Managing low back pain

Dustin Cole, MD Enlargephoto

Dustin Cole, MD

If you’ve never suffered from low back pain, count yourself as one of a lucky minority. It’s estimated that 80 percent of adults will experience low back pain at some point during their lives. In most cases the pain is a short-term annoyance, but severe or chronic low back pain can sometimes be debilitating.

Cortez interventional pain management specialist Dustin Cole, MD, says the good news is that while many people experience back pain, it’s rarely due to serious disease or damage to the spine. “Most back pain is due to muscle spasms, strained muscles, or sprained ligaments of the spine,” said Cole. “The vast majority of back pain gets better in a matter of days or weeks without medical treatment.”

A variety of factors can contribute to or cause low back pain. Lack of regular physical exercise can lead to weakness of the muscles in the abdominal and back area. This deconditioned state can result in low back pain. “The situation may be made worse by being overweight, living with chronic stress, and even by smoking,” said Cole. Arthritis is a common cause of low back pain in older adults. “As we age, there is a higher probability of osteoarthritis affecting the small joints in the spine and the joints in the pelvis,” said Cole.

More serious diagnoses related to the symptoms of low back pain include herniated discs, fractures, spinal stenosis, infection, and cancer of the spine. Herniated discs that place pressure on nerves and cause pain are less common than many people think, according to Cole. “Few people have back pain which is due to a damaged disc or a disc affecting a nerve,” he said.

At-home care

“What a person does early on during an episode of back pain is very important,” said Cole. Using heat or ice on the lower back may offer short-term relief. This can be accomplished with ice packs, heating pads, or a hot bath or shower. Heat or ice should not be left on the affected area for longer than 20 minutes at a time. Some people find that massage or gentle rubbing relaxes muscles and eases low back pain.

Over-the-counter medications such as acetaminophen and NSAIDs often help relieve low back pain. Topical medications such as creams, patches, or gels that are applied to the skin and contain a combination of ingredients may also be beneficial. “It is important to read the package labeling for each of these medications and take them as directed. Speak with a healthcare provider prior to taking these medications if you have a history of kidney or liver damage or gastric ulcers,” said Cole. Further, caution should be exercised in elderly patients when taking NSAIDs as they are at increased risk of serious side effects.

Giving your body a break when you have low back pain is fine, but don’t linger on the sofa for too long. “Resting for more than a day or two usually doesn’t help and can actually lead to extended pain and disability,” said Cole. If you experience a bout of back pain, the sooner you can get moving again and return to normal activities, the better off you’ll be.

Treatments for

low back pain

“If you have back pain that continues to worsen or if you can’t perform your daily activities due to severe back pain, see your physician,” said Cole. Symptoms that warrant immediate medical care include: new-onset difficulty in passing or controlling urine; numbness in the genitals; numbness, tingling, or weakness in the back or legs; or severe unsteadiness.

For most cases of back pain that last for a short period of time, imaging (x-rays, CT scans, and MRI studies) is not indicated. While these imaging technologies are important, Cole says that with few exceptions, an exact cause of low back pain cannot be determined based on imaging studies alone. In fact, imaging studies are sometimes misleading. “Terms like degeneration are often used to describe what is seen on these studies. This sounds worrisome but is typically not. Degeneration is usually associated with normal changes due to aging and does not necessarily cause pain,” said Cole. For this reason, it is important for a doctor to evaluate any x-ray, CT, or MRI in the context of a person’s clinical symptoms and based on a thorough physical examination.

In general, there are four primary categories of treatment (from least to most interventional) for low back pain: directed exercise or physical therapy, medications, injections, and surgery. Remember, though, that most people with low back pain improve within days or several weeks with minimal treatment and don’t require advanced interventions such as injections or surgery.

“Weight loss and regular exercise are perhaps the most important treatment components for the majority of people with low back pain,” said Cole. “For people who are overweight or obese, having extra weight in their abdominal region adds strain to the muscles and ligaments in the back and can stress various parts of the spine and cause low back pain.”

Dietary modification is key to weight loss and should be paired with low impact aerobic exercise and appropriate strengthening and stretching. If you see a physician for back pain, he or she can refer you to a physical therapist with recommendations for creating a specific program tailored to the cause of back pain and your physical abilities. Stress management and appropriate posture are also helpful in reducing pain.

Smoking cessation is an important part of treating any pain disorder, including low back pain. “Studies have shown that smoking can actually worsen pain and interfere with pain medications. If a person with recurrent low back pain smokes tobacco, they should contact their healthcare provider to establish a quit plan, find a support group, and obtain nicotine replacement products if necessary,” said Cole.

If over-the-counter medications do not prove to be effective in the treatment of low back pain, non-narcotic prescription medications are sometimes prescribed and tailored to the source of the pain. Some medications can’t be taken with other medications. Let your physician know which medications and supplements you are taking to ensure you are using all medications safely.

Injections into and around the spine may be indicated if low back pain persists and is not relieved with physical therapy and medications. “The type of injection, for instance, epidural, facet joint, or sacroiliac joint — is determined by what is thought to be causing the pain,” said Cole. Another procedure that can be beneficial is radiofrequency ablation where the nerves to painful joints in the low back are burned. “On rare occasions, if a person’s pain persists despite conservative treatment measures, or if they have a tumor or progressive neurological deficit, surgery is recommended,” said Cole.

Prevention

and management

“Individuals who are physically fit generally experience less back pain and recover faster when they do have pain than people who are less active,” said Cole. “Physical activity is important for keeping the back strong and limber.” Regular physical activity can include aerobic exercise such as walking, hiking, biking, and swimming. Strengthening and stretching exercises such as yoga and Pilates can also help keep the spine healthy.

Practicing good posture when sitting, standing, and walking is helpful, and if you have a desk job, make sure that your chair is a good fit for your body and remember to take regular breaks to move around and stretch. Be careful at work and at home when moving or lifting heavy or awkward objects. Wearing low-heeled, supportive shoes and sleeping on a good quality mattress are also recommended for back health.

Unfortunately, some people experience low back pain off and on throughout their lives and simply learn to live with it. “If a person regularly experiences back pain, it is normal to have good days and bad days. The people who cope best are those who stay active and get on with life despite the pain,” said Cole.

Southwest Health Notes is a public service feature provided by Southwest Memorial Hospital in Cortez, Colorado. The information provided herein is not intended as patient-specific medical advice or as a substitute for consultation with your personal healthcare provider.

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