Aches and pains give everyone a sleepless night now and then. It doesn't take much -- a pulled muscle from an overenthusiastic workout or an afternoon spent helping a friend move furniture. Next thing you know, you're lying in bed at 3 a.m., staring at the ceiling above your bed, aching, and praying for unconsciousness.
While most aches fade pretty quickly, painful and sleepless nights are the norm for people living with chronic pain. "Between 50%-90% of people with chronic pain say that they don't sleep well," says Gilles Lavigne, DDS, MSc, FRCD, an expert on the connection between sleep and pain and a professor of dentistry, physiology and psychiatry at the University of Montreal. "They wake up feeling like they never went to bed."
Not getting enough sleep can have a poisonous effect on your whole life, says Penney Cowan, executive director of the American Chronic Pain Association. It makes you feel rundown and depressed. Your job and family life can suffer. If your sleeplessness is keeping up your spouse too, that can cause even more problems. And that's not all.
"There's very good data that suggests that disturbed sleep can worsen your pain," says Thomas Roth, PhD, director of the Sleep Disorders Center at Henry Ford Hospital in Detroit. It's a vicious cycle: pain prevents you from sleeping, and not sleeping makes the pain worse.
The good news is that there's a lot that you can do -- on your own, and with your doctor -- to break the cycle. With changes to your lifestyle and possibly medication, you can finally get the good night's sleep you crave.
Aches and pains give everyone a sleepless night now and then. It doesn't take much -- a pulled muscle from an overenthusiastic workout or an afternoon spent helping a friend move furniture. Next thing you know, you're lying in bed at 3 a.m., staring at the ceiling above your bed, aching, and praying for unconsciousness.
While most aches fade pretty quickly, painful and sleepless nights are the norm for people living with chronic pain. "Between 50%-90% of people with chronic pain say that they don't sleep well," says Gilles Lavigne, DDS, MSc, FRCD, an expert on the connection between sleep and pain and a professor of dentistry, physiology and psychiatry at the University of Montreal. "They wake up feeling like they never went to bed."
Not getting enough sleep can have a poisonous effect on your whole life, says Penney Cowan, executive director of the American Chronic Pain Association. It makes you feel rundown and depressed. Your job and family life can suffer. If your sleeplessness is keeping up your spouse too, that can cause even more problems. And that's not all.
"There's very good data that suggests that disturbed sleep can worsen your pain," says Thomas Roth, PhD, director of the Sleep Disorders Center at Henry Ford Hospital in Detroit. It's a vicious cycle: pain prevents you from sleeping, and not sleeping makes the pain worse.
The good news is that there's a lot that you can do -- on your own, and with your doctor -- to break the cycle. With changes to your lifestyle and possibly medication, you can finally get the good night's sleep you crave.
Pain and Sleep
"During a normal night, we all go through cycles of light sleep, deep sleep, and REM [rapid eye movement] sleep," Lavigne tells WebMD. "This cycle is repeated three to five times a night." Getting enough deep sleep and REM sleep are key to feeling refreshed in the morning.
The problem is that pain interferes with this cycle. Sudden severe pain can make you bolt upright from a sound sleep. But even milder pain can cause "microarousals," Lavigne says. These are periods when your pain breaks through and bumps you back into the light sleep stage. You may not become conscious, and the next day you won't remember waking up. But your fragmented sleep can leave you feeling like you didn't get any rest at all.
Any pain can interfere with sleep. But some common causes of disturbed sleep are:
Headaches
Back pain
TMJ pain, which is pain in the temporomandibular joint of the jaw
Arthritis
Fibromyalgia, which can cause pain throughout the body's muscles, ligaments, and tendons
Neuropathy, or nerve pain
Premenstrual cramping
Acute injuries, surgery, and more serious diseases, like cancer, can also cause pain and sleeplessness.
It's not just the intensity of pain that can make it hard to sleep. Lavigne says that pain that varies -- that is worse some days than others -- is often the most likely to cause sleeplessness.
"It makes sense," he says. "If you have constant pain for six months, you figure out how to cope with it. But if the pain level goes up and down, if it's unpredictable, you can't get used to it and it can really interfere with sleep."
Finding Solutions
Experts strongly recommend that people with chronic pain and insomnia practice good "sleep hygiene," a medical term for good sleep habits. These suggestions aren't specific to people with chronic pain -- they can help anyone with sleep problems.
Cut back -- or cut out -- the caffeine. If you're overtired, coffee, tea, and caffeinated sodas may help you get through the day. But in all likelihood, they're just worsening your problem, since they disturb your sleep at night. So struggle through a few days without your dose of caffeine and see how you do.
Avoid naps. "Napping during the day just reduces the amount you can sleep at night," says Roth.
Exercise, but not too late. While physical activity is good for everyone, intense exercise -- especially in the late afternoon and evening -- can rev your body up and make sleeping at night difficult. So try a more moderate exercise routine and make sure to do it before the evening.
Cut out the alcohol in the evening. A nightcap might seem like the perfect way to put yourself to sleep. But the problem is that alcohol can interfere with your sleep cycles and wake you up later.
Don't overeat in the evening. A stuffed stomach may make it harder to sleep, says Lavigne.
Make your bedroom a calming place. It's very easy to have your bedroom become a multipurpose dumping ground. It might be filled with baskets of laundry, your kids' toys, and a blaring TV. But experts say that you should make your bedroom a more neutral, soothing place. In fact, they recommend that you reserve you bedroom only for sleeping and sex. Get rid of the distractions.
Relax before bed. Don't do anything before bed that could get you anxious or excited. Avoid doing work in the evening or even getting into serious discussions with your spouse. Instead, try focused relaxation or breathing exercises.
If you can't sleep, don't lie awake in bed. Willing yourself to sleep won't work -- you'll probably just make yourself anxious. So if you're not asleep within 15 minutes of lying down, get out of bed and do something else. Read a book. Take a bath. Listen to soft music. Once you feel yourself getting tired, get back into bed.
Get up at the same time every day regardless of when you went to sleep. It's one way of getting yourself onto a schedule.
Showing posts with label Back pain. Show all posts
Showing posts with label Back pain. Show all posts
Thursday, November 8, 2007
10 Important Questions to Ask Your Doctor About Back Pain
Back pain is common. If you or a loved one is suffering from back pain you may want to ask your doctor these questions.
1. What is causing my back pain?
2. What can I do to prevent my back pain from getting worse?
3. Why is my back vulnerable to pain and injury?
4. Could stress be a contributing factor, and what can I do about it?
5. What are my treatment options?
6. If surgery is recommended, is it really necessary and what are the risks?
7. What are the potential risks and benefits of other available treatments?
8. What lifestyle changes do I need to make to keep my back healthy?
9. How can I be sure that my work does not negatively affect my back?
10. What are the chances that my back pain will result in permanent disability?
1. What is causing my back pain?
2. What can I do to prevent my back pain from getting worse?
3. Why is my back vulnerable to pain and injury?
4. Could stress be a contributing factor, and what can I do about it?
5. What are my treatment options?
6. If surgery is recommended, is it really necessary and what are the risks?
7. What are the potential risks and benefits of other available treatments?
8. What lifestyle changes do I need to make to keep my back healthy?
9. How can I be sure that my work does not negatively affect my back?
10. What are the chances that my back pain will result in permanent disability?
Pain Management: Spinal Cord Stimulation
When other pain treatments have failed, spinal cord stimulation may be an option.
Spinal cord stimulation is a procedure that delivers low-level electrical signals to the spinal cord or to specific nerves to block pain signals from reaching the brain.
What Happens During the Procedure?
In the procedure, a device that delivers the electrical signals is implanted in the body either surgically or percutaneously (through the skin). The patient may turn the current off and on or adjust the intensity of the signals. Most people describe the feelings from the simulator as being pleasant and tingling.
Two kinds of spinal cord stimulation systems are available. The unit that is more commonly used is fully implanted and has a pulse generator and a non-rechargeable battery. The other system includes an antenna, transmitter, and a receiver that relies upon radio frequency. The latter systems antenna and transmitter are carried outside the body, while the receiver is implanted inside the body.
When Is Spinal Cord Stimulation Used?
Spinal cord stimulation is recommended when other treatments have not been successful, when surgery is not likely to help, or when surgery has failed. However, the device is not for everyone; check with your doctor to see if the procedure is right for you.
Spinal cord stimulation is a procedure that delivers low-level electrical signals to the spinal cord or to specific nerves to block pain signals from reaching the brain.
What Happens During the Procedure?
In the procedure, a device that delivers the electrical signals is implanted in the body either surgically or percutaneously (through the skin). The patient may turn the current off and on or adjust the intensity of the signals. Most people describe the feelings from the simulator as being pleasant and tingling.
Two kinds of spinal cord stimulation systems are available. The unit that is more commonly used is fully implanted and has a pulse generator and a non-rechargeable battery. The other system includes an antenna, transmitter, and a receiver that relies upon radio frequency. The latter systems antenna and transmitter are carried outside the body, while the receiver is implanted inside the body.
When Is Spinal Cord Stimulation Used?
Spinal cord stimulation is recommended when other treatments have not been successful, when surgery is not likely to help, or when surgery has failed. However, the device is not for everyone; check with your doctor to see if the procedure is right for you.
Pain Management: Bioelectric Therapy
Bioelectric therapy is a safe, drug-free treatment option for people in pain. It is used to treat some chronic pain and acute pain conditions. It relieves pain by blocking pain messages to the brain. When you are injured, pain receptors send a message to the central nervous system (the brain and spinal cord). The message is registered as pain by certain cells in the body. Using bioelectric currents, bioelectric therapy relieves pain by interrupting pain signals before they reach the brain. Bioelectric therapy also prompts the body to produce endorphins which help to relieve pain.
What Conditions Are Treated With Bioelectric Therapy?
