Lower Back pain


How is back pain treated ?

How is back pain treated?

• 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. 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 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), 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.

• 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.

• 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

• Spinal manipulation is literally a "hands-on" approach in which professionally
licensed specialists (such as chiropractors, osteopaths, and physical therapists) use
leverage and a series of exercises to adjust spinal structures and restore back
mobility. These specialists do not prescribe drugs or use surgery in their treatment
of Low Back Pain.
When back pain does not respond to more conventional approaches, patients may
consider the following options:

• Acupuncture 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.

• 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 flowpatterns). The patient can then learn to effect a change in his or her response topain, for example, by using relaxation techniques. Biofeedback is often used in
combination with other treatment methods, generally without side effects.

• Interventional therapy can ease chronic pain by blocking nerve conduction
between specific areas of the body and the brain. Approaches range from
injections of local anesthetics, steroids, or narcotics into affected soft tissues,
joints, or nerve roots to more complex nerve blocks and spinal cord stimulation.
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 batterypowered
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).
• 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.