Back pain medical therapy: Difference between revisions
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**[[Co-morbidities]] | **[[Co-morbidities]] | ||
**[[Age]] of the [[patient]] | **[[Age]] of the [[patient]] | ||
**[[Chronicity]] | **[[Chronicity]] of [[pain]] | ||
*[[Medications]] that are generally are:<ref name=pmid12804507>{{cite journal | author = van Tulder M, Touray T, Furlan A, Solway S, Bouter L | title = Muscle relaxants for non-specific low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD004252 | year = | id = PMID 12804507}}</ref><ref name=pmid10796356>{{cite journal | author = van Tulder M, Scholten R, Koes B, Deyo R | title = Non-steroidal anti-inflammatory drugs for low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD000396 | year = | id = PMID 10796356}}</ref> | *[[Medications]] that are generally are:<ref name=pmid12804507>{{cite journal | author = van Tulder M, Touray T, Furlan A, Solway S, Bouter L | title = Muscle relaxants for non-specific low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD004252 | year = | id = PMID 12804507}}</ref><ref name=pmid10796356>{{cite journal | author = van Tulder M, Scholten R, Koes B, Deyo R | title = Non-steroidal anti-inflammatory drugs for low back pain. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD000396 | year = | id = PMID 10796356}}</ref> | ||
Revision as of 14:06, 7 June 2021
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Zehra Malik, M.B.B.S[2]
Overview
Medical Therapy
- While deciding which treatment is optimum following aspects should be considered:
- Underlying cause of back pain
- Co-morbidities
- Age of the patient
- Chronicity of pain
- Medications that are generally are:[1][2]
- However, a more recent randomized controlled trial found acetaminophen no better than placebo.[3]
- If non-steroidal medications are inadequate, amitriptyline may be better than pregabalin for a second medication.[4]
- Tramadol has also shown benefits in some registered randomized controlled trials.[5]
Corticosteroids
A clinical practice guideline found no benefit[6].
A randomized controlled trial of oral steroids for acute radiculopathy due to a herniated lumbar disk found "resulted in modestly improved function and no improvement in pain"[7].
- For injections, usually with corticosteroids, a meta-analysis of randomized controlled trials by the Cochrane Collaboration found no difference in long term out come regardless of whether the injection is facet joint, epidural or a local injection.[8]
- At least one study of intramuscular corticosteroids found no benefit.[9] Herbal analgesics may also be effective. It may very well be the case that steriods in and of themselves are not the answer as clinical improvement has been both reported and published numerous times with other injections (anesthetics, etc).
Heat Therapy
- Heat therapy is useful for back spasms or other conditions. A meta-analysis of studies by the Cochrane Collaboration concluded that heat therapy can reduce symptoms of acute and sub-acute low-back pain.[10] Some patients find that moist heat works best (e.g. a hot bath or whirlpool) or continuous low-level heat (e.g. a heat wrap that stays warm for 4 to 6 hours). Cold therapy (e.g. ice or cold pack application) may be effective at relieving back pain in some cases.
Exercise
- Exercises can be an effective approach, particularly when done under supervision of a professional such as a physical therapist. Generally, some form of consistent stretching and exercise is believed to be an essential component of most back treatment programs. However, one study found that exercise is also effective for chronic back pain, but not for acute pain.[11] Another study found that back-mobilizing exercises in acute settings are less effective than continuation of ordinary activities as tolerated.[12]
Physical Therapy
- Physical therapy and exercise, including stretching and strengthening (with specific focus on the muscles which support the spine), often learned with the help of a health professional, such as a physical therapist. Physical therapy, when part of a 'back school', can improve back pain.[13]
Education
- Education and attitude adjustment to focus on psychological or emotional causes - respondent-cognitive therapy and progressive relaxation therapy can reduce chronic pain.[14]
Massage Therapy
- Massage therapy, especially from an experienced therapist, may help. Acupressure or pressure point massage may be more beneficial than classic (Swedish) massage.[15]
Joint Manipulation
- Manipulation, as provided by an appropriately trained and qualified chiropractor, osteopath, physical therapist, or a physiatrist. Studies of the effect of manipulation suggest that this approach has a small benefit similar to other therapies and superior to sham.[16][17]
Body Awareness Therapy
- Body awareness therapy such as the Feldenkrais Method has been studied in relation to fibromyalgia and chronic pain and studies have indicated positive effects.[18] Organized exercise programs using these therapies have been developed.
Acupuncture
- Acupuncture has a small benefit for chronic back pain. The Cochrane Collaboration concluded that "for chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and alternative treatments."[19] More recently, a randomized controlled trial found a small benefit after 1 to 2 years.[20]
Ergonomics
- Most people will benefit from assessing any ergonomic or postural factors that may contribute to their back pain, such as improper lifting technique, poor posture, or poor support from their mattress or office chair, etc. Although this recommendation has not been tested, this intervention is a part of many 'back schools' which do help.[13]
- The avoidance of high impact, weight-bearing activities and especially those that asymmetrically load the involved structures such as: extensive twisting with lifting, single-leg stance postures, stair climbing, and repetitive motions at or near the end-ranges of back or hip motion can ease the pain. Direct bending to the ground without bending the knee causes severe impact on the lower back in pregnancy and in normal individuals, which leads to strain, especially in the lumbo-saccral region that in turn strains the multifidus.
