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==Conservative Management== | ==Conservative Management== | ||
For the vast majority of patients, low back pain can be treated with non-surgical care. | For the vast majority of patients, low back pain can be treated with non-surgical care. For those with acute, short-term back pain, certain home remedies<ref>{{cite web |url=http://www.back.com/articles-back_pain_relief.html |title=Acute back pain. Causes and treatment options. |accessdate=2007-09-26 |format= |work=}}</ref> may be effective. | ||
Most low back pain can be treated without surgery. Treatment involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury. Most patients with back pain recover without residual functional loss. Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. | Most low back pain can be treated without surgery. Treatment involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury. Most patients with back pain recover without residual functional loss. Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care. | ||
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Bed rest — 1–2 days at most. A 1996 Finnish study found that persons who continued their activities without bed rest following onset of low back pain appeared to have better back flexibility than those who rested in bed for a week. Other studies suggest that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs. Patients should resume activities as soon as possible. At night or during rest, patients should lie on one side, with a pillow between the knees (some doctors suggest resting on the back and putting a pillow beneath the knees). | Bed rest — 1–2 days at most. A 1996 Finnish study found that persons who continued their activities without bed rest following onset of low back pain appeared to have better back flexibility than those who rested in bed for a week. Other studies suggest that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs. Patients should resume activities as soon as possible. At night or during rest, patients should lie on one side, with a pillow between the knees (some doctors suggest resting on the back and putting a pillow beneath the knees). | ||
Exercise <ref name="pmid16973063"/> <ref name="pmid16973062">{{cite journal |author=Koes B, van Tulder M |title=Low back pain (acute) |journal=Clinical evidence |volume= |issue=15 |pages=1619–33 |year=2006 |pmid=16973062 |doi=|url=http://clinicalevidence.bmj.com/ceweb/conditions/msd/1102/1102.jsp}}</ref> may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Yoga is another way to gently stretch muscles and ease pain. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor. | Exercise<ref name="pmid16973063"/><ref name="pmid16973062">{{cite journal |author=Koes B, van Tulder M |title=Low back pain (acute) |journal=Clinical evidence |volume= |issue=15 |pages=1619–33 |year=2006 |pmid=16973062 |doi=|url=http://clinicalevidence.bmj.com/ceweb/conditions/msd/1102/1102.jsp}}</ref> may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Yoga is another way to gently stretch muscles and ease pain. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor. | ||
Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Patients should always check with a doctor before taking drugs for pain relief. Certain medicines, even those sold over the counter, are unsafe during pregnancy, may conflict with other medications, may cause side effects including drowsiness, or may lead to liver damage. | Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Patients should always check with a doctor before taking drugs for pain relief. Certain medicines, even those sold over the counter, are unsafe during pregnancy, may conflict with other medications, may cause side effects including drowsiness, or may lead to liver damage. | ||
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* Over-the-counter analgesics, including nonsteroidal anti-inflammatory drugs (aspirin, naproxen, and ibuprofen)<ref name="pmid16973062"/><ref name="pmid16973063">{{cite journal |author=van Tulder M, Koes B |title=Low back pain (chronic) |journal=Clinical evidence |volume= |issue=15 |pages=1634–53 |year=2006 |pmid=16973063 |doi=|url=http://clinicalevidence.bmj.com/ceweb/conditions/msd/1116/1116.jsp}}</ref>, are taken orally to reduce stiffness, swelling, and inflammation and to ease mild to moderate low back pain. Counter-irritants applied topically to the skin as a cream or spray stimulate the nerve endings in the skin to provide feelings of warmth or cold and dull the sense of pain. Topical analgesics can also reduce inflammation and stimulate blood flow. Many of these compounds contain salicylates, the same ingredient found in oral pain medications containing aspirin. | * Over-the-counter analgesics, including nonsteroidal anti-inflammatory drugs (aspirin, naproxen, and ibuprofen)<ref name="pmid16973062"/><ref name="pmid16973063">{{cite journal |author=van Tulder M, Koes B |title=Low back pain (chronic) |journal=Clinical evidence |volume= |issue=15 |pages=1634–53 |year=2006 |pmid=16973063 |doi=|url=http://clinicalevidence.bmj.com/ceweb/conditions/msd/1116/1116.jsp}}</ref>, are taken orally to reduce stiffness, swelling, and inflammation and to ease mild to moderate low back pain. Counter-irritants applied topically to the skin as a cream or spray stimulate the nerve endings in the skin to provide feelings of warmth or cold and dull the sense of pain. Topical analgesics can also reduce inflammation and stimulate blood flow. Many of these compounds contain salicylates, the same ingredient found in oral pain medications containing aspirin. | ||
* [[Muscle relaxant]]s for acute<ref name="pmid16973062"/> or chronic<ref name="pmid16973063"/> pain. | * [[Muscle relaxant]]s for acute<ref name="pmid16973062"/> or chronic<ref name="pmid16973063"/> pain. | ||
