Lower Back Pain

How will my doctor find the cause of the pain? Your doctor will ask you questions about your lower back pain and will give you a physical examination.

Will I need to have an x-ray or scan?

Most people don't need to have these tests. Your doctor will decide if you should have one after he or she examines you.

Will bed rest help?

You may need to rest in bed for a day or two, but too much bed rest can stop you from getting better. Some people worry that staying active will hurt their  lower pack pain even more. Getting back to your normal activities may hurt or be uncomfortable, but it shouldn't cause any damage.

What can I do to help with the pain?

* Try not to do things that make the lower pack pain worse, like sitting for a long time, lifting heavy objects, or bending or twisting.

* Stick to your normal activities as much as you can. Gentle exercise like walking helps you get better more quickly.

* Some over-the-counter medicines can help lower pack pain or swelling. These include ibuprofen (brand name: Advil or Motrin), naproxen (brand name: Aleve or Naprosyn), and acetaminophen (brand name: Tylenol). Your doctor may give you medicine to help with pain or muscle spasms.

* Try using heating pads or taking a warm bath or shower.

* Your doctor can show you some gentle exercises to help stretch your back and make the muscles stronger.

* A physical therapist, massage therapist, or chiropractor may help with your lower pack pain and make you feel better.

When should I return to work?

Your doctor can tell you when it's okay for you to return to work. It is important to try to keep active. But, if you have to sit for many hours or do a lot of physical activity at work, you may need to make some changes for a while.

How can I prevent low back pain?

You can prevent low back pain with physical therapy, exercises, and stretching. Supports and back belts do not prevent low back pain.

Keep in shape, lose weight if you are overweight, and exercise regularly. Being inactive can lead to low back pain. Regular exercise like walking, swimming, or biking is good for your back. These activities put less stress on your back than sitting and standing.

Don't lift heavy objects by bending over at the waist. Bend your hips and knees and then squat to pick up the object. Keep your back straight and hold the object close to your body. Don't twist your body while you are lifting.

If you have to sit at your desk or drive for a long time, take breaks to stretch.

How can I tell if my back pain is serious?

You should get medical care right away if:

* You are older than 50

* The pain was caused by an injury such as a fall or car crash

* You have trouble sleeping because of the pain

* You lose weight without trying or have a fever, chills, or a history of cancer

* You have trouble urinating or controlling your bowels

Tell your doctor if the pain goes down your leg below your knee, or if your leg, foot, or groin feels numb. See your doctor if your pain doesn't get better after two or three weeks of treatment.

Where can I find more information?

Back Care, Web site: http://www.backpain.org     Spine-health.com      Web site: http://www.spine-health.com
COPYRIGHT American Academy of Family Physicians & Gale Group
 

Low back pain: what to do?

An example, a healthy 62 year old male person, presented with a 10 year history of intermittent non-specific low back pain. He had been able to control his symptoms with several self help measures, including weight control, regular aerobic activity, a firm mattress, back mobilization exercises, and a naturally positive attitude.

He had an active lifestyle and traveled extensively, but his episodes of acute pain had become increasingly severe and frequent and were starting to interfere with his quality of life. Radiological examination showed degenerative changes in the lumbar spine, predominantly at L4 and L5. A review of his medical history and a clinical examination did not give rise to any suspicion that he might have a serious spinal abnormality or nerve root problems.
The following clinical question was considered. Which of the treatments available locally showed the best evidence of limiting acute attacks of low back pain in a patient with a history of chronic back pain? Our specific aim in this case was to obtain reliable information as quickly as possible so that we could immediately advise him of the best treatment option.

The search

Our previous experience of reviewing published reports on chronic low back pain had shown that there are many types of treatment, both complementary and conventional. Since our experience is with conventional treatments, we confined our search to these. Four main treatments available locally were relevant to his condition: physiotherapy and exercise program; spinal manipulation; spinal steroid injections; and transcutaneous electrical nerve stimulation. We decided to research the evidence for these treatments and to look for any other evidence based treatments that might be relevant.

The evidence

One document described several treatments for lower pack pain such as laser therapy and injections of collagen proliferate substances. Though these seem promising, little definitive evidence on their use is available. Furthermore, it seemed that attendance at a "back school" alone had little useful effect on pain relief or disability.

Transcutaneous electrical nerve stimulation

A review showing that transcutaneous electrical nerve stimulation for lower pack pain was better than placebo for relieving pain and restoring function in patients with low back pain that had lasted more than eight weeks. However, the beneficial effects were not appreciable, and not all patients showed a benefit.

Exercise program

A large study comparing the effects of McKenzie-type exercises (repetitive movements of flexion, extension, and side gliding) with education without exercises at a back school showed that this exercises on lower pack pain were more effective than placebo even after five years.Of greater interest was a recent study evaluating the effectiveness of a graded exercise program for lower pack pain This showed that education combined with physical reconditioning and exercise could help prevent recurrences of lower pack pain and improve overall levels of functioning.

Manipulation therapy

A mete-analysis of primary studies of spinal manipulation showed an increased likelihood of recovery after 2-3 weeks of treatment for patients with acute and subacute lower back pain.
 However, the benefits were lost within a few weeks, consistent with the course of the disease. Unfortunately, there was insufficient evidence regarding the efficacy of manipulation in helping patients with chronic low back pain.

Spinal steroid injections

One large controlled study showed that patients given an injection into the facet joint had slightly less pain and better functional ability after six months than patients who were given a placebo. Although no patient reported any adverse effects, few patients reported any sustained improvement.

Applying the evidence

The next step was to determine whether these findings could be applied to the person, since recommendations from population based studies often have to be adapted to meet the circumstances of individual patients. However, for patients suffering from chronic and painful conditions any intervention that offers any possibility of success is likely to be considered, even when long term benefits have not been proved. For this reason all the possible options and expected outcomes were considered.

From discussion with the patient, it emerged that previous use of a transcutaneous electrical nerve stimulation machine had not been beneficial. Regular chiropractic and manipulation therapy was not an option because he could not afford this. Although steroid injections had previously brought good relief from pain, these do not offer any long term solution. After full consideration, he chose a more active rehabilitation program using an incremental aerobic exercise and fitness program. He was also advised that recurrences were likely but could be treated in the same manner.

Conclusion

The evidence showed what we had suspected, that general awareness and education about back care combined with a regular exercise program is probably the best option at present. One useful discovery we made was the Cochrane Review Methodology Database, which highlighted all reviews currently in progress. This is a convenient way of tracking the latest updates in any field of interest, and is certainly something we will use in the future.