Vitality - Healthy Aging NewsletterFall 2012

Understanding and Treating Back Pain

Many of us will suffer from back pain at some time in our lives.

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Christine Nguyen, DO, who taught a continuing medical education course on back pain last year, shared the following overview and offered tips for relief with Vitality.

What are some of the most common causes of back pain?
About 70 percent of back pain is mechanical, caused by strains and injuries from trauma, overuse, a sedentary lifestyle, and posture.

What about other conditions that cause pain?
Degenerative joint disease (DJD) causes about 10 percent of cases. Other causes include osteoporosis, spinal stenosis, trauma and fractures, and herniated disks.

In DJD — also known as osteoarthritis, spinal arthritis, and spondylosis — the spinal disk becomes flatter and less flexible, causing back pain and stiffness.

Herniated or ruptured discs are cracks in a spinal disc, the rubbery cushion between the vertebrae that can press on the sciatic nerve and send pain from the low back through the buttocks and down one leg to below the knee, occasionally reaching the foot.

If you have osteoporosis, daily lifting and other routine activities can cause compression fractures that often lead to back pain.

Are we more likely to have back pain as we age?
Yes. it's due in part to the aging process and also as a result of too little (sometimes punctuated with too much) exercise. Bone strength, muscle elasticity, and tone decrease, and our discs begin to lose fluid and flexibility, which reduces their ability to cushion the vertebrae.

If I have back pain now, will I always have it?
No. Most people will have recurrences of back pain throughout their lives. The important thing is to try to find the root cause so that it can be corrected, and work with your doctor on ways to prevent subsequent events.

Can back pain be prevented?
Yes, particularly low back and lumbar strain, which constitute the majority of mechanical back pain. Our physicians begin with prevention, and offer patient education, weight-loss support, and information on fitness programs. Back pain is less prevalent in patients who lead an active lifestyle. You can help prevent injuries by doing strengthening exercises that don't jolt or strain the back, maintaining correct posture, and lifting heavy objects properly.

Is bed rest a good way to recover from back pain?
Bed rest used to be recommended as a way to recover from mechanical back pain. Now it's strongly discouraged. The best remedy is to keep moving and stay as active as you can.

What are some of the most effective treatments?
For acute back pain, such as a lumbar strain, pain medications like acetaminophen and nonsteroidal anti-inflammatory drugs are beneficial. Appropriate imaging helps evaluate for injuries and chronic conditions, and exercise, physical therapy, or other therapies might be recommended. If surgery is found to be warranted, our surgeons are skilled at both minimally invasive spine techniques and more complex spine cases.

How is chronic back pain treated?
Effective treatments include biofeedback, meditation techniques, and behavioral or cognitive therapy, which is especially helpful for patients who have underlying depression or emotional stress that is worsening their perception of pain. If pain is chronic, it's also important to address other psychological or emotional factors that may be hindering your healing process.

Prescription pain medication is usually not recommended for chronic back pain because of side effects, including drowsiness, nausea, confusion, and a high potential for dependency.

How effective are alternative therapies?
Although there is no strong scientific evidence that therapies such as acupuncture, yoga, or massage provide a long-term solution, they have been shown to offer temporary pain relief. Patients report relaxation and relief from massage therapy and other hands-on manipulative therapy. Yoga is beneficial because it relaxes the mind and encourages an active role in the healing process through movement and exercise. It's also a safe way to increase strength and flexibility to help prevent further back pain and injuries.

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