Back Pain

Source: Adapted from Looking After Your Body: An Owner’s Guide to Successful Aging, Reader’s Digest; Know Yo

What is back pain?

The human back consists of intricately connected bones, a complicated lacing of ligaments, tendons, and muscles, rubbery disks between them and the spinal cord, essentially a continuation of the brain itself, connecting a vast network of nerve endings. Day and night, this mechanical wonder is subjected to pressure, twisting, and bending. It’s no wonder things occasionally go awry. Back pain is the inevitable result’from ligaments that sprain, muscles that strain, disks that rupture, nerves that get pinched, or joints that get irritated.

Who is at risk for back pain?

You’re more likely to experience back pain if your posture is poor, you’re overweight, or the psychological stress in your life veers out of control. Illnesses such as weakened bones (osteoporosis), arthritis, and even metastatic cancer increase your risk too.

Treatment for back pain

What helps one person’s back pain doesn’t necessarily work for the next. Your best bet with an acute episode of back pain is a day or two (at most) of bed rest if you think you need it, and over-the-counter medications to blunt discomfort and reduce inflammation. Muscle relaxants can ease painful spasms. Apply cold packs on and off for 48 hours, then heat. As soon as you can, get up and move around. Intense pain usually lets up in the first few hours, and there’ll be steady improvement within the first two weeks. Most back problems resolve in six weeks, although sprained ligaments or muscle strains can take up to 12 weeks to fully heal. Once the pain has passed, avoid heavy chores and vigorous sports for at least two more weeks.

If your back continues to hurt, see your doctor. (Go sooner if you have numbness, weakness in your foot, a tingling sensation that radiates into the buttocks or legs, or trouble passing urine or bowel movements’all signs of sciatica.) To treat chronic back pain, your doctor may prescribe a powerful NSAID or an opiate like Vicodin or suggest physical therapy. Rare cases may require surgery. Most important, you’ll need to be a proactive patient, exploring lifestyle measures that ease your particular problem. Many experts stress the importance of breaking the vicious cycle of chronic back pain: injury leads to pain that leads to muscle tension. Then negative emotions (fear, anxiety, irritation) are followed by negative thoughts (worries, pessimism). This ’emotional guarding’ and subsequent restriction of physical activity causes muscles to lose strength and flexibility. At some point, even the most minor injury can start the cycle all over again.

Medications for back pain

One of the first drugs that you should reach for is acetaminophen (Tylenol). It’s safe and it can quell mild to moderate back pain. But if inflammation is causing your discomfort, NSAIDs may give you more relief: They calm inflammation and inhibit pain receptors. Good choices include aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and ketoprofen (Orudis). You might find that one works particularly well for back pain, while another doesn’t seem to help at all. Be prepared for some trial and error.

NSAIDs can irritate your gastrointestinal (GI) tract, and long-term use may cause stomach bleeding. Enteric-coated forms seem to have fewer side effects. The risk varies, so be sure to tell your doctor about problems that develop with one NSAID. You may be able to switch to another. More GI-friendly NSAIDs called COX-2 inhibitors (Celebrex, Bextra) may be an option.

If your back muscles are in spasm, muscle relaxants can help. They depress the nervous system, making muscles relax. Some doctors are loath to use these drugs, which interrupt a key defense mechanism: the tensing of back muscles, which protects damaged disks or vertebrae. Take muscle relaxants, such as cyclobenzaprine (Flexeril), diazepam (Valium), carisoprodol (Soma), and methocarbamol (Robaxin), for a few days at most. Related reactions’drowsiness, dizziness, and dry mouth’can develop with them all.

Consider opiates for only the initial painful stages of acute back pain. They work by reducing the brain’s response to pain, but they can be habit-forming. Common opiates include codeine, hydrocodone (Vicodin), oxycodone plus acetaminophen (Percocet), and oxycodone plus aspirin (Percodan). Many people, particularly those who have chronic pain, prefer the longer-acting opioids, such as controlled-release oxycodone (OxyContin) and controlled-release morphine (MS Contin), which need to be taken only once every 12 hours. Some doctors criticize the use of opiates for back pain, because these drugs can make you listless precisely when you should be up and about. Drowsiness, headache, constipation, and nausea are a few of the common side effects.

