How is back pain
Most low back pain can be
treated without surgery. Treatment involves using analgesics, reducing
inflammation, restoring proper function and strength to the back, and preventing
recurrence of the injury. Most patients with back pain recover without residual
functional loss. Patients should contact a doctor if there is not a noticeable
reduction in pain and inflammation after 72 hours of
Ice and Heat. Although ice and heat
(the use of cold and hot compresses) have never been
scientifically proven to quickly resolve low back injury, compresses may help
reduce pain and inflammation and allow greater mobility for some individuals. As
soon as possible following trauma, patients should apply a cold pack or a cold
compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel)
to the tender spot several times a day for up to 20 minutes. After 2 to 3 days
of cold treatment, they should then apply heat (such as a heating lamp or hot
pad) for brief periods to relax muscles and increase blood flow. Warm baths may
also help relax muscles. Patients should avoid sleeping on a heating pad, which
can cause burns and lead to additional tissue damage.
Bed Rest. Bed rest may help but only 1–2 days
at most. A 1996 Finnish study found that persons who continued their activities
without bed rest following onset of low back pain appeared to have better back
flexibility than those who rested in bed for a week. Other studies suggest that
bed rest alone may make back pain worse and can lead to secondary complications
such as depression, decreased muscle tone, and blood clots in the legs. Patients
should resume activities as soon as possible. At night or during rest, patients
should lie on one side, with a pillow between the knees (some doctors suggest
resting on the back and putting a pillow beneath the knees).
Exercise. Exercise may be the
most effective way to speed recovery from low back pain and help strengthen back
and abdominal muscles. Maintaining and building muscle strength is particularly
important for persons with skeletal irregularities. Doctors and physical
therapists can provide a list of gentle exercises that help keep muscles moving
and speed the recovery process. A routine of back-healthy activities may include
stretching exercises, swimming, walking, and movement therapy to improve
coordination and develop proper posture and muscle balance. Yoga is another way
to gently stretch muscles and ease pain. Any mild discomfort felt at the start
of these exercises should disappear as muscles become stronger. But if pain is
more than mild and lasts more than 15 minutes during exercise, patients should
stop exercising and contact a doctor.
Medications. Medications are
often used to treat acute and chronic low back pain. Effective pain relief may
involve a combination of prescription drugs and over-the-counter remedies.
Patients should always check with a doctor before taking drugs for pain relief.
Certain medicines, even those sold over the counter, are unsafe during
pregnancy, may conflict with other medications, may cause side effects including
drowsiness, or may lead to liver damage.
Over-the-counter analgesics, including
nonsteroidal anti-inflammatory drugs (aspirin, naproxen, and
ibuprofen), are taken orally to reduce stiffness, swelling, and inflammation and
to ease mild to moderate low back pain. Counter-irritants applied
topically to the skin as a cream or spray stimulate the nerve endings in the
skin to provide feelings of warmth or cold and dull the sense of pain. Topical
analgesics can also reduce inflammation and stimulate blood flow. Many of these
compounds contain salicylates, the same ingredient found in oral pain
medications containing aspirin.
Anticonvulsants--drugs primarily used to
treat seizures-—may be useful in treating certain types of nerve pain and may
also be prescribed with analgesics.
- Some antidepressants,
particularly tricyclic antidepressants such as amitriptyline and desipramine,
have been shown to relieve pain (independent of their effect on depression) and
assist with sleep. Antidepressants alter levels of brain chemicals to elevate
mood and dull pain signals. Many of the new antidepressants, such as the
selective serotonin reuptake inhibitors, are being studied for their
effectiveness in pain relief.
Opioids such as codeine, oxycodone,
hydrocodone, and morphine are often prescribed to manage severe acute and
chronic back pain but should be used only for a short period of time and under a
physician’s supervision. Side effects can include drowsiness, decreased reaction
time, impaired judgment, and potential for addiction. Many specialists are
convinced that chronic use of these drugs is detrimental to the back pain
patient, adding to depression and even increasing
Spinal Manipulation. Spinal manipulation is literally a "hands-on" approach in which professionally licensed specialists
use leverage and a series of exercises to adjust spinal structures and restore
When back pain does not
respond to more conventional approaches, patients may consider the following
Acupuncture. Acupuncture involves
the insertion of needles the width of a human hair along precise points
throughout the body. Practitioners believe this process triggers the release of
naturally occurring painkilling molecules called peptides and keeps the body’s
normal flow of energy unblocked. Clinical studies are measuring the
effectiveness of acupuncture in comparison to more conventional procedures in
the treatment of acute low back pain.
