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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