Don’t be surprised if your doctor recommends antidepressants for chronic back pain, even if you don’t think you have the blues. Some people get as much pain relief from antidepressants as they do from traditional painkillers. Low doses of a tricyclic antidepressant (Elavil, Endep, Norpramin) probably work best, although side effects (dizziness, drowsiness, dry mouth) can be irritating. The newer SSRI antidepressants (Prozac, Zoloft, Paxil) cause fewer side effects but may not do as much for your back pain.

Lifestyle changes

With a wrenched back, your instinct is probably to get horizontal. Try tucking your body into a fetal position with a pillow between your knees, or lie on your back with your knees flexed, using two pillows to support your legs. As soon as you can, try to get out of bed and move around. Activity keeps your muscles strong and flexible. While bed rest was once the standard recommendation for back pain, doctors now think it can prolong recovery. Only people with a definite disk problem should spend more than a few days in bed.

After an injury, apply a cold pack every two hours while you are awake. Cold temporarily blocks pain signals to the brain, and slows blood flow to lessen internal bleeding and swelling. Use a commercial cold pack, a bag of frozen vegetables, or ice in a dampened towel, to prevent muscle spasms, or apply an ice cube to the injured area. Limit cold pack treatments to 10 or 15 minutes at a time.

Heat relieves pain better than ice once 48 hours have passed (or if the pain is chronic). Heat lessens pain and boosts healing by stimulating blood flow. Try a hot water bottle, hot pack, heating pad (on moderate setting), a hot shower, or a soak in a hot tub. Repeat this up to four times a day, for no more than 30 minutes each time.

Then you feel a bit better, exercise is essential. Within two weeks of the back injury, start easy aerobics such as walking or bicycling. Gradually add exercises to strengthen your back and abdominal muscles, and gentle stretches to lengthen the spine and relieve compression of the vertebrae. Avoid jerking, bouncing, or movements that increase your back pain. A daily regimen of stretches and exercises can make a huge difference if your back pain becomes chronic.

Related procedures for back pain

About 30% of those with low back pain undergo chiropractic or osteopathic spinal manipulation in their search for relief. Studies show that this helps acute low back pain’especially within a few weeks of an injury. One review found that spinal manipulation with a chiropractor or osteopath increased the chances of recovering from acute low back pain within two to three weeks by nearly 20%. Some physical therapists do spinal manipulation as well. The goal of this procedure is to help build strength and flexibility, and eventually enable you to become aerobically fit.

Because chiropractors focus almost solely on the back, they are often the best choice for back pain. At your first visit, you will be thoroughly examined. You may have an x-ray or an MRI, if a herniated disk (sometimes called a slipped disk) is suspected. Chiropractors know that spinal manipulation can do more harm than good if your pain stems from a disorder such as osteoporosis, a herniated disk, a vertebral fracture, or a spine infection or tumor. You’ll need to give chiropractic treatment about four weeks to work. If you don’t feel a difference by then, it’s unlikely it will help you.

To relieve symptoms and break a cycle of back pain, some doctors recommend injections of anesthetics, nerve blocks, or steroids into ‘trigger’ points along the spine. Experiments have tested injections of salt water and botulinum toxin (Botox), but its lasting benefits are still unclear. Many find relief for chronic pain from a failed back surgery or for severe leg pain (sciatica) with a spinal cord stimulation device. It blocks pain signals by stimulating the spinal cord with electrical pulses from a surgically implanted pulse generator. You control the pain by directing the outside generator to prompt the electrical pulsing.

When pain persists, many people think back surgery. This is not a good choice for most, however, and is less commonly recommended than it once was. Fewer than 5% of back pain sufferers’typically, only those with herniated disks, spinal stenosis (narrowing), sciatica, or other structural problem’are good candidates for surgery. It may relieve pain; but long-term results are about the same as with nonsurgical treatments. Be sure to get two or three opinions from qualified surgeons before agreeing to a surgical procedure.

If your herniated disk is causing nerve damage, you may need a diskectomy. The surgeon relieves pressure on the pinched nerve by making an incision in the outer layers of the disk and removing the gel-like center. Part of the vertebra may have to be removed (laminectomy). Problems can develop following diskectomy, due to the added strain on the other disks and the shift in the overall structure of the spine.

Several less invasive techniques have also been developed. In one, an enzyme called chymopapain, derived from papaya, is injected into a herniated disk to break it down. Chymopapain treatment is effective about 70% of the time, but is considered risky because of bad reactions (including severe allergic ones) to the enzyme; it’s more commonly done abroad. In another, a probe is inserted through a tiny incision to remove part of a damaged disk. A third less invasive’but controversial’technique uses lasers to burn out the disk. Success rates vary widely.

