^ Jump up to: a b c d e f Practical management of pain. Benzon, Honorio T.,, Rathmell, James P.,, Wu, Christopher L.,, Turk, Dennis C.,, Argoff, Charles E.,, Hurley, Robert W., (Fifth ed.). Philadelphia, PA. ISBN 9780323083409. OCLC 859537559.
T-tests (paired and unpaired where appropriate) employing Holm’s method of p-value adjustment were used for all post-hoc pair-wise comparisons following significant ANOVA/ANCOVA results. The R-Project statistical software version 2.12.1 was used for all data analyses (The R Foundation for Statistical Computing, Institut für Statistik und Wahrscheinlichkeitstheorie, Vienna, Austria).
Imaging is indicated when there are red flags, ongoing neurological symptoms that do not resolve, or ongoing or worsening pain. In particular, early use of imaging (either MRI or CT) is recommended for suspected cancer, infection, or cauda equina syndrome. MRI is slightly better than CT for identifying disc disease; the two technologies are equally useful for diagnosing spinal stenosis. Only a few physical diagnostic tests are helpful. The straight leg raise test is almost always positive in those with disc herniation. Lumbar provocative discography may be useful to identify a specific disc causing pain in those with chronic high levels of low back pain. Similarly, therapeutic procedures such as nerve blocks can be used to determine a specific source of pain. Some evidence supports the use of facet joint injections, transforminal epidural injections and sacroilliac injections as diagnostic tests. Most other physical tests, such as evaluating for scoliosis, muscle weakness or wasting, and impaired reflexes, are of little use.
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Berman BM, Langevin HH, Witt CM, Dubner R. Acupuncture for Chronic Low Back Pain. N Engl J Med. 2010 Jul 29;(363):454–461. PubMed #20818865. PainSci #54942. ← That symbol means a link will open in a new window. Try one!
Given the prevalence of back pain, you would think we’d have treatment for it down pat. Not even close. The challenge is that you can’t see injuries to tendons, ligaments, and muscles the way you can bone fractures and herniated disks, says Jeffrey Katz, MD, a professor of medicine and orthopedic surgery at Brigham and Women’s Hospital in Boston and the author of Heal Your Aching Back. Despite diagnostic advances, doctors can’t pinpoint an exact cause for as many as 85 percent of back problems, which makes them tricky to treat. Spinal manipulation, for example, is controversial — some docs say it does more harm than good — but it’s the only remedy that got me off the couch and back on my bike. Chiropractic care is not without concerns; then again, neither is traditional medicine, particularly when you’re dealing with a problem like back pain, which has no easy, one-size-fits-all fix, says Mark Moyad, MD, a FITNESS advisory board member and the director of preventive and alternative medicine at the University of Michigan Medical Center.
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You don’t need to take my word for anything — you can just take the word of the many low back pain medical experts that I quote,11 and the hard evidence that their opinions are based on. At the same time, I am realistic about the limits of the science, much of which is pretty junky.12 My own credentials are somewhat beside the point. My decade of professional experience as a Registered Massage Therapist does help me understand and write about low back pain, but what really matters is that I refer to and explain recent scientific evidence, but without blindly trusting it.
About 8 in 10 people have one or more bouts of low back pain. In most cases, it is not due to a serious disease or serious back problem, and the exact cause of the pain is not clear. This is called nonspecific lower back pain. The usual advice is to keep active and do normal activities as much as possible. Painkillers can help until the pain eases. In most cases, the pain disappears within six weeks but may come back (recur) from time to time. Persistent (chronic) pain develops in some cases and further treatment may then be needed.
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The discs are pads that serve as cushions between the individual vertebral bodies. They help to minimize the impact of stress forces on the spinal column. Each disc is designed like a jelly donut with a central, softer component (nucleus pulposus) and a surrounding, firm outer ring (annulus fibrosus). The central portion of the disc is capable of rupturing (herniating as in a herniated disc) through the outer ring, causing irritation of adjacent nervous tissue and sciatica as described below. Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae to each other and surround each of the discs.
I was an alternative health professional myself for many years — a Registered Massage Therapist, trained in Canada (which has unusually good training standards). Of course, some of my colleagues in alternative medicine were diligent students of medical science. However, in my experience, most were certainly not — indeed, many lacked even the most basic knowledge of how medical science works or how to keep current about recent discoveries with clinical implications. BACK TO TEXT
Management of low back pain depends on which of the three general categories is the cause: mechanical problems, non-mechanical problems, or referred pain. For acute pain that is causing only mild to moderate problems, the goals are to restore normal function, return the individual to work, and minimize pain. The condition is normally not serious, resolves without much being done, and recovery is helped by attempting to return to normal activities as soon as possible within the limits of pain. Providing individuals with coping skills through reassurance of these facts is useful in speeding recovery. For those with sub-chronic or chronic low back pain, multidisciplinary treatment programs may help. Initial management with non–medication based treatments is recommended, with NSAIDs used if these are not sufficiently effective.
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After a thorough review, your doctor probably has come to one or two conclusions as to what is causing your back pain and other symptoms. To obtain more information about your back problem, and to help confirm the diagnosis, the doctor may order an x-ray, CT scan, or MRI. Sometimes lab tests are ordered too. Keep in mind that an accurate diagnosis is essential to a well-developed treatment plan.
This list includes the more common causes of back pain, but there are many more. Finding the optimal treatment for low back pain usually depends on obtaining a correct clinical diagnosis that identifies the underlying cause of the patient’s symptoms.
^ Jump up to: a b c d e Vos, T (15 December 2012). Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 380 (9859): 2163–96. doi:10.1016/S0140-6736(12)61729-2. PMID 23245607.
The spinal cord, which contains the nerve pathways to and from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae to take and receive messages to various parts of the body.
^ Jump up to: a b c d e f g h Marlowe D (September 2012). Complementary and alternative medicine treatments for low back pain. Prim. Care. 39 (3): 533–46. doi:10.1016/j.pop.2012.06.008. PMID 22958563.