Non-operative Lower Back Pain (Lumbar) Treatments
Most low back pain can be treated without surgery. Treatment of low back pain usually begins with a few basic steps. Before beginning any back pain treatment program, be sure you know your diagnosis and discuss the treatment plan with your doctor. There are some conditions that cause back pain and require immediate treatment. For most cases of back pain, the first treatments are as follows:
A short period of rest (24-48 hours) is appropriate when an acute back strain has occurred. This will allow inflammation to be reduced and strained muscles to heal. Prolonged bed rest has been shown to be counter productive. Once the acute back pain eases, activities can be slowly instituted, avoiding excessive lifting, twisting or poor body mechanics.
Anti-inflammatory medications, or NSAIDs, are helpful in treatment of both back pain and the associated inflammation. There are both over-the-counter and prescription NSAIDs that may be appropriate for low back problems. However, remember that the side-effects of NSAIDs include problems with gastrointestinal bleeding, and these medications should be avoided in patients with stomach ulcers. Your doctor can determine if these medications are appropriate for your back problem.
Application of moist heat can help to ease discomfort associated with muscle spasm in some patients with lower back pain. Patients may find that the use a heating pad, hot water bottles, or even a hot bath can help ease the muscle discomfort.
Strengthening of back muscles is probably the most important step in treatment of most causes of back pain. By increasing strength and flexibility of back muscles, weight is better distributed, and less force is placed on the spine.
These simple measures often lead to the resolution of the symptoms of lower back pain. If not, you should certainly be under the direct care of a physician to aid in the diagnosis and treatment of your condition. There are further steps in the treatment of lower back pain that can be considered.
Back exercises, as listed above, are the focus of physical therapy. However, there are other modalities that may be used by a physical therapist include aquatherapy, ultrasound, electrical stimulation, and manual therapy.
Epidural Steroid Injections
Epidural steroid injections are used to decrease inflammation around the spinal nerves. An epidural steroid injection is performed using an x-ray to guide the medication to the area adjacent to the inflamed spinal nerve. They are best used when the back pain is combined with pain radiating into the buttock or legs caused by nerve root compression.
Narcotic Pain Medication
Narcotic pain medications do assist in relieving pain acutely, but can be dangerous and addictive if used for prolonged periods. These medications should only be used under close supervision of a physician and only for a limited period of time.
Muscle relaxing medications can be very helpful in the treatment of some types of acute back pain with significant associated muscle spasm. Like narcotics, these medications often make you drowsy and have the risk of addiction if used for longer periods of time.
Some antidepressants, particularly tricyclic antidepressants such as amitriptyline and desipramine, have been shown to relieve lower back pain (independent of their effect on depression) and assist with sleep.
Antidepressants alter levels of brain chemicals to elevate mood and dull pain signals. Many of the new antidepressants, such as the selective serotonin reuptake inhibitors, are being studied for their effectiveness in pain relief.
Spinal manipulation is literally a "hands-on" approach in which professionally licensed specialists use leverage and a series of exercises to adjust spinal structures and restore back mobility.
When back pain does not respond to more conventional approaches, patients may consider the following options:
Acupuncture involves the insertion of needles the width of a human hair along precise points throughout the body. Practitioners believe this process triggers the release of naturally occurring painkilling molecules called peptides and keeps the body’s normal flow of energy unblocked. Clinical studies are measuring the effectiveness of acupuncture in comparison to more conventional procedures in the treatment of acute low back pain.
Biofeedback is used to treat many acute pain problems, most notably back pain and headache. Using a special electronic machine, the patient is trained to become aware of, to follow, and to gain control over certain bodily functions, including muscle tension, heart rate, and skin temperature (by controlling local blood flow patterns). The patient can then learn to effect a change in his or her response to pain, for example, by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects.
Interventional therapy can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Chronic use of steroid injections may lead to increased functional impairment.
Transcutaneous electrical nerve stimulation (TENS)
TENS is administered by a battery-powered device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that block incoming pain signals from the peripheral nerves. TENS may also help stimulate the brain’s production of endorphins (chemicals that have pain-relieving properties).
Ultrasound is a noninvasive therapy used to warm the body’s internal tissues, which causes muscles to relax. Sound waves pass through the skin and into the injured muscles and other soft tissues.
Vertebroplasty uses three-dimensional imaging to help a doctor guide a fine needle into the vertebral body. A glue-like epoxy is injected, which quickly hardens to stabilize and strengthen the bone and provide immediate pain relief.