Friday, December 27, 2013

Oh, My Aching Back!

Blog contributed by Jamie Weeder, CRNP

Lower back pain is one of the most common problems seen by health care providers. Most individuals will experience back pain that interferes with their normal daily activities, such as work or recreation, during their lifetime. Luckily, most episodes of back pain resolve within a few days.

Back pain can be considered acute or chronic depending on the duration. Acute lower back pain can last from days to weeks while chronic pain persists beyond 3 months. Chronic back pain often worsens over time, is related to many factors, and can be difficult to treat. The focus of this blog will be to discuss acute lower back pain which is often caused by injury or trauma. The article will discuss conservative management and when to see a health care provider.

Acute lower back pain is often caused by sudden injury or trauma which results in irritation of the muscles, ligaments, or nerves within the back. Often actions as simple as lifting heavy objects or twisting to the side can cause lower back pain. Learning proper body mechanics, such as maintaining a correct posture and lifting objects correctly, would prevent back pain for most individuals.

Symptoms of lower back pain may range from muscle aches to a shooting or stabbing pain. Muscle spasms are often a common symptom. Individuals may also experience decreased back range of motion or flexibility. In some cases, individuals are unable to stand upright due to the pain. Some symptoms are considered “alarms” which if experienced individuals should promptly contact their health care provider. Symptoms that suggest a serious medical condition include back pain accompanied by leg weakness, leg numbness, fever, pain with coughing, or loss of bowel/bladder.  

Most, uncomplicated cases of acute lower back pain can be treated conservatively at home. With self-treatment at home, if there is not a reduction in symptoms within 72 hours individuals should contact their health care provider.

The application of cold compresses after an injury/trauma can aid in reducing pain and inflammation. Cold therapy can be used multiple times throughout the day with application of an ice pack or frozen towel for up to 20 minutes. After the first 48 hours after an injury, heat should be applied to relax the muscles and promote blood flow to the area. Hot packs, heating pads, or warm baths can be used, but individuals should be careful not to burn their skin.

While many individuals believe bed rest is needed to treat back pain, this is incorrect. Resting should be limited as immobility can lead to increased pain and decreased muscle strength and flexibility. Individuals should resume their normal daily activities as soon as possible. Routine exercise and stretching has also been found to speed recovery and prevent back injuries as exercising promotes muscle strengthening, good posture, and coordination/balance. 

There are many over-the-counter medications that can be used to treat acute lower back pain. Individuals should always check with their health care provider before taking any medications. Medications that are sold over-the-counter can cause various side effects and may interact with prescription medications. One class of over-the-counter medication that can be taken to reduce pain, stiffness, inflammation, and swelling is non-steroidal anti-inflammatories (NSAIDs). These medications include: aspirin, ibuprofen/Advil, and naproxen/Aleve. Topical sprays and creams (IcyHot or Bengay) are also available over-the-counter which can be applied to the back to dull pain and decrease inflammation.

Massage, acupuncture, and spine manipulation (chiropractor or physical therapist) have also been found to help treat acute lower back pain. Individuals should seek licensed professionals to perform these types of treatments to prevent complications.

Individuals that do not respond to conservative therapy or experience alarm symptoms should contact their health care provider. The health care provider will obtain a history by asking various questions and perform a physical assessment to determine the best treatment method. He/she may also order diagnostic tests to determine the cause of the symptoms. For individuals that are prone to episodes of acute lower back pain, a health care provider can educate patients on exercises and methods to prevent back injury and promote a healthy back.


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