Heat and/or cold packs may be applied to the affected area of the back. Heat serves to dilate the blood vessels and increase local circulation. Cold packs do the opposite, while still making you feel better. Cold will decrease the blood flow, reduce swelling and numb the area. For many people, pain is alleviated and muscle spasms calmed.
Exercise, done at a comfortable and safe level for your situation, can help an acute episode feel better faster and a chronic condition improve or at least not worsen. You may need advice from your doctor to determine the appropriate level and type of exercise for your situation.
Millions of people suffer from back pain that may be caused by disease, aging, injury or a combination of causes. Back pain is considered chronic if it persists for over 12 weeks. Acute pain episodes occur suddenly and continue for 6 weeks or less. Depending upon the frequency and severity of symptoms, many treatment options are available. It is common to try several treatments before finding one or more that work for a particular individual.
Often, the first line of defense against back pain is over-the-counter medication. Acetaminophen, aspirin or ibuprofen will alleviate pain and inflammation in many cases. Often this is enough to restore a comfortable range of motion and enable people to get on with their day. It’s important to be aware that even non-prescription medicines have side effects, especially with continued daily use or high dosages. Ulcers and kidney damage are only two of the potential dangers. If taking one of these medicines is a daily necessity, it is time to see the doctor for a better remedy.
Doctors may prescribe narcotics, such as codeine, for back pain and a steroid to reduce the associated tissue swelling. Muscle relaxers and even anti-depressants may also be effective in treating back pain. These drugs provide needed relief for many back pain sufferers. However effective they may be, certain prescription medications are not an ideal long-term solution. Side effects such as drowsiness and nausea make some medicines impractical day to day while others can lead to dependency. Prescription medications must be carefully managed by your doctor and discontinued when longer necessary.
If oral medication has not managed the problem, epidural steroid injections may be considered. By injecting medication directly into the spinal membrane, the cycle of pain and nerve or joint inflammation may be interrupted. This may decrease or eliminate symptoms for several days to weeks. Doctors may use this procedure as a diagnostic tool as well. By numbing a certain area of the spine, s/he will be able to determine if that particular disc is the source of the problem. Side effects may include nausea, dizziness, difficulty breathing, blood clots and a drop in blood pressure. Infection is also possible, though rare. The treatment may be repeated only once every several months due to its potential weakening effect on surrounding areas of the body.
In most cases, the goal of treatment is getting the patient back into motion. Exercise to stretch and strengthen the back is key to overcoming pain long term while reducing the chance of recurrence, deterioration or future injury. Bed rest can actually make back pain worse if continued for too long.
As part of the effort to get the body back in motion, physical therapy may be recommended. Treatments may consist of manipulation, stretching exercise, weight bearing exercise and aerobic exercise if possible. These activities are done or directed by a licensed physical therapist with the goal of alleviating current pain and preventing back future problems. Physical therapy may also involve many other types of treatment, from basics such as teaching proper posture to ultrasound, hydrotherapy and electrotherapy.
Some physical therapists use ultrasound treatment to relax the patient, provide a distraction from pain, and/or to warm muscles for exercise. A round-tipped heated probe is rubbed across the affected area, which is covered in conductive gel and sometimes a topical anti-inflammatory. The machine emits high-frequency sound waves that penetrate muscles, causing soft tissues to vibrate creating gentle heat. The heat induces dilatation of local blood vessels, drawing blood into the target tissues. Increased blood flow delivers needed oxygen and nutrients, and removes cell wastes. Many physicians believe that the same benefit may be better achieved via massage.
Massage and acupressure are the go-to treatments to increase circulation in affected areas. In the process, muscle spasms are reduced, back muscles are stretched and the patient relaxed. The heat generated helps relieve pain and inflammation as it accelerates healing and increases range of motion. Where possible, patients will be taught self-massage and stretching techniques they may be able to do at home. Massage is not indicated in all cases, however. It may be harmful for people with unhealed fractures or rheumatoid arthritis in the area, for example. Massage should always be done by a trained therapist who is aware of your medical condition or injury could result.
Hydrotherapy may encompass treatments including hot or cold water as in steam baths, whirlpools and compresses. In most of these treatments, the body is relieved of the effects of gravity and is able to move more freely to perform exercises that would be impossible otherwise. Other goals are similar to those of massage and hot/cold packs discussed earlier including relaxation of muscles, increased circulation, decreased inflammation and better range of motion. The therapy is generally considered safe for back pain but should be directed or supervised by a physical therapist.
Another form of physical therapy is called electrotherapy or TENS (transcutaneous electrical nerve stimulation). It involves electrical stimulation of muscles and nerves, with electrical signals transmitted through adhesive pads placed on the skin. This treatment is said to change the perception of pain for the patient and increase the release of the body’s natural pain-relieving chemicals called endorphins. Patients with a pacemaker should avoid this therapy unless supervised by a physician. Studies have shown mixed results from this treatment for back pain.
As a last resort, if other treatments are not indicated or have failed, surgical options may be available. For certain back problems, surgery has been determined to be only somewhat more beneficial than other less invasive treatments. Patients should not hesitate to get a second opinion if surgery is recommended.
Surgery may be indicated for conditions such as a ruptured disc, compressed nerves, slipped vertebra, pinched nerve, fractures due to osteoporosis, degenerative disc disease or a tumor. The goals of back surgery fall into these main categories: removing a damaged disc or part, correction of deformity, fusing discs around a removed one, nerve decompression and removing tumors or infection.
Some back surgery procedures are less invasive and may be performed on an outpatient basis. Others are major undertakings requiring hospital stays, restricted physical activity for at least 3 months (in the case of spinal fusion) and extended rehabilitation periods. In addition, a back brace may be needed during part of the recovery period.
Any surgical procedure carries risks that include blood clotting, less than completely successful outcome, infection, nerve damage and anesthesia complications in some cases. Additional back surgery risks may include spinal fluid leaks and even paralysis, although this is rare.
This article is intended for educational purposes only. Consult your physician for advice on your unique situation.
Surgery for Low Back Pain: A Review of the Evidence for an American Pain Society Clinical Practice Guideline; Chou, Roger MD; Baisden, Jamie MD, FACS; Carragee, Eugene J. MD; Resnick, Daniel K. MD; Shaffer, William O. MD; Loeser, John D. MD