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Low Back Pain – Topic Overview

admin — Wed, 22 Apr 2009 08:21:56 +0000

Topic Overview

What is low back pain?

Low back pain can affect the back anywhere below the ribs and above the legs. The lower back is the connection between the upper and lower body, and it bears most of the body’s weight. Because of these roles, it is easily injured when you lift, reach, or twist.

Almost everyone has low back pain at one time or another. The good news is that most low back pain will go away in a few weeks with some basic self-care. But if your pain is severe or lasts more than a couple of weeks, see your doctor.

What causes low back pain?

Low back pain is often caused by overuse, strain, or injury. For instance, people often hurt their backs playing sports or working in the yard, being jolted in a car accident, or lifting something too heavy.

Aging plays a part too. Your bones and muscles tend to lose strength as you age, which increases your risk of injury. The spongy discs between the bones of the spine (vertebrae) may suffer from wear and tear and no longer provide enough cushion between the bones. A disc that bulges or breaks open (herniated disc) can press on nerves, causing back pain.

In some people, low back pain is the result of arthritis, broken vertebrae (compression fractures) caused by bone loss (osteoporosis), illness, or a spine problem you were born with.

Often doctors don’t really know what causes low back pain. But it is more likely to become long-lasting (chronic) if you are under stress or depressed.

What are the symptoms?

Depending on the cause, low back pain can cause a range of symptoms. It may:

Be dull, burning, or sharp.
Be felt at a single point or over a broad area.
Come on gradually or suddenly.
Occur with muscle spasms or stiffness.
Cause leg symptoms, such as pain, numbness, or tingling, often extending below the knee. These symptoms can occur on their own or along with low back pain. Leg symptoms are often caused by lower spine problems that place pressure on a nerve that leads to the leg.

A rare but serious problem called cauda equina syndrome can occur if the nerves at the end of the spinal cord are squeezed. Seek emergency treatment if you have weakness or numbness in both legs, or loss of bladder or bowel control.

Doctors say back pain is:

Acute if a spell (or episode) of pain lasts less than 3 months. Most back pain is acute and goes away with 4 to 6 weeks of home treatment.
Recurrent if acute symptoms come back. Most people have at least one episode of recurrent low back pain.
Chronic if your back bothers you most of the time for longer than 3 months.

How is low back pain diagnosed?

The doctor will ask questions about your past health, symptoms, and work and physical activities. He or she will also do a physical exam. Your answers and the exam can help the doctor rule out a serious cause for the pain. In most cases, doctors are able to recommend treatment after the first exam.

Most people do not need further testing. Imaging tests such as X-rays, CT scans, and MRIs are not helpful for diagnosing most episodes of low back pain. In most cases, they are only used if the doctor suspects a serious problem, such as a herniated disc, a broken bone, or cancer, or if surgery is being considered or planned. You might also have imaging tests if worker’s compensation or a lawsuit is involved.

How is it treated?

Most low back pain will improve with the following treatment:

For the first day or two, rest in a comfortable position. Try lying on your side with a pillow between your knees. Or lie on your back on the floor with a pillow under your knees. Do not stay in one position for too long, though. Every 2 to 3 hours, take a short walk (about 10 to 20 minutes), then rest in a comfortable position again.
Take over-the-counter pain medicine if needed, such as acetaminophen (Tylenol, for example) or an anti-inflammatory drug such as aspirin or ibuprofen (Advil or Motrin, for example). These medicines usually work best if you take them on a regular schedule instead of waiting until the pain is severe.
Try using a heating pad on a low or medium setting, or a warm shower, for 15 to 20 minutes every 2 or 3 hours. You can also buy single-use heat wraps that last up to 8 hours. You can also try an ice pack for 10 to 15 minutes every 2 to 3 hours. There is not strong evidence that either heat or ice will help, but you can try them to see if they help.
As soon as possible, get back to your normal activities. Staying in bed for more than 1 or 2 days can weaken your muscles and make the problem worse.

Walking is the simplest and maybe the best exercise for the lower back. It gets your blood moving and helps your muscles stay strong. Start with easy walks of 5 to 10 minutes a day, and gradually increase your time. Walking in water up to your waist or chest is also good exercise.

A doctor or physical therapist can recommend more specific exercises to help your back muscles get stronger. These may include a series of simple exercises called core stabilization. The muscles of your trunk, or core, support your spine. Strengthening these muscles can improve your posture, keep your body in better balance, and lower your chance of injury.

Some people get relief from pain by using treatments such as massage, spinal manipulation (chiropractic or osteopathic manipulation), or acupuncture. Certain treatments work for some people but not for others. You may need to try different things to see which work best for you.