Bioelectric therapy can be used to treat chronic and acute pain conditions including:
Complex regional pain syndrome, also known as reflex sympathetic dystrophy or RSD.
Back pain.
Muscle pain.
Headaches and migraines.
Disorders of blood flow in the upper and lower limbs.
Arthritis.
Temporomandibular joint (TMJ) syndrome. (affects the jaw)
Disorders of the nervous system, such as diabetic neuropathy.
Pain and ulcers of the skin resulting from poor circulation or scleroderma (a chronic condition that can cause thickening or hardening of the skin).
Bioelectric therapy isn't right for everyone. It is not recommended for people who:
Have a pacemaker.
Are pregnant.
Have thrombosis (blood clots in the arms or legs).
Have a bacterial infection.
How Effective Is Bioelectric Therapy?
Bioelectric therapy is effective in providing temporary pain control, but it should only be a part of a total pain management program. When used along with conventional pain-relieving medications, bioelectric treatment may reduce the dose of some pain medications by up to 50%.
What Happens During Treatment?
Several small, flat rubber adhesive discs (called electrodes) are applied to your skin at prescribed areas to be treated. Sometimes rubber suction cups (called vaso pneumatic devices) may be applied to your skin. The electrodes are hooked up to a computer that programs the precise treatment dosage required. High frequency alternating electrical currents (around 4000 cycles per second) are then applied to the electrodes. The currents move through the skin quickly with little discomfort. During treatment, your response to the electrical stimulation is measured.
When electricity is applied, a mild vibrating, tingling sensation is common. This sensation should not be uncomfortable; you should feel a relaxing, soothing pain relief. As the currents are applied, you will provide verbal feedback to the clinician. If the sensation becomes too strong, please tell the clinician right away so the treatment can be adjusted. You should be comfortable and enjoy the treatment, which lasts about 20 minutes.
What Are the Side Effects?
In rare cases, skin irritation and redness can occur under the electrodes.
How Often Should I Get Treated?
The number of treatments required depends on each person's condition and response to bioelectric therapy. One bioelectric therapy session does not usually result in pain relief. Therapy usually begins with about five sessions in one week, followed by three treatments per week. A normal course of treatment includes 16 to 20 treatments.
How Do I Prepare for Bioelectric Therapy?
If you are taking insulin or blood-thinning medications, your doctor may give you specific instructions to follow before the procedure.
You may be asked to fast before the procedure, and you will need to make arrangements for someone to drive you home after treatment.
What Conditions Are Treated With Bioelectric Therapy?
Bioelectric therapy can be used to treat chronic and acute pain conditions including:
Complex regional pain syndrome, also known as reflex sympathetic dystrophy or RSD.
Back pain.
Muscle pain.
Headaches and migraines.
Disorders of blood flow in the upper and lower limbs.
Arthritis.
Temporomandibular joint (TMJ) syndrome. (affects the jaw)
Disorders of the nervous system, such as diabetic neuropathy.
Pain and ulcers of the skin resulting from poor circulation or scleroderma (a chronic condition that can cause thickening or hardening of the skin).
Bioelectric therapy isn't right for everyone. It is not recommended for people who:
Have a pacemaker.
Are pregnant.
Have thrombosis (blood clots in the arms or legs).
Have a bacterial infection.
How Effective Is Bioelectric Therapy?
Bioelectric therapy is effective in providing temporary pain control, but it should only be a part of a total pain management program. When used along with conventional pain-relieving medications, bioelectric treatment may reduce the dose of some pain medications by up to 50%.
What Happens During Treatment?
Several small, flat rubber adhesive discs (called electrodes) are applied to your skin at prescribed areas to be treated. Sometimes rubber suction cups (called vaso pneumatic devices) may be applied to your skin. The electrodes are hooked up to a computer that programs the precise treatment dosage required. High frequency alternating electrical currents (around 4000 cycles per second) are then applied to the electrodes. The currents move through the skin quickly with little discomfort. During treatment, your response to the electrical stimulation is measured.
When electricity is applied, a mild vibrating, tingling sensation is common. This sensation should not be uncomfortable; you should feel a relaxing, soothing pain relief. As the currents are applied, you will provide verbal feedback to the clinician. If the sensation becomes too strong, please tell the clinician right away so the treatment can be adjusted. You should be comfortable and enjoy the treatment, which lasts about 20 minutes.
What Are the Side Effects?
In rare cases, skin irritation and redness can occur under the electrodes.
How Often Should I Get Treated?
The number of treatments required depends on each person's condition and response to bioelectric therapy. One bioelectric therapy session does not usually result in pain relief. Therapy usually begins with about five sessions in one week, followed by three treatments per week. A normal course of treatment includes 16 to 20 treatments.
How Do I Prepare for Bioelectric Therapy?
If you are taking insulin or blood-thinning medications, your doctor may give you specific instructions to follow before the procedure.
You may be asked to fast before the procedure, and you will need to make arrangements for someone to drive you home after treatment.
Pain Management: Trigger Point Injection
Trigger point injection (TPI) may be an option in treating pain for some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin. Trigger points may irritate the nerves around them and cause referred pain, or pain that is felt in another part of the body.
What Happens During the Procedure?
In the TPI procedure, a health care professional inserts a small needle into the patients trigger point. The injection contains a local anesthetic that sometimes includes a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Injections are given in a doctor's office and usually take just a few minutes. Several sites may be injected in one visit. If a patient has an allergy to a certain medication, a dry-needle technique (involving no medications) can be used.
When Is Trigger Point Injection Used?
TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. TPI also is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatments. However, the effectiveness of TPI for treating myofascial pain is still under study.
What Happens During the Procedure?
In the TPI procedure, a health care professional inserts a small needle into the patients trigger point. The injection contains a local anesthetic that sometimes includes a corticosteroid. With the injection, the trigger point is made inactive and the pain is alleviated. Usually, a brief course of treatment will result in sustained relief. Injections are given in a doctor's office and usually take just a few minutes. Several sites may be injected in one visit. If a patient has an allergy to a certain medication, a dry-needle technique (involving no medications) can be used.
When Is Trigger Point Injection Used?
TPI is used to treat many muscle groups, especially those in the arms, legs, lower back, and neck. In addition, TPI can be used to treat fibromyalgia and tension headaches. TPI also is used to alleviate myofascial pain syndrome (chronic pain involving tissue that surrounds muscle) that does not respond to other treatments. However, the effectiveness of TPI for treating myofascial pain is still under study.
Alternative Approaches to Low Back Pain
Has your back been bothering you for months -- or years -- and still you and your doctor haven't been able to figure out why? You're not alone. Back pain is the most common cause of job-related disability in America, according to the National Institutes of Health, and costs about $50 billion a year in treatments. Some 80% of Americans will experience back pain at some time in their lives. But most cases of back pain can't be traced to a specific, definable cause.
"It's a huge problem that we have for both conventional and alternative techniques for treating back pain," says Daniel C. Cherkin, PhD, a senior investigator at the Group Health Cooperative's Center for Health Studies (CHS) in Seattle. "With this huge category of people who have what's referred to as non-specific back pain, you can't trace it to a particular cause."
This conundrum leads many back pain sufferers to seek out "alternative" treatments -- everything from massage and acupuncture to mind-body therapies and exercise programs like yoga and tai chi. For example, studies show that back pain accounts for 20% of visits to massage therapists and 14% of visits to acupuncturists, Cherkin notes. But do any of these options work?
In many cases, the scientific jury is still out. A recent review of dozens of studies looking at massage, acupuncture, and spinal manipulation (chiropractic) as treatments for low back pain, led by Cherkin, showed some evidence pointing toward the effectiveness of massage and spinal manipulation, but less is known about acupuncture.
"The studies we reviewed found massage to be effective for relieving symptoms and increasing function among people with persistent back pain," Cherkin explains. "Spinal manipulation shows small clinical benefits for back pain -- about the same as conventional medical treatments such as over-the-counter pain relievers and various types of physical therapy."
Based on existing studies, the effectiveness of acupuncture remains unclear, but a new, large study recently launched at the Group Health Cooperative aims to answer some of those questions. To be conducted over four years, the study is recruiting nearly 700 back pain sufferers and will compare acupuncture to conventional care.
Building a Stronger Back
"The most predictable way of resolving back problems, based on the scientific literature, is by increasing strength," says Vert Mooney, MD, director of U.S. Spine and Sport in San Diego. "There's good evidence that with chronic back pain, the muscles around the spine become inhibited, and the most rational treatment is a progressive strengthening program."
Ideally, says Mooney, such a program is best done with calibrated equipment that allows the person with low back pain to gradually increase the amount of strengthening involved so that performance and progress can be measured. "With calisthenic-type exercises, it's very difficult to increase the amount of exercise that you do, so you do enough to stimulate repair but not enough to increase pain," he says.
Florida chiropractor Thomas Hyde, DC, stresses the importance of "core stability" in any exercise program designed to strengthen the back and relieve chronic pain.
"It's a huge problem that we have for both conventional and alternative techniques for treating back pain," says Daniel C. Cherkin, PhD, a senior investigator at the Group Health Cooperative's Center for Health Studies (CHS) in Seattle. "With this huge category of people who have what's referred to as non-specific back pain, you can't trace it to a particular cause."
This conundrum leads many back pain sufferers to seek out "alternative" treatments -- everything from massage and acupuncture to mind-body therapies and exercise programs like yoga and tai chi. For example, studies show that back pain accounts for 20% of visits to massage therapists and 14% of visits to acupuncturists, Cherkin notes. But do any of these options work?
In many cases, the scientific jury is still out. A recent review of dozens of studies looking at massage, acupuncture, and spinal manipulation (chiropractic) as treatments for low back pain, led by Cherkin, showed some evidence pointing toward the effectiveness of massage and spinal manipulation, but less is known about acupuncture.