References
- ↑ van Tulder M, Touray T, Furlan A, Solway S, Bouter L. "Muscle relaxants for non-specific low back pain". Cochrane Database Syst Rev: CD004252. PMID 12804507.
- ↑ van Tulder M, Scholten R, Koes B, Deyo R. "Non-steroidal anti-inflammatory drugs for low back pain". Cochrane Database Syst Rev: CD000396. PMID 10796356.
- ↑ Williams, Christopher M (2014-07). "Efficacy of paracetamol for acute low-back pain: a double-blind, randomised controlled trial". The Lancet. doi:10.1016/S0140-6736(14)60805-9. ISSN 0140-6736. Retrieved 2014-07-28. Unknown parameter
|coauthors=ignored (help); Check date values in:|date=(help) - ↑ Kalita J, Kohat AK, Misra UK, Bhoi SK (2014). "An open labeled randomized controlled trial of pregabalin versus amitriptyline in chronic low backache". J Neurol Sci. 342 (1–2): 127–32. doi:10.1016/j.jns.2014.05.002. PMID 24857356.
- ↑ GitHub Contributors. Back pain (chronic) treatment with tramadol: a living systematic review. GitHub. Available at https://github.com/openMetaAnalysis/back-pain-chronic-treatment-with-tramadol/. Accessed February 27, 2017.
- ↑ Chou R, Deyo R, Friedly J, Skelly A, Weimer M, Fu R; et al. (2017). "Systemic Pharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline". Ann Intern Med. 166 (7): 480–492. doi:10.7326/M16-2458. PMID 28192790.
- ↑ Goldberg H, Firtch W, Tyburski M, Pressman A, Ackerson L, Hamilton L; et al. (2015). "Oral steroids for acute radiculopathy due to a herniated lumbar disk: a randomized clinical trial". JAMA. 313 (19): 1915–23. doi:10.1001/jama.2015.4468. PMC 5875432. PMID 25988461. Review in: Evid Based Med. 2015 Aug;20(4):138
- ↑ Nelemans P, de Bie R, de Vet H, Sturmans F. "Injection therapy for subacute and chronic benign low back pain". Cochrane Database Syst Rev: CD001824. PMID 10796449.
- ↑ Friedman B, Holden L, Esses D, Bijur P, Choi H, Solorzano C, Paternoster J, Gallagher E (2006). "Parenteral corticosteroids for Emergency Department patients with non-radicular low back pain". J Emerg Med. 31 (4): 365–70. PMID 17046475.
- ↑ French S, Cameron M, Walker B, Reggars J, Esterman A (2006). "A Cochrane review of superficial heat or cold for low back pain". Spine. 31 (9): 998–1006. PMID 16641776.
- ↑ Hayden J, van Tulder M, Malmivaara A, Koes B. "Exercise therapy for treatment of non-specific low back pain". Cochrane Database Syst Rev: CD000335. PMID 16034851.
- ↑ Malmivaara A, Häkkinen U, Aro T, Heinrichs M, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V (1995). "The treatment of acute low back pain--bed rest, exercises, or ordinary activity?". N Engl J Med. 332 (6): 351–5. PMID 7823996.
- ↑ 13.0 13.1 Heymans M, van Tulder M, Esmail R, Bombardier C, Koes B. "Back schools for non-specific low-back pain". Cochrane Database Syst Rev: CD000261. PMID 15494995.
- ↑ Ostelo R, van Tulder M, Vlaeyen J, Linton S, Morley S, Assendelft W. "Behavioural treatment for chronic low-back pain". Cochrane Database Syst Rev: CD002014. PMID 15674889.
- ↑ Furlan A, Brosseau L, Imamura M, Irvin E. "Massage for low back pain". Cochrane Database Syst Rev: CD001929. PMID 12076429.
- ↑ Assendelft W, Morton S, Yu E, Suttorp M, Shekelle P. "Spinal manipulative therapy for low back pain". Cochrane Database Syst Rev: CD000447. PMID 14973958.
- ↑ Cherkin D, Sherman K, Deyo R, Shekelle P (2003). "A review of the evidence for the effectiveness, safety, and cost of acupuncture, massage therapy, and spinal manipulation for back pain". Ann Intern Med. 138 (11): 898–906. PMID 12779300.
- ↑ Gard G (2005). "Body awareness therapy for patients with fibromyalgia and chronic pain". Cochrane Database Syst Rev. PMID 16012065.
- ↑ Furlan A, van Tulder M, Cherkin D, Tsukayama H, Lao L, Koes B, Berman B. "Acupuncture and dry-needling for low back pain". Cochrane Database Syst Rev: CD001351. PMID 15674876.
- ↑ Thomas K, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell M, Roman M, Walters S, Nicholl J (2006). "Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain". BMJ. 333 (7569): 623. PMID 16980316.