bone, joint, and muscle disorders
Low Back Pain
Treatment of Low Back Pain
If a specific cause can be diagnosed, that disorder is treated. For example, antibiotics are used to treat a Prostatitis . However, there is no specific treatment for musculoskeletal pain due to sprains or strains nor for many other musculoskeletal causes. But many general measures can help. Usually, these general measures are also used when a spinal nerve root is compressed. Measures include Modifying activities Taking drugs that relieve pain Applying heat or cold to the painful area Light exercise as tolerated For low back pain that has recently developed, treatment begins with avoiding activities that stress the spine and cause pain—such as lifting heavy objects and bending. Bed rest does not hasten the resolution of the pain, and most experts recommend continued light activity. Bed rest, if required to relieve severe pain, should last no more than 1 or 2 days. Longer bed rest weakens the core muscles and increases stiffness, thus worsening back pain and prolonging recovery. Spinal corsets and Traction are not helpful. Traction may delay recovery. is usually recommended for pain relief unless inflammation is present. Over-the-counter or prescription Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) can relieve pain and reduce inflammation. If may improve quality of sleep and reduce pain in people with Fibromyalgia . Doctors sometimes tell people to take them only at bedtime. Application of Heat therapy or Massage may provide some temporary relief of low back pain. Some studies suggest that acupuncture may have similar benefits, but others suggest little or no benefit. Spinal manipulation, done by chiropractors or some other doctors (such as osteopathic doctors), may also provide relief when combined with an exercise program. However, spinal manipulation may increase the risk of further injury and should be avoided in people who have inflammatory arthritis, neck problems that cause instability of neck vertebrae, or a After the pain has subsided, light activity, as recommended by a doctor or Physical Therapy (PT) , can speed healing and recovery. In some cases, a course of treatment with a physical therapist can help. Specific exercises to strengthen and stretch the back and to strengthen core muscles are usually recommended to help prevent low back pain from becoming chronic or recurring. Sleeping in a comfortable position on a medium mattress is recommended. People who sleep on their back can place a pillow under their knees. People who sleep on their side should use a pillow to support their head in a neutral position (not tilted down toward the bed or up toward the ceiling). They should place another pillow between their knees with their hips and knees bent slightly if that relieves their back pain. People can continue to sleep on their stomach if they are comfortable doing so. Prevention (maintaining good posture, lifting correctly) should be continued or started. In response to these measures, most episodes of back pain resolve in several days to 2 weeks. Regardless of treatment, 80 to 90% of such episodes resolve within 6 weeks. Additional measures are needed for chronic low back pain. Aerobic exercise may help, and weight reduction, if necessary, is advised. If analgesics are ineffective, other treatments can be considered. Nondrug Pain Treatments (TENS) may be used. The TENS device produces a gentle tingling sensation by generating a low oscillating current. This current can block transmission of some pain sensation from the spinal cord to the brain. The current can be applied to the painful area several times a day for 20 minutes to several hours at a time, depending on the severity of the pain. Sometimes a corticosteroid (such asdexamethasoneormethylprednisolone) plus a local anesthetic (such aslidocaine) can be periodically injected into facet joints in the spine or the epidural space—between the spine and the outer layer of tissue covering the spinal cord. The epidural injections may be more effective for sciatica caused by a herniated disk than for lumbar spinal stenosis. However, it is not clear that they produce a long-term benefit. They are usually effective only for several days to weeks. Their main use is to relieve pain enough that an exercise program, which can provide long-term pain relief, can be started. If aherniated diskis causing relentless or chronic sciatica, weakness, loss of sensation, or loss of bladder and bowel control, surgical removal of the bulging part of the disk (diskectomy) and sometimes part of the vertebra (laminectomy) may be necessary. Forsevere spinal stenosis,a large part of the back of the vertebra (the lamina) may be surgically removed to widen the spinal canal (lumbar laminectomy). A general anesthetic is usually required. The hospital stay is usually 4 or 5 days. People may need 3 to 4 months before they can resume all of their activities. About two thirds of people have a good or full recovery. For most of the rest, such surgery may prevent pain and keep other symptoms from worsening. When the spine is unstable (as may result from a severe herniated disk, spondylolisthesis, or after laminectomy for spinal stenosis), surgery can be done to fuse vertebrae together (called lumbar spinal fusion). However, fusion decreases mobility and may put additional stress on the rest of the spine and cause further problems. Diskectomy involves surgically removing the bulging part of the disk. This procedure may be done when a herniated disk is causing relentless or chronic sciatica, weakness, loss of sensation, or loss of bladder and bowel control. Sometimes part of the vertebra must also be removed. This procedure is called a laminectomy. A person's spinal column consists of 33 vertebrae that house and protect the spinal cord. These vertebrae are separated and cushioned by intervertebral disks. When a disk becomes compressed, it may herniate, or rupture, and press on a nerve where it comes off the spinal cord. This can result in moderate to severe pain. In addition, extra growths of bone known as "spurs" may press against a nerve. If a bone spur is formed in the central canal of the vertebrae, then the spinal cord is also compressed. A surgical procedure called a lumbar laminectomy can relieve the pressure placed on the injured nerve and spinal cord. During a lumbar laminectomy, a small incision is created in the skin along the lumbar vertebrae. The muscles are separated and the bone is exposed. The "lamina" portion of the vertebrae is slowly and carefully removed, taking pressure off the pinched nerve and spinal cord. The nerve is then pulled gently to the side and the herniated portion of the disk is removed. The nerve is then relieved of all pressure and pain. Muscles are then put back in place and the incision is closed. There are several potential complications associated with this procedure that should be discussed with a doctor prior to surgery. The intervertebral disks make up one fourth of your spinal column and act as the spine's shock-absorbing system, protecting the vertebrae, spinal cord, and other structures. However, sometimes these disks degenerate and thin, causing the vertebrae they support to get closer together and pinch the nerves that exit between them. In severe cases, these disks are removed and replaced with bone harvested from the pelvis. This is called spinal fusion. Many doctors choose to approach the diseased disks from the front by first retracting the intestines and other organs to reveal the spinal column. The damaged disk is then removed. Openings slightly wider than the removed disk are drilled into the surrounding vertebrae. Titanium casings, or cages, are filled with the harvested pelvis bone and placed into the holes. Specialized cells called osteocytes within this bone produce new bone and aid in the site's healing. The openings in these cages allow the bone to grow around it. In addition, these casings provide support and structure while the bone is healing. Repeat x-rays of the spine should be done at 6 weeks, 3 months, 6 months, 1 year and 2 years to ensure that the new bone is healing properly. Treatment are quite common among women over 50 years of age. They can be treated conservatively with nonsurgical options such as braces, pain relievers, and possibly If pain is not adequately controlled, two surgical options are available: Vertebroplasty: A cement mixture is injected into the fractured bone. Kyphoplasty: A balloon is inserted into the fractured bone to create space. The balloon is then filled with cement. However, recent studies have shown that, in the long term, these surgical procedures are no more effective than nonsurgical options. 