Treatment of Low Back Pain
(shortcut to summary table of treatment)

Depending on what the underlying cause of the acute low back pain is, the therapy will vary considerably. Most of the back pains, as indicated above, are harmless and self-limiting, but extremely annoying to the patient. In the acute phase icing the back may give relief. Some patients have perhaps a weaker connective tissue.

For this reason are more prone to recurrent acute lower back problems. They may benefit from a few chiropractic manipulative treatments. Minor malalignments of the facet joints can be treated very quickly and effectively this way. But some patients are very sensitive in their back, perhaps because they lean more towards developing fibromyalgia or myofascial pain when they have a back pain.

These patients will find out that they do better with physiotherapy treatment modalities and they should be sent there. Once the patient knows what works for them, they usually gravitate into the right treatment modality. It would be a mistake to recommend one therapy over another. Some patients also seem to respond best to a few acupuncture treatments combined with stretching exercises and subsequent reactivation exercises.

If this is what it takes to overcome the acute back pain, go for it! After an initial one or two week passive treatment modality such as chiropractic, physiotherapy or acupuncture treatments it is important in all cases to switch over to a more active reactivation program with active exercises and stretching exercises.

If reactivation is neglected, the patient gets muscle atrophy from disuse and this sets the patient up to get a chronic back pain, posttraumatic fibromyalgia or myofascial pain syndromes.

The following table lists the specific therapeutic recommendations for the more common underlying causes of back pain. Links are provided in the table for more details of these therapeutic modalities.

Home page Arthritis Back pain Treatment table

 

Treatment modalities for lower back pain
Cause or disease:Treatment modalities:
facet joint disease (lower back strain)chiropractic or physiotherapy treatments initially followed by active exercises
degenerative disc and facet joint diseaseantiinflammatory medication and physiotherapy treatments, swimming; end stage intractible disease, if confined to one or two levels may respond to fusion surgery by spinal surgeon
spondyloarthropathies treat underlying disease and use antiinflammatories; rheumatologist referral for more specific therapy
osteoporosistreat underlying hormone disbalance, if present; regular walking and swimming; avoid alcohol, caffeine, stop smoking; use calcium, biphosphonates, vitamin D
scoliosisbracing during growth spurts; good posture; strehgthening exercises; in severe cases corrective surgery with Harrington rods by spinal surgeon
spinal stenosis decompression surgery for severe cases to free spinal cord and nerve roots
posttraumatic fibromyalgia

low dose antidepressants, cognitive therapy, mild physical exercises

disc herniation with or without sciaticaonly in 3% of all back pain is surgery indicated; many cases heal on their own
spondylolisthesis and other congenital malformations grade I to IIIA do not need surgery, stage IIIB and IV need fusion with instrumentation by spinal surgeon
bone metastases underlying cancer needs treatment, often chemotherapy required

 

Home page Arthritis Back pain Treatment table

Spondyloarthropathies

The underlying disease such as Crohns disease, ulcerative colitis, psoriasis or ankylosing spondylitis that has lead to this inflammatory disease of the spinal column needs to be treated. Sulfasalazine in the case of Crohns disease and ulcerative colitis might also help the spondyloarthropathy. The COX-2 inhibitory drug (brand name: Celebrex) is also useful, as are the regular anti-inflammatories. Keep an eye on side-effects of the COX-2 inhibitory medications, which are easier on the stomach, as one of these drugs (VIOXX) was pulled from the market in October of 2004. The VIOXX link explains this story in detail.

Otherwise reactivation, physical rehabilitation programs and postural improvements are helpful.

Osteoporosis

It is important that this condition be diagnosed as early as possible and not only when a radius or hip fracture occurs with a fall or a compression fracture of a vertebral body happens. A physical exercise program involving swimming, walking and stretching exercises is combined with a good nutritional program. The affected person must ensure that enough calcium is taken in by consuming milk products and taking calcium supplements. Vit. D supplements help to absorb more of the dietary calcium.

Calcitonin or a calcitonin analogue hormone by nasal spray can be given to build up stronger new bone. Sodium fluoride has been recommended in the past in an attempt to build up bone mass, but the bone that is built up with fluoride seems to be more brittle resulting in fractures again. Calcitonin hormone induces new bone growth that is identical to regular healthy bone and is preferred for this reason. Calcitonin is the hormone that stimulates bone cells called osteoblasts. These cells are the ones that have built bone when you grew up. It only makes sense that we would use the same mechanism to built up bone by using calcitonin when bone loss has occurred. In women who enter into the menopause estrogen replacement (in combination with progesterone) can be used to preserve bone mass. However, there is still a slightly higher than normal risk for the development of breast cancer (1.6 to 1.8-fold). In men testosterone levels need to be determined and if they are low, replacement with testosterone can be considered by the physician.

Home page Arthritis Back pain Treatment table

 

 

Disclaimer:

This outline is only a teaching aid to patients and should stimulate you to ask the right questions when seeing your doctor. However, the responsibility of treatment stays in the hands of your doctor and you.

References:

1. ABC of rheumatology, second edition, edited by Michael L. Snaith , M.D., BMJ Books, 1999.

2. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 52.

3. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 275,p.2429.

4. HA King  Orthop Clin North Am 1988 Apr;19(2):247-255.

5. HA King  Orthop Clin North Am 1999 Jul;30(3):467-474, ix.

6. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 59.

7. JA Smith Orthop Clin North Am Jul 1999; 30(3): 487-499.

8. The Merck Manual, 7th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 56, p. 469.

9. Wheeless' Textbook of Orthopaedics: http://www.wheelessonline.com/

10. Goldman: Cecil Textbook of Medicine, 21st ed.(©2000)W.B.Saunders

11. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc.

12. Rakel: Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

13. Suzanne Somers: "Breakthrough" Eight Steps to Wellness-- Life-altering Secrets from Today's Cutting-edge Doctors", Crown Publishers, 2008

Last Modified: March 18, 2012