Second leading cause for sick leave
Experiencing low back pain
Lower back pain is extremely common in today’s society. Seventy-five percent of all people will experience back pain at some time in their lives. The total cost in lost productivity is enormous. Back pain is the second leading cause of absenteeism from work after the common cold and accounts for 15 percent of sick leaves.
The good news is that the vast majority of back-injured patients, probably greater than 90%, will recover completely without surgical treatment. Only 2 to 3% of the population with back pain have a herniated disc and only 1% have compression of a nerve root (leg symptoms).
Causes of Low Back Pain
Some of the common causes of back problems are disc injury (e.g., herniation and internal disc disruption) and degenerative discs. Approximately ten percent of patients with degenerative discs are candidates for some type of spinal surgery.
The intervertebral disc serves as a shock absorber, load distributor and spacer. As we age the disc normally undergoes degenerative change. The disc loses its ability to hold water, resulting in decreased ability to absorb shock and a narrowing of the nerve openings in the sides of the spine, which may pinch the nerves. The result is increased disc stiffness often accompanied by back and leg pain.
The MRI is a relatively sensitive test for the detection of degenerative changes within the intervertebral disc, but is incapable of providing a pain association.
Pain is generally the main complaint with all lower back disorders. Treatment often initially addresses local pain and inflammation before proceeding to further intervention and therapeutic exercise. The physician overseeing the care for a back pain patient should strive to establish a diagnosis, which includes an identification of the cause. The underlying process can be biomechanical, inflammatory or infectious, cancerous or psychological in nature.
5 Ways to reduce Back Pain
#1 – Rest – But Just a Little
If your back hurts, take a a little rest. Lie down and avoid overusing your back muscles for a while. This doesn’t mean stay in bed for a week. In fact, too much rest can make your back pain worse. After a short break, get up, move around, and stretch. You’ll find it actually helps reduce that nagging backache in most cases.
#2 – Medications
While paracetamol’s analgesic and antipyretic (fever reducing) effects are equal to those of aspirin, their anti-inflammatory effects are weak. In the setting of acute low back pain, acetaminophen can be effectively utilized as an analgesic. Several studies have shown paracetamol to be superior to placebo in the treatment of osteoarthritis pain, and because of its efficacy, it has been recommended as a first line agent in osteoarthritis treatment.
The accepted oral dose of paracetamol is 325 to 1000-mg every four to six hours, with a 24-hour use not to exceed 4000-mg. Peak plasma levels and analgesic effects are typically noted from 30 to 60 minutes following ingestion. Paracetamol is available without prescription and is inexpensive.
Aspirin is the prototypical member of the group of medications known as non-steroidal anti-inflammatory drugs (NSAIDs).
The primary mechanism of action in NSAIDs is a reduction of cyclooxygenase (enzymes that make prostaglandins) activity and a resultant decrease in prostaglandin synthesis. Prostaglandins are active mediators of the inflammatory cascade, which also serve to sensitize nerve endings. A reduction in their local concentration could therefore explain the combined anti-inflammatory and analgesic properties of NSAIDs. In single doses, most of the NSAIDs are more effective analgesics than a single dose of acetaminophen or aspirin.
In a review of NSAIDs and sports related soft tissue injuries, studies have found that treated athletes return to practice quicker and without any apparent significant delay in the injury healing process.
The dosing and cost of each NSAID varies significantly. The choice of initial anti-inflammatory agent remains largely empirical. Large variations in patient response to different NSAIDs are observed. Over a one to two week period the dose may be increased to the recommended maximum, and after that time, if the results remain unsatisfactory, a different agent should be tried.
Side effects generally develop within the initial weeks of treatment, although gastric complications can develop at later times. Combination therapy with more than one NSAID is to be avoided as the incidence of side effects is additive and there is little evidence of added benefit to the patient.
NSAIDs are a reasonable choice as a first line agent for the control of acute low back pain. The patient is most likely to benefit from their combined analgesic and anti-inflammatory properties during the first week after injury onset. The anti-inflammatory properties of these agents are most likely to be realized when therapy is initiated with a loading dose and the recommended dosages are then continued at regular intervals.
