What is Back Pain?
A health article about Back Pain from Your Health Online the A to Z directory of dealing with Health Problems & nutritional Self Care Strategies
FACTS vs MYTHS About Back Pain
Let’s begin by learning some facts in order to separate truth from myth with
regards to back pain. First of all, under one percent of acute lower back pain is the
result of a serious infection or condition like cancer or a spinal injury. For those under
50, the rate is even lower.
Back pain is the number one disability for those under age 45. And it runs
second, after the common cold, as the top reason for visiting a healthcare provider in
the United States.
“There is nothing really wrong with you.” Myth! Chronic pain sufferers report that
doctors generally tell this to about 90 percent of them and it is incorrect. In reality, the
majority of low back pain cases or some 90 percent generally come from an unknown
cause, like an infection or a particular injury. And the duration of the pain runs generally four to six weeks.
“People don’t die from chronic back pain.” Wrong! The pain combined with
depression and anxiety in long-term cases places sufferers at risk for suicide, which
does happen from time to time.
“Most back pain requires surgery.” Myth! On the contrary, under two percent of
patients with back pain need surgery. However, back pain is the third top reason for
“Only a small percentage of workers suffer back pain on the job.” Wrong! The top
occupational hazard in the USA is back pain.
“Lie down and rest for back pain.” Contrary to popular believe, bed
rest can hinder recovery. Health care providers recommend remaining active to
decrease down time for patients.
“Men suffer back pain more than women.” Not! With regards to gender issues
and back pain, it is a myth that men suffer back pain more than women. In reality, the
only main difference is with secondary pain to disk disorders during middle age.
However, with regards to race, low back pain is reported more frequently among
Caucasians than other races including African Americans.
“If a patient’s pain description lacks a regular, consistent pattern, it’s probably
imagined or exaggerated.” Myth! No two people, no two cases are totally 100 percent
identical. Activities, events, pain and people themselves vary from day to day and there
is no 100 percent correct way to describe pain in words to fit a perfectly accurate
Types of Back Pain
To learn more about specific types of back pain, it helps to identify the “type” of
pain present, similar to a doctor visit when asked, “Is it a stabbing pain or dull ache?”
These are helpful healthcare term associated with back pain.
ACUTE - Most back pain sufferers fall into this category. With acute low back
pain, certain movement ranges for activities may be limited due to pain. But most
people recover within about four weeks on their own.
CHRONIC - Also referred to as recurrent low back pain or when acute pain
episodes recur for more than three months. This is most generally when medical
treatment is sought. Note one can suffer acute and chronic pain at the same time. As
secondary health problems be involved. In other words, chronic pain sufferers can be
susceptible to acute pain.
ONSET - When the pain began. Acute onset means it occurred suddenly.
Insidious onset means it gradually developed over a period- could be days or longer.
DURATION / FREQUENCY - Some common questions asked with regards to
this area are how often does the worse pain occur and how long does it last.
RECURRENCE - When the back pain occurs from time to time with intervals of
no pain in between.
PERSISTENCE - When the pain is always present.
LOCATION - A printed body diagram is usually used to that the patient can refer
to the place or location where pain is felt.
MOVEMENT - Where the back’s pain movement is located. Most generally it is
centrally located in the middle of the spine or an injury to either side of the spine. Pain
that reaches beyond, for example to legs, is known as peripheral. Other terms
associated with movement are twisting, lifting, bending, straightening, arching, vibrating,
sneezing, coughing and posture.
ASSOCIATED SYMPTOMS - When discussing back pain, other symptoms that
can come up include, but are not limited to, itching, burning, tingling, weakness or
numbness, bladder control loss or change in habit, nausea.
INTENSITY LEVEL - A verbal measurement used to quantify pain on a scale
rating from zero that signifies “no pain” to 10, referring to your “worst pain ever.” Other
criteria to help with understanding this pain indicator are does the scale vary; i.e. does
the pain intensify and if so with each occurrence? And within what range on the scale?
What Causes Back Pain?
Most references to back pain focus on lower back pain in the lumbar spinal
region. However, back pain causes in no particular order are:
A. Accidents or injuries leaving muscle pain
B. Osteoarthritis with deteriorating cartilage
C. Osteoporosis with bone loss / fracture
E. Major conditions like cancer
Muscle, ligament and tendon problems are generally at the root of the pain
problems along with some weakness in the lower back. Other body parts in the region
can also be associated like bones and small joints.
When no specific cause is apparent, the term NSLBP (nonspecific low back pain) is
used. Any number of reasons for this pain can include degenerative disk disease,
psychological issues, systemic disease, facet syndrome (similar to pinched nerves
symptoms), herniated disk, spondylolisthesis or the forward displacement of one of the
lower lumbar vertebrae over the vertebra below it or on the sacrum.
Other factors could
be spinal stenosis or constriction or spondyloarthropathy (disease affecting spinal
Let’s take a look at each of these and what pain relief solutions are available.
DEGENERATIVE DISK DISEASE - The degeneration of vertebral disks is a natural
part of the aging process. What often happens though, is that when the narrowing of
the disk space combines with the nociceptors, sensory receptors that respond to pain,
in the outer annulus (in the disk space outside the nucleus) or dorsal root ganglion
(spinal nerves) that become heightened, the result can be pain, although not always.
Sometimes pain can be felt by some people, and other times not. For example a minor
accident like missing a step and landing a little harder than usual on your feet might
cause back pain. And certain activities can aggravate degenerative disks, like yard work
or house cleaning movements. But overall, pain associated with degenerative disk
disease generally heals within a few days at most.
Preventative measures like
strengthening muscle groups to lessen future traumas are usually recommended along
with an analgesic or medication that helps relieve pain. Only in some cases are
epidurals or injections, blocks or surgery needed.
PSYCHOLOGICAL ISSUES - If acute back pain turns into chronic stages, factors of
depression, fear and anxiety could increase discomfort and pain. And the longer the
chronic pain persists, the more these factors tend to play a role, an increased role over
time. So treatment strategies may need to include learning coping skills and alternative
lifestyle enhancements to deal with the psychological factors present.
SYSTEMIC DISEASE - This disease is the cause for up to 10% of back pain and
largely among the elderly. Causes could be cancer-related or related to reduced bone
mass or simply the aging process. Increasing or decreasing activities as well as
switching positions all may have no affect on pain relief. Alternative therapies may be in
FACET SYNDROME - Similar to pinched nerves symptoms, this is believed to be
associated with pain in the back’s side joints and the main cause of up to 20 percent of
back pain cases, with buttocks and upper leg pain increasing with long-term standing,
and when switching sitting / standing / lying positions. An injection of local anesthetic
into the facet joint helps determine the diagnosis.
However, since the anesthetic
relieves the pain at the same time and is used as a short-term solution, an x-ray doesn’t
help with imaging the pain results. Recommended treatment includes rigorous lumbar
activities and body mechanics exercises to learn proper or more beneficial posture and
HERNIATED DISK - Also known as a ruptured or protruding disk, a herniated disk
extends beyond its own area into a surrounding region. Compression of the nerve root
can cause pain. And pressure on the fibers in surrounding ligaments can cause pain.
Although an accident involving lifting could be the cause of a herniated disk, it’s not
For many, the cause is unknown; pain can occur suddenly or gradually
over time. Relief for the pain can come from walking instead of sitting or standing, and
surgery is rarely required right away, if at all in the event relief from pain happens within
a limited amount of time.
During this time (up to several weeks) any of the following
might be effective to use, depending upon your healthcare provider: medication,
physical therapy or non-frequently, steroid spinal injections.
SPONDYLOLISTHESIS or the forward displacement or slippage of one of the lower
lumbar vertebrae (generally the fourth or fifth) over the vertebra below it or on the
sacrum. This state of health is diagnosed by x-ray. Pain is believed to occur where the
displacement is, at or below the displacement, or from spinal stenosis, discussed next.
Depending upon the patient, strengthening exercises or a back support may be all
that’s required. In others, surgery may be an option.
SPINAL STENOSIS - is the constriction or narrowing of the vertebral canal. Mainly due
to aging, as the gradual lessening of disk space and changes in ligaments advance
upon the nerve roots below the lumbar vertebra or L2, pain can result. It’s often
accompanied by numbness in the legs and is not aided any by walking.
vertebra and varied physical activities can affect the pain’s location, intensity, recurring
and duration. To help diagnose this condition, healthcare providers can use
myelography, or an x-ray of the spinal cord after injection of air or a radiopaque
substance into the subarachnoid space, with a post-CAT scan.
