Wednesday, January 14, 2015

BACK PAIN



Lower back pain is usually felt by everyone at some point.  For many, the prolonged loss of function, loss of work, and medical payments results in difficult economic problems, usually costing the nation billions annually.  Some cases are short lived and transient, but those lasting over 3 months have chronic back pain.

There are many causes of chronic back pain, some very serious.  The work-up includes a history about common causes like osteoporosis and osteoarthritis, infections, and even cancer.  Labs are often ordered to check for inflammatory processes, infections, cancers, and bone pathology.  Finding the right cause can be frustrating as imaging like plain x-rays have limited use, usually requiring and MRI or CT, which are often withheld at least one month from the beginning of symptoms.

Initial treatment is usually done with Tylenol and other nonsteroidal anti-inflammatory drugs (i.e. aspirin).  If these patients do not respond, opioids, muscle relaxants, or Tramadol are used next.  Alternatives like acupuncture, physical therapy, massage, and behavior therapy can be effective in some cases.  Epidural steroid injections have limited use, usually reserved for radicular symptoms.  Surgery is usually the last resort, often without much benefit.  
 
Some studies have suggested Harpagophytum procumbens (devil's claw) in a dosage of 50 mg daily, Salix alba (white willow bark, a source of salicylic acid) in a dosage of 240 mg daily, and Capsicum frutescens (cayenne) plaster applied topically every day may have some positive results.
The length of disability and finding proper treatments often lead to psychosocial problems.  Studies have suggested these issues can arise as depression, anxiety, insomnia, significant weight changes, and disturbed mood, leading to worst outcomes.
 
Much frustration comes from the stepwise approach needed for proper treatment compared to the often patient’s quick fix expectations.  Working with your doctor and multidiscipline teams are essential, and goals should be discussed to assess improvement.

As you can see, chronic back pain can be very detrimental and complicated.  Many cases can be avoided by reducing back stress and keeping back muscles strong and healthy.  So prevention can be started years before pain develops.  Practice proper lifting techniques, lower back exercises, and weight loss.

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