For all the fancy surgeries and medications available these days, it's often the basics such as ice packs and simple stretches that do the trick for an aching back. And after the pain goes away, other sensible lifestyle changes can keep it from returning.
What is happening
The human back is made up of a column of intricately connected but separate bones, which are called vertebrae. A complicated lacing of ligaments, tendons and muscles holds the vertebrae together in a
flexible chain, with rubbery discs between them acting as shock absorbers. The spinal cord, essentially a continuation of the brain itself, tunnels through the vertebrae, and from the cord, a vast network of nerves emerge. 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, discs that rupture, nerves that get pinched or joints that get irritated.
Lower back pain accounts for at least one in twenty GP consultations. 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.
Back pain is labelled 'acute' if it's intense and comes on suddenly. If the pain doesn't subside with standard treatments and lasts six months or more, it's considered 'chronic'. Back pain can affect all aspects of your life, from how you move around your house to how well you do your job.
Because of it, you may feel sleep-deprived, physically and emotionally off-balance and even depressed. And to make matters worse, even the best diagnostic test might not be able to pinpoint a cause.
LIKELY FIRST STEPS
For acute lower back pain:
With back pain, what helps one person doesn't necessarily work for the next. Your best bet with an acute episode is a day or two (at most) of bed rest if you think you need it, and simple analgesics and possibly NSAIDs to blunt the discomfort and reduce inflammation. Muscle relaxants can ease painful spasms. Apply cold packs on and off for 48 hours, and then heat. As soon as possible, get up and move around. The intense pain usually lets up in the first few hours. At least 50 percent of people with acute back pain recover within two weeks and 90 percent within 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. (And go sooner if you have numbness, weakness in your foot or a tingling sensation , that radiates into the buttocks or legs--all signs of sciatica.) To treat chronic back pain, your doctor may prescribe a powerful NSAID, analgesics such as paracetamol with codeine and possibly Tramadol, which is an analgesic that has opiod-like effects. Your doctor may suggest physiotherapy, and, in rare cases, even recommend surgery. There is some evidence that antidepressants are useful for chronic back pain. Most important, you'll need to be a proactive patient. Many experts stress the importance of breaking the vicious cycle of chronic back pain: injury leads to pain that leads to muscle tension and then negative emotions (fear, anxiety, irritation), which are followed by negative thoughts (worries, pessimism)
What is happening
The human back is made up of a column of intricately connected but separate bones, which are called vertebrae. A complicated lacing of ligaments, tendons and muscles holds the vertebrae together in a
flexible chain, with rubbery discs between them acting as shock absorbers. The spinal cord, essentially a continuation of the brain itself, tunnels through the vertebrae, and from the cord, a vast network of nerves emerge. 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, discs that rupture, nerves that get pinched or joints that get irritated.
Lower back pain accounts for at least one in twenty GP consultations. 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.
Back pain is labelled 'acute' if it's intense and comes on suddenly. If the pain doesn't subside with standard treatments and lasts six months or more, it's considered 'chronic'. Back pain can affect all aspects of your life, from how you move around your house to how well you do your job.
Because of it, you may feel sleep-deprived, physically and emotionally off-balance and even depressed. And to make matters worse, even the best diagnostic test might not be able to pinpoint a cause.
LIKELY FIRST STEPS
For acute lower back pain:
- Alternate applications of cold packs and heat.
- Take nonprescription pain medications or prescription drugs if the pain is severe.
- Return to normal activities as rapidly as possible.
For chronic back pain:
- visit a doctor or chiropractor to assess the nature, degree and cause of the pain.
- Pursue daily stretching and strengthening exercises.
- Try medications, including paracetamol, NSAIDs, anti-depressants, antipasmodics and opioids.
QUESTIONS TO ASK
- When will my back stop hurting? Is there something I could 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?
Treatments
With back pain, what helps one person doesn't necessarily work for the next. Your best bet with an acute episode is a day or two (at most) of bed rest if you think you need it, and simple analgesics and possibly NSAIDs to blunt the discomfort and reduce inflammation. Muscle relaxants can ease painful spasms. Apply cold packs on and off for 48 hours, and then heat. As soon as possible, get up and move around. The intense pain usually lets up in the first few hours. At least 50 percent of people with acute back pain recover within two weeks and 90 percent within 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. (And go sooner if you have numbness, weakness in your foot or a tingling sensation , that radiates into the buttocks or legs--all signs of sciatica.) To treat chronic back pain, your doctor may prescribe a powerful NSAID, analgesics such as paracetamol with codeine and possibly Tramadol, which is an analgesic that has opiod-like effects. Your doctor may suggest physiotherapy, and, in rare cases, even recommend surgery. There is some evidence that antidepressants are useful for chronic back pain. Most important, you'll need to be a proactive patient. Many experts stress the importance of breaking the vicious cycle of chronic back pain: injury leads to pain that leads to muscle tension and then negative emotions (fear, anxiety, irritation), which are followed by negative thoughts (worries, pessimism)
Treatment Options
LIFESTYLE CHANGES
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Cold/heat treatments First cold pack; then heat after 48 hours
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Exercises Get out of bed and gradually get moving.
MEDICATIONS
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Analgesics Paracetamol, aspirin, ibuprofen
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Anti-inflammatories NSAIDs or COX-2 inhibitors
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Muscle relaxants For spasming; short-term use only.
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Opiates For severe pain; short-term use only.
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Antidepressants Can provide back pain relief.
Procedures
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Spinal manipulation By chiropractor, osteopath, physiotherapist.
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Injections Anaesthetic, nerve block or steroids
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Surgery Needed only rarely for structural problems.
NATURAL METHODS
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Acupunture/acupressure To stimulate pain-blocking endorphins
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Massage/relaxation To break chronic pain pattern; relieve stress.
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Hydrotherapy Water exercises can help
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Psychotherapy Cognitive-behavioural therapy for emotions.
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