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Managing Back Pain

Back Pain 

Most back pain does not require emergency treatment. However, if you experience back pain combined with bowel or bladder dysfunction, numbness in the groin or rectal area, or become unable to move, you should seek immediate medical evaluation. 

Call the doctor if your back pain is severe, does not improve within a few days, keeps you from participating in normal activities, or keeps returning. In addition, if you experience pain that radiates down an arm or leg, tingling, weakness, fever, or vomiting with back pain, contact your physician.  The are some potential symptoms of a heart-attack or a pending heart-attack.

Self Care 
Most back pain responds to rest and exercise.
Staying in bed for more than a couple of days is not advised, since muscles needed to support the spine will become weaker when not used. 

A recent study showed that maintaining regular activities helps patients recover more quickly than bed rest. Some doctors recommend resuming as much normal activity as possible while avoiding heavy lifting. A gradual program of non-stressful aerobic exercise, such as swimming and walking, can usually be started within the first two weeks of the onset of pain. 

Low-impact exercises will help build strength and endurance. Be sure to avoid any physical activity that includes heavy lifting, lifting when twisting, or bending forward and reaching.

Change your activities and environment if they contribute to pain.

You can learn how to prevent back pain in the future. Practice your posture and let your legs do the work when lifting heavy objects. Avoid sitting for long periods of time, use a chair with good back support, and rest your feet on a low stool. 

Support the small of the back with a pillow when driving, wear low-heeled comfortable shoes, and if you work at a desk, make sure it and your chair are kept at a comfortable height. If standing for a prolonged period, rest one foot on a low stool. Sleep on your side with a pillow between your knees, or if lying on your back, place a pillow under your knees.

Ice packs or heat often provides temporary relief.
Within the first 48 hours after noticing the symptoms, you may want to apply a cold pack to the area for 5 to 10 minutes at a time. If the symptoms persist, a hot shower, bath, or a heating pad can be used. 

While staying in bed for more than a few days is not recommended, practicing relaxing techniques is. Even if the hot water of a bath doesn't help, the calm and soothing environment might. Cold and heat should be used for no more than 5 to 20 minutes at a time. Always place a towel or other material between the skin and the ice or heat. Do not lie on a heating pad.

If you have difficulty moving your neck, special wide-view mirrors are helpful when driving. Your doctor may also suggest shoe inserts, which can help you to distribute your weight more evenly, thus taking the strain off overworked muscles in the back.

Drug Therapy 
Non-steroidal anti-inflammatory drugs (NSAIDs), steroids, pain medications, and muscle relaxants may be ordered to relieve symptoms.

Doctors typically start by ordering the over-the-counter pain reliever acetaminophen or over-the-counter NSAIDs, such as aspirin or ibuprofen. NSAIDs can cause gastrointestinal irritation and bleeding. 

Prescription-strength NSAIDs may be ordered. It is important not to combine NSAIDs. They should be taken as directed, with food, and any side effects should be immediately reported to the physician.

Muscle relaxants have been shown to be effective for short-term use, usually one to three weeks.
Muscle relaxants can cause drowsiness in 30% of patients taking them. 

Patients with severe pain may require narcotic pain medication for a brief period. Narcotic pain relievers can slow reaction times, cause drowsiness, cloud judgment, and cause dependence in as many as 35% of patients.

Sulfasalizine may be ordered for patients with ankylosing spondylitis if NSAIDs have not proven successful at controlling symptoms.

This drug is used in the treatment of certain types of arthritis, inflammatory bowel diseases, and psoriasis, and may be especially beneficial in patients who have one of these conditions already.

National standards recommend limited use of drugs for controlling symptoms.

Other Therapies 
Physical therapy and rehabilitation programs, which aim to help the patient recover and prevent additional injuries, will teach you proper exercises, lifting techniques, and how to make important lifestyle changes.

Specific exercises to improve muscle conditioning are added to a low-impact aerobic routine a few weeks after the initial injury. Patients learn specific exercises to strengthen back and abdominal muscles that help support the spine, and proper posture positions when sitting in a chair, driving, or resting.

While in physical therapy, patients learn the importance of posture, proper ways to lift and move heavy objects, and how to perform household and work-related activities without placing additional stress on the back.

When lifting, the back should be kept straight with the knees bent, letting the legs do the work. If an object is too heavy to lift easily, ask for help moving it. Do not twist, bend forward, or reach when lifting. Keep items being lifted close to the body.

Injections of anesthetics or steroids into trigger points of the spine may break the cycle of pain and relieve symptoms for a short period of time, but the practice is considered controversial with little proof of long-term benefits. If you suffer from sciatica, you may find relief from injections into the area around the spinal nerves (the epidural space).

Fortunately, most back pain does not require surgery and gets better without an operation. In some cases, surgery can cause additional difficulties.

Surgery may keep patients immobile for long periods of time, which is likely to cause muscle shrinkage and further damage. For this reason, surgery candidates are very carefully selected.

Surgery may be considered to relieve conditions involving severe nerve irritation or other types of serious problems.

Doctors only recommend surgical removal of disc tissue (discectomy) to treat sciatica (not back pain) when the patient's psychological profile indicates a good chance of success, the patient does not abuse drugs, is not depressed, and expresses realistic expectations. 

Even when all these conditions are met, surgery offers only short-term benefits over conservative treatment. 

Long-term, the results are about the same. About one out of ten patients who choose surgery will require additional back surgery later, a rate that increases over time. 

Surgery is recommended for people who 1) suffer progressive weakness when walking due to nerve injury or impairment, 2) experience bowel or bladder dysfunction, and 3) have incapacitating pain that does not respond to at least a month of conservative treatment or if it recurs.

Patients with spinal stenosis experiencing progressive, disabling symptoms that do not respond to conservative treatment may be candidates for surgery.

Alternative Medicine 
Spinal manipulation may help some patients who do not have symptoms of a neurological problem or osteoporosis.

Manipulation refers to manually applying pressure to the spine. National guidelines consider it safe for patients with low back pain during the first month as long as they do not have pain in the leg or other symptoms of nerve compression. It has not been proven effective after four weeks. 

Patients who have not noticed improvement in function and symptoms after one month should stop manipulation therapy until re-evaluated. Manipulation may increase disc-related problems and increase the risk of a compression fracture in patients with osteoporosis.

Some patients report relief from massage, biofeedback, or acupuncture, but there is controversy surrounding the effectiveness of these treatments.

Transcutaneous electric nerve stimulation is another alternative therapy some people find helpful, although there is disagreement as to how useful it is. Skin electrodes are applied to nerve endings in order to limit the sensation of pain. The electrodes transmit mild electrical impulses that act to block pain signals to the brain.

Special Circumstances 
Patients who have back pain from areas outside the spine need special attention. Kidney stones or ulcers causing pain in the back need treatments specific to these conditions.

Patients who have had one episode of back pain are more likely to have recurring episodes.
About half the patients who suffer an episode of back pain will experience another bout within a few years.

The back is the key to movement, balance, strength, and the ability to remain upright. The back also plays a major role in the nervous system. It is not hard to see why back problems are so common. 

The intricate elements of the back are easily disturbed. The steps that you can take to avoid back pain are important to follow. You will lessen your probability of having another episode of pain if you learn how to reduce your risks. Your back will benefit, and so will the rest of your body.

If mild to moderate back pain does not resolve within a few days of self-care, visit the doctor.
If the pain persists for four weeks or more, the physician will want to re-examine you, order additional tests, or send you to a specialist.

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