeletal, you will not require surgery, but if its a pinched nerve thats due to a disc herniation or something else, you may need to have surgery, he says. But even in those people, when you go through a six-to-eight-week course of treatment that includes physical therapy and activity modification, 85 to 90 percent of the time, they wont need surgery.
However, if you try the treatments above and dont see any improvement or still feel pain, talk to your doctor about a referral to a pain management specialist, as more specific tests or treatments may be required to get to the bottom of whats going on.
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How Are Back Spasms Treated
Healthcare providers used to prescribe bed rest for those who deal with back spasms. Such inactivity is no longer recommended. Instead, follow your providers instructions about the following:
- Ice/heat: Apply ice or heat to the location of your back spasms. Wrap the ice pack or heating pad in a towel or pillowcase and apply it to your skin for 20 to 30 minutes. Then reapply after 20 to 30 minutes.
- Over-the-counter pain medications: Over-the-counter pain medications, including acetaminophen , naproxen or ibuprofen .
- Muscle relaxants: Your provider may recommend taking a muscle relaxant like cyclobenzaprine, metaxalone or methocarbamol. If you do take them, take them at night and only for 72 hours or less.
- Physical therapy: Your healthcare provider might prescribe physical therapy, where you can learn relaxation techniques and stretches for your back muscles.
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.
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How Cannabis/cbd Can Help With Lower Back Pain
Cannabidiol, popularly known as CBD, is a non-psychoactive agent found within cannabis that has analgesic pain-relieving properties. If you are wondering, Will CBD help with back pain? The answer is Yes.
Research has proven that this chemical compound can be used to treat acute and chronic back pain. Applying CBD oil for back pain may help to reduce inflammation. It could provide relief for persistent pain without producing analgesic tolerance.
Sleeping with lower back pain can also be a nightmare. CBD cream for back pain can upgrade ones quality of sleep by improving their relaxation state. Using CBD can help with sleep disorders and prevent stress and depression, often associated with insomnia. The compound also combats anxiety thats linked to chronic lower back pain.
CBDs muscle relaxant properties can also help alleviate spasms caused by lower back injuries. It interacts with the endocannabinoid system to alter anandamide levels, offering relief to lower back pain.
The amount of CBD that a person can take for lower back pain depends on different variables. As a rule of thumb, it is advisable to start with a small dosage and then adjust until one attains the desired effects. The severity of lower back pain, weight, metabolism rate, and the concentration of the CBD should be considered when choosing a dosage.
For Fast Relief: Advil Liqui
Dosage: 200 mg ibuprofen
Why experts recommend it:
The solubilized ibuprofen in the capsules is more easily absorbed into the bloodstream. This leads to faster relief. The capsule form also makes it easier to swallow.
How it works: Advil Liqui-Gels contain ibuprofen, another nonsteroidal anti-inflammatory drug. Ibuprofens effects do not last as long as naproxen sodium . However, it may be less harsh on the gastrointestinal system. Evidence from a 2016 study showed that liquid gels may provide faster pain relief than tablets.
How to use Advil Liqui-Gels:
-
Use as directed on the label or as instructed by your doctor
-
Do not exceed 6 capsules in 24 hours unless instructed by a doctor
-
If NSAIDs cause you to have gastrointestinal problems, try taking them with food
Precautions when taking NSAIDs :
Nonsteroidal anti-inflammatory drugs can increase the chance of serious gastrointestinal problems such as ulcers, bleeding, inflammation, and perforations.
People who take NSAIDs such as naproxen and ibuprofen, may have a higher heart attack or stroke risks than people who do not take these medications. People with kidney problems, or those who have had coronary artery bypass graft surgery, should not take NSAIDs.
Nonsteroidal anti-inflammatory drug side effects:
Ask a medical professional if you have any questions about taking NSAIDs.
