With back pain, treatment advances occur so rapidly that often it is difficult for patients to keep up with the latest developments. What you need to know to find the right back-pain therapy…
Common Causes Of Back Pain
Back pain can result from a variety of underlying conditions. If you experience back pain for more than two to four weeks, it's important to see an internist or family physician to identify the problem. The cause of back pain can be pinpointed by a careful examination.
Herniated disk, which is among the most common causes of back pain, occurs when the soft material inside one or more of the "cushions" (disks) between spinal vertebrae oozes through a split in the disk's tough outer shell (herniation) or causes the shell to bulge outward.
Sciatica occurs when a herniated or bulging disk presses against the sciatic nerve, which exits from the lower (lumbar) spine, usually causing severe pain on one side of the body in the buttock and down the back of the leg.
Compression fractures, the breakdown of one or more spinal vertebrae, are usually caused by osteoporosis, while muscle strain and muscle spasm typically result from physical activity.
Choosing The Right Medication
Best choices…
- Anti-inflammatory medication.
Typically used for: Back pain due to muscle spasms or strain. Mild-to-moderate back pain usually improves within a few weeks with the use of over-the-counter anti-inflammatory medication, such as ibuprofen (Advil), and home treatments, such as ice packs.
What you may not know: To minimize swelling and inflammation, ice or a cold pack should be applied to the painful area- 10 minutes several times daily-for only two days after the pain starts. Thereafter, it's better to use heat--for 10 minutes several times daily. Heat (from a heating pad, a towel soaked in hot water or a hot bath or shower) relaxes your muscles and increases blood flow to the painful area, which speeds healing.
Typically used for: Severe back pain due to a herniated disk. An injection of cortisone or another steroid in the epidural space, which surrounds the sciatic nerve, reduces inflammation within hours. The injection can be administered in a doctor's office and doesn't require an anesthetic.
*Sudden onset of back pain accompanied by fever, numbness or weakness in the legs or groin area and/or loss of blackler or bowel control may indicate an infection or other serious condition. Seek immediate medical attention.
The treatment, which may be repeated two or more times for any episode of sciatica, generally is safe, with only a low risk for infection. Between 50% and 60% of patients injected with an epidural steroid report less pain and disability.
What you may not know: Patients who don't get steroid injections tend to have the same level of relief over a one-year period, according to recent research.
Other Options
Typically used for: Back pain due to spasms or muscle strain. This technique involves analyzing musculoskeletal patterns-such as a patient's posture—and creating movements that are designed to improve posture and release muscular tension.**
New finding: When 579 patients with chronic (more than three months) or recurrent (three or more weeks) low-back pain were followed for one year, those treated with the Alexander Technique had less pain than those who received massage or conventional treatments, such as physical therapy.
What you may not know: Patients who receive as few as six lessons in the Alexander Technique have been shown to do as well as those who took 24 lessons.
Caveat: The study lasted for only one year, so the long-lasting benefits are unknown.
Typically used for: Patients with pain caused by one or more herniated disks. The McKenzie Method, also known as Mechanical Diagnosis and Therapy (MDT), involves an extensive assessment to identify the patient's pain response to repeated test movements, positions and activities. Precise pain-eliminating exercises and posture modifications are then recommended. MDT educates patients in lifestyle practices that not only decrease pain, but also help restore function and independence.***
**To find a trained Alexander Technique practitioner, consult the American Society for the Alexander Technique, 800-473-0620, www.alexandertech.org.
***To find a certified McKenzie provider in your area, consult the McKenzie Institute, 800-635-8380, www.mckenziemd.org.
There's no long-term (more than one year) data on outcomes from MDT, but it does seem to be effective for some patients with sciatica from a herniated disk.
What you may not know: Research has shown that the initial McKenzie assessment procedures can be as reliable as diagnostic imaging, such as X-rays, in determining the source of pain.
Surgical Approaches
If back pain is not relieved by medication and/or other therapies, surgery is an option. For example...
- Diskectomy (removal of the herniated portion of a disk, which relieves pressure on a nerve).
Typically used for: Excruciating back pain due to a herniated disk. This surgery used to be routinely recommended for a herniated disk with sciatica because doctors thought that unrelieved nerve irritation could lead to permanent disability, such as muscle weakness or persistent pain. In fact, this rarely happens, but surgery can help patients recover more quickly and may lead to better outcomes in some cases.
An influential study published in The Journal of the American Medical Association found that back patients who had surgery had virtually the same recovery rates as those who were treated with oral anti-inflammatory medication and physical therapy. The only difference was that patients in the surgery group recovered within a few months, while those who didn't have surgery took longer to recover-up to two years, in some cases. Over time, the herniated portion of a disk can be spontaneously reabsorbed by the body.)
What you may not know: Researchers who tracked 1,244 patients with herniated disks—and associated back and leg pain—for four years found that those who had surgery improved more in physical functioning and had less pain than those in the nonsurgical group.
Bottom line: Most patients with sciatica will recover without surgery. But those who have surgery will usually recover more quickly-and, in some cases, regain more mobility.
Typically used for: Compression fractures. With this relatively new approach, the doctor threads a balloon guided by a catheter into the open space inside a vertebra. The balloon is then inflated, which pushes the surrounding bone back to its normal shape. A cement-like substance is then injected to reinforce the vertebra.
What you may not know: Kyphoplasty can repair compression fractures and eliminate related symptoms in 75% of cases.
Best Treatment for Spinal Stenosis
Researchers studied 654 men and women with spinal stenosis (narrowing of the spinal canal).
Result: Patients who had surgery (in most cases, removal of excess bone, ligament and soft tissue to make more room for nerves) reported significantly greater function and less disability than those who had nonsurgical care that included physical therapy and nonsteroidal anti-inflammatory drugs. Few postsurgical complications were reported.
If you have spinal stenosis: Ask your doctor if surgery is right for you.
