Managing Chronic Low Back Pain
Managing Chronic Low Back Pain
Whether you call it backache, low back pain, lumbar pain, or just a pain in the back, chronic low back pain is the number one reason men and women under the age of 45 curb their activity.1 Although it may begin as a sudden (or acute) pain, low back pain is considered chronic if it persists for more than three to six months. The pain is usually caused by an injury to one of the structures of the spine, such as the joints. Chronic low back pain also can result when these structures degenerate with age or trauma and irritate the nearby nerve roots.
What are the management options?
When considering management options, the doctor's first
task is to find out whether your condition is a medical emergency, such
as an infection or a disease. If it is not an emergency, you will follow
a doctor-supervised program of physical therapy to increase muscle tone
in the back and abdomen (stomach area) and range of motion in the spine,
along with a regimen of anti-inflammatory medications (e.g., ibuprofen).
This program can be very effective in controlling pain. A key component
to a comprehensive pain management program includes making fundamental
lifestyle changes, such as losing weight and stopping smoking.
When recommended by a doctor, you may elect to undergo a series of spinal injections to help the doctor diagnose and treat the condition. If you have an advanced case of chronic low back pain, you may have electric stimulation devices implanted in the spine to prevent pain signals from reaching the brain. This treatment offers the benefit of reducing your reliance on oral medications. To help relieve severe low back pain resulting from joint movement, the doctor may fuse portions of the spinal column to prevent their painful movement. This treatment requires conventional surgery and hospitalization.
More extreme alternative treatments are available. However, you should discuss potential consequences with your doctor before trying any of these treatments, which include electrical stimulation of the spinal cord.
Who can be helped by these options?
Although chronic low back pain may recur intermittently,
you usually can return to a less strenuous job or activity and expect to
function reasonably well if you are willing to follow the prescribed treatment
plan. In addition, under the supervision of a doctor and in a gradual manner,
you may be able to return to sports participation.
Back pain can be difficult to treat if it results from advanced inflammation of a nerve or from an injury that has caused permanent changes to the nervous system. These permanent changes may include scarring around the nerve or even death of the nerve. Treatment can be unsuccessful if you are reluctant to make significant lifestyle changes. A small portion of people with back pain never fully recover from their injuries. However, they usually can be made comfortable enough to perform their daily activities.
Is activity-intensive treatment better than bed
rest?
Activity-intensive treatment is better than bed rest.
Bed rest leads to weak, stiff muscles and pain. Activity helps develop
strong, flexible back and abdominal muscles that take the stress off the
spine and decrease pain. Furthermore, activity-intensive treatment contributes
to your perception of self-worth and feelings of control over your life.
When should you consult a doctor about low back pain?
The types of back pain and associated problems that are
signals for you to see your doctor include the following:
Chronic low back pain can be an inconvenient or even
disabling problem. Through proper treatment, most people find relief from
pain and continue their normal activities.
Daniel H. Serrato, M.D.
Columbus, Georgia
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