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Low Back Pain

Low Back Pain

Low back pain is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of disability, a leading contributor to missed work, and the second most common neurological ailment (See reference 1).

What causes low back pain?

The vast majority of low back pain episodes are the result of benign musculoskeletal problems, and are referred to as non specific low back pain. This type may be due to muscle, ligament or joint sprains or strains. However, there are also many non-musculoskeletal causes of low back pain that may or may not require medical care. For this reason, if you are experiencing back pain that is not going away on its own, a visit to your healthcare provider is very important.

The healthcare professionals at Able Body Health Clinic are experts in the differential diagnosis of low back pain and can advise you on your treatment options, or tell you if your condition requires a visit to your medical physician.

How can low back pain be treated?

Depending on the cause, most cases of lower back pain will resolve on their own in 1-3 months; however, some cases of low back pain may not resolve themselves if ignored (See reference 2). Up to 30% of those with low back pain will not recover in one year (See reference 3).

For many people with low back pain, there are treatments that can shorten the recovery time and reduce the likelihood that the pain will come back:

Chiropractic care is the most effective and most researched therapy for low back pain!

What does the public say? The 2011 Consumer Reports Overview of Alternative Therapies rated chiropractic the most effective treatment for back pain. Moreover, the 2009 Consumer Reports Health Ratings Center survey revealed that chiropractic was the most satisfying treatment available overall for back pain.

What does the research say? A 2010 review found that spine manipulation achieves equal or superior improvement in pain and function than all other commonly used treatments (See reference 4).

What do medical doctors say? In 2007 the American College of Physicians and the American Pain Society jointly recommended that spine manipulation be considered for people who do not improve on their own (See reference 5).

Other non-surgical treatments

*Note: These therapies are available at Able Body Health Clinic. The health care professionals at Able Body Health Clinic can tell you which therapies are safe and effective depending on your specific condition.

Rehabilitative exercises and specific activity recommendations – Engaging in physical activity within the limits of your pain can speed recovery if done correctly. Specific stretching and strengthening can help to restore motion and strength to your lower back can be very helpful in relieving pain and preventing future episodes of low back pain.

Physical modalities – These therapies can offer short-term pain relief and include ultrasound and electrical stimulation.

Acupuncture – Acupuncture can offer significant relief of chronic low back pain (See reference 6).

Massage Therapy – Massage therapy can offer significant relief of low back pain (See reference 7).

What about medications or surgery?

*Note, while the health care professionals at Able Body Health Clinic can provide you with information regarding your pharmaceutical and surgical options for back pain treatment, you should never start taking any new medications without the advice of your pharmacist or medical physician.

Medication – According to the American Pain Society/American College of Physicians clinical practice guideline, medications with good evidence of short-term effectiveness for low back pain are NSAIDs, acetaminophen, skeletal muscle relaxants (for acute low back pain), and tricyclic antidepressants (for chronic low back pain). Evidence is insufficient to identify one medication as offering a clear overall net advantage because of complex tradeoffs between benefits and harms (See reference 8).

Surgery – Surgery is sometimes necessary for some people; however, surgery and overtreatment should be avoided and used as a final resort (See reference 9).

References

1) National Institute of Health. “Lower Back Pain Fact Sheet. nih.gov”. Retrieved 2012-03-16. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm

2) Hestbaek L, Leboeuf-Yde C, Manniche C. Low back pain: what is the long-term course? A review of studies of general patient populations. Eur Spine J. 2003;12(2):149-65.

3) Henschke N, Maher CG, Refshauge KM, Herbert RD, Cumming RG, Bleasel J, York J, Das A, McAuley JH. Prognosis in patients with recent onset low back pain in Australian primary care: inception cohort study. BMJ. 2008 Jul 7;337:a171.

4) Dagenais, S; Gay, RE; Tricco, AC; Freeman, MD; Mayer, JM. “NASS Contemporary Concepts in Spine Care: spinal manipulation therapy for acute low back pain”. The spine journal : official journal of the North American Spine Society. 2010;10(10): 918–40.

5) Chou R, Qaseem A, Snow V et al. “Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society”. Ann Intern Med. 2007;147 (7):478–91.

6) Trigkilidas D. Acupuncture therapy for chronic lower back pain: a systematic review. Ann R Coll Surg Engl. 2010 Oct;92(7):595-8.

7) Cherkin DC, Sherman KJ, Kahn J, Wellman R, Cook AJ, et al. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial. Ann Intern Med. 2011 Jul 5;155(1):1-9.

8) Chou R, Huffman LH; American Pain Society; American College of Physicians. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/ American College of Physicians clinical practice guideline. Ann Intern Med. 2007 Oct 2;147(7):505-14.

9) Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91.