If your symptoms are severe or you still have them after 2 weeks of self-care, see your doctor. You may need stronger pain medicines, or you might benefit from physical therapy.

Having ongoing back pain can make you depressed. In turn, depression can have an effect on your level of pain and whether your back gets better. People with depression and chronic pain often benefit from both counseling and medicine. A cognitive-behavioral therapist can teach stress management and pain control skills. Antidepressant medicines may help too.

Only a few people with low back pain need surgery. Surgery may help if you have a herniated disc or back pain along with symptoms of nerve damage, such as numbness in your legs. Even in these cases, most people will improve without surgery. Having surgery does not guarantee that all your pain will go away. Before you have surgery, it is a good idea to get a second opinion.

How can you prevent low back pain from returning?

After the first time you have had low back pain, you are likely to have it again. To help keep your back healthy and avoid further pain:

Practice good posture when you sit, stand, and walk.
Get regular, low-impact exercise. Walk, swim, or ride a stationary bike. Stretch before you exercise.
Wear low-heeled shoes with good support.
Sleep on your side. A medium-firm mattress may put the least stress on your back.
Watch your weight. Being too heavy, especially around your waist, puts extra stress on your back.
Don’t try to lift things that are too heavy for you. When you must lift, bend your knees and keep your back straight, keep the object you are lifting close to your belly button, and avoid lifting and twisting at the same time. See a picture of proper lifting technique.

If you sit or stand for long periods at work:

Pay attention to your posture. Sit or stand up straight, with your shoulders back.
Make sure your chair has good back support.
Take regular breaks to walk around.

If your work involves a lot of bending, reaching, or lifting:

Talk to your human resources department to see if there are other ways you can do your work.
Don’t depend on a “back belt” to protect your back. Studies have not shown these belts to be effective in reducing back injuries. The most they can do is to help remind you to use good techniques for lifting.

Spinal cord stimulation for low back pain

admin — Mon, 13 Apr 2009 11:14:48 +0000

Treatment Overview

Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. To treat chronic low back pain, a small pulse generator, implanted in the back, transmits electrical pulses to the spinal cord. These pulses interfere with the nerve impulses responsible for leg pain due to nerve damage (sciatica).

Implanting the stimulator is considered to be a simple procedure, typically done using a local anesthetic and a sedative. Your doctor usually will first insert a trial stimulator through the skin (percutaneously) to give the treatment a trial run. (A percutaneous stimulator tends to move from its original location, so it is considered temporary.) If the trial is successful, your doctor can implant a more permanent stimulator. The stimulator itself is implanted under the skin of the belly (abdomen), and the small coated wires (leads) are inserted under the skin to the point where they are inserted into the spinal canal. This placement in the abdomen is a more stable, effective location. Most stimulator batteries must be replaced every 2 to 5 years.

After this outpatient procedure is complete, you and your doctor determine the best pulse strength. You are then given instructions for using the stimulator at home. A typical schedule for spinal cord stimulation is to use it for 1 or 2 hours, 3 or 4 times a day.

When in use, the spinal cord stimulator creates a tingling feeling, rather than the pain you have felt in the past.

What To Expect After Treatment

You will have a small incision that you should keep clean and dry until it heals.

Why It Is Done

This treatment may be done for people with severe, chronic pain who have:

Had a failed spinal surgery.
Severe nerve-related pain or numbness, as caused by sciatica, spinal cord inflammation (arachnoiditis), or scar tissue on the spinal cord (epidural fibrosis).
Chronic pain syndromes, such as reflex sympathetic dystrophy.

Spinal cord stimulation is typically considered investigational for various other conditions, including multiple sclerosis, paraplegia, and intractable angina.

How Well It Works

Some researchers have reported that more than 60% of people receiving spinal cord stimulation for low back and leg pain (with or without surgery) have pain reduction or relief. But there is still not strong proof that spinal cord stimulation works. Treatment success varies widely, influenced by the cause of pain and, if there has been a previous back surgery, the amount of time that has passed since the first surgery on the affected area. The more time that has passed since a first surgery, the less likely spinal cord stimulation is to overcome the pain signals that have developed over time. One long-term study suggests that conditions that are most likely to have long-term benefit from spinal cord stimulation are failed back syndrome (pain that spreads or that continues after surgery), reflex sympathetic dystrophy, multiple sclerosis, peripheral arterial disease, and peripheral neuropathy.

Initial pain relief is often followed by a gradual decline in effectiveness, apparently caused by the body’s increasing tolerance to the treatment.