"The studies we reviewed found massage to be effective for relieving symptoms and increasing function among people with persistent back pain," Cherkin explains. "Spinal manipulation shows small clinical benefits for back pain -- about the same as conventional medical treatments such as over-the-counter pain relievers and various types of physical therapy."
Based on existing studies, the effectiveness of acupuncture remains unclear, but a new, large study recently launched at the Group Health Cooperative aims to answer some of those questions. To be conducted over four years, the study is recruiting nearly 700 back pain sufferers and will compare acupuncture to conventional care.
Building a Stronger Back
"The most predictable way of resolving back problems, based on the scientific literature, is by increasing strength," says Vert Mooney, MD, director of U.S. Spine and Sport in San Diego. "There's good evidence that with chronic back pain, the muscles around the spine become inhibited, and the most rational treatment is a progressive strengthening program."
Ideally, says Mooney, such a program is best done with calibrated equipment that allows the person with low back pain to gradually increase the amount of strengthening involved so that performance and progress can be measured. "With calisthenic-type exercises, it's very difficult to increase the amount of exercise that you do, so you do enough to stimulate repair but not enough to increase pain," he says.
Florida chiropractor Thomas Hyde, DC, stresses the importance of "core stability" in any exercise program designed to strengthen the back and relieve chronic pain.
Chiropractic Care and Back Pain
Chiropractic ("kye-roh-PRAC-tic") is a form of health care that focuses on the relationship between the body's structure, primarily of the spine, and function. Doctors of chiropractic, who are also called chiropractors or chiropractic physicians, use a type of hands-on therapy called manipulation (or adjustment) as their core clinical procedure. While there are some differences in beliefs and approaches within the chiropractic profession, this Research Report will give you a general overview of chiropractic, discuss scientific research findings on chiropractic treatment for low-back pain, and suggest other sources of information. Terms that are linked are defined in the "Definitions" section of this report.
Key Points
Chiropractic is most often used to treat musculoskeletal conditions--problems with the muscles, joints, bones, and connective tissue such as cartilage, ligaments, and tendons.
Research studies of chiropractic treatment for low-back pain have been of uneven quality and insufficient to allow firm conclusions. Nonetheless, the overall sense of the data is that for low-back pain, chiropractic treatment and conventional medical treatments are about equally helpful. It is harder to draw conclusions about the relative value of chiropractic for other clinical conditions.
The risk of experiencing complications from chiropractic adjustment of the low back appears to be very low. However, the risk appears to be higher for adjustment of the neck.
It is important to inform all of your health care providers about any treatment that you are using or considering, including chiropractic. This will help each provider make sure that all aspects of your health care are working together.
What is chiropractic?
The word "chiropractic" combines the Greek words cheir (hand) and praxis (action) and means "done by hand." Chiropractic is an alternative medical system and takes a different approach from conventional medicine (see box) in diagnosing, classifying, and treating medical problems.
What is conventional medicine?
Conventional medicine is medicine as practiced by holders of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine.
What is complementary and alternative medicine (CAM)?
Health care practices and products that are not presently considered to be part of conventional medicine are called CAM. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine.
For more information on conventional medicine and CAM, see the NCCAM fact sheet "What Is Complementary and Alternative Medicine (CAM)?"
Key Points
Chiropractic is most often used to treat musculoskeletal conditions--problems with the muscles, joints, bones, and connective tissue such as cartilage, ligaments, and tendons.
Research studies of chiropractic treatment for low-back pain have been of uneven quality and insufficient to allow firm conclusions. Nonetheless, the overall sense of the data is that for low-back pain, chiropractic treatment and conventional medical treatments are about equally helpful. It is harder to draw conclusions about the relative value of chiropractic for other clinical conditions.
The risk of experiencing complications from chiropractic adjustment of the low back appears to be very low. However, the risk appears to be higher for adjustment of the neck.
It is important to inform all of your health care providers about any treatment that you are using or considering, including chiropractic. This will help each provider make sure that all aspects of your health care are working together.
What is chiropractic?
The word "chiropractic" combines the Greek words cheir (hand) and praxis (action) and means "done by hand." Chiropractic is an alternative medical system and takes a different approach from conventional medicine (see box) in diagnosing, classifying, and treating medical problems.
What is conventional medicine?
Conventional medicine is medicine as practiced by holders of M.D. (Doctor of Medicine) or D.O. (Doctor of Osteopathic Medicine) degrees and by their allied health professionals, such as physical therapists, psychologists, and registered nurses. Other terms for conventional medicine include allopathy; Western, mainstream, orthodox, and regular medicine; and biomedicine.
What is complementary and alternative medicine (CAM)?
Health care practices and products that are not presently considered to be part of conventional medicine are called CAM. Complementary medicine is used together with conventional medicine. Alternative medicine is used in place of conventional medicine.
For more information on conventional medicine and CAM, see the NCCAM fact sheet "What Is Complementary and Alternative Medicine (CAM)?"
At-Home Back Pain Remedies
Nonoperative treatments
Hot or cold: Hot or cold packs – or sometimes a combination of the two – can be soothing to chronically sore, stiff backs. Heat dilates the blood vessels, improving the supply of oxygen that the blood takes to the back and reducing muscle spasms. Heat also alters the sensation of pain. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area. Although cold may feel painful against the skin, it numbs deep pain. Applying heat or cold may relieve pain, but it does not cure the cause of chronic back pain.
Exercise: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce its risk of returning. The following four types of exercise are important to general physical fitness and may be helpful for certain specific causes of back pain:
Flexion: The purposes of flexion exercises, which are exercises in which you bend forward, are to 1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; 2) stretch muscles of the back and hips; and 3) strengthen abdominal and buttock muscles. Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. One word of caution: If your back pain is caused by a herniated disc, check with your doctor before performing flexion exercises because they may increase pressure within the discs, making the problem worse.
Extension: With extension exercises, you bend backward. They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting while lying prone and raising the trunk while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.
Stretching: The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion.
Aerobic: Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while. For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include brisk walking, jogging, and swimming. For back problems, you should avoid exercise that requires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the discs and actually do more harm than good. In addition, avoid high-impact activities if you have disc disease. If back pain or your fitness level makes it impossible to exercise 30 minutes at a time, try three 10-minute sessions to start with and work up to your goal. But first, speak with your doctor or physical therapist about the safest aerobic exercise for you.
Hot or cold: Hot or cold packs – or sometimes a combination of the two – can be soothing to chronically sore, stiff backs. Heat dilates the blood vessels, improving the supply of oxygen that the blood takes to the back and reducing muscle spasms. Heat also alters the sensation of pain. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area. Although cold may feel painful against the skin, it numbs deep pain. Applying heat or cold may relieve pain, but it does not cure the cause of chronic back pain.
Exercise: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce its risk of returning. The following four types of exercise are important to general physical fitness and may be helpful for certain specific causes of back pain:
Flexion: The purposes of flexion exercises, which are exercises in which you bend forward, are to 1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; 2) stretch muscles of the back and hips; and 3) strengthen abdominal and buttock muscles. Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. One word of caution: If your back pain is caused by a herniated disc, check with your doctor before performing flexion exercises because they may increase pressure within the discs, making the problem worse.
Extension: With extension exercises, you bend backward. They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting while lying prone and raising the trunk while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.
Stretching: The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion.
Aerobic: Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while. For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include brisk walking, jogging, and swimming. For back problems, you should avoid exercise that requires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the discs and actually do more harm than good. In addition, avoid high-impact activities if you have disc disease. If back pain or your fitness level makes it impossible to exercise 30 minutes at a time, try three 10-minute sessions to start with and work up to your goal. But first, speak with your doctor or physical therapist about the safest aerobic exercise for you.
Understanding Back Pain - Treatment
How Do I Know What Kind of Back Problem I Have?
Before a doctor can begin treating back pain, he or she may do tests to determine what is causing the patient's back pain. Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort.
Blood and urine tests will make sure the pain is not due to an infection or other systemic problem.
X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. X-rays and imaging studies are generally used only for checking out direct trauma to the back, back pain with fever, or nerve problems such as extremity weakness or numbness. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.
What Are the Treatments?
Because back pain stems from a variety of causes, treatment goals are pain relief and restored movement. The basic treatment for relieving back pain from strain or minor injury is rest. An ice pack can be helpful, as can aspirin or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. After the inflammation subsides, applying heat can soothe muscles and connective tissue.
Long-term bed rest is not only no longer considered necessary for most cases of back pain, it is actually potentially harmful, making recovery slower and potentially causing new problems. In most cases, you will be expected to start normal, nonstrenuous activity (such as walking) within 24 to 72 hours. After that you should begin controlled exercise or physical therapy. Physical therapy treatments may employ massage, ultrasound, whirlpool baths, controlled application of heat, and individually tailored exercise programs to help you regain full use of the back. Strengthening both the abdominal and back muscles helps stabilize the spine. You can prevent further back injury by learning -- and doing -- gentle stretching exercises and proper lifting techniques, and maintaining good posture.
If back pain keeps you from normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as Tylenol, aspirin, or ibuprofen can be helpful. Your doctor may prescribe prescription strength anti-inflammatories/pain medicines or may prefer to prescribe combination opioid/acetaminophen medications such as Vicodin or Percocet. Some doctors also prescribe muscle relaxants. But beware, these medications have their main effect on the brain, not the muscles, and often cause drowsiness.
If your primary doctor isn't able to help you control the pain, he/she may refer you to a back specialist or a pain specialist. Sometimes these doctors will use injections of steroids or anesthetics to help control the pain. Some newer treatments have been developed recently to help with the treatment of pain. One of these is radiofrequency ablation, a process of delivering electrical stimulation to specific nerves to make them less sensitive to pain, or by delivering enough electricity to actually destroy the nerve to prevent further pain. A similar type of procedure that delivers heat to a herniated disc can shrink the disc so that it no longer bulging onto the nerve root causing pain. Other medicines such as antidepressants and anticonvulsants are sometimes prescribed to help with pain related to irritated nerves.