* | * Anticonvulsants— drugs primarily used to treat seizures— may be useful in treating certain types of nerve pain and may also be prescribed with analgesics. | ||
* Some antidepressants, particularly tricyclic antidepressants such as amitriptyline and desipramine, have been shown to relieve pain (independent of their effect on depression) and assist with sleep. Antidepressants alter levels of brain chemicals to elevate mood and dull pain signals. Many of the new antidepressants, such as the selective serotonin reuptake inhibitors, are being studied for their effectiveness in pain relief.<ref name="pmid16973063"/> | * Some antidepressants, particularly tricyclic antidepressants such as amitriptyline and desipramine, have been shown to relieve pain (independent of their effect on depression) and assist with sleep. Antidepressants alter levels of brain chemicals to elevate mood and dull pain signals. Many of the new antidepressants, such as the selective serotonin reuptake inhibitors, are being studied for their effectiveness in pain relief.<ref name="pmid16973063"/> | ||
* Opioids such as codeine, oxycodone, hydrocodone, and morphine are often prescribed to manage severe acute and chronic back pain but should be used only for a short period of time and under a physician’s supervision. Side effects can include drowsiness, decreased reaction time, impaired judgment, and potential for addiction. Many specialists are convinced that chronic use of these drugs is detrimental to the back pain patient, adding to depression and even increasing pain. <ref name="pmid17636781">{{cite journal |author=Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D |title=Opioids for chronic low-back pain |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD004959 |year=2007 |pmid=17636781 |doi=10.1002/14651858.CD004959.pub3}}</ref> | * Opioids such as codeine, oxycodone, hydrocodone, and morphine are often prescribed to manage severe acute and chronic back pain but should be used only for a short period of time and under a physician’s supervision. Side effects can include drowsiness, decreased reaction time, impaired judgment, and potential for addiction. Many specialists are convinced that chronic use of these drugs is detrimental to the back pain patient, adding to depression and even increasing pain.<ref name="pmid17636781">{{cite journal |author=Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D |title=Opioids for chronic low-back pain |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD004959 |year=2007 |pmid=17636781 |doi=10.1002/14651858.CD004959.pub3}}</ref> | ||
Spinal manipulation is literally a "hands-on" approach in which professionally licensed specialists (doctors of chiropractic care) use leverage and a series of exercises to adjust spinal structures and restore back mobility | Spinal manipulation is literally a "hands-on" approach in which professionally licensed specialists (doctors of chiropractic care) use leverage and a series of exercises to adjust spinal structures and restore back mobility<ref name="pmid16973062"/> or chronic<ref name="pmid16973063"/> pain. A [[clinical prediction rule]] can guide who is most likely to respond to manipulation.<ref name="pmid15611489">{{cite journal |author=Childs JD, Fritz JM, Flynn TW, ''et al'' |title=A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study |journal=Ann. Intern. Med. |volume=141 |issue=12 |pages=920-8 |year=2004 |pmid=15611489 |doi=}} [http://www.annals.org/cgi/content/full/141/12/920/T1 Summary of the rule]</ref> | ||
When back pain does not respond to more conventional approaches, patients may consider the following options: | When back pain does not respond to more conventional approaches, patients may consider the following options: | ||
*Acupuncture<ref name="pmid16973063"/> involves the insertion of needles the width of a human hair along precise points throughout the body. Practitioners believe this process triggers the release of naturally occurring painkilling molecules called peptides and keeps the body’s normal flow of energy unblocked. Clinical studies are measuring the effectiveness of acupuncture in comparison to more conventional procedures in the treatment of acute low back pain.<ref name="pmid17893311">{{cite journal |author=Haake M, Müller HH, Schade-Brittinger C, ''et al'' |title=German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups |journal=Arch. Intern. Med. |volume=167 |issue=17 |pages=1892–8 |year=2007 |pmid=17893311 |doi=10.1001/archinte.167.17.1892}}</ref> | |||
Acupuncture<ref name="pmid16973063"/> involves the insertion of needles the width of a human hair along precise points throughout the body. Practitioners believe this process triggers the release of naturally occurring painkilling molecules called peptides and keeps the body’s normal flow of energy unblocked. Clinical studies are measuring the effectiveness of acupuncture in comparison to more conventional procedures in the treatment of acute low back pain.<ref name="pmid17893311">{{cite journal |author=Haake M, Müller HH, Schade-Brittinger C, ''et al'' |title=German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups |journal=Arch. Intern. Med. |volume=167 |issue=17 |pages=1892–8 |year=2007 |pmid=17893311 |doi=10.1001/archinte.167.17.1892}}</ref> | *Biofeedback is used to treat many acute pain problems, most notably back pain and headache. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature (by controlling local blood flow patterns). The patient can then learn to effect a change in his or her response to pain, for example, by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects.(PMID 12076429) | ||
*Interventional therapy can ease pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, proliferative agents ([[Prolotherapy]]) or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Chronic use of steroid injections may lead to increased functional impairment. | |||
