Health & Safety

February 14, 2014

Get doc’s opinion on how to treat low back pain

Low back pain is number one in the top ten diagnoses seen by providers at the 56th Medical Group.

There are two classifications of back pain: Acute back pain, which lasts up to 12 weeks in duration, or chronic back pain, which lasts more than 12 weeks. Approximately 98 percent of acute low back pain events can be attributed to soft tissue injuries involving the muscles, fascia and ligaments. This type of pain is self-limiting and usually resolves itself within a few weeks. Only 2 percent of back pain diagnoses are linked to underlying conditions such as metastatic cancer, spinal osteomyelitis, herniated discs or trauma in which nerve damage can be involved.

The American College of Physicians and the American Pain Society did an extensive review of clinical studies to determine the best approach to treating low back pain. Here are their recommendations:

•Doctors should use a patient’s history and the results of a physical examination to determine whether that patient’s low back pain is musculoskeletal, associated with nerve damage or potentially related to another serious condition.

•Doctors should not order X-rays, CT scans, MRIs, or other tests unless they suspect nerve damage or a specific cause of the low back pain that would show up on the test.

•Doctors and patients should discuss the expected course of low back pain, the importance of remaining active, and self-care options, such as heating pads, special mattresses and exercise.

•They should also consider acetaminophen or nonsteroidal anti-inflammatory drugs along with self care.

•Doctors and patients should consider the following nondrug treatments for patients who do not respond to self-care: rehabilitation, spinal manipulation, exercise therapy, massage, acupuncture, yoga, progressive relaxation or cognitive-behavioral therapy.

Imaging for acute lower back pain has limited benefits and is not needed for diagnosis. It is only warranted if there are red flags that point to a more serious condition on examination.

The primary goal in treating acute low back pain is to reduce the pain to a manageable level in order to facilitate the healing process and rehabilitation. Resolution of symptoms takes time. It may seem counterintuitive, but evidence demonstrates that continued activity improves function and that bed rest is rarely recommended.

Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen are usually the drugs of choice for low back pain. Most NSAIDS are sold over the counter. Acetaminophen or Tylenol is another drug effective in relieving back pain.




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