Medications And Other Treatments
Because most back pain will get better on its own within a few weeks, the most effective approach is often patience. However, this recommendation is among the most difficult to accept, especially in the early going, when the pain has not yet begun to improve.
If simple measures don't sufficiently relieve your pain and the problem persists over time, it's a good idea to see a health-care provider if you haven't already. A full assessment may include selected diagnostic tests, which may help decide the best course of action for your symptoms.
Remember that each person's symptoms and response to therapy are unique and can change, so it's important to keep an open mind about treatment options. A series of empiric treatments — that is, a series of treatments tested by trial and error to see which works best — may be needed in order to find an effective therapy for you. Follow-up with your health-care provider or specialists may be important if the pain does not improve, especially if new symptoms arise over time. Sticking with an action plan, but being ready to change course, is a major challenge for you and your health-care provider when dealing with chronic or unresponsive low back pain.
Depending on what further assessment turns up, you and your health-care provider may decide to pursue any of the following approaches:
Drugs such as ibuprofen or naproxen may be helpful for low back pain when given in higher doses than are available over the counter. However, you may need to avoid anti-inflammatory drugs if you have certain medical problems, such as ulcer disease or kidney failure, that may be exacerbated by these drugs. If over-the-counter medications, such as acetaminophen or low-dose anti-inflammatory medicines (including ibuprofen or naproxen) are effective, there is no reason to take stronger, prescription-strength drugs.
Muscle relaxants (such as cyclobenzaprine or diazepam), tramadol (a nonnarcotic pain reliever) or narcotic medications (such as codeine) may be considered for low back pain. Some health-care providers advocate a brief course of corticosteroids for disk disease or spinal stenosis, although the effectiveness of this approach is unclear. For certain causes of pain, especially infections or cancer, other prescription drugs, including antibiotics or chemotherapy, may be recommended.
Physical therapists offer a number of treatment approaches for low back pain, including education about posture, lifting, stretching, exercise and other activities. Ultrasound (sound waves) and electrical stimulation applied to the lower back may be useful as well. Exercises to gradually strengthen abdominal, hip flexor and back muscles may also help.
Pain management clinics focus on evaluating and treating severe low back pain and other painful conditions. These specialists may recommend different prescription drugs (such as amitriptyline or Neurontin, commonly prescribed for chronic pain) or injections of cortisone and anesthetic agents into the painful area. Or they may suggest combining medical treatments with counseling, to help with coping for example. A combination of these options is often best. Combination treatment should be tailored to each patient, as treatment for one type of back pain may not be effective for another. For instance, degenerative joint disease or spinal stenosis may respond better than muscle strain to a local injection. Specialists who can be helpful in treating low back pain include neurologists, rheumatologists and orthopedic surgeons.
For certain conditions, such as disk disease, spinal stenosis or spondylolisthesis, surgery may prove to be the only highly effective treatment, although it is usually tried as a last resort. Surgery won't work well for all causes of low back pain, however, and it is usually appropriate for only those cases in which there is a clear physical problem, such as a pinched nerve, that can be corrected with surgery. Surgical options now include minimally invasive procedures for some type of fractures and disk disease. Minimally invasive procedures allow surgeons to operate through small incisions, rather than the large openings required in traditional surgery. This can speed healing.
For low back pain caused by cancer, radiation therapy along with chemotherapy, surgery or both can often significantly reduce pain.
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