Common, mild side effects of NSAIDs:
-
Heartburn
-
Abdominal pain
Severe side effects of nonsteroidal anti-inflammatory drugs:
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How Can I Relieve Back Pain At Home
You can manage back pain at home with over-the-counter medications, natural remedies, or very light exercise techniques. Medications such as ibuprofen, naproxen, acetaminophen, or aspirin can alleviate pain. Natural remedies like turmeric or ice can reduce inflammation. Or, you can try stretching, walking, or other light exercise. However, you should consult a doctor before starting new physical activity to avoid injuring yourself further.
When Is Surgery A Good Idea For Back Pain
These red flags can be indicators for surgery, if theyre found to berelated to your spine condition:
- New or progressing bowel/bladder issues
- Weakness in limbs
- Gait and balance problems
- Evidence of increased reflexes
Surgery can also be an option for chronic back pain if there is a knowncause confirmed by imaging and if other treatments didnt help. Getopinions from at least two surgeons, suggests Nava, as pain can stillcome back after the surgery.
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Prescription Pills For Back Pain
There are many types of prescription medicines used to treat back pain – many in pill form. Some are nonsteroidal anti-inflammatory drugs or NSAIDs. Theyre similar to Aleve Back & Muscle Pain tablets, Advil Liqui-Gels, and Motrin PM that youll read about below.
Most of the prescription pain pills are narcotics – this means that they act on the central nervous system, the brain, nerve pathways, and spinal cord. Although they work well in the short term to relieve back pain, they have many side effects, are potentially dangerous, and can lead to dependence and addiction.
Over time, narcotics may also lead to tolerance. This means you have to take higher doses to get the same effect. This further increases dependence and addiction risks, as well as some serious side effect risks.
Opioids are generally categorized as narcotics and are prescribed for pain relief in some situations. You may be familiar with some of the common side effects of opioids like sedation, nausea, and constipation .
Less common side effects include heightened sensitivity to pain, immune system dysfunction, rigid muscles, and spasms of the muscles. The side effects are serious and some of them are actually pain-causing. Isnt the idea to reduce back pain and feel better?
This brings us back to OTC pain pills. You are much less likely to have problems with OTC pain pills. Although they need to be used carefully and have potential side effects, they are in most cases, a better, safer choice.
Surgery For Lower Back Pain
Because the vast majority of patients recover from their low back pain with little help from a doctor, the rationale behind choosing surgery must be convincing. Eighty percent of patients with sciatica recover eventually without surgery.
Severe progressive nerve problems, bowel or bladder dysfunction and the cauda equina syndrome make up the most clear-cut indications for back surgery. Back surgery will also be considered if the patients signs and symptoms correlate well with studies such as MRI or electromyogram .
In the most serious cases, when the condition does not respond to other therapies, surgery may well be necessary to relieve pain caused by back problems. Some common procedures include:
- Discectomy, such as a or removal of a portion of a
- a bone graft that promotes the vertebrae to fuse together
- removal of the lamina to create more space and reduce irritation and inflammation
References and useful links
- 1, 2. Excerpted from Low Back Pain Fact Sheet, National Institute of Neurological Disorders and Stroke, National Institutes of Health
- 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.
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Medicines And Pain Relief For Lower Back Pain
Expert reviewer, Justin HaydeWest, Chief Pharmaceutical Officers Clinical Fellow at Bupa UKNext review due December 2023
Your GP may recommend medicines to help ease your back pain. Pain relief can help ease the symptoms but these medicines wont treat the cause. This is why its really important to keep active and mobile too.
The pain relief your doctor may offer will depend on whats causing your pain, how severe it is and whether a medicine is suitable for you. Most people with acute back pain will recover fairly quickly, within a few weeks.
The information below is an overview of the pain relief medicines your doctor may suggest. If your pain is very severe, is getting worse or is seriously affecting your quality of life, your GP may refer you to a specialist pain service or clinic for more specialist help.
