Back Pain - Treatment

Understanding Back Pain - Treatment

How Do I Know What Kind of Back Problem I Have?

Before a doctor can begin treating back pain, he or she may do tests to
determine what is causing the patient's back pain. Unless you are totally
immobilized from a back injury, your doctor probably will test your range of
motion and nerve function and touch your body to locate the area of
discomfort.

Blood and urine tests will make
sure the pain is not due to an infection or other systemic problem.
X-rays
are useful in pinpointing broken bones or other skeletal defects. They can
sometimes help locate problems in connective tissue. To analyze soft-tissue
damage, computed tomography (CT) or magnetic resonance imaging (MRI) scans may
be needed. X-rays and imaging studies are generally used only for checking out
direct trauma to the back, back pain with fever, or nerve problems such as
extremity weakness or numbness. To determine possible nerve or muscle damage, an
electromyogram (EMG) can be useful.

What Are the Treatments?

Because back pain stems from a variety of causes, treatment goals are pain
relief and restored movement. The basic treatment for relieving back pain from
strain or minor injury is rest. An ice pack can be helpful, as can aspirin or
another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and
inflammation. After the inflammation subsides, applying heat can soothe muscles
and connective tissue.

Long-term bed rest is not only no longer considered necessary for most cases
of back pain, it is actually potentially harmful, making recovery slower and
potentially causing new problems. In most cases, you will be expected to start
normal, nonstrenuous activity (such as walking) within 24 to 72 hours. After
that you should begin controlled exercise or physical therapy. Physical therapy
treatments may employ massage, ultrasound, whirlpool baths, controlled
application of heat, and individually tailored exercise programs to help you
regain full use of the back. Strengthening both the abdominal and back muscles
helps stabilize the spine. You can prevent further back injury by learning --
and doing -- gentle stretching exercises and proper lifting techniques, and
maintaining good posture.

If back pain keeps you from normal daily activities, your doctor can help by
recommending or prescribing pain medications. Over-the-counter painkillers such
as Tylenol, aspirin, or ibuprofen can be helpful. Your doctor may prescribe
prescription strength anti-inflammatories/pain medicines or may prefer to
prescribe combination opioid/acetaminophen medications such as Vicodin or
Percocet. Some doctors also prescribe muscle relaxants. But beware, these
medications have their main effect on the brain, not the muscles, and often
cause drowsiness.

If your primary doctor isn't able to help you control the pain, he/she may
refer you to a back specialist or a pain specialist. Sometimes these doctors
will use injections of steroids or anesthetics to help control the pain. Some
newer treatments have been developed recently to help with the treatment of
pain. One of these is radiofrequency ablation, a process of delivering
electrical stimulation to specific nerves to make them less sensitive to pain,
or by delivering enough electricity to actually destroy the nerve to prevent
further pain. A similar type of procedure that delivers heat to a herniated disc
can shrink the disc so that it no longer bulging onto the nerve root causing
pain. Other medicines such as antidepressants and anticonvulsants are sometimes
prescribed to help with pain related to irritated nerves.

What Are the Treatments? continued...

Knowing the cause of the pain and fixing the problem if possible should be
primary in the course of your treatment, however.

Some physicians advocate using a
transcutaneous electrical nerve stimulator (TENS), although whether TENS is
clearly helpful for back pain has not been resolved. Electrodes taped to the
body carry a mild electric current that helps relieve pain. After appropriate
training, patients can use TENS on their own to help reduce pain while they
recover from strained or moderately injured backs.

Surgery for nonspecific back pain is a last resort. In cases of persistent
pain from extreme nerve damage, rhizotomy -- surgically severing a nerve -- may
be necessary to stop transmission of pain to the brain. Rhizotomy can correct
the symptoms caused by friction between the surfaces in a spinal joint, but it
doesn't address other problems, such as herniated discs.

Chiropractors have a role in the treatment of back pain. The U.S. Agency for
Healthcare Research and Quality recognizes spinal manipulation by chiropractors
and osteopaths as effective for acute low-back pain. Its effectiveness for
treating chronic back pain is less well established. Some researchers suggest
that early chiropractic adjustments for acute back pain may prevent chronic
problems from developing. Other doctors warn against some chiropractic
manipulations, particularly those that involve rapid twisting of the
neck.
Osteopathic treatment is likely to combine drug therapy with spinal
manipulation or traction, followed by physical therapy and exercise.

Acupuncture may bring moderate to complete pain relief for many sufferers. It
can be used alone or as part of a comprehensive treatment plan that includes
medications and other bodywork. Clinical achievements, along with positive
research results, prompted the National Institutes of Health (NIH) to declare
acupuncture a reasonable treatment option for those suffering low back pain.

If you consult a psychotherapist for cognitive behavioral therapy (CBT), your
treatment may include stress management, behavioral adaptation, education, and
relaxation techniques. CBT can lessen the intensity of back pain, change
perceptions about levels of pain and disability, and even lift depression. The
NIH considers CBT useful for relieving low back pain, citing studies that show
CBT to be superior to routine care and placebo.
Other comprehensive
behavioral programs have shown similar success, with participants able to lessen
the amount of medication they needed while improving their outlook and
pain-related behavior.

If lower back pain is related to muscle tension or spasm, biofeedback can be
effective for lessening pain intensity, decreasing drug use, and improving
quality of life. Biofeedback may help you train your muscles to respond better
to stress or movement.

The Alexander Technique, Pilates, and the Feldendkrais Method are all
specialized forms of body work that help you learn to move in a more
coordinated, flexible, and graceful manner. They may help reduce pain and can
relieve stress. Some of the postures of yoga may help diminish low back pain,
improve flexibility, strength, and sense of balance. Yoga is good for stress
reduction and can help with the psychological aspects of pain.
Aquatic
therapy and exercise can also improve flexibility and decrease pain for those
with chronic low back problems. The unique properties of water make it an
especially safe environment for exercising a sore back; it provides gentle
resistance, comfort, and relaxation.