Muscle relaxants are often prescribed in the treatment of acute low back pain in an attempt to improve the initial limitations in range of motion from muscle spasm and to interrupt the pain-spasm-pain cycle. Limiting muscle spasm and improving range of motion will prepare the patient for therapeutic exercise.
Combination therapy of an NSAID and muscle relaxant was found to be superior in reducing tenderness, spasm, and range of motion in patients presenting with ten days or less of low back pain and spasm.
Sedation is the most commonly reported adverse effect of muscle relaxant medications. These drugs should be used with caution in patients driving motor vehicles or operating heavy machinery. By initially prescribing muscle relaxants at bedtime, the physician might take advantage of their sedative effects and minimize daytime drowsiness.
The use of benzodiazepines (xanax, diazepam) does not appear to offer any significant benefit to patients experiencing acute low back pain.
While several classes of anti-depressants have been used successfully in the treatment of a variety of pain syndromes, the literature most strongly supports the analgesic efficacy of the tricyclics (anti-depressant drug). Amitriptyline (a type of anti-depressant) has been investigated as an analgesic more than the other anti-depressant agents and appears to be the most popular anti-depressant analgesic in the clinical setting. Migraine headaches, neuropathic pain associated with diabetic neuropathy, and postherpetic neuralgia have been found to respond favorably to anti-depressant administration.
While anti-depressants have been demonstrated as useful adjuncts in the treatment of pain, their analgesic mechanism remains unclear. Initial dosage should be low and then slowly be increased to minimize side effects. When taken at night, the sedating properties of these agents can be beneficial in those pain patients experiencing difficulty sleeping.
Opioids occupy the second rung on the World Health Organization (WHO) analgesic ladder in the treatment of moderate to severe cancer pain and are commonly prescribed for postoperative pain, where they have been found to successfully treat both local and more generalized pain symptoms.
Despite the stigmas and fears of addiction associated with their use, when properly utilized by a knowledgeable physician, opioid analgesics successfully treat otherwise intractable pain. The potential role of opioids in the treatment of non-malignant acute low back pain is limited; reserved for those patients who have either failed to realize adequate pain relief¬†from other medications such as NSAIDs plus or minus a muscle relaxant, or who have contraindications to the use of other analgesics.
For more information on medications feel free to contact the author: Dr. Dick Luttekes – http://www.philipsburgpharmacy.com/contact-me/
#3 – Cold/Heat therapy
Cold therapy can help reduce inflammation, muscle spasm, and pain. Cold therapy may be recommended immediately following a sprain or strain. Apply cold to your back using cold packs, ice cubes, iced towels or compresses, or take a cool bath.
Apply heat to your aching back by using a hot compress, a dry or moist heating pouch such as the Joint Heat Pouch, or hydrotherapy (hot bath). Heat therapy can help decrease muscle spasms, relax tense muscles, relieve pain, and can increase range of motion.
A good general rule if you are unsure whether heat or cold would be better is – does it make your back feel better when you apply it? If you feel better then it is working. Remember, never apply cold or heat/hot therapies directly on your skin – wrap it in a towel first.
#4 – Massage
Massage is a popular therapy that can help relieve muscle tension, spasms, inflammation, aches, stiffness, and pain. It can also help improve circulation, flexibility, and range of motion. Massage can be administered by a professional (massage therapist) or you can give yourself a mini-massage using hand-held massagers that can help increase blood flow and relieve pain.
#5 – See Your Doctor or Chiropractor
The most important thing to remember about periodic bouts of back pain is that if they occur more and more frequently, increase in duration (more than a few days), or the pain starts to interfere with your usual activities, this indicates that it is time to see your doctor or consult your Chiropractor. It could be more than just a minor strain.
The good news is that most back problems can be treated with non-surgical methods. Back problems that go untreated may get worse and could become a cause for serious health consequences.
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