And depending upon
the patient, treatments can vary and be minor with medication if the pain gradually
disappears, to epidural corticosteroid injections in the epidural, to blocks or surgery.
SPONDYLOARTHROPATHY - This term refers to a variety of diseases affecting
spinal joints; arthritis variations- psoriatic arthritis and ankylosing spondylitis, the more
common of the two and in males more often than women; and sacroiliitis, accompanies
Diagnosis consists of a physical exam, history and testing
including x-rays, CAT or MRI, as the disease progresses slowly long-term fusing
sacroiliac joints together and joints between vertebrae together. To relieve pain, there is
treatment with exercises and physical therapy to promote better enhanced posture and
mobility and some arthritic medications.
Prevention & Healing of Back Pain:
What you can do to prevent back pain and injuries and, if you do sustain them,
what can be done to promote the healing process? Though the focus here is on what
can be done on an individual basis, it must always be remembered that there is no
replacement for consultation with a qualified physician.
80 percent of the adult
population suffers from back pain at some point in their lives, so, whether it’s you of
somebody you care for, it is useful to have some techniques at hand for treating it.
The good news about back pain is that is usually goes away on its own over
The vast majority of it comes from simply straining muscles and joints at levels
they are not designed to withstand, which leads into the first recommendation:
Slow Down In most cases a few days worth of reducing the normal load you
put on your back in enough. A strained back muscle may cramp or “freeze,” which
causes acute discomfort. Given time to mend, however, the muscle will began to relax
and the body’s natural healing processes will commence.
Over-The-Counter-Medications In response to an injury a body part may
become inflamed, which you will know by the signs of swelling, pain, warmth, and
redness. To achieve a measure of pain relief and assist the healing process you can
buy over-the-counter anti-inflammatory medications like ibuprofen. Acetominophen is
another alternative. Though not an anti-inflammatory drug, it does treat pain effectively
and is easier on the stomach.
A) Ice and Heat During the first 48 hours after a back injury ice slows down
the swelling process and acts to reduce the pain. After 48 hours,
however, it loses these abilities. This is when your switch to heat, as in
the form of a heating pad. This increases the blood flow to recovering
tissue and relaxes the muscles.
B) Massage Be it done by a friend or family member with a nice touch or a
professional, a massage can relax strained muscles and, just as
importantly, a strained psyche that is causing back muscles to tense up.
C) Keep Moving When we are hurt instinct tells us to lay low and keep
movement to a minimum. Indeed, the traditional approach to treating
back pain used to tell us exactly that. More recent studies, however, have
shown that careful movement does a better job of promoting recovery
than remaining still. Much can be accomplished with simple exercises -
provided you have consulted with a specialist who can dispense advice
and instructions on what is best for you.
D) Change Your Routine Though movement can help in the recovery from
a back injury, it is also important during this period to avoid things that
result in putting too much stress, be it physical or psychological, on your
healing back. Whether it is in improving your posture in a chair, not lifting
heavy objects, or avoiding things that cause you aggravation, adapt your
daily routine to the requirements of your recovering back. Otherwise,
there is a pronounced risk of re-injury, a longer than necessary recovery
period, or an injury that does not heal properly and is vulnerable to further
E) Pain Management For persistent or long lasting pain, refer to the
chapter on chronic pain for additional strategies.
The Simple Things
An encouraging thing about back pain is that so much of it can be avoided by
simple cautionary measures, usually, in fact, by making slight modifications to things we
do every day.
When standing upright, your chest should be forward, your head up, shoulders
straight, and your weight even distributed between your feet with your hips tucked in.
you have to remain standing for long periods, avoid remaining in the same position for
the entire time. Be sure to move around and change positions regularly. Another good
idea is to rest one foot on a stool, curb, etc. then switch to the other foot after a few
If your work requires you to perform tasks on a platform or desk make sure to
adjust it to a height that is comfortable for you. Spending day after day hunched over
while on your feet is almost a sure recipe for back problems.
In today’s work world many of us have jobs that involve spending most of our
time in a seated position. The rule of thumb here is to sit for as little as possible, and
even then for only short periods of time. Since this is not always possible, be sure to
get up and walk around frequently. Even a short stroll across a room will help.
When in a seated position for long periods, sit with a support positioned in the
curve of your back. Nothing fancy, even a firm pillow or a rolled up towel will do the
trick. At the same time, keep your hips and knees at right angles. If your chair is too
high for this, either replace the chair or get a stool to rest your feet on. Otherwise keep
both feet on the floor and do not cross your legs.
The chair you use should be firm and have a high back and arm rests. The
problems with soft chairs or couches in that the curve in your back is not supported and
it can come to be in a rounded position, which causes the kind of muscle and joint
stress that leads to problems.
When seated in a chair in front of a desk, make sure the different pieces of
furniture complement each other so that you can sit up straight as you work, with your
elbows and arms on your chair or desk and your shoulders relaxed. Hunching or
leaning over should be avoided.
Finally, when getting out of a chair after sitting for a period of time, be sure to
stand up by straightening your legs, not bending at the waist. Once in a standing
position stretch your back by doing a series of simple back bends.
Much of the same applies when driving in a seated position. Support the curve
of your back and be sure your seat is positioned close enough to the wheel so that your
knees can bend and your feet reach the pedals without having to stretch for them.
The simplest thing to do is avoid lifting heavy objects, or those whose size or
shape make them awkward to move. Since lifting cannot always be avoided, be sure
not to lift with your back.
When grasping a object to be lifted have it close to your body
with your feet spread shoulder width apart and planted firmly on the ground. Use your
leg muscles to do the actual lifting, with the simplest means of doing this being to start
with your legs bent so that you merely need to straighten your knees.
Once you have lifted the object, keep it in front of you and move with small, slow
steps. Instead of twisting, change direction with your entire body coordinated together
for the move. When the object is set down, once again keep it close to your body and
let your legs do the work. Remember, the muscles in your legs are a lot bigger and
stronger than those in the lower back.
Many a back injury can be prevented by following an exercise program that
keeps the muscles strong and flexible. When designing your own, do so with the aid of
your physician, physical therapist, or a qualified trainer.
Invest in a firm mattress and box spring that supports your body without sagging.
It is best to sleep in a position where the curve in your back can be supported. Lying on
one’s stomach on a soft mattress is exactly the wrong thing to do for your back.
The sleeping method recommended by many experts in on your back with three
sources of support for your body: one below your lower back that is fitted to the curve
there, one below your knees that supports them enough to take strain off the lower
back, and a pillow below your neck that, like the lower back support, conforms to the
natural curve found there and provides support.
Here are some other helpful healing strategies and tips for back pain relief. Try
one or more to see how they work in with your lifestyle.
Control your breathing slow and steady for a few minutes. Focus on rhythmic,
controlled breathing, holding inhaled breaths in for about three seconds, then exhale
and repeat to help redirect focus from back pain and allow the body to naturally
respond on its own.
Repeat as needed throughout the say to help the body relax.
Some helpful suggestions are:
Choose a comfortable position that takes the strain off your back and is least painful
for you. Some suggestions are:
A. On your back with your knees up, rest your lower legs over the coach or a chair.
B. Lie in a fetal position on your side and place a pillow between your knees.
When possible for back relief, rest for a couple of days. Find a couple of your
most comfortable breathing positions above and alternatively use them throughout the
day. From time to time, every hour to couple hours or so, include these into your
A. Get up and move around a little, walking and arching your back a little.
B. Add some light stretching activities like gently pulling knees, one at a time, to
C. Light water / pool activity or aquatherapy
D. Light stationary bike riding or sitting in a comfortable chair for brief periods.
Check with your local drug store pharmacist to see which pain medications are
available over-the-counter (OTC). Popular to use are aspirin for overall pain relief,
ibuprofin for a combination anti-inflammatory and pain relief response like in the Advil,
and acetaminophen products like Tylenol.
When selecting the type of medication, keep
in mind that liquid gel types absorb fasted into your system. However, regardless of
your choice, do follow the directions on the labels, unless otherwise directed by your
physician, and follow the recommended dosage guidelines.
Check with your local pharmacist and health store to see which liniments and
ointments are available. Some popular items on the market are BENGAY, Tiger Balm
and Sportscreme; generally products with a form of rubbing alcohol listed in the
Ask about the availability of other back pain remedies including herbal
treatments. Some health food stores stock packaged herbal tablets, teas and other
products. Be aware, though, that most often these alternative products are not
thoroughly tested as OTC products are, nor can the contents be assured for safety,
quality and potency.
Here are some other back pain relief strategies for you.
