What To Use For Lower Back Pain

Low Back Pain Shouldn’t Sideline You

Explore the common but under treated and misunderstood issues that accompany chronic back pain in our Back Pain Series. Part 1 explains the latest treatments that could relieve that aching back.

Many Penn State alumni fondly remember David K., now 34, as the student who crawled to class. Mired by back pain throughout his four years of college, David saw tons of doctors from top neurosurgeons to psychologists for the pain. Instead of listening to the popular college music of his day like REM, he listened to the soothing sounds of pain expert John E. Sarno, MD, on cassette tapes called Mind Over Back Pain when he drove his Mustang around the college campus.

“If you don’t have chronic back pain, you can’t possibly imagine what it feels like,” he says. “It’s unbearable — literally.” He says that there were many times he couldn’t walk and would have to crawl from his fraternity house all the way to class so he would not miss a midterm or final exam. “My fraternity brothers made a lot of fun of me,” he says. “Still do.”

About 80% of Americans — or four in five — experience low back pain at some point in their lives and understand David’s plight all too well. Many people with chronic low back pain are working age and for them, back pain is the most frequent case of lost productivity. Treatment for back pain costs roughly $100 billion a year, according to the American Academy of Orthopaedic Surgeons in Rosemont, Ill.

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:

• , 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

The Source Of Back Pain

A lot of back pain in older men is caused by weak core muscles and declining muscle mass. However, pain also could be related to osteoarthritis, an injury, or even depression. “It’s always important to get checked out by your doctor if your pain does not subside after a few weeks, or right away if it’s accompanied by other conditions like leg weakness, incontinence, or a fever,” says Dr. Shmerling.

Keep in mind that NSAIDs might not always be the best medicine for back pain. A study published online Feb. 2, 2017, by Annals of the Rheumatic Diseases reviewed 35 placebo-controlled studies that included more than 6,000 people who had all sorts of spine-related pain, including neck pain, low back pain, and sciatica.

There are several categories of back pain medication. The common ones include nonsteroidal anti-inflammatory drugs , opioids, muscle relaxants, and antidepressants. What’s your best option? It depends on your particular pain and how your body reacts to the medication and dosage.

“Advertisements pitch a particular drug as if it would work for everyone, but back pain varies from person to person, as does its response to drugs,” says Dr. Shmerling.

Here’s a look at these types of drugs and how they help with back pain:

NSAIDs. NSAIDs are often the go-to drugs for back pain relief. They can be purchased over the counter and include ibuprofen and naproxen .

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Medical And Family History

Your doctor will ask questions about your medical and family history to help determine if an injury or underlying medical condition is the source for the back pain. Some questions your doctor may ask:

• Can you describe your pain?
• Where is the exact location of your back pain?
• When did the pain start and how long have you had the pain?
• What were you doing when you first noticed the pain?
• How severe or bad is the pain?
• What makes the pain worse or better?

Your doctor may ask you to rate your pain on a scale from 1 to 10 to gauge the severity of the pain and talk to you about your ability to perform activities of daily living.

What’s The Best Way To Use A Tens Unit For Lower Back Pain

Using a TENS unit is simple, though you should read the instruction manual for any device you’ll be attaching to your body. In general, people use a TENS machine for 10-30 minutes, a few times a week. For most, this is enough to manage their back pain, but you’ll likely have to experiment with settings and timing to see what works best for you.

The steps below describe the basic process of using a TENS machine:

Check the battery

You don’t want to run out of charge halfway through a session that’s providing you with relief, so make sure the battery is fully charged before beginning.

Clean the skin

The device needs to make good contact with your skin to work. Before applying the pads, you should clean the skin. Be careful to read the guidelines on your machine: some may recommend that you use alcohol, while others may say to avoid it as it dries the skin and can lead to inflammation from the pads. The manufacturer will know which is best for your product.

Apply gel

A special gel is used on the electrode pads to ensure a good connection. Apply the gel to the pads according to the instructions provided by the manufacturer.