Biofeedback is used to treat many acute pain problems, most notably back pain and headache. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature (by controlling local blood flow patterns). The patient can then learn to effect a change in his or her response to pain, for example, by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. (PMID 12076429) | *Traction involves the use of weights to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Traction is not recommended for treating acute low back symptoms. | ||
*Transcutaneous electrical nerve stimulation (TENS) is administered by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves. TENS may also help stimulate the brain’s production of endorphins (chemicals that have pain-relieving properties). | |||
Interventional therapy can ease pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, proliferative agents ([[Prolotherapy]]) or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Chronic use of steroid injections may lead to increased functional impairment. | *Viniyoga (PMID 16365466), Iyengar (PMID 15836974), and Hatha yoga (PMID 15055095 - small trial). | ||
*Correcting leg length difference may help (PMID 16271551). To correct leg length difference, insert a hard rubber or cork heel pad into the shoe of the short leg if the difference between the two legs is 3/8ths inch or less. If more, have a shoe repairman build up the sole and heel. Taper the toe to avoid tripping. If more than 3/4 inch, start with 1/2 of what you need so that your body can adjust. | |||
Traction involves the use of weights to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Traction is not recommended for treating acute low back symptoms. | *[[Muscle Energy Technique]] (MET) may help (PMID 14524509 - small study) | ||
Transcutaneous electrical nerve stimulation (TENS) is administered by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves. TENS may also help stimulate the brain’s production of endorphins (chemicals that have pain-relieving properties). | |||
* Viniyoga (PMID 16365466), Iyengar (PMID 15836974), and Hatha yoga (PMID 15055095 - small trial). | |||
* Correcting leg length difference may help (PMID 16271551). To correct leg length difference, insert a hard rubber or cork heel pad into the shoe of the short leg if the difference between the two legs is 3/8ths inch or less. If more, have a shoe repairman build up the sole and heel. Taper the toe to avoid tripping. If more than 3/4 inch, start with 1/2 of what you need so that your body can adjust. | |||
* [[Muscle Energy Technique]] (MET) may help (PMID 14524509 - small study) | |||
Ultrasound is a noninvasive therapy used to warm the body’s internal tissues, which causes muscles to relax. Sound waves pass through the skin and into the injured muscles and other soft tissues. | Ultrasound is a noninvasive therapy used to warm the body’s internal tissues, which causes muscles to relax. Sound waves pass through the skin and into the injured muscles and other soft tissues. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Conservative Management
For the vast majority of patients, low back pain can be treated with non-surgical care. For those with acute, short-term back pain, certain home remedies[1] may be effective.
Most low back pain can be treated without surgery. Treatment involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury. Most patients with back pain recover without residual functional loss. Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care.
Although ice and heat (the use of cold and hot compresses) have never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals.(PMID 16437495) As soon as possible following trauma, patients should apply a cold pack or a cold compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel) to the tender spot several times a day for up to 20 minutes. After 2 to 3 days of cold treatment, they should then apply heat (such as a heating lamp or hot pad) for brief periods to relax muscles and increase blood flow. Warm baths may also help relax muscles. Patients should avoid sleeping on a heating pad, which can cause burns and lead to additional tissue damage.
Bed rest — 1–2 days at most. A 1996 Finnish study found that persons who continued their activities without bed rest following onset of low back pain appeared to have better back flexibility than those who rested in bed for a week. Other studies suggest that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs. Patients should resume activities as soon as possible. At night or during rest, patients should lie on one side, with a pillow between the knees (some doctors suggest resting on the back and putting a pillow beneath the knees).
Exercise[2][3] may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Yoga is another way to gently stretch muscles and ease pain. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, patients should stop exercising and contact a doctor.
Medications are often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Patients should always check with a doctor before taking drugs for pain relief. Certain medicines, even those sold over the counter, are unsafe during pregnancy, may conflict with other medications, may cause side effects including drowsiness, or may lead to liver damage.
- Over-the-counter analgesics, including nonsteroidal anti-inflammatory drugs (aspirin, naproxen, and ibuprofen)[3][2], are taken orally to reduce stiffness, swelling, and inflammation and to ease mild to moderate low back pain. Counter-irritants applied topically to the skin as a cream or spray stimulate the nerve endings in the skin to provide feelings of warmth or cold and dull the sense of pain. Topical analgesics can also reduce inflammation and stimulate blood flow. Many of these compounds contain salicylates, the same ingredient found in oral pain medications containing aspirin.