Knowing the cause of the pain and fixing the problem if possible should be primary in the course of your treatment, however.
Some physicians advocate using a transcutaneous electrical nerve stimulator (TENS), although whether TENS is clearly helpful for back pain has not been resolved. Electrodes taped to the body carry a mild electric current that helps relieve pain. After appropriate training, patients can use TENS on their own to help reduce pain while they recover from strained or moderately injured backs.
Surgery for nonspecific back pain is a last resort. In cases of persistent pain from extreme nerve damage, rhizotomy -- surgically severing a nerve -- may be necessary to stop transmission of pain to the brain. Rhizotomy can correct the symptoms caused by friction between the surfaces in a spinal joint, but it doesn't address other problems, such as herniated discs.
Chiropractors have a role in the treatment of back pain. The U.S. Agency for Healthcare Research and Quality recognizes spinal manipulation by chiropractors and osteopaths as effective for acute low-back pain. Its effectiveness for treating chronic back pain is less well established. Some researchers suggest that early chiropractic adjustments for acute back pain may prevent chronic problems from developing. Other doctors warn against some chiropractic manipulations, particularly those that involve rapid twisting of the neck.
Osteopathic treatment is likely to combine drug therapy with spinal manipulation or traction, followed by physical therapy and exercise.
Acupuncture may bring moderate to complete pain relief for many sufferers. It can be used alone or as part of a comprehensive treatment plan that includes medications and other bodywork. Clinical achievements, along with positive research results, prompted the National Institutes of Health (NIH) to declare acupuncture a reasonable treatment option for those suffering low back pain.
If you consult a psychotherapist for cognitive behavioral therapy (CBT), your treatment may include stress management, behavioral adaptation, education, and relaxation techniques. CBT can lessen the intensity of back pain, change perceptions about levels of pain and disability, and even lift depression. The NIH considers CBT useful for relieving low back pain, citing studies that show CBT to be superior to routine care and placebo.
Other comprehensive behavioral programs have shown similar success, with participants able to lessen the amount of medication they needed while improving their outlook and pain-related behavior.
If lower back pain is related to muscle tension or spasm, biofeedback can be effective for lessening pain intensity, decreasing drug use, and improving quality of life. Biofeedback may help you train your muscles to respond better to stress or movement.
The Alexander Technique, Pilates, and the Feldendkrais Method are all specialized forms of body work that help you learn to move in a more coordinated, flexible, and graceful manner. They may help reduce pain and can relieve stress. Some of the postures of yoga may help diminish low back pain, improve flexibility, strength, and sense of balance. Yoga is good for stress reduction and can help with the psychological aspects of pain.
Aquatic therapy and exercise can also improve flexibility and decrease pain for those with chronic low back problems. The unique properties of water make it an especially safe environment for exercising a sore back; it provides gentle resistance, comfort, and relaxation.
Before a doctor can begin treating back pain, he or she may do tests to determine what is causing the patient's back pain. Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort.
Blood and urine tests will make sure the pain is not due to an infection or other systemic problem.
X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. X-rays and imaging studies are generally used only for checking out direct trauma to the back, back pain with fever, or nerve problems such as extremity weakness or numbness. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.
What Are the Treatments?
Because back pain stems from a variety of causes, treatment goals are pain relief and restored movement. The basic treatment for relieving back pain from strain or minor injury is rest. An ice pack can be helpful, as can aspirin or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. After the inflammation subsides, applying heat can soothe muscles and connective tissue.
Long-term bed rest is not only no longer considered necessary for most cases of back pain, it is actually potentially harmful, making recovery slower and potentially causing new problems. In most cases, you will be expected to start normal, nonstrenuous activity (such as walking) within 24 to 72 hours. After that you should begin controlled exercise or physical therapy. Physical therapy treatments may employ massage, ultrasound, whirlpool baths, controlled application of heat, and individually tailored exercise programs to help you regain full use of the back. Strengthening both the abdominal and back muscles helps stabilize the spine. You can prevent further back injury by learning -- and doing -- gentle stretching exercises and proper lifting techniques, and maintaining good posture.
If back pain keeps you from normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as Tylenol, aspirin, or ibuprofen can be helpful. Your doctor may prescribe prescription strength anti-inflammatories/pain medicines or may prefer to prescribe combination opioid/acetaminophen medications such as Vicodin or Percocet. Some doctors also prescribe muscle relaxants. But beware, these medications have their main effect on the brain, not the muscles, and often cause drowsiness.
If your primary doctor isn't able to help you control the pain, he/she may refer you to a back specialist or a pain specialist. Sometimes these doctors will use injections of steroids or anesthetics to help control the pain. Some newer treatments have been developed recently to help with the treatment of pain. One of these is radiofrequency ablation, a process of delivering electrical stimulation to specific nerves to make them less sensitive to pain, or by delivering enough electricity to actually destroy the nerve to prevent further pain. A similar type of procedure that delivers heat to a herniated disc can shrink the disc so that it no longer bulging onto the nerve root causing pain. Other medicines such as antidepressants and anticonvulsants are sometimes prescribed to help with pain related to irritated nerves.
Knowing the cause of the pain and fixing the problem if possible should be primary in the course of your treatment, however.
Some physicians advocate using a transcutaneous electrical nerve stimulator (TENS), although whether TENS is clearly helpful for back pain has not been resolved. Electrodes taped to the body carry a mild electric current that helps relieve pain. After appropriate training, patients can use TENS on their own to help reduce pain while they recover from strained or moderately injured backs.
Surgery for nonspecific back pain is a last resort. In cases of persistent pain from extreme nerve damage, rhizotomy -- surgically severing a nerve -- may be necessary to stop transmission of pain to the brain. Rhizotomy can correct the symptoms caused by friction between the surfaces in a spinal joint, but it doesn't address other problems, such as herniated discs.
Chiropractors have a role in the treatment of back pain. The U.S. Agency for Healthcare Research and Quality recognizes spinal manipulation by chiropractors and osteopaths as effective for acute low-back pain. Its effectiveness for treating chronic back pain is less well established. Some researchers suggest that early chiropractic adjustments for acute back pain may prevent chronic problems from developing. Other doctors warn against some chiropractic manipulations, particularly those that involve rapid twisting of the neck.
Osteopathic treatment is likely to combine drug therapy with spinal manipulation or traction, followed by physical therapy and exercise.
Acupuncture may bring moderate to complete pain relief for many sufferers. It can be used alone or as part of a comprehensive treatment plan that includes medications and other bodywork. Clinical achievements, along with positive research results, prompted the National Institutes of Health (NIH) to declare acupuncture a reasonable treatment option for those suffering low back pain.
If you consult a psychotherapist for cognitive behavioral therapy (CBT), your treatment may include stress management, behavioral adaptation, education, and relaxation techniques. CBT can lessen the intensity of back pain, change perceptions about levels of pain and disability, and even lift depression. The NIH considers CBT useful for relieving low back pain, citing studies that show CBT to be superior to routine care and placebo.
Other comprehensive behavioral programs have shown similar success, with participants able to lessen the amount of medication they needed while improving their outlook and pain-related behavior.
If lower back pain is related to muscle tension or spasm, biofeedback can be effective for lessening pain intensity, decreasing drug use, and improving quality of life. Biofeedback may help you train your muscles to respond better to stress or movement.
The Alexander Technique, Pilates, and the Feldendkrais Method are all specialized forms of body work that help you learn to move in a more coordinated, flexible, and graceful manner. They may help reduce pain and can relieve stress. Some of the postures of yoga may help diminish low back pain, improve flexibility, strength, and sense of balance. Yoga is good for stress reduction and can help with the psychological aspects of pain.
Aquatic therapy and exercise can also improve flexibility and decrease pain for those with chronic low back problems. The unique properties of water make it an especially safe environment for exercising a sore back; it provides gentle resistance, comfort, and relaxation.
What Kind of Back Problem Do You Have?
How Do I Know What Kind of Back Problem I Have?
Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort.
Blood and urine tests will make sure the pain is not due to an infection or other systemic problem.
X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. X-rays and imaging studies are generally used only for checking out direct trauma to the back, back pain with fever, or nerve problems such as extremity weakness or numbness. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.
Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort.
Blood and urine tests will make sure the pain is not due to an infection or other systemic problem.
X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. X-rays and imaging studies are generally used only for checking out direct trauma to the back, back pain with fever, or nerve problems such as extremity weakness or numbness. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.
Understanding Back Pain - Symptoms
What Are the Symptoms?
Most people have experienced back pain sometime in their life. The causes of back pain are numerous; some are self-inflicted due to a lifetime of bad habits. Other back pain causes include accidents, muscle strains, and sports injuries. Although the causes may be different, most often they share the same symptoms.
The symptoms for back pain are:
Persistent aching or stiffness anywhere along your spine, from the base of the neck to the hips.
Sharp, localized pain in the neck, upper back, or lower back -- especially after lifting heavy objects or engaging in other strenuous activity.
Chronic ache in the middle or lower back, especially after sitting or standing for extended periods.
Call Your Doctor If:
You feel numbness, tingling, or loss of control in your arms or legs. This may signal damage to the spinal cord.
The pain in your back extends downward along the back of the leg. You may be suffering from sciatica.
The pain increases when you cough or bend forward at the waist. This can be the sign of a herniated disc.
The pain is accompanied by fever. You may have a bacterial infection.
You have dull pain in one area of your spine when lying in or getting out of bed. If you are over 50 you may be suffering from osteoarthritis.
Most people have experienced back pain sometime in their life. The causes of back pain are numerous; some are self-inflicted due to a lifetime of bad habits. Other back pain causes include accidents, muscle strains, and sports injuries. Although the causes may be different, most often they share the same symptoms.
