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Treating Back Pain Conservatively: Medications and Bedrest

Eighty-five to ninety percent of people develop some back pain during their lifetime. Of this group, most people (95%) get better in 6 to 12 weeks.

Acute back pain may be related to several common conditions, such as degenerative arthritis, degenerative disk disease, spinal canal stenosis, muscular pain/ligament strain or sciatica. Often, the pain is caused by a combination of these conditions.

What to do?

Most people diagnose their own back pain based on previous experience, and treat the pain with over-the-counter medications and rest. Families, friends and neighbors are also a source of information. However, it is important to realize that everyone is different and it is never safe to take someone else's medication. Always contact your health care provider before taking any medication that is not prescribed specifically for you.

There are circumstances when you should seek immediate medical attention for back pain. These include:

  • Severe back pain
  • Radiating pain into your legs
  • Bowel or bladder incontinence
  • Leg weakness
  • Persistent fever
  • Color changes in legs or feet

For severe pain or pain that lasts more than one week, it is reasonable to seek medical attention. Your physician will review your medical history, examine you and then organize a plan for diagnosis and management.

Although back pain diagnosis may include tests such as X-rays, MRI scans and EMG testing, it is reasonable in some cases to treat the symptoms of back pain without having those tests.

Treatment of acute back pain during this time is designed to reduce pain, relieve muscle spasms, improve sleep (which is often disrupted by back pain), and employ conditioning measures to improve the overall health of the back.

How is acute back pain managed?

Management of acute low back pain ranges from conservative to intensive. Conservative pain management includes prevention, rest (brief), cold packs, pain relievers, muscle relaxants, and physical therapy.

Bedrest may be recommended for 1 to 2 days. During this time, you should not perform tasks that may place strain on your back, such as walking, house cleaning, sitting and lifting. Your doctor may ask you to begin gentle back exercises to keep your back muscles flexible.

Prevention is the most important management technique and even plays a prominent role in rehabilitating people with problematic pain. Prevention methods include:

  • A well-balanced diet
  • Regular exercise program
  • Smoking cessation
  • Weight loss
  • Good body mechanics (posture, lifting heavy objects, workplace evaluation and changes)

When these conservative measures fail to provide adequate relief, more intensive treatment is warranted. These methods include nerve blocks and chronic pain management programs. This occurs in approximately 5% of people with acute back pain.

Intensive pain management

Intensive pain management includes more invasive techniques to relieve pain. These techniques are associated with more side effects and potential complications, as well as higher cost. These techniques are used for people with intractable pain and include:

  • Nerve blocks and injections. Medications to treat pain or interfere with nerve function are injected directly into the space surrounding the spinal cord.
  • Intraspinal implants
  • Spinal cord stimulation
  • Intraspinal infusion systems
  • Surgery. Surgery may be done to relieve pressure (decompress) and pain by removing parts of the vertebrae that are pressing on the nerves.

Nerve blocks and injections

Nerve blocks and other injections are used to facilitate physical therapy and include:

  • Trigger point injections
  • Epidural steroid injections
  • Facet joint injections or facet nerve blocks
  • Specific nerve root injections
  • Spinal differential nerve blocks

Trigger point injections are used for myofascial pain syndromes. Myofascial pain is sometimes severe muscular pain that may travel to other parts of the body, similar to nerve pain. The muscles become very sensitive and tender. Part of the muscle -- the "trigger point" -- may go into spasm. Injection of medication into a muscular trigger point reduces muscle pain and spasm, and allows a person to resume his or her physical therapy program.

Epidural steroid injections (ESIs) are injections of a short-acting local anesthetic and a long-acting steroid into the epidural space. The epidural space is an area in the spine that contains fat, blood vessels and the spinal nerves covered with membranes. ESIs are usually used for pain from herniated intervertebral disks (radicular pain), spinal canal stenosis and some mechanical back pain.

Sometimes, a caudal epidural steroid injection is used as a different approach to ESIs. This approach is most often used for people who have had previous back surgery.

Facet joint injections or facet nerve blocks are other types of blocks that are used for people who have degenerative arthritis of the facet joints, or predominately back pain with minimal leg pain.

Intraspinal implants

Intraspinal implants are available for patients with pain that does not respond to other treatment methods. Implanted devices include:

  • Spinal cord stimulation. This involves placing a small wire attached to a power source to apply electrical impulses to the space surrounding irritated or damaged spinal nerves. The electrical impulses block pain signals from reaching the brain.
  • Intraspinal infusion. Intraspinal infusion uses an implanted pump to deliver a continuous flow of medication to the spaces surrounding the spinal nerves.

These devices require realistic expectations for pain reduction, and need ongoing medical follow-up for revisions, refills and battery changes. Additionally, patients need ongoing behavioral management techniques

Chiropractic adjustment

For some people with whiplash injuries, gentle chiropractic or osteopathic adjustments may help to restore movement, and speed recovery. Chiropractic care focuses on improving motion and diminishing pain caused by a whiplash injury.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 12/20/2013...#4553


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