Consultation with a health care provider is advised before use. The following are the main types of medications used for low back pain:. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques have been shown to provide small to moderate short-term benefits in people with chronic low back pain. Evidence supporting their use for acute or subacute low back pain is generally of low quality.
Neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released the back pain tends to return. There is no evidence that traction provides any longterm benefits for people with low back pain. It involves the insertion of thin needles into precise points throughout the body.
Others who may not believe in the concept of Qi theorize that when the needles are inserted and then stimulated by twisting or passing a low-voltage electrical current through them naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine are released. The therapy involves the attachment of electrodes to the skin and the use of an electromyography machine that allows people to become aware of and selfregulate their breathing, muscle tension, heart rate, and skin temperature.
People regulate their response to pain by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects. Evidence is lacking that biofeedback provides a clear benefit for low back pain. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation.
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When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve. Chronic use of steroid injections may lead to increased functional impairment. Pain relief associated with the injections, however, tends to be temporary and the injections are not advised for long-term use. An NIH-funded randomized controlled trial assessing the benefit of epidural steroid injections for the treatment of chronic low back pain associated with spinal stenosis showed that long-term outcomes were worse among those people who received the injections compared with those who did not.
The theory is that stimulating the nervous system can modify the perception of pain. More recent studies, however, have produced mixed results on its effectiveness for providing relief from low back pain.
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When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. It may be months following surgery before the patient is fully healed, and he or she may suffer permanent loss of flexibility. Surgical procedures are not always successful, and there is little evidence to show which procedures work best for their particular indications. Patients considering surgical approaches should be fully informed of all related risks. Surgical options include:. Next, the region is heated, resulting in localized destruction of the target nerves.
Pain relief associated with the technique is temporary and the evidence supporting this technique is limited.
Recurring back pain resulting from improper body mechanics is often preventable by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress repeated or constant contact between soft body tissue and a hard or sharp object , vibration, repetitive motion, and awkward posture. Using ergonomically designed furniture and equipment to protect the body from injury at home and in the workplace may reduce the risk of back injury.
The use of lumbar supports in the form of wide elastic bands that can be tightened to provide support to the lower back and abdominal muscles to prevent low back pain remains controversial.
Chronic back pain
Such supports are widely used despite a lack of evidence showing that they actually prevent pain. Multiple studies have determined that the use of lumbar supports provides no benefit in terms of the prevention and treatment of back pain. Although there have been anecdotal case reports of injury reduction among workers using lumbar support belts, many companies that have back belt programs also have training and ergonomic awareness programs.
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The reported injury reduction may be related to a combination of these or other factors. Furthermore, some caution is advised given that wearing supportive belts may actually lead to or aggravate back pain by causing back muscles to weaken from lack of use.
Following any period of prolonged inactivity, a regimen of low-impact exercises is advised. Speed walking, swimming, or stationary bike riding 30 minutes daily can increase muscle strength and flexibility. Yoga also can help stretch and strengthen muscles and improve posture.
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Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles. NINDS-funded studies are contributing to a better understanding of why some people with acute low back pain recover fully while others go on to develop chronic low back pain. Brain imaging studies suggest that people with chronic low back pain have changes in brain structure and function.
In one study, people with subacute back pain were followed for one year. Researchers found that certain patterns of functional connectivity across brain networks correlated with the likelihood of pain becoming chronic. The findings suggest that such patterns may help predict who is most likely to transition from subacute to chronic back pain.
Other research seeks to determine the role of brain circuits important for emotional and motivational learning and memory in this transition, in order to identify new preventive interventions. Disc degeneration remains a key cause of chronic low back pain and the pain often persists despite surgery. NIH-funded basic science and preclinical studies are investigating molecular-level mechanisms that cause discs in the spine to degenerate, as well as protective mechanisms involved in disc remodeling that may diminish with advancing age.
Such studies may help identify future therapeutic strategies to block degenerative mechanisms or promote remodeling processes. NIH also is funding early research on stem cell approaches to promote disc regeneration and rejuvenate cells of the nucleus pulposus, the jelly-like substance in the center of intervertebral discs that loses water content as people age.
Several NIH-funded clinical trials and other studies in patients aim to improve treatment options and prevention strategies for chronic low back pain, as well as add to the evidence base about existing treatments. Topics General medicine. Musculoskeletal diseases. Monotherapies Monotherapies are interventions of a single, particular kind that a medical practitioner might prescribe as sole treatment.
Complete Guide to Low Back Pain ()
Multidisciplinary therapy There is no universal definition of multidisciplinary therapy. Reductionism Reductionism describes the pursuit of a pathoanatomical diagnosis for chronic low back pain with the view to implementing a target-specific treatment. Target-specific treatment The ultimate measure of a diagnostic test is its therapeutic utility.
Failed back surgery syndrome Patients with chronic low back pain who fail to benefit from surgery can be difficult to treat. Suggested approach The evidence on treatment of chronic low back pain leaves GPs with few options.
Opioids only partially relieve the pain and must be used carefully. Willow bark is effective therapy for exacerbations of pain. Massage can help relieve pain. Exercises can be beneficial. Surgery can help some patients to various degrees, but nearly half will not benefit. Spinal cord stimulators can help some patients who gain no relief from surgery.
Treatment is available for zygapophysial joint pain. View this article on Wiley Online Library. Competing interests:. Clinical guidelines for the management of low back pain in primary care: an international comparison.