The symptoms for back pain are:
Persistent aching or stiffness anywhere along your spine, from the base of the neck to the hips.
Sharp, localized pain in the neck, upper back, or lower back -- especially after lifting heavy objects or engaging in other strenuous activity.
Chronic ache in the middle or lower back, especially after sitting or standing for extended periods.
Call Your Doctor If:
You feel numbness, tingling, or loss of control in your arms or legs. This may signal damage to the spinal cord.
The pain in your back extends downward along the back of the leg. You may be suffering from sciatica.
The pain increases when you cough or bend forward at the waist. This can be the sign of a herniated disc.
The pain is accompanied by fever. You may have a bacterial infection.
You have dull pain in one area of your spine when lying in or getting out of bed. If you are over 50 you may be suffering from osteoarthritis.
Understanding Back Pain - Treatment
How Do I Know What Kind of Back Problem I Have?
Before a doctor can begin treating back pain, he or she may do tests to determine what is causing the patient's back pain. Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort.
Blood and urine tests will make sure the pain is not due to an infection or other systemic problem.
X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. X-rays and imaging studies are generally used only for checking out direct trauma to the back, back pain with fever, or nerve problems such as extremity weakness or numbness. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.
What Are the Treatments?
Because back pain stems from a variety of causes, treatment goals are pain relief and restored movement. The basic treatment for relieving back pain from strain or minor injury is rest. An ice pack can be helpful, as can aspirin or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. After the inflammation subsides, applying heat can soothe muscles and connective tissue.
Long-term bed rest is not only no longer considered necessary for most cases of back pain, it is actually potentially harmful, making recovery slower and potentially causing new problems. In most cases, you will be expected to start normal, nonstrenuous activity (such as walking) within 24 to 72 hours. After that you should begin controlled exercise or physical therapy. Physical therapy treatments may employ massage, ultrasound, whirlpool baths, controlled application of heat, and individually tailored exercise programs to help you regain full use of the back. Strengthening both the abdominal and back muscles helps stabilize the spine. You can prevent further back injury by learning -- and doing -- gentle stretching exercises and proper lifting techniques, and maintaining good posture.
If back pain keeps you from normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as Tylenol, aspirin, or ibuprofen can be helpful. Your doctor may prescribe prescription strength anti-inflammatories/pain medicines or may prefer to prescribe combination opioid/acetaminophen medications such as Vicodin or Percocet. Some doctors also prescribe muscle relaxants. But beware, these medications have their main effect on the brain, not the muscles, and often cause drowsiness.
If your primary doctor isn't able to help you control the pain, he/she may refer you to a back specialist or a pain specialist. Sometimes these doctors will use injections of steroids or anesthetics to help control the pain. Some newer treatments have been developed recently to help with the treatment of pain. One of these is radiofrequency ablation, a process of delivering electrical stimulation to specific nerves to make them less sensitive to pain, or by delivering enough electricity to actually destroy the nerve to prevent further pain. A similar type of procedure that delivers heat to a herniated disc can shrink the disc so that it no longer bulging onto the nerve root causing pain. Other medicines such as antidepressants and anticonvulsants are sometimes prescribed to help with pain related to irritated nerves.
Knowing the cause of the pain and fixing the problem if possible should be primary in the course of your treatment, however.
Some physicians advocate using a transcutaneous electrical nerve stimulator (TENS), although whether TENS is clearly helpful for back pain has not been resolved. Electrodes taped to the body carry a mild electric current that helps relieve pain. After appropriate training, patients can use TENS on their own to help reduce pain while they recover from strained or moderately injured backs.
Surgery for nonspecific back pain is a last resort. In cases of persistent pain from extreme nerve damage, rhizotomy -- surgically severing a nerve -- may be necessary to stop transmission of pain to the brain. Rhizotomy can correct the symptoms caused by friction between the surfaces in a spinal joint, but it doesn't address other problems, such as herniated discs.
Chiropractors have a role in the treatment of back pain. The U.S. Agency for Healthcare Research and Quality recognizes spinal manipulation by chiropractors and osteopaths as effective for acute low-back pain. Its effectiveness for treating chronic back pain is less well established. Some researchers suggest that early chiropractic adjustments for acute back pain may prevent chronic problems from developing. Other doctors warn against some chiropractic manipulations, particularly those that involve rapid twisting of the neck.
Osteopathic treatment is likely to combine drug therapy with spinal manipulation or traction, followed by physical therapy and exercise.
Acupuncture may bring moderate to complete pain relief for many sufferers. It can be used alone or as part of a comprehensive treatment plan that includes medications and other bodywork. Clinical achievements, along with positive research results, prompted the National Institutes of Health (NIH) to declare acupuncture a reasonable treatment option for those suffering low back pain.
If you consult a psychotherapist for cognitive behavioral therapy (CBT), your treatment may include stress management, behavioral adaptation, education, and relaxation techniques. CBT can lessen the intensity of back pain, change perceptions about levels of pain and disability, and even lift depression. The NIH considers CBT useful for relieving low back pain, citing studies that show CBT to be superior to routine care and placebo.
Other comprehensive behavioral programs have shown similar success, with participants able to lessen the amount of medication they needed while improving their outlook and pain-related behavior.
If lower back pain is related to muscle tension or spasm, biofeedback can be effective for lessening pain intensity, decreasing drug use, and improving quality of life. Biofeedback may help you train your muscles to respond better to stress or movement.
The Alexander Technique, Pilates, and the Feldendkrais Method are all specialized forms of body work that help you learn to move in a more coordinated, flexible, and graceful manner. They may help reduce pain and can relieve stress. Some of the postures of yoga may help diminish low back pain, improve flexibility, strength, and sense of balance. Yoga is good for stress reduction and can help with the psychological aspects of pain.
Aquatic therapy and exercise can also improve flexibility and decrease pain for those with chronic low back problems. The unique properties of water make it an especially safe environment for exercising a sore back; it provides gentle resistance, comfort, and relaxation.
Before a doctor can begin treating back pain, he or she may do tests to determine what is causing the patient's back pain. Unless you are totally immobilized from a back injury, your doctor probably will test your range of motion and nerve function and touch your body to locate the area of discomfort.
Blood and urine tests will make sure the pain is not due to an infection or other systemic problem.
X-rays are useful in pinpointing broken bones or other skeletal defects. They can sometimes help locate problems in connective tissue. To analyze soft-tissue damage, computed tomography (CT) or magnetic resonance imaging (MRI) scans may be needed. X-rays and imaging studies are generally used only for checking out direct trauma to the back, back pain with fever, or nerve problems such as extremity weakness or numbness. To determine possible nerve or muscle damage, an electromyogram (EMG) can be useful.
What Are the Treatments?
Because back pain stems from a variety of causes, treatment goals are pain relief and restored movement. The basic treatment for relieving back pain from strain or minor injury is rest. An ice pack can be helpful, as can aspirin or another nonsteroidal anti-inflammatory drug (NSAID) to reduce pain and inflammation. After the inflammation subsides, applying heat can soothe muscles and connective tissue.
Long-term bed rest is not only no longer considered necessary for most cases of back pain, it is actually potentially harmful, making recovery slower and potentially causing new problems. In most cases, you will be expected to start normal, nonstrenuous activity (such as walking) within 24 to 72 hours. After that you should begin controlled exercise or physical therapy. Physical therapy treatments may employ massage, ultrasound, whirlpool baths, controlled application of heat, and individually tailored exercise programs to help you regain full use of the back. Strengthening both the abdominal and back muscles helps stabilize the spine. You can prevent further back injury by learning -- and doing -- gentle stretching exercises and proper lifting techniques, and maintaining good posture.
If back pain keeps you from normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as Tylenol, aspirin, or ibuprofen can be helpful. Your doctor may prescribe prescription strength anti-inflammatories/pain medicines or may prefer to prescribe combination opioid/acetaminophen medications such as Vicodin or Percocet. Some doctors also prescribe muscle relaxants. But beware, these medications have their main effect on the brain, not the muscles, and often cause drowsiness.
If your primary doctor isn't able to help you control the pain, he/she may refer you to a back specialist or a pain specialist. Sometimes these doctors will use injections of steroids or anesthetics to help control the pain. Some newer treatments have been developed recently to help with the treatment of pain. One of these is radiofrequency ablation, a process of delivering electrical stimulation to specific nerves to make them less sensitive to pain, or by delivering enough electricity to actually destroy the nerve to prevent further pain. A similar type of procedure that delivers heat to a herniated disc can shrink the disc so that it no longer bulging onto the nerve root causing pain. Other medicines such as antidepressants and anticonvulsants are sometimes prescribed to help with pain related to irritated nerves.
Knowing the cause of the pain and fixing the problem if possible should be primary in the course of your treatment, however.
Some physicians advocate using a transcutaneous electrical nerve stimulator (TENS), although whether TENS is clearly helpful for back pain has not been resolved. Electrodes taped to the body carry a mild electric current that helps relieve pain. After appropriate training, patients can use TENS on their own to help reduce pain while they recover from strained or moderately injured backs.
Surgery for nonspecific back pain is a last resort. In cases of persistent pain from extreme nerve damage, rhizotomy -- surgically severing a nerve -- may be necessary to stop transmission of pain to the brain. Rhizotomy can correct the symptoms caused by friction between the surfaces in a spinal joint, but it doesn't address other problems, such as herniated discs.
Chiropractors have a role in the treatment of back pain. The U.S. Agency for Healthcare Research and Quality recognizes spinal manipulation by chiropractors and osteopaths as effective for acute low-back pain. Its effectiveness for treating chronic back pain is less well established. Some researchers suggest that early chiropractic adjustments for acute back pain may prevent chronic problems from developing. Other doctors warn against some chiropractic manipulations, particularly those that involve rapid twisting of the neck.