1. Place an ice pack on the pain area up to three times a day for about 12 minutes
per session during the first two days of the onset of your pain.
2. Moist heat applied to the pain after one day can help sooth your body. A warm
washcloth or a heating pad for about 30 minutes should do the trick.
3. After the first day or two, interchange your ice and heat solutions. Heat is for
mornings and before physical activity. Ice is for after activities, and in the
4. As your back pain decreases, gradually increase your activity
When to seek Medical Advice:
Where To Go For Pain Relief
Where to go for a diagnosis about back pain can include your family doctor, the
emergency room, an orthopedic surgeon, a naturopathic specialist, a rheumatologist ,
an occupational therapist, a physiotherapist, a chiropractor, an acupuncturist, a
massage therapist, an osteopath and a chronic pain heath care provider. And here is a
brief overview of each.
FAMILY DOCTOR - This is a popular beginning point for many seeking back pain relief.
Although family doctors generally do not have extensive orthopedic backgrounds nor
sufficient time to schedule complete histories and examinations during regular hectic
weekdays, they are often able to do preliminary testing and assessment.
tests and general knowledge of your health and basic back care can help them point
you to further resources and places for following up, especially if they deem the case an
emergency. And hopefully your family doctor will be at the center or helm of your pain
relief management so that all testing, treatments, office visits, etc. are coordinated and
not left to chance, and also so that patient care is optimized.
EMERGENCY ROOM - When a family or general doctor is not available, some
symptoms may warrant an emergency room visit. The following list of symptoms,
though not limited, is what most often sends people to the emergency room for back
pain relief; a major injury or trauma, history of osteoporosis, steroid medications or
cancer, severe pain, fever, aggressive or quick weight loss for no known reason.
degree of suggested seriousness in the symptoms may determine how quickly a person
is seen in the emergency room, with the more serious cases seen quicker.
Emergency room procedures can involve history and examination assessments
and a series of blood, urine and other tests. Additionally the emergency room physician
may recommend a consult with a specialist while you are there. Or they may
recommend you to your family doctor or other treatment facility for follow up, depending
upon their results.
ORTHOPEDIC SURGEON - Orthopedic medicine in a nutshell deals with the
prevention or correction of injuries or disorders of the skeletal system and associated
muscles, joints, tendons and ligaments.
Surgeons in this field offer treatment for
fractures, strains, arthritis, dislocations and other related problems throughout the entire
body. And their treatments vary with surgery and non-surgical health care; structure
repair, joint replacement, arthroscopy or the examination and possible treatment of the
interior of a joint, like the knee, using a type of endoscope inserted into the joint through
a small incision.
Likewise, they coordinate healing activities during healing and pain
relief stages. Note that some orthopedic surgeons specialize: in the area of back pain
relief, a specialist based in spinal practice may be advisable.
NATUROPATHIC SPECIALIST - Naturopathic medicine refers to natural substances or
remedies massage as treatments. Doctors in this field are educated in nutrition and
herbal, botanical, homeopathic and Chinese medicines (and acupuncture). They may
also treat with hands-on procedures and lifestyle consultations where preventative
measures are a focus.
These specialists may refer you to your family doctor and may
also coordinate healthcare activities before, during and after your back pain episode for
overall improved wellness. Often for back pain relief, they may advise natural
supplements like herbal medicines or minerals along with dietary modifications. And
physical therapy; acupuncture or message, combined with stress management and
relaxation therapy may be added in for good measure.
RHEUMATOLOGIST - A rheumatologist deals with an array of pathological conditions
like arthritis related to the tendons, muscles, joints, nerves or bones, when seeking aid
for discomfort and disability. Although some may perform arthroscopy, most do not do
surgery. For back pain relief, they may suggest medications, occupational or injection
therapy and other medical treatment to determine cause and pain relief.
OCCUPATIONAL THERAPIST - An occupational therapist emphasizes correct
ergonomics or design factors, posture and safety practices both at the workplace and in
the home environment. These therapists educate patients about daily life activities and
can help with adjusting to health devices for mobility and operation. Adjusting to using
crutches, a back brace, a cane and other lifestyle changes are benefits of occupational
PHYSIOTHERAPIST - Registered therapists practice physiotherapy and focus on
educating and instructing patients about their pain- both in book learning and physical
understanding, like with posture and movement modifications. Their shared knowledge
helps patients overcome fear and anxiety and better manage their treatment programs.
Doctors often refer patients to physiotherapists for extended learning, particularly if
there is difficulty in diagnosing the cause and / or treatment for pain. Additionally,
physiotherapists help with the development and managing of their healthcare programs,
activities and preventive care instruction. For example, they may teach about using heat
or ice along with a varied range of motion for pain relief.
CHIROPRACTOR - In a nutshell, chiropractors diagnose spine, joint and muscle
problems with their hands. And their treatment is hands-on as well. For back pain relief,
they use mobilizations and manipulations in manual spinal movements, some known as
“cracking” the back into place.
Although there is no scientific evidence to support or
negate chiropractors treatment, most generally work with the relief of acute low back
pain. Besides in-office treatment, many provide exercise and preventative strategies for
ACUPUNCTURIST - Acupuncture, relating to Chinese medical practice, is the piercing
of specific areas of the body with fine needles. The reasons for acupuncture are
threefold; for therapeutic purposes, to relieve pain or for regional anesthesia. It is
mainly used for musculoskeletal pain and low back pain and other related relief.
MASSAGE THERAPIST - Massage therapy incorporates hands-on handling or
manipulation of body tissues, especially helpful for low back pain relief. The reasons for
massage vary; for relief from pain and muscle spasms associated with it, for relaxation,
for stretching, improved circulation and metabolism.
OSTEOPATH - Osteopaths use Osteopathic Manual Medicine (OMM) to practice
medicine based on the theory that conditions in the musculoskeletal system affect other
bodily parts. These conditions cause disorders that they believe can hopefully be
corrected by manipulative techniques combined with traditional medical,
pharmacological, surgical and other therapeutic strategies.
Generally within 10 to 14
days, osteopathy relieves low back pain. But there is no evidence to suggest
osteopathy as preventative treatment long-term.
CHRONIC PAIN SPECIALIST - A chronic pain specialist is for rare cases and works in
teams. He or she generally manages pain relief treatment with psychiatrists, social
workers and other medical and counseling healthcare providers.
METHODS OF BACK PAIN DIAGNOSIS
In order to diagnose back pain for relief treatments, generally health care
professional begin by ordering a medical history and physical examination. A look at
each of these in depth can shed some light into what to look for and how to find relief
from pain. Then we’ll look at specific diagnostic tests. And then where to go for the
diagnosis and testing follows.
No matter whether the patient has acute back pain, which is what most have and
recover from with around a 4-week period, or chronic, recurring pain episodes, a
medical history helps patient an doctor become familiar with one another in confidence
to begin or continue a treatment program together.
The medical history delves into
these areas of the person seeking pain relief: family medical history and personal and
work history with regards to back pain episodes and related symptoms and issues,
psychological and psychosocial factors, referral source(s) for evaluation and treatment,
education on the subject and treatment options, assessment throughout their working
together on pain relief treatment and treatment outcomes.
For example, if physical
therapy needs to be added to the regimen or enhanced, it would be discussed in the
medical history and updated as needed.
The medical history incorporates past and present factors of fatigue, fever and
weight loss. And it notes any use of drugs or herbs, minerals and supplements. A
history of past and present infections, cancer or other conditions is also noted.
The history also includes details about the back pain, focusing on the many
facets of the pain: information about any initial injury or trauma, if available, onset,
intensity, duration, location, associated symptoms, etc.
The physical examination includes evaluating the person generally inn the
“hospital gown” with the body and especially the back in a variety of postures and
movement ranges to determine pain symptoms, tenderness and range of motion. So
the patient may need to sit, stand, touch toes, move arms, etc. and share any pain
symptoms or other information notated with each change along the way.
Neurological testing can also be a part of the routine. A neurologic screening
may consist of tests for reflexes, strength of muscles, cramping and a detailed look at
sensory issues via various range of motion and movement exercises. Included in this
can be an assessment of the legs, upper leg, hip and groin area and pulses for
neurological and vascular conditions.
Results may point to a secondary problem like kidney stones or a slight bone
fracture, for instance, in which cases, further assessment and treatment options would
be considered and discussed in both the medical history and physical examination.
Noteworthy is that patients seeking relief after an extended period can tend to
exaggerate or magnify their symptoms out of a variety of reasons; possibly
psychological factors associated with fear of the unknown, change, coping alternatives,
insurance coverage and treatment costs, previous visits with health care providers, etc.