Alternative therapies for back pain

Acupuncture is very a popular alternative. Based on the ancient Asian theory that pain occurs when the body’s natural flow of energy (qi) is off balance, acupuncture involves a practitioner inserting 10 to 15 hair-thin needles in the back and other parts of the body to balance qi. How actual pain relief occurs is a mystery. Conventional doctors believe the needles prompt nerves to emit natural, pain-blocking chemicals (endorphins). Many people get real’if transient’pain relief. To enhance the effect, the needles may be charged with electricity, heated, or periodically rotated. In a related therapy called acupressure, three to five minutes of continuous pressure and massage applied to an acupuncture point stimulates qi.

With straightforward therapeutic massage, back tension can melt away as the muscles are manipulated. The muscle movement overwhelms pain signals’at least temporarily. Always use a massage therapist who’s professionally trained and licensed.

To break a pattern that seems to be leading to chronic back pain, try learning relaxation techniques, such as yoga, tai chi, guided imagery, and meditation. Your metabolic response to meditation’the opposite of its response to stress’is believed to unravel the ravages of stress on your body. Biofeedback can help you become aware of how you can relax your body most effectively. Electronic sensors measure different bodily functions’such as muscle tension, pulse rate, and breathing pattern’while you practice various relaxation methods. In time, you’ll learn to consciously regulate your body’s stress levels without the sensors. Cognitive-behavioral therapy has proved quite useful for chronic back pain. This approach helps you gain insight into your emotions and provides tools for managing stress and effectively dealing with feelings of helplessness and depression.

Questions for your doctor

• ‘ When will my back stop hurting? Is there something I can do to hasten the process?
• ‘ Should I get a back x-ray? An MRI?
• ‘ Could another medical condition be causing my back pain?
• ‘ What do I need to know before I undergo surgery?

Living with back pain

If you are among the many who live with Back Pain, here are some helpful hints to help you cope:

• ‘ Try alternating drugs. Since acetaminophen and NSAIDs work differently, you can safely combine the two for more complete pain coverage. A long-acting NSAID such as Aleve is a good choice to take along with the shorter-acting Tylenol.
• ‘ Consider a back brace. If you have to stand or sit much of the time’or lift heavy objects’try a back brace. Properly fit and correctly worn, it can comfort and support you, but don’t overdo it: A back brace limits normal movement, detracts from muscle conditioning, and reinforces the notion that your back needs protection.
• ‘ Deal with your anxiety. This can make back pain worse’and even perpetuate the problem. Anti-anxiety drugs (benzodiazepines are the classic choice) can blunt the jitters, although becoming dependent on them (physically and psychologically) is a risk. SSRI antidepressants also lessen anxiety but aren’t habit-forming.
• ‘ Try the Alexander technique. Trainers of this mind-body re-education method use verbal instruction and gentle touch to teach proper alignment of the head, neck, and spine. The goal is to replace bad postural habits with good ones.
• ‘ Watch out for ‘miracle cures.’ There aren’t any. Back pain is simply too varied and complex. On the list: spinal traction, permanent bipolar magnets, and facet injections (steroids or anesthetics injected into connections between adjoining vertebrae).

Prevention of back pain

Stand up straight. Keep your shoulders back and your abdomen pulled in. When standing for long periods of time, move around frequently and shift your weight from one foot to the other. If you’re standing a lot in one spot’say, doing the dishes’place one foot on the rung of a stool or a small step to take the pressure off your lower back.

Sit pretty. Choose a chair with good back support and a firm seat. Armrests help, too. Insert a pillow in the small of your back, or use a lumbar roll or rolled-up towel. Whenever sitting for a long time, get up every 20 minutes or so to stretch.

Lift like the pros. When lifting objects, don’t bend over from the waist. Instead, kneel or squat beside the object, then use your thigh muscles to do the lifting while keeping your stomach muscles tight. Once you’ve lifted the object, don’t twist your back to put it where you want it. Instead, turn your whole body.

Sleep right. Sleep on a firm mattress or one with a bed board under it. Lie on your side’never on your stomach’with your legs bent and a small pillow between your knees. Or lie on your back with a large pillow under your knees.

Chill out. Severe emotional stress can exact a physical toll, even throwing your back muscles into spasm. Make stress-reduction techniques (such as yoga, deep-breathing exercises, and meditation) part of your personal health maintenance plan.