What Structures Make Up The Back
The back is an intricate structure of bones, muscles, and other tissues that form the back, or posterior part of the bodys trunk, from the neck to the pelvis. At the center is the spinal column, which not only supports the upper bodys weight but houses and protects the spinal cord the delicate nervous system structure that carries signals that control the bodys movements and convey its sensations. Stacked on top of one another are about 30 bones the vertebrae that form the spinal column, also known as the spine. Each of these bones contains a roundish hole that, when stacked in line with all the others, creates a channel that surrounds the spinal cord. The spinal cord descends from the base of the brain and extends to just below the rib cage.1
Starting at the top, the spine has four vertebral regions:
- Seven cervical or neck vertebrae
- Twelve thoracic or upper back vertebrae
- Five lumbar vertebrae , known as the lower back
- The sacrum and coccyx, a group of bones fused together at the base of the spine.
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What Are The Symptoms Of Low Back Pain
Low back pain is classified as acute and chronic. Acute low back pain lasts from a few days to a few weeks. Most acute low back pain will resolve on its own. Chronic low back pain lasts for more than 3 months and often gets worse. The cause of chronic low back pain can be hard to find. These are the most common symptoms of low back pain. Symptoms may include discomfort or pain in the lower back that is:
- Aching
- Protruding or herniated disk
- Disease
The Dangers Of Opioids To Treat Lower Back Pain
We know this change can be frustrating for patients who have been treated with opioids or other strong painkillers in the past. But were here to put our patients well-being first. That means we need to try safer treatment approaches first before we consider potentially dangerous painkillers. If your back pain has gotten to the point where opioid medications are potentially needed, carefully discuss the risks and benefits with your doctor.
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How Is Low Back Pain Treated
Treatment may include:
- A prevention program
- Surgery
- Assistive devices
Rehabilitation is often a part of treatment for low back pain. Generally, there are 3 phases of low back pain rehab.
- Acute phase. During this initial phase, the physiatrist and treatment team develop a plan to reduce the initial low back pain and source of inflammation. This may include using ultrasound, electrical stimulation, or specialized injections.
- Recovery phase. Once the initial pain and inflammation are better managed, the rehab team focuses on helping you return to normal daily activities while starting a specialized exercise program to regain flexibility and strength.
- Maintenance phase. In this phase, you will learn ways to prevent further injury and strain to the back. You will also learn how to start a fitness program to help further increase strength and endurance.
Are Other Medicines Better
Acute low back pain usually gets better on its own, and no treatment has been shown to improve the outcome much beyond its natural course.3
However, other medicines for pain relief include anti-inflammatory medicines such as ibuprofen , aspirin and diclofenac . These may give a small amount of relief, but they are more likely to cause side effects than is paracetamol.8
Some people, including those with high blood pressure, asthma or stomach ulcers, or who take other medicines have a higher risk of side effects from NSAIDs. Before taking any NSAIDs, including those bought over the counter, ask your doctor or pharmacist about the benefits and potential risks.
There are non-medicine treatments available for back pain, but many have not been studied in detail and so it is not known how helpful they are.8 However, this does not necessarily mean they will not help you to manage the pain. Ask your health professional about other treatments that might be right for you.
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Finding The Right Treatment
Most cases of lower back pain are comparable to the common cold.
Depending on each patients unique situation and condition, conservative treatments and over-the-counter pain relievers may not address the underlying problem. In these cases, stronger medications or perhaps surgery might be the answer. Our goal is to provide the right treatment for the right condition, for the right patient, at the right time.
Times have changed, and the practice of medicine changes with time. As we learn more about lower back pain and how it works, well continue to refine our treatment recommendations. But our goal remains the same: using evidence-based medicine to give our patients safe, effective relief from back pain.
Otcs And Integrative Medicine For Back Pain
Integrative medicine
Complimentary methods include nutritional supplements, relaxation, meditation, etc. It focuses on the whole person, as opposed to the specific problem. There is considerable evidence that integrative care has a positive effect on many areas of a persons health and overall well-being, including decreased pain.
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What Can I Do To Relieve My Lower Back Pain
There are many options for relieving lower back pain depending on the cause, severity, and duration of the pain. For some patients medications or treatments such as transcutaneous electrical nerve stimulation and epidural steroid injections can help. Others see specialists like chiropractors, physical therapists, or pain management physicians. Each patients needs are different. A great first step is seeing your primary care provider.
