Tuesday, March 21, 2017

New Treatment Guidelines Stress Non-Drug Interventions for Back Pain


Back pain is one of the most common health complaints across the globe, and the No. 1 cause of job disability. It's also one of the most common reasons triggering opioid dependence, the side effects of which can be lethal.

In 2013 alone 16,000 Americans died from overdosing on prescription painkillers. If you have back pain and suffer depression or anxiety you're at particularly high risk for opioid abuse and addiction.
Mechanical low-back pain (LBP), is the second most common symptom-related reason for doctor's visits. LBP is typically preceded by some form of injury or strain, such as lifting, twisting while holding something heavy, a car collision or a fall.  
Prolonged sitting is also on this list, which may explain why simply standing up more is part of the solution in many cases. Some of the things that can help low back pain are controlling inflammation, restoring range of motion, improving muscle strength and endurance, coordination training and cardiovascular reconditioning and an exercise program.
Activity Is the First Line of Treatment
Research shows us emphasis is on functional movement and exercise. This holds true for most forms of back pain, not just LBP. This makes sense since your body needs regular activity to remain pain-free. When you sit for long periods of time, you typically end up shortening your iliacus, psoas and quadratus lumborum muscles that connect from your lumbar region to the top of your femur and pelvis. When these muscles are shortened it can cause severe pain upon standing, as they will effectively pull your lower back forward. When there's insufficient movement in your hip- and thoracic spine, you also end up with excessive movement in your lower back.
Most people tend to "baby" the pain and avoid moving about as much as possible, but in most cases, this is actually contraindicated.
Lesley Colvin, a pain medicine specialist in Edinburgh, says the best evidence is for exercise. 'If I had back pain, I'd do exercise that strengthens the core and stretching.' Just when you least feel like it, and it hurts the most, is when experts say you have to get moving. 'Avoid bed rest'."
Exercise is also the most effective way to prevent back pain in the first place, or a relapse, according to a recent scientific review of 21 studies. 
Among people who had a history of back pain, those who exercised had a 25% to 40%  lower risk of having another episode within a year than those who did no exercise. Medical doctors are increasingly starting to prescribe activity in combination with a wait-and-watch approach for back pain patients.
On February 14/17, the American College of Physicians issued updated treatment guidelines for acute, subacute and chronic low back pain, now sidestepping medication as a first-line treatment and recommending non-drug therapies instead. This is a significant change, and one that could potentially save thousands of lives by avoiding opioid addiction.
The new guidelines include three primary recommendations, all of which focus on alternative treatments and physical activity, leaving painkillers as a very last resort. Even in the rare case when an opioid is given, it should only be prescribed in the lowest dose and for the shortest duration possible.
Steroid injections and acetaminophen are also discouraged, as studies suggest neither is helpful or beneficial. Acetaminophen does not lower inflammation, and a review of the research shows steroids are on par with placebo when it comes to treating back pain in the long term.
1. “Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select non-pharmacologic treatment with superficial heat … massage, acupuncture, or spinal manipulation … If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants.
2. For patients with chronic low back pain, clinicians and patients should initially select non-pharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, or spinal manipulation.
3. In patients with chronic low back pain who have had an inadequate response to non-pharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy.
Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.”
Scans and Surgery Are Useless for Most Cases of Back Pain
According to the American College of Physicians, scans like MRIs are also to be avoided, as they're "worse than useless" for diagnosing back pain. Exceptions include cases of known trauma to the spine and where there are warning signs of underlying disease causing the pain (such as cancer). Contrary to popular belief, disc degeneration does not cause back pain, so getting a scan and receiving a structural diagnosis of a bulging disc for example, is not going to be very helpful, at least not in terms of dictating a course of treatment for your pain. In many cases, such a diagnosis may simply lead to unnecessary surgery, which in many cases sends patients in a downward spiral of increasing pain and reduced mobility. According to the medical literature, spinal fusions for back pain have a success rate of about 20 to 25 percent. For 75 to 80 percent of these patients, the surgery simply results in lifelong pain and suffering.
Live Life and Avoid Medicalizing Your Pain 
Dr. James Weinstein, a back pain specialist stated "What we need to do is to stop medicalizing symptoms. Pills are not going to make people better … why not just go back to your normal activities? I know your back hurts, but go run, be active, instead of taking a pill."
While this may sound harsh to some of you, it's actually really good advice. As noted by Dr. Steven Atlas, an associate professor at Harvard Medical School who wrote an accompanying editorial about the guidelines, "We are moving away from simple fixes like a pill to a more complex view that involves a lot of lifestyle changes," and that is certainly a much-needed turnaround.
Non-Exercise Activity May Be Part of Long-Term Solution for Back Pain
Keep in mind that part of "staying active" includes avoiding sitting as much as possible. Avoid the hazards of sitting and began standing more. Be aware that your pain may worsen initially, but will improve with time. If you have a desk job, consider investing in a stand-up desk.
Non-Drug Solutions for Pain Relief
It's extremely important to be fully aware of the addictive potential of opioid drugs, and to seriously weigh your need for them. There are many other ways to address pain.  Clearly, there are times when pain is so severe that a narcotic pain reliever may be warranted. But even in those instances, the options that follow may allow you to at least reduce the amount you take, or the frequency at which you need to take them. 
If you need a pain reliever, consider an over-the-counter (OTC) option. Research shows prescription-strength naproxen (sold OTC in lower dosages as Aleve) provides the same pain relief as more dangerous narcotic painkillers.
Many studies have confirmed that chiropractic management is much safer and less expensive than allopathic medical treatments, especially when used for pain such as low back pain.
Chiropractic and naturopathic physicians are reliable, as they have received extensive training in the management of musculoskeletal disorders during their course of graduate healthcare training. We have comprehensive training in musculoskeletal management.
Medical doctors are often slow to change from pharmaceutical treatments.
As Chiropractors, this research backs up what we have been saying for over 100 years. Get the spine that is in abnormal position moving again with Chiropractic adjustments. Then stretch and exercise to strengthen the spine and its supporting structures. M.D.’s and researchers are finally coming around to what has been a Chiropractic tenant since its inception. So if you have back pain, do what the research says, get adjusted and avoid drugs.

Dr. Stephen Kelly practices at Family First Chiropractic, 142 Erickson Drive, Red Deer, Alberta. 403-347-3261.www.family1stchiro.ca.


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