Back Pain

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Treatment

Most cases of back and neck pain are treated conservatively. If pain persists or worsens, or if other symptoms develop, a more aggressive approach is taken.

Home Remedies
Applying ice immediately during the 48 hours after straining a muscle can reduce pain. Ice slows inflammation and swelling, numbs soft tissue, and slows nerve impulses in the injured area. After spasms and acute pain subside, heat can be applied to loosen tight muscles.

Two or three days of bed rest followed by a gradual return to normal activity is sometimes recommended.

Medication
Acetaminophen and ibuprofen are most commonly recommended for pain relief. Package directions or the advice of a physician should be followed.

To relieve acute back pain, anti-inflammatory drugs (e.g., Celebrex®), non-narcotic pain relievers (e.g., Tramadol®), muscle relaxants (e.g., Flexeril®), and narcotic pain relievers may be prescribed.

An oral steroid (e.g., prednisone) is sometimes prescribed for acute episodes of low back pain. Patients are started on a high dose that is gradually reduced over 5 or 6 days. Serious side effects associated with steroid use may include bone loss, impaired wound healing, headache, and others.

Chronic back pain caused by nerve root damage is sometimes treated with tricyclic antidepressants, such as amitriptyline (Elavil®) and nortriptyline (Pamelor®), for numbness, burning, aching, throbbing, or stabbing pains that shoot down the limbs. Some of the side effects include drowsiness, dry mouth, and constipation.

Anticonvulsant drugs, such as gabapentin (Neurontin®), may alleviate pain caused by nerve degeneration and persistent leg pain after surgery. The pain relieving action of anticonvulsants is not well understood. Side effects include drowsiness, dizziness, fatigue, impaired motor coordination, and others.

Injections
Steroid injections can significantly decrease inflammation and pain caused by spinal stenosis, disc herniation, and degenerative disc disease. A steroid is injected directly into the membrane that surrounds the nerve roots (dura). Selective nerve root block (SNRB) uses a steroid with anesthetic.

Physical Therapy
The goals of physical therapy are to decrease pain, increase function, restore normal movement, and prevent recurrences.

Massage therapy increases circulation to the affected area. There are several techniques and devices used in massage therapy.

Electrotherapy involves sending gentle electric currents through the skin to stimulate muscular contraction, increase muscle strength, and increase the flow of neurochemicals to the area.

In ultrasound, sound waves penetrate the skin and cause soft tissues to vibrate, creating deep gentle heat that increases blood flow, relieves pain and inflammation, and reduces muscle spasms.

Exercise
Exercise can correct current back problems, help prevent new ones, and relieve back pain, particularly after an injury. Proper exercise strengthens back muscles that support the spine and strengthens the abdomen, arms, and legs, reducing strain on the back. Exercise also strengthens bones and reduces the risk of falls and injuries.

It is essential to speak with a doctor or physical therapist before starting an exercise regimen to ensure that it is appropriate.

Adjustment
Chiropractors and osteopaths manipulate the spine, called an adjustment, to relieve pain arising from musculoskeletal conditions such as facet joint injuries, osteoarthritis, and whiplash.

Acupuncture
An acupuncturist inserts hair-thin needles under the skin, which remain in place for 15 to 30 minutes. The needles cause little or no pain. Pain relief may result from the release of endorphins, the body's intrinsic painkillers. Generally, several sessions are needed.

Surgery
Surgery may be indicated for progressive or severe neurological dysfunction—such as muscle weakness, spinal cord compression, or bowel, bladder, or sexual dysfunction—and for cases of pain that is not easily relieved.

Discectomy is the removal of herniated disc material that is compressing nerves. Laminectomy, or removal of the lamina, relieves compression on the spinal cord. Spinal instability is corrected by using a bone graft to fuse adjacent vertebrae.

Implanted pumps deliver a constant rate of pain-relieving medication to the spinal area. Surgically implanted spinal cord stimulators modulate the pain response, so the patient experiences less pain.

Prevention

There is much that a person can do to maintain a healthy back. Preventative measures are especially important if back pain has already been experienced:

• Learn proper body mechanics, particularly if an occupation involves repetitive bending, lifting, and twisting.
• Exercise regularly to keep back muscles strong and flexible.
• Maintain good posture.
• Avoid standing or sitting in one place for long periods of time.
• Maintain weight within an ideal range for body size.
• Eat a healthy diet.

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