Biofeedback. Biofeedback is used
to treat many acute pain problems, most notably back pain and headache. Using a
special electronic machine, the patient is trained to become aware of, to
follow, and to gain control over certain bodily functions, including muscle
tension, heart rate, and skin temperature (by controlling local blood flow
patterns). The patient can then learn to effect a change in his or her response
to pain, for example, by using relaxation techniques. Biofeedback is often used
in combination with other treatment methods, generally without side
Interventional Therapy. Interventional therapy can ease chronic pain by blocking nerve conduction between specific
areas of the body and the brain. Approaches range from injections of local
anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve
roots to more complex nerve blocks and spinal cord stimulation. When extreme
pain is involved, low doses of drugs may be administered by catheter directly
into the spinal cord. Chronic use of steroid injections may lead to increased
Traction. Traction involves
the use of weights to apply constant or intermittent force to gradually “pull”
the skeletal structure into better alignment. Traction is not recommended for
treating acute low back symptoms.
nerve stimulation (TENS) is administered by a battery-powered device that
sends mild electric pulses along nerve fibers to block pain signals to the
brain. Small electrodes placed on the skin at or near the site of pain generate
nerve impulses that block incoming pain signals from the peripheral nerves. TENS
may also help stimulate the brain’s production of endorphins (chemicals that
have pain-relieving properties).
Ultrasound. Ultrasound is a
noninvasive therapy used to warm the body’s internal tissues, which causes
muscles to relax. Sound waves pass through the skin and into the injured muscles
and other soft tissues.
Outpatient Treatments. Minimally invasive
outpatient treatments to seal fractures of the vertebrae caused by osteoporosis
include vertebroplasty and kyphoplasty. Vertebroplasty uses
three-dimensional imaging to help a doctor guide a fine needle into the
vertebral body. A glue-like epoxy is injected, which quickly hardens to
stabilize and strengthen the bone and provide immediate pain relief. In
kyphoplasty, prior to injecting the epoxy, a special balloon is inserted and
gently inflated to restore height to the bone and reduce spinal
Surgery. In the most serious
cases, when the condition does not respond to other therapies, surgery may
relieve pain caused by back problems or serious musculoskeletal injuries. Some
surgical procedures may be performed in a doctor’s office under local
anesthesia, while others require hospitalization. It may be months following
surgery before the patient is fully healed, and he or she may suffer permanent
loss of flexibility. Since invasive back surgery is not always successful, it
should be performed only in patients with progressive neurologic disease or
damage to the peripheral nerves.
Discectomy is one of the more common ways to
remove pressure on a nerve root from a bulging disc or bone spur. During the
procedure the surgeon takes out a small piece of the lamina (the arched bony
roof of the spinal canal) to remove the obstruction
Foraminotomy is an operation that “cleans
out” or enlarges the bony hole (foramen) where a nerve root exits the spinal
canal. Bulging discs or joints thickened with age can cause narrowing of the
space through which the spinal nerve exits and can press on the nerve, resulting
in pain, numbness, and weakness in an arm or leg. Small pieces of bone over the
nerve are removed through a small slit, allowing the surgeon to cut away the
blockage and relieve the pressure on the nerve.
IntraDiscal Electrothermal Therapy (IDET)
uses thermal energy to treat pain resulting from a cracked or bulging spinal
disc. A special needle is inserted via a catheter into the disc and heated to a
high temperature for up to 20 minutes. The heat thickens and seals the disc wall
and reduces inner disc bulge and irritation of the spinal
Nucleoplasty uses radio frequency energy to
treat patients with low back pain from contained, or mildly herniated, discs.
Guided by X-ray imaging, a wand-like instrument is inserted through a needle
into the disc to create a channel that allows inner disc material to be removed.
The wand then heats and shrinks the tissue, sealing the disc wall. Several
channels are made depending on how much disc material needs to be
Radiofrequency lesioning is a procedure
using electrical impulses to interrupt nerve conduction (including the
conduction of pain signals) for 6 to12 months. Using X-ray guidance, a special
needle is inserted into nerve tissue in the affected area. Tissue surrounding
the needle tip is heated for 90-120 seconds, resulting in localized destruction
of the nerves.
Spinal fusion is used to strengthen the
spine and prevent painful movements. The spinal disc(s) between two or more
vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts
and/or metal devices secured by screws. Spinal fusion may result in some loss of
flexibility in the spine and requires a long recovery period to allow the bone
grafts to grow and fuse the vertebrae together.
Spinal laminectomy (also known as spinal
decompression) involves the removal of the lamina (usually both sides) to
increase the size of the spinal canal and relieve pressure on the spinal cord
and nerve roots.
Other surgical procedures to relieve severe chronic
pain include rhizotomy, in which the nerve root close to where it
enters the spinal cord is cut to block nerve transmission and all senses from
the area of the body experiencing pain; cordotomy, where bundles of nerve fibers
on one or both sides of the spinal cord are intentionally severed to stop the
transmission of pain signals to the brain; and dorsal root entry zone
operation, or DREZ, in which spinal neurons transmitting the
patient’s pain are destroyed surgically.
© 2010 Vivacare. Last updated April 5, 2011.
Reference: The National Institute of Neurological Disorders and