Place the pads

For the best results, place the first pad on the area where you feel pain. The second pad is mainly to complete the circuit and allow electricity to flow. If you have pain on both sides of your back, place the second pad on the opposite side. If not, you can place it next to the first one.

Attach the electrodes

Adjust the setting

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Low Back Pain Diagnosis

Getting diagnosed with a specific cause of low back pain is the first step to getting treatment. If you land in your doctors office hoping for back pain relief, theyll use a variety of diagnostic tools and methods, such as:

• A thorough medical history including any recent injuries, other diagnoses, family history of disease, and your job, activities and other lifestyle considerations

• Physical exams, which may include manipulating the painful area or reflex or other neurological tests

• Electromyography, which measures muscle and nerve function

• ImagingX-rays can show bone spurs and damage to bone, while CT scans and MRIs can depict damage to soft tissue like discs or ligaments

Arthritis Of The Spine

Arthritis of the spine the slow degeneration of the spinal joints is the most frequent cause of lower back pain. All of us experience wear and tear as we age, and it is normal for your lower back to start acting up as you get older. As the cartilage breaks down between the spinal joints, surrounding tissues may become inflamed. The inflammation and the thinning of cartilage increase friction in the joints, which may cause pain in the lower back.

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What Is Lower Back Pain

Low back pain can result from many different injuries, conditions or diseases most often, an injury to muscles or tendons in the back.

Pain can range from mild to severe. In some cases, pain can make it difficult or impossible to walk, sleep, work or do everyday activities.

Usually, lower back pain gets better with rest, pain relievers and physical therapy . Cortisone injections and hands-on treatments can relieve pain and help the healing process. Some back injuries and conditions require surgical repair.

Can A Tennis Ball Relieve Muscle Knots

Tennis ball massages are also effective at treating muscle knots and pains. Heres how it works with a tennis ball: by manipulating your bodys natural triggers, you can reach the pain points that you feel with your hands.

Reduce Your Pain With A Massage

Massage is an effective way to relieve muscle pain and to loosen the muscles.

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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.

Exercise To Loosen Muscles

Although it may seem counterintuitive to exercise when lower back pain is causing you grief, the right kind of movement can help eliminate the discomfort. Its always important to consult your physician before you engage in exercise when you have pain, but this conversation is well worth having if youre suffering.

First, you should keep in mind that not all exercise is beneficial in combating back pain. Try to avoid toe-touch exercises and sit-ups, which may add to the stress on your spine instead of relieving it. Leg lifts are another exercise to stay away from when you are hurting. If your core is not strong, leg lifts could be too demanding on your body if youre already experiencing pain.

Several types of exercises can be useful when you need to relieve back pain. Partial crunches can aid in strengthening your core without applying too much pressure to the area. Slow and controlled wall-sit exercises may also be useful. Other repetitions to consider include bringing each knee to the chest in succession, pelvic tilts, and swimming.

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Low Back Pain Surgery

Spine surgery is not necessary for most people who have lower back pain. If you do need it, your doctor will recommend an appropriate procedure to address your specific symptoms and medical situation. Common spine surgeries include:

. Two or more vertebrae are permanently fused together to limit excess spinal motion. Your surgeon will use a combination of bone, bonelike material, screws, plates and rods to hold the vertebrae together so they can heal into a single unit. Spinal fusion may be done to correct spinal deformities or to increase the spines stability in severe cases of spinal osteoarthritis or herniated discs.

. Laminectomy is a surgery in which your surgeon removes the back portion of one or more vertebrae to create more space for the spinal cord or other nerves. In people with severe arthritis, bone spurs within the spinal canal can grow large enough to press on the spinal cord, causing pain and limiting mobility. In a similar surgery known as laminotomy, your surgeon will remove a small piece of bone called the lamina from the back of the vertebra.

How Is Low Back Pain Treated

Treatment may include:

• A prevention program
• 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.

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More Advanced Care Options

Surgery When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:

Implanted nerve stimulators

• Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
• Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
• Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.