So education and patience is advised to that all bases can be covered, i.e. so that
effective pain relief remedies can be determined.
For back pain relief, any of several tests can be performed; x-rays or
radiographs, isotope bone scan (referred to as technetium and SPECT), magnetic
resonance imaging (MRI), computerized axial tomography (CAT) scan, myelogram,
blood and nerve tests and injections.
The main relief treatment for chronic low back pain is conservative intervention.
In other words, jumping into surgery is not advised because many people suffer no
back pain yet have degenerative change or aging issues going on in the back region.
And other treatment options may offer relief instead. And according to studies, there is
no evidence that points to delayed surgery resulting in increased complications.
approximately 80 percent of the cases where surgery was indicated as a solution
recovered regardless of the surgery. So whether or not they had it made no difference.
Really under 40 percent are reported to have benefited from surgery. And on the
contrary, those people with surgical pasts reported the need for future surgeries, many
because their pain actually increased with surgery. So good medical history and
physical examination preparation and assessment can go a long way in determining
Conservative treatment would include an overall physical and psychological painhandling
program incorporated into the patient’s lifestyle. It would education and offer
training about symptom management; movement and posture strategies, physical
therapy, acupuncture, epidural analgesics, pain medication and other associated
NATURAL SUPPLEMENT TREATMENTS
There are a number of different ways you can treat your back pain naturally:
vitamins, minerals, herbs, nutrition, and homeopathy medicine. Some will help heal your
back pain and others are dangerous, so it’s best to consult with a physician or nurse
practitioner before taking anything and never, ever exceed recommended dosages.
FDA has no control over natural supplements, so it does not recommend them. Since
supplements are not FDA approved they must be accompanied by a two-part disclaimer
on the product label: that the statement has not been evaluated by FDA and that the
product is not intended to "diagnose, treat, cure or prevent any disease."
That doesn’t mean, though, that all supplements are bad. Some medications turn
out to be unsafe, too, despite rigorous trials and testing. The bottom line is to research
every product you consider taking and make sure you get supplements from a
reputable source, like a health food store. Everybody’s chemistry is different and reacts
differently, so if you are considering taking a supplement equivalent to a
pharmaceutical, you may still have some side effects.
There are many natural supplements that can be found in supermarkets and
drug stores. You may have to check health food stores for more obscure supplements.
Like any kind of medication that you buy over the counter, you’ll have a choice between
the store brand and name brands. Store brands are perfectly safe to use and are less
expensive because you don’t have to pay for advertising.
You can also buy
supplements over the internet, but you should be sure you buy from a reputable source
so you know exactly what you are getting. Do some research and ask around to find out
which online suppliers are the best and most reputable.
Listed below are some natural supplement treatments that have been publicized
to help alleviate back pain. When dosages are listed, you should know that if you are
particularly thin or heavy, you should consult an expert before taking the supplement.
And remember, natural supplements will not relieve pain immediately, but have to be
taken for weeks or sometimes even months before you see results.
Vitamins and Minerals
VITAMIN E-400 IU daily; anti-inflammatory
VITAMIN C-250-500mg twice daily
ZINC-30 mg twice daily; anti-inflammatory
CALCIUM-600mg daily; strengthens bones
BORON: 1-3 mg daily with food; helps the body absorb calcium and magnesium
MAGNESIUM- 250 mg daily; strengthens bones and relaxes muscles
COPPER: 2 mg daily
GLUCOSAMINE SULFATE: 500 mg. three times daily. Can rebuild cartilage in joints
and has been studied by the American College of Rheumatology as an effective
treatment for rheumatoid arthritis.
NIACINAMIDE: 500 mg three times daily; anti-inflammatory and heals damaged
cartilage. Can cause liver damage and aggravate diabetes, low blood pressure, ulcers,
and glaucoma, so have a doctor monitor you if you take this supplement.
Herbal supplements can be found in capsule or powder form, or as teas. If you
are making your own herbal tea, use 1 tsp. of herb per cup of hot water. Cover mixture
and steep for 5-10 minutes, or 10-20 if you are using roots. You can safely drink 3-6
cups of tea daily.
KAVA KAVA: Recognized by some doctors as a safe alternative to Xanax and Valium.
BLACK HAWK: relieves muscle spasms and is similar to aspirin
VALERIAN ROOT: Widely researched and documented as a sleep aid, valerian has
been given a number 1 rating for safety by The American Herbal Products Association.
WILD YAM: Long used to treat menstrual cramps; generally taken as a tea.
JAMAICA DOGWOOD: Used to treat muscle inflammation and spasms; little research
has been done on it and excessive amounts can be toxic. Do not use with sedatives.
BROMELAIN: 500 mg three times daily
BOSWELLIN: 150 mg three times daily. Has been proven in clinical trials to help
alleviate low back pain
CURCUMIN: 400-600 mg three times daily; sometimes mixed with ginger, curcumin
has not been studied in clinical trials, but herbalists use it as an anti-inflammatory.
MSM: Has not been researched, but herbalists use it as an anti-inflammatory.
ST. JOHN’S WORT: 300-500 mg capsule three times daily; interacts with a wide variety
of medications and should only be taken under the advisement of an herbal specialist.
WHITE WILLOW BARK: effects are similar to taking aspirin
DEVIL’S CLAW: 400 mg three times daily. Used to treat arthritis, research shows
devil’s claw may boost the effectiveness of conventional drugs.
Homeopathy is a practice of medicine that has been around for about 200 years.
It is based upon what is called the Law of Similars and works on the same principle as
do immunizations: give someone a small dose of what would make them sick to cure
their sickness. Treatments have been proven in clinical trials, and are prepared by a
homeopathic pharmacy under FDA guidelines.
Researchers don’t completely
understand how homeopathic medicines work, but the evidence is clear that they do.
Homeopathy has been popular in Europe and India for a long time, and is gaining
popularity in the United States.
Many practitioners are doctors or have some other kind
of medical degree, perhaps in nursing or psychology. The legal issues surrounding
homeopathic practitioners that do not have medical degrees is unclear, but most
homeopathic remedies are sold over the counter and do not need a prescription.
are some natural homeopathic remedies that are helpful in alleviating back pain:
AESCULUS: used for dull, nagging pain
ARNICA MONTANA: used in cases of trauma to the back
COLOCYNTHIS: used for weakness and muscle cramps in the lower back
GNAPHALIUM: used to treat sciatica, which is often associated with back pain
LYCOPODIUM: used to treat burning pain
RHUS TOXICODENDRON: used for lower back stiffness and pain
Unless back pain is due to an infection, malformation of the back, or tumor, your
pain can probably be alleviated by some type of physical treatment. All physical
treatments are more effective when done in combination with other treatments.
It is best
if you can get a referral from your doctor for physical treatment, and many insurance
companies require you to do so before they will pay for treatment. The effectiveness of
the various physical treatments varies, and it’s really up to you as to which you are most
comfortable with. The effectiveness of physical treatments is increased when they are
combined with exercise.
One of the most common physical treatments for back pain is chiropractic
therapy, which is the manipulation of the spine. The purpose is to realign the spine,
increase the range of motion in the muscles of the back, increase the flexibility of spinal
soft tissue, break down scar tissue, and reduce pressure that occurs from restricted and
misaligned spinal joints, all of which help to relieve pain.
Chiropractic therapists, which
include not only chiropractors, but also osteopaths and some physical therapists,
diagnose and treat only problems with the muscles, nerves, and skeletal system and do
not use drugs or surgery. Going to a chiropractor is much like going to a regular doctor:
you will be asked for a case history involving your symptoms, have a physical exam,
and possibly have x-rays taken.
Chiropractors undergo intense medical training. They must have two years of
undergraduate work, and when they enter chiropractic college, they study the same
topics doctors do, including anatomy, physiology, x-ray, psychology, and orthopedics.
After getting the basics down, chiropractors then study diagnosis and adjustment
techniques that most other doctors do not.
Besides their coursework, chiropractors also
have intern and externships, where they observe and assist licensed chiropractors. All
in all, chiropractors spend about 900 hours studying and working in their field. After
graduation, chiropractors must either take a test to be licensed in the state in which they
want to practice or the National Board of Chiropractic Examination.
Osteopaths are medical doctors and can prescribe medications. They must have
an undergraduate degree and take the Medical College Admissions Test before being
admitted to osteopathic medical school. Like other doctors, osteopaths take four years
of coursework and spend time observing in medical settings. They do internships and
sometimes residencies, and must take exams in order to be licensed.
