Treatment for lower back pain

Drugs

Experiencing back pain can disrupt your ability to sit, stand, walk, bend, drive, sleep or lift. Unless controlled and managed with adequate treatment, back pain will likely be a major obstacle when performing routine activities.

What is Lower Back Pain?

Current data predicts that just about every person will experience some sort of lower back pain at least once in their adult lifetime. Why? — Lower back pain, a common musculoskeletal condition, affects up to 84% of the adult population. Lower back problems are described as muscle tension and pain anywhere below the rib and above the buttocks and thigh.

Back pain can be categorized into multiple subgroups. Mechanical back pain is a result of injuries to the spine and intervertebral discs. Infectious back pain occurs due to spinal infections and tissue abscesses. Oncological back pain is caused by damage to the spine and marrow cancers. Degenerative back pain is a result of osteoarthritis— deterioration of joints. Inflammatory back pain is caused by acute or chronic inflammation such as ankylosing spondylitis.

Lower back pain can be either acute or chronic. Acute pain usually lasts less than six weeks, while chronic pain typically lasts longer than three months.

Common causes of lower back pain include muscle strain and tension, genetic predisposition, and minimal physical movement. Additional pain signals may be a result of stress, anxiety, depression, health history, exposure to chemical, workplace hazards, and habits of daily life. 

A research study looked at the connections between workplace risk factors and lower back pain. The results of the study showed that females and older individuals had an increased risk of lower back pain. Additionally, those who worked more than 60 hours per week and who had work-family issues and job insecurities were more at risk of lower back complications.

Red Flags

Acute lower back pain is usually no sign of concern. It is possible that the pain may come back or fluctuate over time.. A physician may consider certain symptoms as warning signs or “red flags.” These symptoms include pain unrelated to any activity or time, weight loss, spinal deformity, previous medical history of HIV, carcinoma or steroids, pain worse towards the feet than the back and numbness in the area. X-rays and other imaging analysis tools can be used to effectively identify any potential spinal or nerve disorders.

What is Chronic Lower Back Pain?

Chronic lower back pain is the most predictable cause of chronic pain, affecting both men and women in all ethnic groups. As the name suggests, this pain is defined as a sharp and/or throbbing sting in the lower back region which lasts for approximately 12 weeks.

Muscles in the lower back are extremely important for spinal stability and are the major effectors for daily physical functioning. There are two groups of core muscles that stabilize the spine. The first category involves local stabilizing muscles like the lumbar multifidus and the quadratus lumborum which allow for accurate motor control. The second category involves global stabilizing muscles such as the erector spine and the hip muscles which connect the ribs to the pelvis.

These counteract additional forces on the spine by producing high torque, thereby secondarily, stabilizing the spine. What causes chronic low back pain? —This question is still not answered but current data suggests that the major causes of the pain include exhausting the shallow trunk and weakening the abdominal muscles.

Pregnancy and Lower Back Pain

Pelvic pain and lumbar pain are the two common lower back pains involved during pregnancy. Pelvic pain occurs between the iliac crest and gluteal fold during the pregnancy term. Lumbar pain occurs near the lumbar spine during the postpartum period.

Pregnant women are encouraged to use a footstool, use back support, and rest during midday. It is critical to practice proper posture techniques during pregnancy to minimize the development of future lower back pain.

Medicinal Treatment for Lower Back Pain

The difficulty of diagnosing lower back pain makes it extremely challenging to clinically access and treat. That is why observing the symptoms and keeping an eye out for acute lower back pain can significantly help in treating the pain. Most instances of back pain are not a cause of concern and can be treated with pain medications, most commonly nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are fast acting pharmaceuticals for lower back pain. They are competitive, active site inhibitors of cyclo-oxygenase 2 (Cox-2). Cox-2 converts arachidonic acid into inflammatory prostaglandins—molecules capable of causing pain. Essentially, NSAIDs block the molecules capable of causing pain. Common NSAIDs include aspirin, ibuprofen, and naproxen, which can be used to manage and provide pain relief.