Osteopathic treatment is likely to combine drug therapy with spinal manipulation or traction, followed by physical therapy and exercise.
Acupuncture may bring moderate to complete pain relief for many sufferers. It can be used alone or as part of a comprehensive treatment plan that includes medications and other bodywork. Clinical achievements, along with positive research results, prompted the National Institutes of Health (NIH) to declare acupuncture a reasonable treatment option for those suffering low back pain.
If you consult a psychotherapist for cognitive behavioral therapy (CBT), your treatment may include stress management, behavioral adaptation, education, and relaxation techniques. CBT can lessen the intensity of back pain, change perceptions about levels of pain and disability, and even lift depression. The NIH considers CBT useful for relieving low back pain, citing studies that show CBT to be superior to routine care and placebo.
Other comprehensive behavioral programs have shown similar success, with participants able to lessen the amount of medication they needed while improving their outlook and pain-related behavior.
If lower back pain is related to muscle tension or spasm, biofeedback can be effective for lessening pain intensity, decreasing drug use, and improving quality of life. Biofeedback may help you train your muscles to respond better to stress or movement.
The Alexander Technique, Pilates, and the Feldendkrais Method are all specialized forms of body work that help you learn to move in a more coordinated, flexible, and graceful manner. They may help reduce pain and can relieve stress. Some of the postures of yoga may help diminish low back pain, improve flexibility, strength, and sense of balance. Yoga is good for stress reduction and can help with the psychological aspects of pain.
Aquatic therapy and exercise can also improve flexibility and decrease pain for those with chronic low back problems. The unique properties of water make it an especially safe environment for exercising a sore back; it provides gentle resistance, comfort, and relaxation.
Understanding Back Pain - Prevention
How Can I Prevent Back Pain?
In learning how to prevent back pain, keep your posture in mind. The most important preventive measure for lower back pain is practicing good posture when standing and sitting.
First, analyze your posture by standing with your heels against a wall. Your calves, buttocks, shoulders, and the back of your head should touch the wall. You should be able to slip your hand behind the small of your back. Now step forward and stand normally. If your posture changes, correct it right away. If you stand for long periods at work, wear flat shoes with good arch support and get a box or step about six inches high to rest one foot on from time to time.
Your sitting posture may be even more important. A good chair bottom supports your hips comfortably but doesn't touch the backs of your knees. Your chair back should be set at an angle of about 10 degrees and should cradle the small of your back comfortably. If necessary, use a wedge-shaped cushion or lumbar pad. Your feet should rest flat on the floor. Your forearms should rest on your desk or work surface with your elbows almost at a right angle.
When you have to lift heavy objects, don't bend at the waist. Squat with your legs and keep your back upright as you grasp the object and stand upright again. Let your legs do the lifting, not your back. Back braces don't actually help protect your back other than reminding you to not bend with your back. Finally, ask your doctor or health club trainer about back-strengthening exercises. You might also check with your local YMCA or hospital for back-strengthening classes. These stretching and strengthening exercises can help chronic back pain and prevent future episodes. Also, some forms of yoga and tai chi can help you learn proper posture, improve strength, balance, and flexibility.
In learning how to prevent back pain, keep your posture in mind. The most important preventive measure for lower back pain is practicing good posture when standing and sitting.
First, analyze your posture by standing with your heels against a wall. Your calves, buttocks, shoulders, and the back of your head should touch the wall. You should be able to slip your hand behind the small of your back. Now step forward and stand normally. If your posture changes, correct it right away. If you stand for long periods at work, wear flat shoes with good arch support and get a box or step about six inches high to rest one foot on from time to time.
Your sitting posture may be even more important. A good chair bottom supports your hips comfortably but doesn't touch the backs of your knees. Your chair back should be set at an angle of about 10 degrees and should cradle the small of your back comfortably. If necessary, use a wedge-shaped cushion or lumbar pad. Your feet should rest flat on the floor. Your forearms should rest on your desk or work surface with your elbows almost at a right angle.
When you have to lift heavy objects, don't bend at the waist. Squat with your legs and keep your back upright as you grasp the object and stand upright again. Let your legs do the lifting, not your back. Back braces don't actually help protect your back other than reminding you to not bend with your back. Finally, ask your doctor or health club trainer about back-strengthening exercises. You might also check with your local YMCA or hospital for back-strengthening classes. These stretching and strengthening exercises can help chronic back pain and prevent future episodes. Also, some forms of yoga and tai chi can help you learn proper posture, improve strength, balance, and flexibility.
Back Pain: Medication and Addiction
In the last few years, everyone's heard about the apparent epidemic of prescription drug addiction, especially to narcotic painkillers. We see human-interest stories on the news about regular folks getting hooked on OxyContin or Vicodin. Every few months, it seems, we get another news release from a new celebrity confessing to an addiction. The reports may give you the impression that the lure of these drugs is irresistible, that we're all just a few pills away from addiction.
This leaves many people with chronic back pain -- and often their doctors -- stuck in the middle. On the one hand, they're afraid of the risks of addiction that come with powerful painkillers. On the other, they're suffering from severe and debilitating pain and need some kind of help.
But are the risks of prescription drug addiction really as great as we think?
"There's this buzz that these painkillers are demon drugs being marketed to unsuspecting grandmas," says Karen Miotto, MD, an addiction psychiatrist at the UCLA Neuropsychiatric Institute. "But that's not the case."
There's no doubt that prescription drug addiction can be devastating and destroy lives. But for many experts, the more widespread public health issue is that people in desperate and debilitating pain aren't getting the painkillers they need because of inflated fears of addiction. While opioid painkillers -- like OxyContin, Percocet, and Vicodin -- have risks, they're often outweighed by the benefits, experts say.
How Big Is the Addiction Problem?
Prescription drug addiction is a growing problem. According to the Office of National Drug Policy, emergency room visits resulting from the abuse of painkillers alone has gone up 163% since 1995. There are three main classes of prescriptions drugs that are abused: opioid narcotics used to treat pain, depressants used to treat anxiety, and stimulants used to treat conditions like ADHD and obesity.
But those numbers may not be as meaningful they appear, says Jim Zacny, PhD, a professor in the department of anesthesia and critical care at the University of Chicago. More people are abusing the drugs because more people are receiving prescriptions for them. So while there has been a growth in the number of abusers, there has been a much greater rise in the number of people who are using these medications safely and benefiting from them.
Zacny also cites recent data showing that of all the people in the U.S. who checked into substance abuse centers in 2002, only 2.4% were there because of an addiction to opioid narcotics. "In other words," he tells WebMD, "the majority of people who use prescription opioids are using them responsibly."
Miotto stresses that addiction is a more complex process than people tend to think. "It's not the pills alone that make an addiction," she says. She points out that addiction develops from a number of physiological, psychological, and social factors.
Zacny agrees. "There's this myth out there that if you take an opiate, you automatically become enslaved to it," he says. "That's not the truth at all."
Who Is at Risk?
Most people who have back pain are not at risk of prescription drug addiction for a number of reasons. First off, the majority of people with back pain never get prescribed potentially addictive painkillers in the first place.
"Most of the people with back pain will take drugs that don't pose a risk of addiction," says Larry Khoo, MD, co-director of the UCLA Comprehensive Spine Center. People with back pain often use non-addictive medications like Tylenol or nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs are over-the-counter, like Motrin or Advil, and others are by prescription. In April 2004 the FDA asked that over-the-counter NSAIDs revise their labels to include information about potential heart and stomach ulcer bleeding risks.
Steroids can also be prescribed for pain due to swelling and inflammation. Steroids are not narcotics either, but these powerful drugs must be used carefully.
While opioid narcotics like OxyContin, Percocet, and Vicodin are options for patients with acute pain that's more severe, the risks of developing prescription drug addiction still aren't very high.
"Most of the people who need opioid drugs will only use them for a very short time, often a few weeks or a month," says Khoo. "Even the most powerful drugs are not very addictive when they're used that way."
Khoo says these drugs relieve pain immediately and allow people to get out of bed, start physical therapy, and change some of the behaviors that caused their back problem in the first place. "But it all hinges on being able to get out of bed," says Khoo, and without these drugs, that first step is sometimes just too painful.
While some treatments and physical therapy work for most people, Khoo says there are some problems that don't respond to this approach. Despite a good treatment plan, the pain remains. Khoo says patients who develop chronic back pain often have multiple problems with the spine, due perhaps to arthritis or a history of heavy labor, that can't be corrected surgically. He also says people who don't respond to one or two surgeries are more likely to develop difficult-to-treat chronic pain.
It's this small population of people who have chronic pain and hard-to-treat problems that usually need long-term medication, Khoo says.
What Increases the Risk of Abuse?
According to rough estimates, between 3%-16% of people who suffer from chronic pain and are treated with long-term opioid narcotics have a prescription drug addiction, says Miotto. But what increases the risk?
According to Zacny, we still don't have a perfect way of knowing. "The studies just haven't been done," he says. However, most people agree that a recent history of any substance abuse may increase the danger.
Other possible risk factors for prescription drug addiction include any personal or family history of substance abuse, as well as recent emotional or psychiatric problems. "If you're in a high-risk group, if you or a family member has had a past history of addiction, or you're coping with a great deal of stress, you and your doctor may need to be especially vigilant," says Miotto.
What Increases the Risk of Abuse? continued...
Miotto says she worries less about people who are simply taking too much of the painkiller than those who use the painkiller along with other drugs, such as sleeping pills or muscle relaxants. "It's the people who are mixing drugs that I find are often at highest risk of problematic use and side effects," she tells WebMD.
There's also a widely held belief that people who are in pain are less likely to experience euphoric effects from a drug. The idea is that the medication is targeted -- it "goes to the pain" only and doesn't cause other euphoric effects, meaning that people with real pain are less likely to become addicted than people who don't.