Studies have shown that chiropractic manipulation is effective in treating lower
back pain. However, it has not been shown to be any more effective than any other
method of treatment, but has been shown to be better than no treatment at all.
Chiropractic treatment is most effective when applied within two months of the onset of
lower back pain, but probably will not help people who have disc prolapsed, previous
back surgery, or back pain due to disease. If you decide to consult a chiropractor, make
sure you tell him about any serious back injuries you have had, and any sharp pain or
lower back pain with leg pain or numbness. These could be the signs of serious
conditions that could be worsened by spinal manipulations.
If you are interested in chiropractic treatment, meet with the chiropractor in
person to get a feel for the kind of treatment he offers, and look for someone who
diagnoses with a physical exam. While x-rays are occasionally taken, they should not
be the only diagnostic tool used.
Ask about what kind of manipulations the doctor or
therapist generally does and look for someone who uses primarily slow, gentle motions
rather than sharp and sudden jolts. Avoid anyone who wants to crack your neck, as this
can be very dangerous.
When you go for treatment, you will lie on your side or stomach while the
therapist does various manipulations. He may put one hand on your shoulder and one
on your hip and gently twist your body, or he may put pressure on the spinal joints.
When this is done, you may or may not hear a crack. Chiropractors may also use
ultrasound, therapeutic massage, stretching, and muscle stimulation to help relieve
back pain. You may have some soreness for a day or two after treatment.
Studies have shown that you should feel relief from pain in four to eight
sessions. While some chiropractors may suggest a longer course of treatment, there is
no evidence that it will be more effective. If you don’t feel better in four to eight
sessions, chiropractic treatment probably won’t help you.
There are few risks involved with gentle manipulations, but there are some
serious ones that can occur in certain situations. People with osteoarthritis should avoid
twisting manipulations as this can cause bone spurs to damage the spinal cord and
Although it is rare, there have been cases where forceful neck manipulations
have resulted in neurological damage and death. It’s best to avoid spinal manipulations
if you have osteoporosis or nerve damage. Check with your doctor if you’ve had spinal
surgery, or back pain along with fever, chills, sweats, or unintentional weight loss.
Chiropractic therapy won’t help you if you have back pain due to infection or tumor.
finally, rapid neck manipulations can lead to strokes. You can avoid risks by giving your
therapist a thorough account of all injuries and illness you’ve had.
A good chiropractor is one who is willing to work with your other medial
professionals. She should also give you self-care information and exercises to do at
home. Avoid anyone who wants you to continue sessions to prevent future back pain;
studies do not show this to be effective.
Acupuncture is an ancient form of Chinese medicine that has been around for
more than 2500 years and is becoming an increasingly popular treatment for back pain.
According to the theory of acupuncture, energy-called chi or qi-flows through the body
along pathways called meridians. If the flow of chi is interrupted, pain or illness can
occur. When that happens, very thin needles can be inserted along the meridians to
correct the flow of chi.
No one is sure exactly why acupuncture works. Eastern philosophy holds that the
needles unblock interrupted chi. Western medicine has a few theories of its own.
believe acupuncture stimulates the nervous system and the 2000 energy centers in the
body, which in turn triggers the release of natural painkillers in the form of endorphins,
opioid peptides, and chemicals from the hypothalamus and pituitary gland.
believe that acupuncture needles help contracted muscles relax, stimulate nerves in the
legs, and decrease inflammation of the nerves in the lower back.
Studies by the National Institute of Health show that acupuncture is effective in
treating back pain, and 2500 years of success for the Chinese backs this up. Like all
back pain treatments, acupuncture seems to be most effective when used in
conjunction with other treatments. It is also very safe, with no known risks as long as
you chose a reputable practitioner. Needles are sterile, disposable, and FDA-approved.
In the U.S. they are used only one time, sealed before use, and disposed as hazardous
waste after treatment.
In the United States there are over fifty acupuncture training schools, which
require approximately 3000 credit hours of study and offer the equivalent of a Master’s
Degree. Often an undergraduate degree is required for admittance to an acupuncturist
The first two years in acupuncture school are spent in classroom study, the
third year is spent as an apprentice to a licensed acupuncturist, and the fourth year is
spent as in intern working under supervision on patients. States have different
requirements for acupuncturists, but all must take a state examinations and/ or a
national exam in order to be licensed to practice. To find an acupuncturist, contact the
American Academy of Medical Acupuncture.
During an acupuncture treatment session, the practitioner will insert anywhere
from one to twenty needles into various places in the body. Some needles may go in
just under the skin, while others may go deeper into muscle and fat. Needles will be left
in from fifteen to thirty minutes. The practitioner may turn needles one way or another
after inserting them into the body, or leave some in for only a few seconds before
removing them and inserting them elsewhere in the body.
Don’t be surprised if the
practitioner treats your back pain by putting needles in your ankles, knees, or fingers.
This is a technique called percutaneous electrical nerve stimulation (PENS), where
needles are inserted into nerve centers and electrically stimulated. You can expect to
feel relief for chronic pain in about ten to fifteen treatments and sooner for acute or
Other things an acupuncturist may do:
1) Use moxibustion, an herb that is
burned onto the needle before insertion to stimulate the area being treated;
burn cotton in a glass cup, which is then placed on the skin to create a vacuum; and
3) prescribe herbal supplements in addition to physical treatment.
You may be surprised to learn that acupuncture is rarely described as painful. In
fact, many people find it relaxing and even fall asleep during treatment. Some people
feel energized. One reason for this is the type of needles used.
are very different from hypodermic needles. Instead they are very thin and fine, like
hair. They are also solid, whereas hypodermic needles are not, as they are made to
extract tissue. So getting acupuncture needles inserted into your skin will feel nothing
like getting a shot at the doctor’s office.
When you are considering acupuncture, it is important to make sure the
practitioner is someone you feel comfortable working with. Look for someone who is
interested in your whole health and takes time to ask and answer questions.
some medical doctors also practice acupuncture, you will want to make sure they are
licensed in acupuncture in addition to their other training. To check if a practitioner is
licensed and accredited, contact the American Association of Acupuncture and Oriental
Physical therapy uses different techniques, such as ultrasound, electrical
stimulation, cryotherapy, massage, exercise, and heat in order to relieve muscle
spasms, increase flexibility, strengthen muscles, relieve pain, and accelerate the
healing process. A study in The New England Journal of Medicine found that the
effectiveness of physical therapy for low back pain was about the same as that of
chiropractic treatment and better than no treatment at all.
Physical therapists must graduate from an accredited physical therapy program,
many of which offer master’s and doctoral degrees along with bachelor’s degrees.
schools require two to four years of pre-physical therapy coursework before admittance.
Like other physical treatment programs, physical therapists spend time in both the
classroom and medical settings before graduation. After graduation, they must take
exams to become licensed, and some states require continuing education to maintain
After it is determined by a doctor or back specialist that you are a candidate for
physical therapy-some time between two to six weeks after the onset of low back pain
or sooner if the pain is severe or recurs frequently-you will meet with the therapist to
determine the best plan of treatment for you. You will be asked how your back pain
developed, how long you’ve had it, whether or not it’s recurring, what actions make the
pain better or worse, and any relevant medical history you have.
The therapist will also
give you a physical exam of your spine movement, muscular flexibility, sitting and
standing posture, muscle strength, reflexes, respiration, motor function, and repetitive
movements. From there, he or she will determine which treatments will be best for you.
There is some trial and error involved, so if one treatment doesn’t work to alleviate pain,
the physical therapist may try something different.
There are basically two types of physical therapy, passive and active. Passive
therapy is done to you and includes heat, cryotherapy, electrical stimulation, ultrasound,
massage, and lontophoresis. In heat, or thermal, therapy, the therapist applies heating
pads, heat wraps, or warm gel packs to the affected area.
This works to increase the
flow of oxygen to the muscle, allowing it to heal faster and relieve pain by softening
muscles. In cryotherapy, cold is applied rather than heat, and is considered more
effective than heat in reducing inflammation. Electrical stimulation sends mild electrical
impulses to the nerves and spinal cord, which releases endorphins and blocks pain
signals from the brain.
Ultrasound heats the deep tissue and allows it to relax and
stretch more easily. Massage breaks up scar tissue and encourages the relaxation of
muscle spasms. During lontophoresis treatment, a painkiller and steroid are rubbed into
the skin and a low level electrical current is applied to speed up the absorption of the
drugs. It works similarly to transdermal patches used to quit smoking.
You participate in active therapy, and it includes stretching, strength building
exercises, and aerobic exercise. A good physical therapist will combine passive and
active treatments, as exercise is essential to treating back pain. The therapist will
determine which exercises are best for your particular condition and supervise you in
those exercises to ensure you are doing them correctly.