Risks

Possible risks related to spinal cord stimulation include:

Scar tissue (fibrosis) developing around the electrode.
Pain gradually moving beyond the reach of the nerve stimulator.
Breakage of an electrode or hardware failure.
Infection.
Leakage of spinal fluid.
Headache.
Bladder problems.
Getting used to the stimulation, making it less effective.

What To Think About

Spinal cord stimulation may be recommended for a small subset of people suffering from certain types of chronic pain such as pain from a nerve root injury.

Most spinal cord stimulator batteries must be replaced every 2 to 5 years.

Stop Back Pain Instantly!

admin — Mon, 09 Mar 2009 13:32:43 +0000

By Julie A. Evans, Prevention

When Heather Chapman, 34, was two months pregnant, she suffered excruciating back pain caused by a herniated disk. Her doctor prescribed anti-inflammatory drugs and muscle relaxants. She was concerned that the drugs might harm her baby, so she reduced the amount of medication she was taking.

Heather’s pain continued, so she began to search for natural alternatives and found a book about acupressure, a needle-free form of acupuncture. Using the book as her guide, Heather pressed her thumb onto a point just above her anklebone, which the book said would relieve her pain.

“I was amazed,” says Heather. “I felt better within minutes.”

Sound miraculous? It’s not. In fact, the next time your back goes SPROING!—even if you’re so debilitated you can’t get up from your bed—try some of these easy, natural techniques. Not only can they provide instant temporary relief, but done regularly, some can even help keep your back from ever getting out of whack again.

When Backs Go Bad
Back pain—which affects an estimated 80 percent of all Americans at some time or another—can have many causes. Since your pain can be triggered by anything from muscle strain after lifting something heavy to a spinal fracture caused by osteoporosis, it’s always wise to see your doctor. Fortunately, most back pain isn’t serious, despite how it feels.

Most often, it’s due to strained muscles, which could result from performing any number of activities when your muscles are tight—such as lifting, bending, or twisting—or inactivity, which allows your back muscles to weaken and become stiff. Stress can also contribute to back pain.

As long as yours falls into the nonserious category, you can safely try these techniques the next time your back is killing you.

That’s Why It Hurts So Much
Back pain can be serious torture because most of the pain receptors in your back are found in the muscle tissues. And back muscles are approximately 20 times more painful than any other muscles in the body because they’re complex and located so close to the spinal cord, says Art Brownstein, MD, author of Healing Back Pain Naturally (Harbor Press, 1998). “If you were a champion basket weaver, you couldn’t weave a basket so sophisticated with all the different angles and fibers as your back muscles, which orchestrate the many joints in your back.”

Stretch Those Strained Muscles
Stretching—that thing you may do involuntarily when you wake up every morning—can directly relieve the back pain that emanates from strained or sore muscles, says Art Brownstein, MD, author of Healing Back Pain Naturally (Harbor Press, 1998) and assistant clinical professor of medicine at the University of Hawaii in Manoa.

Stretching elongates muscle tissues, improves blood flow, and speeds delivery of oxygen and nutrients to the back. It also helps decompress the vertebrae (the 24 movable bones that make up your spine), which press on the disks, the cushionlike pads between them.

Here is a simple stretch you might want to try: Lie on your back. Slowly bring your right leg, bent, in toward your chest, only as far as comfortable. With your hands on your shin, hold this position for 10 to 20 seconds, then slowly release and repeat with your other leg. Repeat five or six times in the morning before you rise and in the evening before you go to sleep.

This can help even if your pain is so severe that you can’t get out of bed—or off the floor. Start slowly and gently, gradually increasing the stretch as your back begins to loosen up and heal.

Remember to breathe deeply and fully, adds Dr. Brownstein. “Your breath is the link between your mind and body,” he says. “When you’re mentally agitated and upset, you can hyperventilate and not get enough oxygen. When you breathe slowly and deeply, your mind calms down, your nerves calm down, and your muscles stop contracting and start to lengthen. With this, blood flow is restored, and healing can occur.”

Relax Spasms With Yoga
During acute lower back strain, the muscles on either side of your spine at your waist, known as the paraspinal muscles, will go into spasm and feel tender and tight. As the muscles contract continuously, they squeeze off their own blood supply and deprive themselves of oxygen, explains Mary Pullig Schatz, MD, author of Back Care Basics: A Doctor’s Gentle Yoga Program for Back and Neck Pain Relief (Rodmell Press, 1992).