"That's lore, sad to say," Zacny says. "It may very well be true, but it hasn't been really established. There's just a lot we don't know."
Although certain opioid drugs are often viewed as more addictive than others, there's very little evidence one way or another, Zacny says. Still, many think that the narcotics that don't last very long -- such as quick-release oxycodone or Vicodin -- may pose a somewhat higher risk of causing addiction. For opiods that last only a few hours, the pain will return. Over time, repeated medication can lead to a tolerance to these drugs. When tolerance develops, higher doses will be needed to get the same effective pain relief.
The risks of prescription drug addiction also depend on how you react to the drug. People who become addicted to prescription painkillers clearly experience a high, but most people find that the drug makes them feel unwell or nauseated. Other frequent side effects include mild dizziness, sedation, and confusion. According to some of Zacny's research, the majority of people who try the drug don't like the effects and would rather not take it again. So the risks of addiction may be higher in those who, for physiological reasons not understood, have a more positive reaction to the drug's effects.
What Increases the Risk of Abuse? continued...
Miotto says she worries less about people who are simply taking too much of the painkiller than those who use the painkiller along with other drugs, such as sleeping pills or muscle relaxants. "It's the people who are mixing drugs that I find are often at highest risk of problematic use and side effects," she tells WebMD.
There's also a widely held belief that people who are in pain are less likely to experience euphoric effects from a drug. The idea is that the medication is targeted -- it "goes to the pain" only and doesn't cause other euphoric effects, meaning that people with real pain are less likely to become addicted than people who don't.
"That's lore, sad to say," Zacny says. "It may very well be true, but it hasn't been really established. There's just a lot we don't know."
Although certain opioid drugs are often viewed as more addictive than others, there's very little evidence one way or another, Zacny says. Still, many think that the narcotics that don't last very long -- such as quick-release oxycodone or Vicodin -- may pose a somewhat higher risk of causing addiction. For opiods that last only a few hours, the pain will return. Over time, repeated medication can lead to a tolerance to these drugs. When tolerance develops, higher doses will be needed to get the same effective pain relief.
The risks of prescription drug addiction also depend on how you react to the drug. People who become addicted to prescription painkillers clearly experience a high, but most people find that the drug makes them feel unwell or nauseated. Other frequent side effects include mild dizziness, sedation, and confusion. According to some of Zacny's research, the majority of people who try the drug don't like the effects and would rather not take it again. So the risks of addiction may be higher in those who, for physiological reasons not understood, have a more positive reaction to the drug's effects.
For people who have a past history of substance abuse or are at higher risk of developing a prescription drug addiction for any reason, seeking out an expert -- or specialty center -- is especially important.
"Too often, addiction programs are completely divorced from pain management programs and vice versa," says Miotto. Khoo agrees and recommends programs that combine not only pain management and prescription drug addiction treatment, but also exercise, physical therapy, weight loss, and if necessary, therapy for depression.
One common way of using opioid narcotics safely is to use a pain agreement, a formal understanding between a doctor and patient about how the drugs will be used. The patient may promise to use the medication as instructed and, in some cases, agree to regular drug testing by urine analysis. In return, the doctor agrees to prescribe narcotic pain relievers as part of the treatment plan.
"Pain agreements or contracts are a way for a doctor to say to the patient, 'We're taking you seriously, so you need to take us seriously,'" says Khoo.
But these agreements may not be enough for people at high risk of addiction. "Some people decide that they just can't take pain medications responsibly," says Miotto. If that's the case, you may be able to get someone else to hold and dispense your medication for you. Another possibility is to use a transdermal patch -- these contain the medicine but deliver it slowly through the skin, preventing the high and reducing the risk of addiction.
For anyone with chronic pain, having a knowledgeable doctor and a trusting relationship is key. An expert won't have unfounded worries about the relatively small risk of prescription drug addiction. But he or she will also know how to help people at high risk of developing a problem.
"Doctors should not be afraid of treating pain," Miotto tells WebMD. "There are addicts out there who don't have pain but shop around and hustle for medication. But I think that there are very few compared to the number of people who have terrible pain and need help."
This leaves many people with chronic back pain -- and often their doctors -- stuck in the middle. On the one hand, they're afraid of the risks of addiction that come with powerful painkillers. On the other, they're suffering from severe and debilitating pain and need some kind of help.
But are the risks of prescription drug addiction really as great as we think?
"There's this buzz that these painkillers are demon drugs being marketed to unsuspecting grandmas," says Karen Miotto, MD, an addiction psychiatrist at the UCLA Neuropsychiatric Institute. "But that's not the case."
There's no doubt that prescription drug addiction can be devastating and destroy lives. But for many experts, the more widespread public health issue is that people in desperate and debilitating pain aren't getting the painkillers they need because of inflated fears of addiction. While opioid painkillers -- like OxyContin, Percocet, and Vicodin -- have risks, they're often outweighed by the benefits, experts say.
How Big Is the Addiction Problem?
Prescription drug addiction is a growing problem. According to the Office of National Drug Policy, emergency room visits resulting from the abuse of painkillers alone has gone up 163% since 1995. There are three main classes of prescriptions drugs that are abused: opioid narcotics used to treat pain, depressants used to treat anxiety, and stimulants used to treat conditions like ADHD and obesity.
But those numbers may not be as meaningful they appear, says Jim Zacny, PhD, a professor in the department of anesthesia and critical care at the University of Chicago. More people are abusing the drugs because more people are receiving prescriptions for them. So while there has been a growth in the number of abusers, there has been a much greater rise in the number of people who are using these medications safely and benefiting from them.
Zacny also cites recent data showing that of all the people in the U.S. who checked into substance abuse centers in 2002, only 2.4% were there because of an addiction to opioid narcotics. "In other words," he tells WebMD, "the majority of people who use prescription opioids are using them responsibly."
Miotto stresses that addiction is a more complex process than people tend to think. "It's not the pills alone that make an addiction," she says. She points out that addiction develops from a number of physiological, psychological, and social factors.
Zacny agrees. "There's this myth out there that if you take an opiate, you automatically become enslaved to it," he says. "That's not the truth at all."
Who Is at Risk?
Most people who have back pain are not at risk of prescription drug addiction for a number of reasons. First off, the majority of people with back pain never get prescribed potentially addictive painkillers in the first place.
"Most of the people with back pain will take drugs that don't pose a risk of addiction," says Larry Khoo, MD, co-director of the UCLA Comprehensive Spine Center. People with back pain often use non-addictive medications like Tylenol or nonsteroidal anti-inflammatory drugs (NSAIDs). Some NSAIDs are over-the-counter, like Motrin or Advil, and others are by prescription. In April 2004 the FDA asked that over-the-counter NSAIDs revise their labels to include information about potential heart and stomach ulcer bleeding risks.
Steroids can also be prescribed for pain due to swelling and inflammation. Steroids are not narcotics either, but these powerful drugs must be used carefully.
While opioid narcotics like OxyContin, Percocet, and Vicodin are options for patients with acute pain that's more severe, the risks of developing prescription drug addiction still aren't very high.
"Most of the people who need opioid drugs will only use them for a very short time, often a few weeks or a month," says Khoo. "Even the most powerful drugs are not very addictive when they're used that way."
Khoo says these drugs relieve pain immediately and allow people to get out of bed, start physical therapy, and change some of the behaviors that caused their back problem in the first place. "But it all hinges on being able to get out of bed," says Khoo, and without these drugs, that first step is sometimes just too painful.
While some treatments and physical therapy work for most people, Khoo says there are some problems that don't respond to this approach. Despite a good treatment plan, the pain remains. Khoo says patients who develop chronic back pain often have multiple problems with the spine, due perhaps to arthritis or a history of heavy labor, that can't be corrected surgically. He also says people who don't respond to one or two surgeries are more likely to develop difficult-to-treat chronic pain.
It's this small population of people who have chronic pain and hard-to-treat problems that usually need long-term medication, Khoo says.
What Increases the Risk of Abuse?
According to rough estimates, between 3%-16% of people who suffer from chronic pain and are treated with long-term opioid narcotics have a prescription drug addiction, says Miotto. But what increases the risk?
According to Zacny, we still don't have a perfect way of knowing. "The studies just haven't been done," he says. However, most people agree that a recent history of any substance abuse may increase the danger.
Other possible risk factors for prescription drug addiction include any personal or family history of substance abuse, as well as recent emotional or psychiatric problems. "If you're in a high-risk group, if you or a family member has had a past history of addiction, or you're coping with a great deal of stress, you and your doctor may need to be especially vigilant," says Miotto.
What Increases the Risk of Abuse? continued...
Miotto says she worries less about people who are simply taking too much of the painkiller than those who use the painkiller along with other drugs, such as sleeping pills or muscle relaxants. "It's the people who are mixing drugs that I find are often at highest risk of problematic use and side effects," she tells WebMD.
There's also a widely held belief that people who are in pain are less likely to experience euphoric effects from a drug. The idea is that the medication is targeted -- it "goes to the pain" only and doesn't cause other euphoric effects, meaning that people with real pain are less likely to become addicted than people who don't.
"That's lore, sad to say," Zacny says. "It may very well be true, but it hasn't been really established. There's just a lot we don't know."
Although certain opioid drugs are often viewed as more addictive than others, there's very little evidence one way or another, Zacny says. Still, many think that the narcotics that don't last very long -- such as quick-release oxycodone or Vicodin -- may pose a somewhat higher risk of causing addiction. For opiods that last only a few hours, the pain will return. Over time, repeated medication can lead to a tolerance to these drugs. When tolerance develops, higher doses will be needed to get the same effective pain relief.