You will likely be given
stretches to be done daily, fifteen to twenty minutes of strengthening exercises, and
thirty to forty minutes of low-impact aerobic exercise, such as swimming or walking, to
be done three times a week.
You may feel some soreness or discomfort after active physical therapy, but it
should go away in about twelve to eighteen hours. If it doesn’t, let your therapist know.
You may need to change exercises or how you are exercising. Results vary depending
upon the type of treatment done and the severity of symptoms, but a physical therapist
should know in about two weeks if the treatment is working or not.
Massage therapy breaks down scar tissue and releases muscles from spasms. It
is becoming increasingly more recognized as a form of medical treatment; a study by
the American Massage Therapy Association found that 54% of healthcare providers
encourage massage therapy, along with other types of therapy for back pain.
have shown that massage therapy is more effective than both chiropractic and
acupuncture for relieving pain due to muscle spasms. The benefits of massage therapy
include improved circulation, which helps alleviate muscle soreness; muscle relaxation,
which helps muscles move without pain; and increased endorphins, the body’s natural
If muscle spasms do not relax with massage therapy, that means
inflammation is likely present and cannot be treated with massage. So if you know your
back pain is due to inflammation, it won’t help to seek out massage therapy.
You should be aware that the kind of massage you receive in a spa is not the
same kind of massage used to treat back pain.
Swedish massage is the most common
type of massage found in spas and similar places that offer massages, and while it
feels good, it is too superficial to reach deep tissue and muscles and have any lasting
affect on back pain.
The kind of massage used to treat back pain is called Neuromuscular therapy
(NMT), or trigger point myotherapy. This type of massage works to relieve pain by
balancing the musculoskeletal and nervous systems. NMT incorporates special
massage therapy techniques, myofacial release, and stretching to relive both acute and
chronic patterns of pain.
There are many massage training schools throughout the United State. Along
with massage, neuromuscular therapists study neurological laws governing pain, the
roles of soft tissue in pain, and palpation, as well as anatomy, physiology, and the
function of the spine. In order to practice, massage therapists must be licensed and
you should make sure that when looking for a massage therapist, you choose one that
has had training in neuromuscular therapy.
To find a massage therapist, get a referral
from your doctor or contact the American Massage Therapist Association.
A neuromuscular therapist will ask you for all of the information that other
therapists do and examine your spine to determine where exactly the pain is and what’s
She will determine where nerves are compressed and where they are
trapped within soft tissue. The therapist will work to relieve your back pain with her
hands, fingers, elbows, and pressure bars, which are used to reach deeper into spinal
muscles and tendons. She will use some kind of lubrication and start first on superficial
tissue before moving deeper.
This should not hurt, but you will feel pressure, and you
may be sore afterwards due to the muscles releasing lactic acid. The therapist will also
palpate trigger points, elevated neurological areas deep within the muscles. This may
hurt initially, but the pain should go away quickly as the therapist continues to work.
Back pain should respond to massage within four treatments over six weeks. If not,
massage is clearly not the best treatment.
Several types of water therapies exist and can be broken down into two very
different groups: water exercise therapy and hydrotherapy. Water exercise therapy
should be done only by a qualified physical therapist, while hydrotherapy may be done
by a therapist but can also be done at home to relieve backaches.
Water exercise therapy has many benefits. The buoyancy of water supports the
patient’s weight, allowing a greater range of motion when the person has too much pain
to exercise on land. This makes water exercise therapy ideal for everyone who seeks
relieve from back pain. Additionally, the water temperature should be warm enough to
relax muscles, which also helps relieve pain.
A physical therapist will have you do in the
pool the same exercises you would do on land; they will just be easier to do. Some
people transition to land exercises when their back allows it, some continue treatment in
the water because they prefer it, and some incorporate both land and water exercises
into the therapy.
Hydrotherapy for back pain relieves pain by loosening the muscles and ridding
the body of toxins that produce pain and inflammation. Studies have shown that people
who soak in a hot tub or warm bath have less stiffness, more flexibility, and tend to use
less pain medication. Hydrotherapy consists of douches, sauna or steam baths, wraps,
and hot baths with or without herbal additives.
It has been used for centuries and is
most popular in Europe. Many spas now offer various hydrotherapy treatments. The
only risks involved are to people who are temperature sensitive and to those who have
diabetes. You must be careful, though, not to get overheated.
To douche your back, use a hose hooked up to your bathtub faucet. Direct the
stream of warm water over the painful area and toward the heart.
The water should not
splash, but rather wash gently over the skin. Do this for ten to fifteen.
Saunas and steam baths help relieve mild back pain because they stimulate the
flow of blood, which relieves the pain of pulled muscles.
You should not use a sauna if
pregnant and never stay in longer than fifteen to twenty minutes. To keep from getting
over heated, wipe your face frequently with a cold cloth. Drink plenty of water to keep
from becoming dehydrated.
Warm baths are excellent for relieving mild backaches. Fill the tub with about 6
inches of tepid water and get in. Gradually add hot water until the water level in the tub
reaches your naval. The final temperature should be no hotter than 104 degrees.
Anything higher can induce a mock fever.
Soak for fifteen to thirty minutes, and when
you get out, wrap up warmly and go to bed. For even more benefit, you can add ½ cup
of Epsom salts to the water to help draw toxins from the body. Essential oils can also
be added to the bath.
Some good ones for alleviating back pain are lavender,
marjoram, rosemary, clary sage, black pepper, ginger, and birch. First mix two or three
drops of the essential oil with two tablespoons of a carrier oil, such as sweet almond,
peanut, olive, grape seed, or walnut oil, and then pour the mixture under running water.
The mixture can also be massaged directly into the skin. To get a similar effect, tie ½
cup of herbs in cheesecloth and hang under the faucet so the water runs through the
bag. Some good herbs for alleviating back pain are birch, German chamomile, white fir,
wintergreen, and lavender.
Using herbs and essential oils for healing is called
aromatherapy; it promotes self-healing by indirectly stimulating the immune system.
Sometimes a physical therapist may do a heat wrap for your back pain, or you
can also do one yourself at home. Moisten a cloth with warm water, wring it out, and
wrap it snugly around the painful area of your back. Then wrap up in a dry cloth and
next a blanket. Relax for 45-60 minutes. Herbs or hot mud may be added to the water
for added benefit.
The good news about surgical treatments for back pain is twofold: 1) Less than 1
percent of those who suffer from back pain ever need it. 2) Medical advances have
made back surgery easier to tolerate and recover from, with more optimistic prospects
for recovery than ever before.
At present, many experts agree that more back surgery
than was medically necessary was performed in the past, with too many of the
recipients not benefiting from it. Some even became worse as a result. Today the
standard for back surgery is that an individual has a clearly defined medical condition
with a specific solution that will provide clear benefits.
Below we will look at the three most common types of back surgery:
There are general standards that must be met before one can be a candidate for
disc surgery, a procedure that is usually done when a disc is herniated (protrudes from
its normal spot) and causing severe discomfort.
A) An MIR or CT scan reveals that a disc is pressing against the root of a nerve.
B) Persistent pain is experienced despite the use of more conservative
measures, such as weight loss, exercise, and ergonomic measures.
C) Severe pain is radiating down the leg or into the buttock, despite
conservative interventions of physical therapy or medications.
D) Neurological warning signs are observed, such as the loss of reflexes or
bodily control. These may be indicators of a surgical emergency.
Once the need for disc surgery has been established there are a number of
1 Discectomy: This is the most frequently performed back operation. In
general, an incision is made over the disc and a part, or all of it, is removed in
order to relieve pressure on the nerve.
2 Microdiscectomy: The procedure is much the same as for a discectomy. The
difference is that a smaller incision is made because magnification is used to
enlarge the view of the target space.
2 Laser Decompression: A needle is inserted into the disc and a portion of it is
destroyed with a laser. This relieves pressure on the nerve. The advantage
of the procedure is that it is less invasive than traditional surgeries and can
be performed on an outpatient basis.
3 Percutaneous Removal: A small tube called an endoscope is inserted into the
back and used to remove portions of the disc. This allows the surgeon to
pinpoint the problem and leave the surrounding area intact. This, too, can be
performed on an outpatient basis.
4 Chemonucleolysis: This is an alternative to taking out part or all of a disc. A
preparation from papaya plants, called chymopapain, is injected and has the
effect of decreasing the size of a disc, with the intention of relieving nerve
In this form of back surgery two vertebrae are joined together in a process called
spinal fusion. It is accomplished by putting bone grafts either between or alongside the
Hollow metal cages filled with bone graft can also be inserted between the
vertebrae. The bones may be attached to the vertebrae with metal plates or screws
that serve as a brace.
