Oh, my aching back! — Understanding back pain is crucial to treating it

Back pain is one of the most common issues that causes people to see a health care provider, and it can be considered either acute or chronic.

Acute back pain usually comes on quickly and typically lasts fewer than six weeks. It is the most common type of back pain and often is caused by a fall or lifting something using poor body mechanics. Back pain is considered chronic when it lasts longer than three months. Chronic back pain can develop suddenly or occur slowly over time.

The National Institute of Arthritis and Musculoskeletal and Skin Diseases notes that chronic back pain can be caused by mechanical and structural problems, such as disk breakdown or rupture, spasms, muscle tension or injuries from sprains, fractures, accidents and falls. Chronic back pain also can accompany medical conditions and diseases, including arthritis; scoliosis, which is a curvature of the spin; spondylolisthesis, a condition in which a bone in the spine slips out of place; or spinal stenosis, which is a narrowing of the spinal column.

Back pain also can accompany pregnancy, kidney stones, some infections, endometriosis, fibromyalgia, osteoporosis, tumors and stress.

Often, acute back pain will improve with self-care measures including movement and exercise, rest, heat or cold applications, and over-the-counter pain or anti-inflammatory medications. In general, bed rest is not recommended for back pain. Most people recover more quickly if they can continue daily activities, including walking and other exercises, with modifications to minimize discomfort.

A free program on Oct. 25 at the Lawrence Public Library will focus on back pain. Monica Hart, a nurse practitioner with Lawrence Spine Care, said she and other presenters will focus on education. She is hopeful the program will help people better understand their backs and any pain they might have, noting that 1 in 8 people have back pain.

“We like to help people understand when their back pain’s an emergency and when it’s just pain,” she said.

For example, she said, a sprained ankle can be terrifically painful. However, it likely won’t require surgery.

“There’s a time and a place for surgery in the back,” Hart said. “More times than not, that pain does not need surgery.”

The Mayo Clinic recommends that people with back pain see their health care provider if self-care measures do not significantly improve their back pain within two weeks. Other reasons to seek medical care include severe pain that doesn’t improve with rest; pain spreading down one or both legs, especially if the pain extends below the knee; weakness, numbness or tingling in one or both legs; or if the back pain is accompanied by unexplained weight loss. Also seek medical follow-up if you start having back pain for the first time after age 50, or if you have a history of cancer, osteoporosis, steroid use or drug or alcohol abuse.

In rare cases, back pain may indicate a serious medical problem. Seek immediate care if back pain causes new bowel or bladder problems, is accompanied by fever, or occurs after a fall, blow to the back or other traumatic injury.

Your health care provider likely will use a combination of physical examination and imaging such as X-ray, MRI or CT scans to diagnose the cause of your back pain. Other possible tests may include blood tests, bone scans or nerve studies known as electromyography or EMG.

Once a diagnosis is made, your health care provider may recommend several treatment strategies based on the cause of your back pain. Generally, physical therapy and ongoing exercise are the “backbone” of treatment. A physical therapist may apply a variety of treatments such as ultrasound, electrical stimulation and muscle-release techniques to your back muscles and soft tissues to reduce pain. As pain improves, the therapist may suggest exercises to increase flexibility, strengthen your back and abdominal muscles, and improve posture. Ongoing exercise is important to prevent pain from returning.

Lawrence Memorial Hospital Therapy Services has locations in Lawrence, Baldwin City and Eudora, where physical therapy professionals are available to treat back pain and other conditions. In early November, LMH Therapy Services’ newest location will open in Tonganoxie, adjacent to Family Medicine of Tonganoxie.

Depending on the type of and cause of your back pain, your health care provider might prescribe these medications to augment physical therapy treatment:

• Over-the-counter pain relievers

• Prescription NSAIDs (nonsteroidal anti-inflammatories)

• Muscle relaxants

• Topical pain relievers: creams, salves or ointments to rub into your skin at the pain site

• Narcotics, such as codeine or hydrocodone, which may be used for a short time with close supervision by a doctor

• Antidepressants: low doses of certain types of antidepressants may relieve some types of chronic back pain, independent of their effect on depression.

• Injections: if other measures don’t relieve the pain, and especially if the pain radiates down your leg, a doctor may inject an anti-inflammatory or numbing medication into the space around your spinal cord. You may need multiple injections over a period of time.

Less often, surgery may be recommended to relieve chronic back pain. It is typically reserved for pain related to structural problems such as spinal stenosis or a herniated disk that haven’t responded to other therapy. If back pain is unrelenting or associated with radiating leg pain or progressive muscle weakness caused by nerve compression, surgery also may be recommended.

Some alternative therapies that may provide relief to some with acute or chronic back pain can include chiropractic care, acupuncture, therapeutic massage and yoga. However, it is important to determine the cause of your chronic back pain before employing any therapy.

It also is important to focus on prevention strategies, including:

• Regular exercise, especially activities that are low-impact aerobic, such as walking or swimming, and exercises that strengthen your core and back muscles such as yoga and Pilates, as well as other strengthening and flexibility exercises;

• Working on getting or keeping weight at a healthy level;

• Using proper body mechanics when you walk, sit or lift;

• Not smoking — smoking may prevent the delivery of nutrients to the disks in the back, leading to disk disease.

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