How do I know what is causing my back pain?
To diagnose back pain—unless you are completely immobile due to a back injury—your doctor may test your range of motion and nerve function, and touch your body to locate uncomfortable parts. Sometimes blood and urine tests are done to make sure the back pain is not caused by infection or other broader medical problems.
If your symptoms persist for more than four to six weeks, you have suffered trauma. If your doctor suspects a serious cause behind back pain, he may order an X-ray. X-rays can be used to pinpoint fractures or other bone defects. They can sometimes help locate problems in connective tissue. In order to analyze soft tissue damage, including disc problems, a computed tomography (CT) or magnetic resonance imaging (MRI) scan may be required. To determine possible nerve or muscle damage, electromyography (EMG) may be useful.
X-ray and MRI studies have limitations and must be interpreted with caution. Back pain may be wrongly attributed to non-specific and irrelevant abnormalities on the image. Normal and expected wear and tear of the spine and intervertebral discs can be mistaken for a person’s back pain.
Most back pain originates in the back, not the actual spine. Since most back pain is related to the back muscles, the specific cause of most back pain cannot usually be determined by imaging studies.
What are the treatments for low back pain?
Only after determining the cause of the problem, the doctor can begin to treat back pain.
rest: The basic treatment to relieve acute back pain caused by strain or minor injury is to rest for 24 to 72 hours in a limited time. Ice packs can help reduce pain and inflammation just like aspirin or other non-steroidal anti-inflammatory drugs (NSAIDs). Do not give aspirin to children 18 years of age or younger, as this increases the risk of Reye’s syndrome. After the inflammation subsides, heating can relieve the cramping muscles and tense connective tissue.
For most cases of back pain, long-term bed rest is not only no longer considered necessary, but can actually be harmful, slowing down recovery and possibly causing new problems. In most cases, you need to start normal non-strength activities (such as walking) within 24 to 72 hours. Afterwards, ask your doctor for information about controlling exercise or physical therapy. Physical therapy may use massage, ultrasound, whirlpool baths, controlled calorie applications, and tailored exercise programs to help you get the most out of your back. Strengthening the abdominal and back muscles helps stabilize the spine. You can help prevent further back injuries by learning and doing gentle stretching exercises, correct weight lifting techniques, and maintaining good posture.
drug: If back pain prevents you from performing normal daily activities, your doctor can help by recommending or prescribing pain medication. Over-the-counter pain relievers, such as Tylenol, aspirin, or non-steroidal anti-inflammatory drugs such as ketoprofen, ibuprofen (Advil, Motrin), and naproxen (Aleve), may help. For severe pain, your doctor may prescribe a prescription-strength anti-inflammatory/pain reliever, or may prefer to prescribe a short-term combination of opioids (narcotics) and acetaminophen drugs (such as Vicodin or Percocet). Some doctors also prescribe muscle relaxants. But be aware that some of these drugs have a direct effect on the brain and usually cause drowsiness.
Opioids can be addictive and long-term use of them should be avoided unless a clear cause of back pain related to injury or illness can be determined. Even so, they must be used with caution under the close supervision of a doctor.
If your attending doctor cannot help you manage your pain, they may refer you to a back specialist or pain specialist. Sometimes these doctors will use steroid or anesthetic injections to help control pain or make a diagnosis.
The use of injections and surgery in and around the spine is limited because such treatments usually only provide temporary relief. However, when other methods fail, they may be important in helping diagnose the structural causes of pain and assisting in physical recovery. Various injection procedures are costly and have potential side effects and should be discussed in detail before proceeding. Usually, pain specialists or back specialists also hire non-physicians (such as therapists, counselors, and patient educators) to provide rehabilitation and counseling services.
ten: Some doctors advocate the use of transcutaneous electrical nerve stimulators (TENS). The electrodes attached to the body carry a gentle current, which helps to relieve pain. After proper training, patients can use TENS on their own to help relieve back tension or pain from moderate injuries.
Non-specific back pain surgery is the last resort, because in the absence of loss of movement and sensation or other findings (such as loss of muscle volume and reflexes), spinal problems are unlikely to be the cause of chronic non-specific back pain. If the pain spreads to the extremities and imaging studies show that the nerve tissue in the spine is compressed or damaged, if loss of function and pain persist after conservative treatment trials with medications and activity adjustments (including home), surgery is still a consideration Exercise plan and physical therapy.
Rootectomy: In the case of persistent pain due to extreme nerve damage, a rhizotomy (surgical cutting of the nerve) may be required to prevent the pain from being transmitted to the brain. Nerve rhizotomy can correct symptoms caused by friction on the joint surface of the spine, but it cannot solve other problems, such as a herniated disc.
Chiropractic: The United States Health Care Research and Quality Institute recognizes that chiropractors and osteopaths perform chiropractic as effective for acute low back pain. Its effectiveness in treating chronic back pain is unclear. Some researchers believe that early manual treatment of acute back pain can prevent the development of chronic problems. Other doctors warn against some chiropractic therapies, especially those that involve a quick twist of the neck. Spinal manipulation can be considered a conservative treatment for acute and chronic back pain because it is not invasive and does not use prescription drugs.
Because osteopathic doctors are fully licensed doctors, their osteopathic treatment is likely to be a combination of medication and chiropractic, followed by physical therapy and exercise.
acupuncture: Both the American Pain Association and the American College of Physicians have issued guidelines stating that when other treatments fail, acupuncture can help patients with chronic low back pain. It can be used alone or as part of a comprehensive treatment plan that includes drugs and other therapies. However, there is not enough evidence to recommend it for acute back pain.
CBT: If you consult a psychotherapist for cognitive behavioral therapy (CBT), your treatment may include stress management, behavioral adaptation, education, and relaxation techniques. CBT can reduce the intensity of back pain, change the perception of pain and disability, and even relieve depression. NIH believes that CBT can be used to relieve low back pain, and the cited research shows that CBT is superior to conventional care and placebo.
Other comprehensive behavioral programs have achieved similar success, where participants were able to reduce the amount of medication needed while improving their outlook and pain-related behaviors.
Biofeedback: If low back pain is related to muscle tension or cramps, biofeedback can effectively reduce pain intensity, reduce medication use, and improve quality of life. Biofeedback can help you train your muscles to better cope with stress or exercise.
Exercise method: The Alexander technique, Pilates, and Fedenquist method are all special forms of physical exercise that can help you learn to move in a more coordinated, flexible, and elegant manner. They may help you better understand your movements and may help relieve stress. Some yoga postures may help reduce back pain and improve flexibility, strength and balance. Yoga is also good for reducing stress and can help relieve the psychological aspect of pain. Core exercises can strengthen the muscles that support the back and help reduce pain. These non-medical and conservative treatments empower patients. The empowerment of this self-help plan can reduce feelings of helplessness and pain without any impact on body tissues and structures. More research is needed to understand how these exercise techniques affect back pain.
Spa: Hydrotherapy and exercise can also improve the flexibility and relieve pain of some people with chronic low back problems. It is especially beneficial for patients who cannot tolerate land-based physical therapy. This is because the unique properties of water usually make it a safe environment for back pain exercise, providing gentle resistance, comfort and relaxation. Fear of exercise-related pain is the main limiting factor in rehabilitation and exercise therapy. The support and warmth of water enable people to gradually introduce daily exercise into their treatment.
In many cases, it is impossible to understand the cause of pain and be able to solve the problem. In this case, the main goal of pain management therapy may be to make the patient as effective as possible despite any discomfort.