Dealing with low back pain

Back pain is one of the most common, non-life-threatening, painful conditions, affecting four in five Americans at some point in their lives [A Nigerian study, published in the journal ‘Occupational Medicine' in 2003 concluded that "the occurrence of low back pain in this study is comparable with that reported in studies from more industrialized countries."] And many have to be wary of return bouts.

But low back pain treatment has undergone a sea change over the past 15 or so years. Experts now appreciate the central role of exercise in treating back problems and maintaining a healthy back. They also better understand which conditions surgery will help and which patients are good surgical candidates.

Patient-driven treatment

Today's treatment decisions for most cases of back pain are patient-driven. In other words, you're in the driver's seat (with your doctor beside you) when it comes to deciding what would be an appropriate treatment path for you based on your type of back problem and the physical and other demands of your lifestyle. Since you have a considerable number of options at your disposal and a lifestyle to accommodate, it's worth not rushing into a decision.

Besides, if you allow yourself some deliberation time, your back problem may clear up with little or no medical intervention within a few weeks. Indeed, awareness of your condition's timeline is the first crucial step. To a considerable extent, this knowledge determines the steps you can take toward healing yourself during an initial attack and maintaining a healthy back thereafter.

Taking time to deliberate doesn't mean you do nothing. On the contrary, there's much you can do to ease your pain and speed your healing from the start. Obviously, reducing pain is a No. 1 priority. In 2007, the Annals of Internal Medicine published a comprehensive review of non-drug treatments for low back pain, along with a discussion of pain medications and other therapies.

Early days: Cold and heat

Applying moderate cold or heat to your back can reduce your discomfort. It's best to use only cold compresses or an ice pack immediately following injury, since this can alleviate pain by numbing the area and prevent or reduce swelling caused by inflammation.

About 48 hours after the onset of back pain, though, applying heat to your back may be more helpful. The warmth soothes and relaxes aching muscles; it also increases blood flow, which carries oxygen and nutrients to the injured area and thus promotes the healing process. Generally, electric heating pads and hot water bottles are effective and easy to use. The Annals review noted that heat therapy helps in the early days of an acute attack only (up to a week).

Limited bed rest

Bed rest was once a mainstay of treatment for low back pain, but no longer. Bed rest can be useful, particularly if you are in severe pain while sitting and standing. But limit bed rest during the day to a few hours at a time, for no more than a couple of days. You can lie down on a bed or sofa, in any comfortable position.

To ease the strain on your back, try putting pillows under your head and between your knees when lying on your side, under your knees when lying on your back, or under your hips when lying on your stomach. These positions reduce forces that sitting or standing impose on the back -- especially on the disks, ligaments, and muscles. An extended period of bed rest is not appropriate for moderate back strain at any stage of therapy.

Why? Although lying in bed does minimize stress on the lumbar spine, extended bed rest creates other problems. For example, muscles lose conditioning and tone. You may also develop gastrointestinal problems, such as constipation. There is some risk of blood clotting in the veins of your pelvis and legs and thus of pulmonary embolism (a serious medical condition where a blood clot, usually dislodged from the veins of your pelvis and legs, blocks the arteries in your lungs).

Depression, as well as an increased sense of physical weakness and malaise, is common among people confined to bed rest. For these reasons, it's far better to engage in a limited amount of activity rather than lie in bed. Well-designed research trials indicate that an early return to work -- with some restrictions or light duty, if necessary - is preferable to staying home from work for an extended period.

Getting going: Exercise

Exercise therapy is routinely used to help the healing process during an acute episode, to prevent repeat episodes of acute low back pain, and to improve function in chronic low back pain. Developing a suitable exercise program under expert supervision will enable you to build strong, flexible muscles that will be less prone to injury.

If you are suffering from acute back pain, the goal is to help you resume normal activities as soon as possible and to remain symptom-free following recovery from the acute attack. If you have chronic back pain, work with your physician to define your desired functional goal - whether it involves being able to take a tour of museums, play with your grandchildren, or simply sit in the backyard reading a good novel.

Any exercise program should be customized to meet your individual needs and introduced gradually a couple of weeks after the onset of symptoms or when you are feeling reasonably comfortable. One golden rule about any exercise program is to stop if it becomes painful. Exercise is meant to help, not hurt.

If you were exercising before an episode of back pain and then had to slow down or stop for a while because of the pain, don't resume exercising at the same level of exercise as before the episode.

Deconditioning occurs quickly; if you try to pick up your exercise routine where you left off, you might get hurt. Start by doing less (fewer minutes or repetitions) and gradually build back up to where you were before.

Excerpted from a report prepared by the editors of Harvard Health Publications in consultation with Jeffrey N. Katz, M.D., M.S., Associate Professor of Medicine and Orthopedic Surgery, Harvard Medical School. (2008)