Once the grafts are in place the bones begin growing together, which serves to
fuse the vertebrae. This serves to bring normal stability and strength to structures that
have been fractured or damaged by disease.
Creating Additional Space
The purpose of this form of surgery is quite simple: by opening up more room for
the vertebrae pressure is taken off the affected nerve(s). Most often this is done for
patients with spinal stenosis. In this condition the spinal canal has become too narrow,
with the result being a lack of suitable space for the spinal cord and nerves that causes
pain in the back and weakness of the legs.
In order to provide more space a laminectomy is performed. This involves
removing portions of the laminae, the bones on the back of the vertebrae.
An Improved Process
With greater specialization in back surgery and the ongoing development of
techniques, success rates have improved and there has been a reduction in postsurgery
Recovery times, especially given the growth in outpatient
procedures and rehabilitation strategies, have been significantly reduced. Surgeries
that once were regarded as things we needed months to fully recover from are now
seen more as temporary interruptions, with some only requiring a few hours.
An important point to remember when considering back surgery is that it is only
helpful when a specific change in the anatomy of an individual’s back is called for to
correct a condition that has been clearly identified. It is not done on an exploratory
basis or because no cause has yet been found.
In addition, even when the problem
has been identified, surgery is generally regarded as a last resort and recommended
only after more conservative approaches, such as medication and physical therapy,
have been attempted and judged not to be sufficient.
MEDICATIONS AND INJECTIONS
Among the common pain relief medications prescribed by physicians are muscle
relaxants, antidepressants, NSAIDs (nonsteroidal inflammatory drugs) and COX -2
inhibitors. Some popular muscle relaxants are cyclobenzaprine (Flexeril), carisoprodol
(Soma), methocarbamol (Robaxin) and gabapentin, in seizure medications. The
NSAIDs help with stiffness and in reducing inflammation. Opiates like Duragesic or
OxyContin may be prescribed but are not a popular choice with a low risk of possible
With all medications, other treatment strategies should be combined into the
relief program. So physical therapy, movement and posture techniques and other
treatment options should be carefully assessed to see which combination best helps
relief over time.
Doctors may also prescribe injections, such as Sacroiliac joint blocks, Thoracic
Facet Joint injections, Epidural steroid injections, selective nerve root block, and Facet
Muscle relaxants act on the brain, not on the muscle. They help relieve pain so
that patients are able to exercise and have other physical treatments that would
otherwise be too painful. Muscle relaxants are sedatives, so doctors may prescribe
them to be taken at night to avoid daytime drowsiness. They should not be taken when
driving or operating heavy machinery.
Muscle relaxants have been shown to be
effective alone or in conjunction with anti-inflammatory medications within a week of the
onset of severe muscle spasm in the lower back. Side effects include drowsiness,
dizziness, addiction after one week of use, dry mouth and urinary retention.
common muscle relaxants are carisoprodol (Soma), cyclobenzaprine (Flexeril),
diazepam (Valium), metaxalone (Skelaxin), methocarbamol (Robaxin).
Low doses of tricyclic antidepressants have been used to relieve chronic back
pain. They work by increasing the level of certain chemicals in the brain that change the
way the brain perceives pain.
They are not used for sudden and acute pain, and usually
take two to three weeks to go into effect. Side effects include constipation, dry mouth,
blurred vision, drowsiness, fatigue, low blood pressure, weight gain, increased appetite,
sweating, and urinary retention. Since side effects vary from medication to medication,
it is worth trying another antidepressant if one does not work well.
antidepressants used to treat back pain are amitriptyline (Amitril, Elavil, Endep),
doxepin hydrochloride (Sinequan), imipramine hydrochloride (Janimine, Tofranil),
nortriptyline (Pamelor), and desipramine (Norpramin).
NSAIDS and COX-2 inhibitors are effective in relieving pain and reducing
inflammation. They are generally the first line of treatment in acute low back pain.
NSAIDS are usually taken for one to three weeks but can be taken for four weeks or
longer. People under the age of twenty should not take NSAIDS because they can
cause Reye’s syndrome, a central nervous system disorder.
Other people who should
not take NSAIDS include those taking blood thinners, corticosteroids, lithium, and oral
antidiabetic medication. Before taking NSAIDS you should let your doctor know if you
are pregnant, trying to get pregnant, breastfeeding, or have a peptic ulcer, history of
gastrointestinal bleeding, nasal polyps, kidney or liver disease, allergic reactions to
aspirin or related drugs, anemia, or a blood-clotting defect.
Short-term side effects can
include stomach irritation, which can be minimized by taking them with food and a full
glass of water. Taking NSAIDS long term can cause ulcers. In rare cases, naproxen,
ibuprofin and rofecoxib have caused meningitis. A common nonprescription NSAID is
aspirin (Anacin, Bayer, Bufferin). A common prescription NSAID is naproxin (Naprosyn).
Some common COX-2 inhibitors are celecoxib (Celebrex), rofecoxib (Vioxx), and
COX-2 inhibitors are less likely to cause stomach problems, but they may
increase the risk of heart attack. If you have a history of heart trouble, talk to your
doctor to see if COX-2 inhibitors are best to treat your back pain.
Spinal injections have been used to as an alternative to surgery in treating back
pain since the early 1900s. Studies have shown injections to be effective in up to 50%
of patients. They are typically given after medication and physical treatments have been
utilized, but before surgery. Injections tend to be more effective than oral pain
medication because they deliver medicine right to the source of the pain.
Sacroiliac (SI) joint blocks are injections used to treat low back pain.
sacroiliac joints are located next to the spine and connect the sacrum to the pelvis.
Painful joints cause pain in the lower back, buttocks, abdomen, groin, and legs. SI joint
blocks work in three ways:
1) they are used to determine if the SI joint is the source of
back pain (if the injection makes the pain better, that’s where the pain is coming from),
2) the numbing medication used in the block gives temporary relief so the patient can
have chiropractic or other physical treatments immediately after the block is
3) a time-release steroid gives extended pain relief by reducing
During an SI block, the patient lies on his stomach and live x-ray, known as
fluoroscopic guidance, is used to allow the doctor to see the joints. The skin is
sterilized and numbed. The doctor then inserts a very small needle into the joint and
injects it with lidocaine (a numbing agent) and a steroid (an anti-inflammatory). After
treatment the legs sometimes feel numb or weak for a few hours. Side effects are rare
and include allergic reaction, infection, excessive bleeding, nerve damage, and
Thoracic Facet joints are small joints about the size of a thumbnail and are
located in pairs along the back of the spine. If they become irritated, middle back pain
occurs. Thoracic facet joint injections have the same purpose as SI joint injections, are
performed in exactly the same manner, and have the same side effects. The only
difference is they treat middle back pain instead of lower back pain.
Epidural steroidal injections are similar to SI and thoracic facet join injections,
except the cortosteroid is injected into the spinal canal surrounding the spinal cord.
They are used to treat chronic and not acute low back pain. This procedure has the
same side effects of other injections. Relief generally lasts anywhere from one week to
Selective nerve root blocks (SNRB) are used primarily as a diagnostic tool and
secondarily as treatment for pain. Back pain can occur when nerve roots become
compressed and inflamed. While MRIs can be used to show which nerves are causing
the pain, they don’t always work successfully. In cases when this happens, an SNRB
injection can be performed in order to isolate the source of the pain. SNRBs are also
used to treat disc that rupture outside of the spinal canal, or far lateral herniated discs.
The procedure is the same for other types of injections. As with other injections, SNRBs
should not be performed more than three times per year. SNRBs are considered more
difficult to perform than other types of injections and should be done only by a physician
experienced in them.
Facet rhizotomy may be recommended if three facet blocks have been performed but
more pain relief is needed. Facet rhizotomy injections disable the sensory nerves that
lead to the facet joint, thereby providing pain relief. The procedure for facet rhizotomy
injections is different from that of other injections. A needle with a probe is inserted just
outside the joint, is heated with radio waves, and applied to the sensory nerve. This
disables the nerve and keeps it from sending pain signals to the brain.
Self Care strategies for Living with Back Pain
COPING WITH CHRONIC PAIN
There is not a single definition of pain that is appropriate for everybody because
it is a highly subjective experience. What, to another person, is excruciating may be
nothing more that a slight discomfort for you. Not only do views of pain vary among
individuals, your own perception of it can change over time.