Medication From The Store

There are two kinds of over-the-counter pain relievers that frequently help with back pain: nonsteroidal anti-inflammatory drugs and acetaminophen. Both have some side effects, and some people may not be able to take them. Talk to your doctor before taking pain relievers. And don’t expect medication alone to solve your pain problem. Studies show you’ll probably need more than one type of treatment.

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Being Mindful Of Your Movements

How many times has someone told you to lift with your legs, not with your back? Though its almost become cliché, its good advice. Your lower back supports a lot of the function of your body. Even if you lift using correct posture most of the time, a few haphazard hoists can be all it takes to cause long-term pain.

For example, parents with small children will lean over and pick them up out of a crib several times a day. Once or twice might not put much strain on the back, but repeating this movement hundreds or thousands of times over the years can cause serious discomfort. Mind those movements today, and your back will be more forgiving in the future.

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Goals And Mechanisms Of Back Bracing For Pain Relief

A back-bracing prescription usually has a few complementary goals:

• Reduce muscle tension and low back pain
• Improve posture to redistribute weight in the spine
• Provide a healthy healing environment for spinal structures
• Increase function during daily activity

See Non-Surgical Treatments for Lower Back Pain

The above goals are achieved by the basic mechanisms of the back brace during use. Mechanisms of pain relief vary somewhat by brace design, but in general a brace is able to:

Adding a back brace to a treatment regimen has been shown in some studies to improve mobility and pain scores better than only physical therapy and pain medication.1Morrisette D, Cholewicki J, Logan S, Seif G, McGowan S. A randomized clinical trial comparing extensible and inextensible lumbosacral orthoses and standard care alone in the management of lower back pain. Spine . 2014 October 1 39:1733-42. However, more research is needed to confirm this finding.

Range Of Lower Back Problems That Can Benefit From Heat And Cold Therapy

Heat and /or cold therapy is beneficial either as a primary or adjunctive therapy, but people often overlook this treatment because its simple, inexpensive, and readily available. The following common lower back conditions may benefit from heat or cold therapy:

• Lower back pain from common conditions, such as herniated or degenerated discs, spinal stenosis , or spondylolisthesis

  Read more about Causes of Lower Back Pain

• Direct lower back injury from falls, sprains, sports injuries , or collisions1
• Pulled back muscle due to excessive strain or force leading to overstretching of the muscle fibers, such as from lifting weights1

  See Pulled Back Muscle Treatment

• Exercise-induced muscle soreness, such as a from trying a new exercise, exercising without an initial period of warming up, or overdoing a specific exercise1

Always use heat and cold therapy intermittently, for 15 to 20 minutes, with a 2-hour break in between to avoid skin and nerve damage.

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Overlooked Remedies For Lower Back Pain Relief

When lower back pain persists and continues to interfere with your quality of life, multiple treatment options may be needed for adequate relief. Below are some back pain treatments that are commonly overlooked or underused. Try one or more of these remedies to see which one, or combination, works best for you.

The Changing Face Of Spinal Surgery

Only a small percentage of patients with back pain are candidates for surgery, but for these patients, advances in techniques have made recovery a much easier road, says Boden of The Emory Orthopaedics and Spine Center.

Fifty years ago, a spine fusion meant a two-week hospital stay, a body cast or brace for months, and a minimum of six months away from normal activities. A spinal fusion is performed by fusing the vertebrae together with bone grafts to eliminate motion between two adjacent vertebrae where motion is causing lower back pain.

Today, minimally invasively techniques allow for smaller incisions, less blood loss, and faster recovery time, Boden says. Some spine fusion techniques can be done on an outpatient basis.

Fifty years from now, Boden predicts that disc replacement will be an alternative to spinal fusion. Moreover, gene therapy will be able to prevent or reverse disc degeneration, and genetic research will help discover genetic sources of back pain, he says.

“Gene therapy for disc regeneration may be more than five years off, but less than 20,” he predicts.

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