“You can get into a vicious circle, where the reaction of the muscles to continuous spasm and oxygen deprivation causes more spasm and thereby more pain,” says Dr. Schatz. To relieve back spasms, Dr. Schatz recommends the following yoga pose:

Lie on your back on the floor. Place a rolled-up towel under your neck and towels under your head.

Place the back of your calves on a chair so that your thighs and calves form a 90-degree angle. For extra relief, place a 2-pound bag of dried beans on your belly. Your arms should be outstretched at your sides, palms facing up, at a slight distance from your body. Remain in this pose for 5 to 10 minutes. As you’re doing this pose, use what Dr. Schatz calls the “relaxation breath.”

Inhale through your nose, then exhale, also through your nose.

Near the end of the exhalation, count silently to yourself—1,001…1,002…1,003—allowing the air to gently escape and the exhalation to come to a natural pause. Then begin the next breath.

Continue breathing this way for 2 to 3 minutes. Then return to normal, relaxed breathing for the remainder of your time in the pose.

When you’re ready to get back on your feet, roll onto one side and rest there for 1 minute before you push up into a sitting position. If you get up too quickly, you could prompt the spasms to return.

Acupressure: Fast Relief
It sounds too good to be true: You can make your back pain subside, or even disappear, by applying pressure to a particular point on your body. That’s a simplified description of acupressure, a traditional Chinese technique that brings almost instant relief to back-pain sufferers.

By placing pressure on certain points on your body-points used in acupuncture—the Chinese believe that you unblock the flow of vital energy, or qi (pronounced chee). Those blockages, they say, create an imbalance of qi in the body, which can make you more susceptible to pain and illness. (Western scientists who have studied acupuncture, however, believe it may work by increasing the production of endorphins, hormonelike pain relievers your body makes in response to injury. The same may be true of acupressure.)

However, if it works—and it apparently does—acupressure brings only partial relief from back pain, says Christina Stemmler, MD, a Houston-based physician who uses both acupuncture and acupressure in her practice. Depending on the source of the problem, acupressure could lower pain by 50 to 75 percent, although acupuncture tends to bring instant and complete relief for acute back pain, she says.But if back pain strikes suddenly, you’re probably not going to be anywhere near an acupuncturist, so acupressure is best for a quick fix. Dr. Stemmler recommends the following acupressure points for back pain. Press these points with the tip of a mechanical pencil with the lead retracted or with the fingernail on your index finger:

Center the pencil tip between your nose and upper lip. Apply deep pressure, hold for several seconds, and release. Repeat 5 to 10 times until the pain begins to release.

Place the pencil tip between your inner anklebone and Achilles tendon, the large tendon running from your heel bone to the calf muscle. Apply deep pressure, hold for several seconds, and release. Repeat 5 to 10 times.

Make a fist. On the outside of your hand, next to the pinky finger, locate the spot where the skin folds and bulges. That’s your acupressure point. Place the pencil tip there, apply deep pressure, hold for several seconds, and release. Repeat 5 to 10 times.

Quick Fix for “Sitting Strain”
You think of it as resting, but your back regards sitting as a real strain. Too much time on your duff for any reason can lead to back pain, says Jerome McAndrews, DC, national spokesperson for the American Chiropractic Association in Arlington, VA.

Here’s why: When you sit for long periods of time, the muscles in the back of your legs shorten and contract abnormally from lack of activity. When you stand up, these muscles resist returning to their normal length and “yank” on the back of the pelvis. In turn, the muscles in your lower back, which are attached to the top of the pelvis, also get pulled. This pulling and tugging can lead to back pain, says Dr. McAndrews.

Here’s how to loosen the muscles in the back of your legs:

Lie on the floor with your knees bent, feet flat on the floor.

Grasping your hands around your right thigh, gently pull one leg in toward your chest, keeping your other leg slightly bent. Only go as far as is comfortable.

Hold for 10 to 20 seconds and release. Repeat with the other leg. If your pain becomes worse, stop doing the exercise.

When you can easily do this exercise, try doing it with your inactive leg straight, but not locked. Hold a towel or rope around your leg to gently pull it toward you. Only go as far as is comfortable.

As a variation, stand on the balls of your feet on the bottom stair. To keep your balance, hold the railing with one hand. Now, let your weight carry your heels down below the level of the step to stretch out the calf muscles in the back of your legs. Hold for 1 minute. Repeat several times until you feel the calf muscles relax or “let go,” says Dr. McAndrews.

Get Herbal Relief
When back pain strikes, you can reach for a nonprescription pain reliever such as acetaminophen, ibuprofen, or even aspirin. And why not? They work. But some people can’t tolerate their side effects, including stomach upset.