The risks of prescription drug addiction also depend on how you react to the drug. People who become addicted to prescription painkillers clearly experience a high, but most people find that the drug makes them feel unwell or nauseated. Other frequent side effects include mild dizziness, sedation, and confusion. According to some of Zacny's research, the majority of people who try the drug don't like the effects and would rather not take it again. So the risks of addiction may be higher in those who, for physiological reasons not understood, have a more positive reaction to the drug's effects.
What Increases the Risk of Abuse? continued...
Miotto says she worries less about people who are simply taking too much of the painkiller than those who use the painkiller along with other drugs, such as sleeping pills or muscle relaxants. "It's the people who are mixing drugs that I find are often at highest risk of problematic use and side effects," she tells WebMD.
There's also a widely held belief that people who are in pain are less likely to experience euphoric effects from a drug. The idea is that the medication is targeted -- it "goes to the pain" only and doesn't cause other euphoric effects, meaning that people with real pain are less likely to become addicted than people who don't.
"That's lore, sad to say," Zacny says. "It may very well be true, but it hasn't been really established. There's just a lot we don't know."
Although certain opioid drugs are often viewed as more addictive than others, there's very little evidence one way or another, Zacny says. Still, many think that the narcotics that don't last very long -- such as quick-release oxycodone or Vicodin -- may pose a somewhat higher risk of causing addiction. For opiods that last only a few hours, the pain will return. Over time, repeated medication can lead to a tolerance to these drugs. When tolerance develops, higher doses will be needed to get the same effective pain relief.
The risks of prescription drug addiction also depend on how you react to the drug. People who become addicted to prescription painkillers clearly experience a high, but most people find that the drug makes them feel unwell or nauseated. Other frequent side effects include mild dizziness, sedation, and confusion. According to some of Zacny's research, the majority of people who try the drug don't like the effects and would rather not take it again. So the risks of addiction may be higher in those who, for physiological reasons not understood, have a more positive reaction to the drug's effects.
For people who have a past history of substance abuse or are at higher risk of developing a prescription drug addiction for any reason, seeking out an expert -- or specialty center -- is especially important.
"Too often, addiction programs are completely divorced from pain management programs and vice versa," says Miotto. Khoo agrees and recommends programs that combine not only pain management and prescription drug addiction treatment, but also exercise, physical therapy, weight loss, and if necessary, therapy for depression.
One common way of using opioid narcotics safely is to use a pain agreement, a formal understanding between a doctor and patient about how the drugs will be used. The patient may promise to use the medication as instructed and, in some cases, agree to regular drug testing by urine analysis. In return, the doctor agrees to prescribe narcotic pain relievers as part of the treatment plan.
"Pain agreements or contracts are a way for a doctor to say to the patient, 'We're taking you seriously, so you need to take us seriously,'" says Khoo.
But these agreements may not be enough for people at high risk of addiction. "Some people decide that they just can't take pain medications responsibly," says Miotto. If that's the case, you may be able to get someone else to hold and dispense your medication for you. Another possibility is to use a transdermal patch -- these contain the medicine but deliver it slowly through the skin, preventing the high and reducing the risk of addiction.
For anyone with chronic pain, having a knowledgeable doctor and a trusting relationship is key. An expert won't have unfounded worries about the relatively small risk of prescription drug addiction. But he or she will also know how to help people at high risk of developing a problem.
"Doctors should not be afraid of treating pain," Miotto tells WebMD. "There are addicts out there who don't have pain but shop around and hustle for medication. But I think that there are very few compared to the number of people who have terrible pain and need help."
Low Back Pain: Many Options for Relief
People who suffer low back pain have high odds of finding relief without surgery, an expert panel says.
The panel, made up of experts from the American Pain Society and the American College of Physicians, has released guidelines for the diagnosis and treatment of low back pain.
The guidelines cover what doctors call "nonspecific low back pain" -- that is, back pain not due to a specific condition such as cancer, a slipped disk, a compressed nerve, or a fracture.
If you have this kind of bad pain, there's good news, says panelist Roger Chou, MD, associate professor of medicine at Oregon Health & Science University in Portland. Chou is director of the clinical guidelines development program of the American Pain Society.
"There are lots of options out there that have pretty good evidence they work," Chou tells WebMD. "There is no one perfect treatment for everybody. If you are interested in spinal manipulation and acupuncture, the evidence is just as good as for medications."
Once upon a time, doctors told people with low back pain to stay in bed for three days -- perhaps with a board under their mattress. That very bad advice actually made back pain worse, Chou says.
"We don't want people lying in bed," he says. "Get out. Try a normal range of activities, but back off if your back hurts. But you won't hurt your back by doing regular stuff, and it may actually keep your back conditioned and strong."
Doctors also used to give routine X-rays to patients complaining of low back pain. That, according to the expert panel, also is wrong. X-rays are indicated only when a doctor has reason to suspect an underlying condition that could be confirmed by imaging studies.
Back Pain Relief Menu
Most people with low back pain have an acute pain episode. But up to a third of patients report persistent pain of at least moderate intensity -- chronic low back pain.
The panel found evidence that different patients can get relief from a wide variety of treatments. These treatments include:
Cognitive-behavioral psychotherapy
Exercise therapy
Spinal manipulation from a chiropractor, osteopath, or physical therapist
Intensive interdisciplinary rehabilitation (physical, vocational, and behavioral therapies provided by multiple providers with different clinical backgrounds)
Acupuncture
Massage therapy
Yoga
Progressive relaxation
"Patients and doctors need to talk," Chou says. "Don't use stuff not backed up by evidence. Don't fall for stuff just because it's touted on the Internet or whatever."
Scott D. Boden, MD, professor of orthopaedic surgery and director of the Emory University orthopaedics and spine center, says the panel's advice confirms what back specialists have been saying for years.
"These programs have been around for 15 to 20 years," Boden tells WebMD. "Some studies show they have a benefit, some not. A lot of this has to do with the psychological makeup of patients."
Boden adds one more possible cure to Chou's list: time.
"Fortunately for most patients, it is just a short period of time where back pain is absolutely debilitating," he says. "For some, the most important thing is just the education that they are not falling apart, so they can to stop searching for the cure and go on and live their lives."
Both Boden and Chou stress that surgery is not the answer for most patients. In fact, Consumer Reports this month listed back surgery as the No. 1 most overused medical treatment.
"Since surgery doesn't offer a large advantage in most patients, the message is that most people will be able to get better without surgery," Chou says. "If you can avoid it, you are going to be better off."
Boden suggests that patients settle on a treatment that helps and warns that some patients may never be totally cured of back pain.
"Unfortunately, while looking for a cure patients can run into surgery that would be moderately risky with a small chance of success," Boden says. "Or they could end up with something that is not necessarily dangerous, but equally ineffective. There are a lot of new things that sound good, but the real back pain options really haven't changed that much in decades."
The panel, made up of experts from the American Pain Society and the American College of Physicians, has released guidelines for the diagnosis and treatment of low back pain.
The guidelines cover what doctors call "nonspecific low back pain" -- that is, back pain not due to a specific condition such as cancer, a slipped disk, a compressed nerve, or a fracture.
If you have this kind of bad pain, there's good news, says panelist Roger Chou, MD, associate professor of medicine at Oregon Health & Science University in Portland. Chou is director of the clinical guidelines development program of the American Pain Society.
"There are lots of options out there that have pretty good evidence they work," Chou tells WebMD. "There is no one perfect treatment for everybody. If you are interested in spinal manipulation and acupuncture, the evidence is just as good as for medications."
Once upon a time, doctors told people with low back pain to stay in bed for three days -- perhaps with a board under their mattress. That very bad advice actually made back pain worse, Chou says.
"We don't want people lying in bed," he says. "Get out. Try a normal range of activities, but back off if your back hurts. But you won't hurt your back by doing regular stuff, and it may actually keep your back conditioned and strong."
Doctors also used to give routine X-rays to patients complaining of low back pain. That, according to the expert panel, also is wrong. X-rays are indicated only when a doctor has reason to suspect an underlying condition that could be confirmed by imaging studies.
Back Pain Relief Menu
Most people with low back pain have an acute pain episode. But up to a third of patients report persistent pain of at least moderate intensity -- chronic low back pain.
The panel found evidence that different patients can get relief from a wide variety of treatments. These treatments include:
Cognitive-behavioral psychotherapy
Exercise therapy
Spinal manipulation from a chiropractor, osteopath, or physical therapist
Intensive interdisciplinary rehabilitation (physical, vocational, and behavioral therapies provided by multiple providers with different clinical backgrounds)
Acupuncture
Massage therapy
Yoga
Progressive relaxation
"Patients and doctors need to talk," Chou says. "Don't use stuff not backed up by evidence. Don't fall for stuff just because it's touted on the Internet or whatever."
Scott D. Boden, MD, professor of orthopaedic surgery and director of the Emory University orthopaedics and spine center, says the panel's advice confirms what back specialists have been saying for years.
"These programs have been around for 15 to 20 years," Boden tells WebMD. "Some studies show they have a benefit, some not. A lot of this has to do with the psychological makeup of patients."
Boden adds one more possible cure to Chou's list: time.
"Fortunately for most patients, it is just a short period of time where back pain is absolutely debilitating," he says. "For some, the most important thing is just the education that they are not falling apart, so they can to stop searching for the cure and go on and live their lives."
Both Boden and Chou stress that surgery is not the answer for most patients. In fact, Consumer Reports this month listed back surgery as the No. 1 most overused medical treatment.
"Since surgery doesn't offer a large advantage in most patients, the message is that most people will be able to get better without surgery," Chou says. "If you can avoid it, you are going to be better off."
Boden suggests that patients settle on a treatment that helps and warns that some patients may never be totally cured of back pain.
"Unfortunately, while looking for a cure patients can run into surgery that would be moderately risky with a small chance of success," Boden says. "Or they could end up with something that is not necessarily dangerous, but equally ineffective. There are a lot of new things that sound good, but the real back pain options really haven't changed that much in decades."
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