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Severe back pain that lasts a few days, or a week, and happens a few times a year is one of the most common patterns. Unfortunately, no specific cause is usually found. The attacks of pain may become more frequent and limiting, and they can be expensive when loss of income is added to medical costs.
The best treatment is a combination of (1) moist heat, such as a warm shower or whirlpool, twice daily, (2) exercises for the back, and (3) medication to control the pain. If an 6ver-the-counter pain medication doesn't control the pain, your doctor can help with a prescription medication.
You can continue to work if you are able to endure the pain and still function in you? job. Bed rest does not seem to make the back pain go away any faster. Our patients make every effort to keep to their usual schedule while protecting the back from extra stress and injury until the attack is over.
The best and most helpful longer-term plan is exercise. Special exercises to strengthen the back have proven to be the most effective way to make our patients' attacks of back pain become milder and less frequent.
If you find yourself easing off your exercise program when the pain is no longer a problem, try to remember what the pain was like; you suffered physically and from loss of income. The trouble of an exercise program to keep the back strong is well worth the improvement and freedom from pain. The book Winning with Back Pain has many suggestions for learning to control back pain.
Sciatica refers to pain from pressure on a sciatic nerve, which travels down the back of the leg from the buttock. Pressure on the nerve causes pain in the area that the nerve supplies. There may also be numbness and tingling or burning sensations. True sciatica-pressure on the sciatic nerve-is usually from a ruptured disc in the lower spine which (along with surrounding inflammation) then irritates the nerve.
Over the years, many patients with back and leg pain have been diagnosed with sciatica, even though many do not have true sciatica, or pressure on the nerve itself. Many other conditions that can mimic true sciatica are actually caused by inflammation in the soft tissues of the back (such as the muscles) or bursitis.
Treatment includes rest, moist heat exercises, and medications. (For more information and medications read the book Winning with Back Pain)*
Your situation is common among people with chronic back pain. One or more injuries results in chronic pain that make it hard to walk, bend, or perform their job activities.
First be sure that you find any treatable causes of your back pain. Begin a basic treatment program of moist heat twice daily, exercises, and a simple walking program. Find the combination of medications that gives the best control of the pain.
If you don't begin to improve and increase your activity, other measures will be needed. Among them are nerve blocks, the use of TENS, and other treatments, as your physician recommends.
Often, it is very helpful to begin to deal with the stress caused by the pain. Don't feel that, because a psychiatrist or psychologist was suggested, your pain is in your head."
Chronic pain causes stress, stress can cause very real physical problems, and these problems can make it harder to manage other everyday problems. Psychological treatment can help you develop strong coping strategies to deal with the pain and your other problems. It is beneficial for almost all chronic back pain patients, not just those who acknowledge that they have "psychological problems."
Psychological evaluation looks at you the whole person, not simply the painful back, and is an essential part of good and effective treatment of chronic back pain.
Your story is familiar. There are many expensive ways to treat chronic back pain, but the best treatment is not always the most expensive. In chronic back pain, the best treatment may be the LEAST expensive.
First, see your doctor to make sure that no specific causes are present that can be treated and removed. Then, begin a basic daily (every day) treatment program: moist heat (such as a warm shower) and exercises twice daily, and gradually increasing amounts of walking.
A number of medications are available that can help control the pain. One of the non-cortisone anti-inflammatory drugs may help, especially if the pain is partly caused by a form of arthritis, such as osteoarthritis. One of a different group of medications can also help a great deal. Try to minimize muscle relaxants and narcotics. Pain medicines of other types are acceptable when necessary.
If there is no improvement over the next three to eight weeks, you should have an evaluation for chronic pain control. There are a number of possibilities for treatment of your individual pain problem, and some combination is likely to help.
In this organized way, you are most likely to find relief of your pain and incur the least expense. If a medication or treatment is giving no improvement, reevaluate it with your doctor. Is it necessary? Should it be changed? Avoid continuing treatments, especially expensive ones, that clearly are not helping.
An exercise program is one of the very few treatments for chronic back pain that should be continued in almost every case. It is the cornerstone for improvement and can be done at home no additional expense. Remember that those who improve usually are those who are able to follow a regular exercise program. It does not have to be expensive.
Osteoporosis is a common cause of back pain in women over 50. The amount of bone usually decreases after ages 30 to 40. If the bones become thin enough, then minor injuries or eventually only the weight of the body is enough to cause a bone in the spine to fracture, which can cause severe back pain. The fracture does heal, but it takes a few weeks.
When the fracture heals, the pain improves or may even away. If the problem of osteoporosis is discovered, good treatment now available can actually increase the amount of bone present which may result in fewer fractures. The goal of treatment in osteoporosis is to strengthen the bones and prevent the NEXT fracture. Hip fracture is the most dangerous. A hip fracture requires surgery, which carries its own risks. Up to twenty percent of older patients who suffer a broken hip die within a year.
If you have certain risk factors for osteoporosis, then you may already be affected, even without symptoms. Osteoporosis is not random-females who are over 40, white, and have had menopause are at higher risk. If you smoke cigarettes, do not have a regular exercise program, and have had low calcium intake for years, you are at higher risk. If other family members are affected, you are also at higher risk. The more risk factors you have, the more likely osteoporosis is present with the potential for fractures. By the age of 65, as many as 80 percent of women may have osteoporosis.
If you have more than two or three risk factors for osteoporosis, it may be a good idea to have a bone density test. This is a simple and safe way to tell whether you need treatment to prevent fractures.
The dowager's hump, stooped posture that happens in many older women, is often caused by osteoporosis. The bones of the spine change shape: they become shorter and allow the back to become stooped. This may be the only sign of osteoporosis until a major fracture occurs.
The best advice is to check your risk factors. If you have more than two or three risk factors, begin specific prevention measures as outlined Winning with Osteopososis. If a bone density test shows that osteoporosis is present, start treatment to strengthen your bones. You may be able to avoid future fractures.
You can help prevent back pain and loss of time from your job with a few simple steps. You should definitely begin an exercise program to strengthen your back muscles. You can start with a simple program at home, using the exercises for the back that begin on page 59*.
Once you can do 20 repetitions of each of these exercises twice daily, you may want to add weights or resistance, using machines that can be found in a health club or gym. Swimming is another excellent exercise for the back. The more you maintain a regular exercise program, the better support you're giving your back.
In Chapter Five*, you'll find ways to prevent unnecessary injury to the back from lifting. Learning to lift properly is easy and very important. Lifting alone accounts for many cases of back injury. If a load is too heavy for you to lift get help or use mechanical assistance.
Back supports are worn routinely in many jobs to try to prevent back injury. These aids do not eliminate the need to lift correctly, but many workers find that the added support they give the back and abdomen muscles is helpful. Wear a support if your job requires frequent or heavy lifting. The support may help and it certainly won't hurt.
A number of the tips given in Winning with Back Pain can greatly help in the prevention of back injuries at your job. Protecting the back is the best protection against back pain. A large utility company found that when workers were taught measures to prevent back injury, their number of back injury claims went down. Less suffering, fewer lost workdays, and decreased medical bills were the reported results.
Additional Resources: Winning with Arthritis, Winning with Chronic Pain, The Osteoporosis Cure, Winning with Back Pain, The Fibromyalgia Handbook.
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