Non-Surgical Management of Back Pain - Activity Modification and Drugs

Introduction:

Back pain is amongst the most frequent reasons why people visit a doctor or miss work. It can also result in disability. There are various causes for back pain, and patients are usually confused about their management and treatment options. The question that makes many ponder is if there is really an effective way to reduce the pain without undergoing surgery. The good news is, there are various non-surgical modalities that are sufficient to control the symptoms, and surgery may be deferred. Simple home treatment and activity modification often heal the back within a few weeks and provides relief from back pain. Before we get into the non-surgical treatment options, let us discuss the common causes of back pain and associated symptoms.

What Are the Common Causes of Back Pain?

The following are the most common causes of lower back pain:

1. Muscle Strain - A strained back muscle is the most common cause. This results from lifting heavy objects in the wrong position and suddenly or over-activity.

2. Disk Injury - The spine is made up of interlocking vertebrae, and disks provide cushioning between each vertebra. Injury to the disk is a fairly common cause of back pain.

3. Osteoarthritis - Arthritis or inflammation of the spine can narrow the space around the spinal cord (spinal stenosis) or damage the cartilage present in the lower back.

4. Osteoporosis - A condition where the loss of bone density can cause fractures in the vertebrae.

5. Slipped or Herniated Disk - When the cushioning disks move out of position, they can press on the nerve exiting the vertebra, resulting in severe back pain, numbness, and sciatica.

There are various other possible causes for back pain, but they are rare. Suppose your back pain does not resolve in a few weeks; your doctor will rule out other rare causes of back pain, such as degenerative spondylolisthesis, cauda equina syndrome, cancer, kidney infection, or kidney stones.

What Are the Non-Surgical Treatment Modalities?

1) Activity Modification:

Activity modification is of prime importance. Decreased lifting, twisting, and forward bending are the mainstay in non-surgical management. A period of relative rest may be needed for acutely flared-up symptoms. A period of rest to reduce the pain should always be followed by exercise. Stationary bicycle riding, aquatic exercises, and partially unloaded treadmill exercises are well tolerated. Hyperextension regimens should always be avoided. Flexion exercises are preferred as they increase the flexibility of lumbar soft tissues.

2) Medication (Drugs):

Various drugs can be used to reduce the pain and symptoms. Some examples include:

• Painkillers - Acetaminophen, Ibuprofen, Naproxen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) have been frequently used. However, these should be taken with precaution. NSAIDs may lead to gastrointestinal problems and hence may be avoided in elderly individuals.

• Narcotics/Opioids - Opioids may be used in acute flare-up cases. These are more potent painkillers. Examples include Oxycodone and Hydrocodone. They are habit-forming and should be used with caution and under medical supervision.

• Topical Ointments - Ointments containing Diclofenac, Ibuprofen, and Lidocaine are highly effective in reducing back pain.

• Muscle Relaxants - If the cause is muscle spasm, muscle relaxants are helpful.

• Injections - Injection therapies are variably recommended for back pain, trigger points, and nerve root sleeves. Epidural injections are more common yet also remain controversial. Such injections and blocks are mainly helpful in acute conditions to reduce the pain. Typically, three-weekly injections of Depo-Medrol (Methylprednisolone acetate) and Xylocaine (Lidocaine) are given through the sacral hiatus.

The use of muscle relaxants and injections are controversial, except in acute cases.

3) Physical Therapy:

A physiotherapist or physical therapist will teach you exercises and perform hands-on manipulation. This modality reduces pain without medications. PT can help with pain due to osteoarthritis, nerve pain, etc.

4) Lumbar Corset:

A lumbar corset decreases movement, and hence the pain is reduced. However, it may lead to weakness and is therefore advised based on the individual condition.

5) Other Modalities:

Other modalities of non-surgical treatment include:

• Manipulation - Spinal adjustment or manipulation uses pressure on the spine to ease the pain. Manipulation can be done with the help of hands or special devices.

• Stress Reduction - Yoga and other stress-reduction techniques can reduce pain.

• Acupuncture - Acupuncture can help release certain chemicals from the spinal cord, which have natural pain-relieving properties.

• Ultrasound - Using an ultrasound, heat and energy are delivered to the lower back, which reduces pain.

• Transcutaneous Electrical Nerve Stimulation (TENS) - Here, a low voltage electric current is used to relieve pain.

• Traction - This is done to relieve pressure on the spine.

Can You Prevent Back Pain From Recurring?

You might be able to prevent back from recurring by strengthening your back muscles and avoiding its common triggers or risk factors.

• Exercise - Perform activities that do not strain your back, such as low-impact aerobics, walking, and swimming. You can also strengthen your back muscles with the help of abdominal and back muscle exercises.

• Weight Maintenance - Excess weight strains the back muscles, which can be avoided by maintaining an ideal weight.

• Smoking Cessation - As smoking increases the risk of back pain, quit smoking.

• Good Posture - Do not slouch while standing or sitting, and maintain a neutral pelvic position. Maintaining a good posture reduces the stress on your back muscles. If you spend hours sitting, choose a chair with good back support and armrests. Under the guidance of a physician, individuals have the option to buy back support for pain relief.

• Avoid Heavy Lifting - Instead of engaging your back muscles while lifting something heavy, put the load on your legs. Do not twist your back and just bend the knees.

It is important to know whether a person would require a surgical or non-surgical modality. Hence, proper X-rays or MRIs may be needed before coming to a definite conclusion. In a study, it was published that about 73 % of back pain patients may get relieved by non-surgical methods. However, 27 % would still require surgery. So, it is important to find out the group one belongs to before starting medications.