Muscle relaxants like cyclobenzaprine and metaxalone may also be used. These medications work to reduce pain and muscle spasms. There are side effects associated with all medications. Always consult your doctor regarding the best treatment options for your lower back pain.

Non-Medicinal Treatment for Lower Back Pain

Non-medicinal options to treat lower back pain include regular physical activity, spinal manipulation, behavioural therapy, acupuncture, ti chi and yoga. According to present studies, the most effective physical activity to manage back pain (with appropriate duration and intensity) is resistance-strength training. Additionally, those with obesity may find it beneficial to speak to a nutritionist about managing their weight in order to prevent lower back pain.

Thermotherapy (heating) and cryotherapy (cooling) therapies are used to treat various back pains. Heating therapy—for example, the use of a heating pad—increases blood flow and tissue temperature thereby decreasing tension in the muscles and relieving pain. Cooling therapy—for example, the use of cold packs—decreases inflammation and tissue metabolism, helping in the reduction of muscle spasms and strain. Applying ice or heat for long periods of time, as in more than 20 minutes, can lead to skin damage such as frostbite and ulcers.

Research suggests that physical therapy exercises are extremely beneficial in the treatment of lower back pain. The McKenzie method is one of the most effective physiotherapy exercises in the treatment of back pain. In the 1950s, Robin Anthony McKenzie engineered a variety of spinal exercises. Some spinal extension exercises involved in the treatment of lower back pain include standing lumbar extension, prone position propped on hands and prone position propped on elbows.

Seeing a physical therapist for the treatment of your long-term pain may be beneficial to your health. Current research continues to find various options for the treatment of lower back pain. Always consult a physician for the best pain management option.

References:

  1. Koes, B. W., van Tulder, M. W., & Thomas, S. (2006). Diagnosis and treatment of low back pain. BMJ (Clinical research ed.)332(7555), 1430–1434. https://doi.org/10.1136/bmj.332.7555.1430
  2. Massimo Allegri, Silvana Montella, Fabiana Salici, Adriana Valente, Maurizio Marchesini, Christian Compagnone, Marco Baciarello, Maria Elena Manferdini, and Guido Fanelli (2016)Mechanisms of low back pain: a guide for diagnosis and therapy. doi: 10.12688/f1000research.8105.1
  3. Casiano VE, Dydyk AM, Varacallo M. Back Pain. [Updated 2020 Oct 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/
  4. Mann SJ, Lam JC, Singh P. McKenzie Back Exercises. [Updated 2020 Dec 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK539720/
  5. Kuritzky, L., & Samraj, G. P. (2012). Nonsteroidal anti-inflammatory drugs in the treatment of low back pain. Journal of pain research5, 579–590. https://doi.org/10.2147/JPR.S6775
  6. Chang, W. D., Lin, H. Y., & Lai, P. T. (2015). Core strength training for patients with chronic low back pain. Journal of physical therapy science27(3), 619–622. https://doi.org/10.1589/jpts.27.619
  7. Dreisinger T. E. (2014). Exercise in the management of chronic back pain. The Ochsner journal14(1), 101–107.
  8. Kim, E. J., Choi, Y. D., Lim, C. Y., Kim, K. H., & Lee, S. D. (2015). Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial. Trials16, 285. https://doi.org/10.1186/s13063-015-0800-4
  9. InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Low back pain: Overview. 2012 Feb 9 [Updated 2019 Feb 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK284941/
  10. Using Ice and Cold Packs. https://www.healthlinkbc.ca/health-topics/sig43888spec
  11. Yang, H., Haldeman, S., Lu, M. L., & Baker, D. (2016). Low Back Pain Prevalence and Related Workplace Psychosocial Risk Factors: A Study Using Data From the 2010 National Health Interview Survey. Journal of manipulative and physiological therapeutics39(7), 459–472. https://doi.org/10.1016/j.jmpt.2016.07.004
  12. Katonis, P., Kampouroglou, A., Aggelopoulos, A., Kakavelakis, K., Lykoudis, S., Makrigiannakis, A., & Alpantaki, K. (2011). Pregnancy-related low back pain. Hippokratia15(3), 205–210.

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