Even when you do have a
clear perception of what pain means to you, there is not an objective way to measure it
you can use to convey your impressions to somebody else. It is not unusual for
patients in a doctor’s office, who have come in because pain is severely impairing their
day-to-day lives, to have great difficulty describing it clearly.
One thing we do know, however, is the difference between when we are hurting
and when we are not. In the case of acute pain, you may cry out from it and experience
terrible suffering for a time, but it ends eventually, and usually the sufferer returns to
their normal activities and way of life.
Chronic pain is different. A sufferer of chronic
pain not only hurts, but they keep on hurting. Indeed, the psychological impact of
chronic pain can be worse than the physical sensation itself, especially when the daily
grind of it wears you down and turns the world grim. Acute pain usually does not
change one’s personality. Chronic pain, if not addressed properly, can alter it
Chronic pain may have a physical basis, a psychological basis, or some mix of
the two. Maybe it comes from an injury. Maybe it comes from stress. Maybe the two
factors are interconnected. People who cannot pinpoint a clear physical connection
often say, or are told, that it is “all in their heads.” But that is not how it feels. Chronic
back pain caused by stress can hurt just as badly as chronic pain that resulted from
falling off of a roof.
It has been estimated that over 34 million Americans suffer from chronic pain, be
it from arthritis, migraine headaches or their backs (with lower back pain being the most
common). 15 million people experience chronic pain at work on a daily basis. So if you
are a sufferer of chronic pain you are not alone - though it can certainly feel that way.
What Can You Do About It?
To begin with, you must make sure clear lines of communication have been
established with you physician(s) and any other health care providers being seen for
chronic back pain. Do not just assume it is your cross to bear and suffer in silence.
Though it is true that the majority of back pain in general is not symptomatic of serious
illness, do not assume you are therefore free from all risk.
There have been cases of
people whose backs’ hurt persistently and they just mistook it for a fact of life and went
on the best they could, only to discover that “bad back” was really a sign of something
much worse, like cancer or otherwise damaged internal organs.
In order to facilitate communication to a health care professional it is a good idea
to spell out some specific things to yourself first as a means of organizing your thoughts
and presentation. For example, asking yourself and answering the following questions
can go a long way toward clarifying what you are experiencing:
• How bad, on a scale of 1 - 10 is my pain?
• How long have I had this pain?
• What words can be used to describe it (tearing, burning, throbbing, etc.)?
• What could have caused my pain? Is there an injury, psychologically stressful event, or activity I can link to its onset?
• Are there any other health problems I am having?
• In addition to pain medication, what other medicines am I taking?
• What kinds of things have I done to try alleviating the pain? Have any helped, even some?
• Both emotionally and physically, how has pain affected my daily life, be it at work or at home?
The questions do not have to end with the examples above, of course, and
asking a few may help you zero in on more specific inquiries - just as the information
provided will help your physician to get a clearer picture of what is happening with you.
Once the chronic pain is described, a variety of approaches, alone or in combination,
are available to treat it.
A wide range of drugs are available for the treatment of chronic pain. Most
commonly used are aspirin, acetaminophen, and the anti-inflammatory drugs like
ibuprofen. Then there are the more powerful narcotic analgesics, such as morphine
People respond to these differently and there is no one medication that is
right for everybody. Only a physician who knows your medical history and what other
medications you might be taking is truly qualified to make the best recommendation for
you. And, after beginning to take one, it is important to keep your physician updated on
their effectiveness, not only if they are working or not, but also about any side effects
you might experience.
Do not fall into the trap of thinking that a lack of effectiveness or the experience
of side effects are things that must be tolerated without question. Many different drugs
are available and improvements in pharmacology bring us more and better alternatives
as time goes one. Regular contact with a physician is necessary to make sure the
course of medication one is on is indeed the best available.
Psychological approaches are best for chronic pain where a specific physical
cause has not been identified or, when it has, is used in conjunction with a sensible
course of medical treatment. The strategies used generally fall into four categories,
with plenty of room for overlap and the use of more than one technique at a time.
These categories are: relaxation, imagery, hypnosis, and biofeedback.
Though it is
best to seek the advice of experts to ascertain what, or what combination, is best for
you, below are examples of some things you can do on your own in the effort to cope
with chronic back pain.
Splitting: Separate your experience of pain from the pain itself. If the pain is
throbbing, for example, focus on the throb and not the hurt. Another variation
is to separate the painful body part (your back) from the rest of your body.
Numbing: Imagine an injection of a powerful medicine that numbs the area of
your back that hurts.
Projection: Imagine yourself at a time in the past or future where you are free
of pain. A pain-free location, like a favorite vacation spot, may also work.
Movement: Visualize the pain moving from your back to another area of the
body where it is easier to handle. An alternative is to imagine it leaving your
body and taking up residence somewhere else, like the ground.
Be aware that psychological approaches are particularly helpful when stress is
suspected as the culprit in your experience of chronic back pain. Our daily lives are
constantly subject to stress, be it from work, relationships, or simply new and different
People react to stress in different ways. Some individuals feel tired,
others get upset stomachs, and many of us show our tension in the form of back pain.
Instead of a psychological technique that focuses on pain management, then, a more
sensible approach could be the identification and treatment of the factors that cause
you to experience stress.
A Physical Approach
Most chronic back pain is the result of activities that have an adverse effect, such
as lifting heavy objects improperly or simply sitting in a chair for long periods with bad
posture. Changing our habits, therefore, can have a significant impact. Below are
some of the most commonly advised physical measures to take. As always, see a
physician or other qualified professional for assistance in deciding what is best for you.
Weight loss: approximately 67 percent of Americans are overweight. These
extra pounds put pressure on the back and strain both back and abdominal
muscles, which can weaken these muscles and compound the problem.
Improve Posture: Bad posture means your body is out of balance. When it
comes to your back this means that only a small number of muscles and
joints are doing most of the work. Proper posture will spread out the task and
relieve the intense pressure on small areas of the back
Exercise: A good exercise program, designed by a professional, will
strengthen muscles in your back, keep them limber, and increase endurance.
Though our instincts may tell us to rest until the pain passes, the proper
exercise can be an effective means of pain relief or reduction.
Movement: Simple measures, like using your leg strength, instead of back
muscles, to lift heavy objects can make a big difference. Whether at work,
home, or engaged in leisure activities, be aware of how you can alter you
movements to avoid unnecessary stress on your back.
Diet change strategies:
Vitamin & Nutrient Associations
Even when we try to eat well, we're disadvantaged. The nutritional content of most food has been compromised over the years, not only by deficient soils and modern production, transportation, storage and processing methods, but also by the enormous amounts of chemical and artificial substances added to promote growth, storage life, taste and appearance.
It's for this reason that more and more medical authorities are advocating the use of vitamin and mineral supplements. However, finding them in the right combination can be both confusing and costly.
Quality nutrition products make use of knowledge gained from the botanical world's 6,000 year history. They incorporate health building nutritional herbs with the best modern technology to help our bodies cleanse and detoxify so that the cells - the tiniest living units - can be as fully nourished as possible.
This allows the cells to grow, repair and to perform their functions with the best possible efficiency so that we feel and look better and are more able to prevent and fight disease. Once the body begins to clear itself of toxins it can more efficiently absorb nutrition.
You may find benefit from our information on detoxification as well as a bit about detoxing because of change of diet
It may be due to difficulties with your digestive system that is causing your body to be starved of key nutrients, vitamins or minerals. In this case you may find useful answers by reviewing our article on Nutrition For Your Cells. There is also more information here about why is nutrition such an issue nowadays?
It may be that your metabolism has slowed due to pressures that have been placed on your system through life in general or through specific “challenges” you have faced in the last few months or last few years. Review this by looking at our article about balancing your Metabolic Rate.
Further reading through our articles on health issues will give you a body of information that will help you decide what options you have to deal with the underlying causes of your problem through giving your body the nutrition products that will assist you body to heal from the inside out.
We wish you well in your search for solutions to this problem and your movement towards better health in all areas.
More Resources available about Back Pain :
Get relief with back pain exercises
Many people believe that rest is best for a painful back, but actually, what your
back really needs when it’s hurt is exercise. Regular exercise relieves back pain by
strengthening and stretching the muscles that support the spine and helps to prevent
future injury. This is a use it or lose it situation: the more you rest, the weaker your back
gets, even if it is hurt. Studies have actually shown that you can heal your back pain
faster and get back to your regular activities with just two days of rest. So let’s look at
some of the best exercises for relieving back pain.
(To read the rest of this article click on the Title above here.)
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