- Muscle relaxants for acute[3] or chronic[2] pain.
- Anticonvulsants— drugs primarily used to treat seizures— may be useful in treating certain types of nerve pain and may also be prescribed with analgesics.
- Some antidepressants, particularly tricyclic antidepressants such as amitriptyline and desipramine, have been shown to relieve pain (independent of their effect on depression) and assist with sleep. Antidepressants alter levels of brain chemicals to elevate mood and dull pain signals. Many of the new antidepressants, such as the selective serotonin reuptake inhibitors, are being studied for their effectiveness in pain relief.[2]
- Opioids such as codeine, oxycodone, hydrocodone, and morphine are often prescribed to manage severe acute and chronic back pain but should be used only for a short period of time and under a physician’s supervision. Side effects can include drowsiness, decreased reaction time, impaired judgment, and potential for addiction. Many specialists are convinced that chronic use of these drugs is detrimental to the back pain patient, adding to depression and even increasing pain.[4]
Spinal manipulation is literally a "hands-on" approach in which professionally licensed specialists (doctors of chiropractic care) use leverage and a series of exercises to adjust spinal structures and restore back mobility[3] or chronic[2] pain. A clinical prediction rule can guide who is most likely to respond to manipulation.[5]
When back pain does not respond to more conventional approaches, patients may consider the following options:
- Acupuncture[2] involves the insertion of needles the width of a human hair along precise points throughout the body. Practitioners believe this process triggers the release of naturally occurring painkilling molecules called peptides and keeps the body’s normal flow of energy unblocked. Clinical studies are measuring the effectiveness of acupuncture in comparison to more conventional procedures in the treatment of acute low back pain.[6]
- Biofeedback is used to treat many acute pain problems, most notably back pain and headache. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature (by controlling local blood flow patterns). The patient can then learn to effect a change in his or her response to pain, for example, by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects.(PMID 12076429)
- Interventional therapy can ease pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, proliferative agents (Prolotherapy) or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Chronic use of steroid injections may lead to increased functional impairment.
- Traction involves the use of weights to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Traction is not recommended for treating acute low back symptoms.
- Transcutaneous electrical nerve stimulation (TENS) is administered by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves. TENS may also help stimulate the brain’s production of endorphins (chemicals that have pain-relieving properties).
- Viniyoga (PMID 16365466), Iyengar (PMID 15836974), and Hatha yoga (PMID 15055095 - small trial).
- Correcting leg length difference may help (PMID 16271551). To correct leg length difference, insert a hard rubber or cork heel pad into the shoe of the short leg if the difference between the two legs is 3/8ths inch or less. If more, have a shoe repairman build up the sole and heel. Taper the toe to avoid tripping. If more than 3/4 inch, start with 1/2 of what you need so that your body can adjust.
- Muscle Energy Technique (MET) may help (PMID 14524509 - small study)
Ultrasound is a noninvasive therapy used to warm the body’s internal tissues, which causes muscles to relax. Sound waves pass through the skin and into the injured muscles and other soft tissues.
Minimally invasive outpatient treatments to seal fractures of the vertebrae caused by osteoporosis include vertebroplasty and kyphoplasty. Vertebroplasty uses three-dimensional imaging to help a doctor guide a fine needle into the vertebral body. A glue-like epoxy is injected, which quickly hardens to stabilize and strengthen the bone and provide immediate pain relief. In kyphoplasty, prior to injecting the epoxy, a special balloon is inserted and gently inflated to restore height to the bone and reduce spinal deformity.
References
- ↑ "Acute back pain. Causes and treatment options". Retrieved 2007-09-26.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 van Tulder M, Koes B (2006). "Low back pain (chronic)". Clinical evidence (15): 1634–53. PMID 16973063.
- ↑ 3.0 3.1 3.2 3.3 Koes B, van Tulder M (2006). "Low back pain (acute)". Clinical evidence (15): 1619–33. PMID 16973062.
- ↑ Deshpande A, Furlan A, Mailis-Gagnon A, Atlas S, Turk D (2007). "Opioids for chronic low-back pain". Cochrane database of systematic reviews (Online) (3): CD004959. doi:10.1002/14651858.CD004959.pub3. PMID 17636781.
- ↑ Childs JD, Fritz JM, Flynn TW; et al. (2004). "A clinical prediction rule to identify patients with low back pain most likely to benefit from spinal manipulation: a validation study". Ann. Intern. Med. 141 (12): 920–8. PMID 15611489. Summary of the rule
- ↑ Haake M, Müller HH, Schade-Brittinger C; et al. (2007). "German Acupuncture Trials (GERAC) for Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups". Arch. Intern. Med. 167 (17): 1892–8. doi:10.1001/archinte.167.17.1892. PMID 17893311.