Noninvasive treatments for back pain

The goal of noninvasive treatment for back pain is twofold:

• Reduce but not necessarily eliminate your pain
• Help you improve your function so that you can resume as closely as possible your normal routine of work and leisure

After talking to you about the particular circumstances involving your back pain, your doctor may recommend one or more of the following common treatment options:

Back brace. Many back braces or corsets (lumbar supports) are available without a prescription at pharmacies and medical supply stories. Or, your doctor may prescribe a specific brace customized for your back. The rationale behind braces is that they may support your abdomen and take some of the load off your lower back, they may restrict motion, and they may improve posture. But there's also concern that use of braces may result in the wasting away (atrophy) of some muscles that support the spine through lack of use. If you use a brace, limit the use to intermittently several hours a day. If you have a labor-intensive job that places stress on your lower back, a back brace or corset can help you when you first return to work after a back injury by avoiding too much strain on your spine.

Back braces and corsets may also make transitional movements — such as from a sitting to a standing position — more comfortable during an episode of back pain. There's insufficient evidence that back braces are more effective at relieving back pain than no treatment at all. The best course of action may be strengthening your trunk muscles to be the primary support for your back.

Pain medications. You can take nonprescription medications, or your doctor may suggest prescription medications to relieve your discomfort until inflammation subsides and your body heals itself. Options include:

• Over-the-counter (OTC) analgesics. Analgesics are medications that relieve pain. They include nonsteroidal anti-inflammatory drugs (NSAIDs), counterirritants and topical analgesics. NSAIDs, such as aspirin, naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), can relieve pain and reduce inflammation. Another option is counterirritants, which you apply to your skin as a cream or spray. These nonprescription medications — which include Bengay, Icy Hot and capsaicin (Zostrix) — stimulate your sensory receptors of heat or cold to cover up or counter pain. Counterirritant products may temporarily relieve chronic pain. Topical analgesics, many of which contain salicylates — the main ingredient in aspirin — also can reduce inflammation. NSAIDs appear to provide some relief for acute back pain, but evidence is still lacking regarding effectiveness of NSAIDs in chronic low back pain. In addition, though NSAIDs are widely used for treatment of low back pain, long-term use can have side effects, particularly effects on the gastrointestinal system and the kidneys.
• Anticonvulsants. Low doses of drugs more commonly used in the treatment of seizures and epilepsy are sometimes used to help people who have low back pain in conjunction with leg pain. These medications include gabapentin (Neurontin), topiramate (Topamax), clonazepam (Klonopin), carbamazepine (Carbatrol, Tegretol) and valproate (Depacon). These drugs aren't usually useful in treating low back pain. Instead, they're sometimes directed at treating the leg pain component in people who primarily have back pain associated with leg pain.

• Antidepressants. Some antidepressant medications, taken in lower doses than would be used to treat depression, may help in the treatment of low back pain. Antidepressants may work in a variety of ways. For example, they may result in a higher level in your brain of serotonin, a neurotransmitter associated with pain control. Antidepressants may also reduce anxiety and muscle tension.

  The evidence on the effectiveness of antidepressant medications in the treatment of low back pain is mixed. Among this group of medications, tricyclic antidepressants (TCAs) appear to be the most effective. They include such medications as nortriptyline (Aventyl, Pamelor), amitriptyline, desipramine (Norpramin), doxepin (Sinequan) and imipramine (Tofranil). Medications called selective serotonin reuptake inhibitors (SSRIs) don't appear to be as effective as TCAs for back pain.

• Opioids. In select cases, doctors may use certain narcotic medications (opioid analgesics) to treat low back pain. Examples of these medications include morphine (MS Contin, Oramorph SR, others), oxycodone (OxyContin), methadone (Dolophine HCL), fentanyl (Duragesic) and levorphanol (Levo-Dromoran). There is debate regarding the use of opioids, and they're not used as a long-term treatment. Among the reasons are side effects, as well as concerns about dependence. The most common side effects that limit their use include nausea and constipation, which can be severe. In addition, other common but less known important side effects include dizziness and sedation. Before your doctor prescribes opioids, have a thorough discussion with him or her about their benefits and drawbacks.