Herbs provide a natural alternative to over-the-counter pain relievers without the undesirable side effects, says Douglas Schar, DipPhyt, MCPP, a medically trained herbalist in London and editor of the British Journal of Phytotherapy.

“Back pain is an ongoing problem for many people. They often have to use medicine off and on for long periods of time. That’s where herbal medicines make a big contribution. They’re milder, and they don’t have the same side effects as some of the over-the-counter preparations,” Schar says.

If you know what’s causing your back pain, try one of the following herbal remedies:

Cramp Bark
For back pain caused by strain and overuse of muscles, Schar recommends cramp bark, a muscle relaxant that soothes spasms. Cramp bark is available as bark or as a tincture.

Tea: Add 1 teaspoon of the bark to 1 cup of boiling water. Steep for 10 minutes. Strain and drink the tea three times daily.

Tincture: 1 teaspoon three times daily. You should feel some relief immediately. Continue to use cramp bark for up to two weeks, until the pain completely disappears.

Valerian Root
Back pain caused by tension and stress can be eased with valerian root, which blocks the transmission of stress from the brain to the body. Valerian root is especially helpful when used preventively because it calms you in stressful situations, Schar says. “Some people get a backache during stressful periods. The smartest plan is to start using valerian root at the onset of the difficult time—before the backache sets in,” he says.

Look for valerian root capsules or tablets. Follow the instructions on the product label, and use it for the duration of the stressful period.

Back pain during pregnancy

admin — Mon, 24 Nov 2008 13:32:40 +0000

Back pain is a common complaint during pregnancy. And it’s no wonder. You’re gaining weight. You’re walking in a new way. Your hormones are relaxing the joints and ligaments throughout your body.

But you don’t have to grin and bear it. Often, you can treat — or prevent — back pain during pregnancy with simple self-care strategies or complementary therapies.

Give back pain the boot

Consider these steps to ease back pain:

Practice good posture. As your baby grows, your center of gravity shifts forward. As you compensate in some way to avoid falling forward, you may strain the muscles in your lower back — which can cause back pain. Enter the principles of good posture. Tuck your buttocks under, pull your shoulders back and downward, and stand straight and tall.
Sit and stand with care. Sit with your feet slightly elevated, and don’t cross your legs. Choose a chair that supports your back. Change position often, and avoid standing for long periods of time. If you must stand, rest one foot on a low step stool.
Sleep on your side. Sleep on your side, not your back. Keep one or both knees bent. It may also help to place one pillow between your knees and another under your abdomen, or use a full-length body pillow.
Lift properly. When lifting a small object, squat down and lift with your legs. Don’t bend at the waist or lift with your back. Try to avoid sudden reaching movements or stretching your arms high over your head. And know your limits. Don’t attempt to lift heavy objects or children.
Get the right gear. Wear low-heeled shoes with good arch support. Wear maternity pants with a low, supportive waistband. Consider using a maternity support belt.
Try heat, cold or a back rub. Apply heat to your back. Soak in a warm bathtub, or use a hot water bottle or a heating pad. Some women find relief by alternating ice packs with heat. Rubbing your back also may help. Better yet, ask someone to rub your back for you.
Stay fit. Regular exercise can keep your back strong and may actually relieve back pain. With your health care provider’s OK, try swimming, walking or riding a stationary bike.
Try pelvic tilt exercises. Kneel on your hands and knees with your head in line with your back. Pull in your abdomen, arching your spine upward. Hold the position for several seconds, then relax your abdomen and back. Repeat three to five times, working gradually up to 10. Ask your health care provider about other stretching exercises, too.
Consider complementary treatments. For some women, massage therapy or chiropractic care provides relief. Although these techniques haven’t been proved effective for treating low back pain, they may provide some comfort and are generally safe during pregnancy — as long as you’re receiving good prenatal care. Discuss your pain with your health care provider first, however, to make sure you’re dealing with muscular back pain rather than an underlying condition.

Acetaminophen (Tylenol, others) is safe to use during pregnancy, but other pain relievers — including aspirin and ibuprofen (Advil, Motrin, others) — are not. Check with your health care provider before taking any medication to treat your back pain.

To lift correctly, bend at your knees — not at your waist. Keep your back as straight as possible. Use your leg muscles to stand, keeping the object close to your body.

Take back pain seriously

Back pain during pregnancy probably won’t come as a surprise, but that doesn’t mean you should ignore it. A low, dull backache may be a sign of preterm labor. And severe back pain or back pain that’s accompanied by vaginal bleeding or discharge may indicate an underlying problem that needs attention. If you’re concerned about your back pain, contact your health care provider right away.