Cold or heat therapy. Using cold and heat therapy may relieve pain and muscle tension in the initial days after back pain begins. Some studies show that heat is an effective approach for acute nonspecific back pain. As for chronic back pain, cold and heat likely won't cause harm and may be helpful, but there isn't scientific evidence at this time to prove that cold and heat are effective treatments for chronic low back pain. Cold or ice applied to your back can reduce inflammation and swelling by constricting blood vessels. The cold also acts to slow nerve impulses and make it less likely that your muscles will contract, in this way reducing pain.

To use cold packs, wrap an ice pack or a bag of frozen vegetables in a piece of cloth. Hold it on the sore area for about 15 minutes, several times a day. To avoid frostbite, don't place ice directly on your skin. Heat therapy increases blood circulation, which can aid healing of damaged tissues. Heat also allows tissues to stretch more easily, resulting in less stiffness, greater flexibility and less pain. To use heat therapy, take a warm bath, or use warm packs, a heating pad or a heat lamp for pain relief. Be careful not to burn your skin with extreme heat. If you find that cold provides more relief than heat, you can continue using cold packs, or try a combination of the two methods.

Electrical stimulation. Transcutaneous electrical nerve stimulation (TENS) delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn't painful or harmful. It's not known exactly how TENS works, but it may stimulate release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses. However, it's unclear whether those who benefit from TENS achieve relief by some direct effect on their nervous system or from the belief that they will benefit from the therapy (the so-called placebo effect). Some people with chronic pain use TENS to help them function with less discomfort. But several studies have concluded that TENS has not been proved effective in relieving chronic low back pain.

Exercise and physical therapy. Physical activity plays a strong role in recovering from back pain and particularly in helping to prevent future pain and loss of function. Physical activity can include one or many among a wide range of exercises that you do in the presence of a physical therapist, or exercises that you do on your own at home. An exercise program can include any or all of the following components: flexing, stretching, endurance training, strength building and aerobic.

Supervised programs that include stretching and strengthening exercises, which don't specifically target the back, are more beneficial in relieving chronic low back pain and improving function. Your doctor or physical therapist can tailor an exercise program to meet your individual needs. There is no one-size-fits-all approach. Exercise programs are individualized because people have different levels of pain and differing injuries that caused the pain initially.

Exercise doesn't appear to increase your risk of future back injuries and may help prevent back pain at work. Benefits of a physical activity program may include:

• Pain reduction
• Strengthening of weak muscles
• Stretching of contracted muscles
• Decreasing mechanical stress on your back
• Improving your fitness to prevent injury
• Stabilizing your back
• Improving your posture
• Improving your mobility
• Decreasing the rate and severity of recurring back pain
• Allowing quicker recovery from future flares of back pain

Some studies suggest that exercise therapy is more effective than are conservative or inactive treatments in people with chronic low back pain. Short-term, modest improvements were seen in such areas as pain, disability, strength and flexibility. Exercise and physical therapy are an important part of your treatment program and should become part of your permanent routine at home. Improving the strength, endurance and function of your back helps minimize the chance of recurrence of back pain. One study showed that people who didn't exercise after an initial episode of acute low back pain were more likely to experience a recurrence of low back pain than were people in the study's exercise group. Mild discomfort that you may feel as you begin an exercise program should gradually ease as your muscles become stronger. The key is to start an exercise program at a low level to ensure your comfort and proper technique, and then progress slowly as your symptoms allow.

Cognitive behavior therapy. This type of talk therapy combines attempts to identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts determine how you behave. Even if an unwanted situation hasn't changed, you can change the way you think and behave in a positive way. The therapy may have a role in the case of chronic low back pain for which no specific physical cause is evident.

Your doctor may talk to you about the psychological and social issues surrounding your chronic pain, such as whether you have stress, anxiety or depression, how your family has responded, how the pain has affected your work and other activities, and what you believe causes the pain to continue. You and your doctor may also talk about your readiness to accept that the condition will improve over time without any major medical intervention. Cognitive behavior therapy has been shown to be effective in relieving pain and improving function as one component of back care.

Multidisciplinary treatment programs. A multidisciplinary approach to treating chronic low back pain involves, as the phrase suggests, a variety of therapies. These may include a combination of exercise, physical therapy, education, cognitive behavior therapy, vocational counseling and other strategies. Reviews of studies show long-term effectiveness of multidisciplinary treatment programs in lowering pain, improving function and reducing return to work time.

source: www.mayoclinic.com