If you are wondering about the evidence for or against any treatments commonly used for low back pain, see the pdf from the TOP Alberta Low Back Pain Guidelines website:
You can also download documents, especially patient handouts, on acute and chronic back pain at tiny.cc/au9ko. Keep in mind that these guidelines are not intended for children or seniors.
If you haven’t experienced severe low back pain yourself, you almost certainly know someone who has. When it appears, knowing the difference between myth and truth can help healing.
In fact, low back pain is so common that most of us will have an episode at least once in our lives. The good news is that almost all cases resolve within days to weeks, without any particular treatment. In fact, often it is not even possible to pinpoint the exact anatomic cause of an attack. We do know that the body is using pain as a warning - not necessarily indicating that something is seriously wrong or that damage has been done.
It is a cue to think about whether lifestyle changes such as getting more exercise can prevent problems.
Most cases of low back pain resolve with nothing more than a little common sense. In other words, if an activity makes the pain worse, give it up for a few days. A simple over the counter remedy such as acetaminophen, ibuprofen or naproxen may also help.
However, a small number of people do need medical care. Don’t hesitate to seek help if the pain is severe, gets worse instead of better, or involves the bowel, bladder, or legs down to the toes. Speak to your family physician if you are older than 50 and this is the first time that you have had low back pain. In all of these situations, possible underlying medical diseases need to be ruled out.
Even if you are just confused or worried about something new or different, it is reassuring to talk with your family doctor.
While these tests can be useful in certain cases, often results do not alter treatment. In fact the opposite can be true - they may lead to confusion about the cause of your pain. For instance, studies show that about 40 per cent of people over age 40 with no back pain have herniated discs seen on MRI scans. If back pain appears some time later, is the disc really causing it? Most of us develop degenerative changes seen on x-rays as we age, yet not everyone has low back pain. Our backs just get older and the tests pick it up. While test results are important, they are only one part of in finding a cause and treatment for low back pain. Your doctor can reassure you that testing hasn’t been forgotten. It just may not be necessary or helpful this time around.
Once, this was common advice. However, recent research strongly supports a different approach. There may be times when the pain is so disabling that a brief rest period is necessary. Still, resting too much can mean lost muscle tone and physical conditioning. This slows recovery and increases the risk of the pain returning. Instead, stay as active as you normally would be at home, school and on the job, while respecting the limits set by your pain. Using over the counter medications such as acetaminophen, ibuprofen or naproxen can increase your tolerance. Carefully applying heat or cold to your lower back may be just as comforting. Sometimes, you might have to restrict your activities – perhaps spending fewer hours at work or doing less lifting.
As you begin to feel better, use the experience as a reminder that you may need to make some lifestyle changes. Consider involving an expert such as a physiotherapist to safely guide you.
While it seems to oppose the first four myths, this one can be the most dangerous. In fact, some patients with low back pain do need care. Warning signs include severe or worsening pain, being over age 50, a history of trauma, cancer, infection, or intravenous drug use. Sudden loss of bowel or bladder control is the one time that low back pain is considered a true emergency that may require immediate hospitalization.
Most episodes of low back pain resolve without treatment. Using common sense and making lifestyle changes can help you to cope with this common problem.
If you have chronic back pain, knowing the difference between myth and truth can help you to cope with it.
Most spine surgery specialists will tell you that low back surgery is a treatment for leg pain (sciatica). They don’t expect that it will really improve low back pain. Still, there are exceptions to this rule. If your pain has become chronic, lasting three months or longer, it is time for a comprehensive review by your family doctor.
As with acute low back pain, it is not always possible to find an anatomical reason for chronic low back pain. Signs of arthritis and age-related changes are common as we get older. Finding them on x-rays does not mean that they are the source of the pain.
For many of us, chronic low back pain becomes a fact of life. It can be managed in the same way as other chronic health problems like diabetes or high blood pressure. While not pleasant, pain does not always signal that damage is being done. Sometimes, the choice lies between living actively with pain, or inactively with pain. Many excellent sources can help ease the burden, beginning with your family doctor.
In fact, while some treatments help, in many cases results are temporary. You must decide whether the results are worth the cost. Talk to a doctor or therapist experienced in managing chronic low back pain. You may be referred to community resources that help deal with chronic medical conditions, including pain. Less common treatments might be useful, but expert assessment is needed to find out if they are appropriate for you.
We do know that medications can help. Remaining as active as possible is also important. There is truth to the saying, ‘Use it or lose it.’
There is very little risk of addiction to medications, including opiate medications, when they are used properly for chronic pain. Still, precautions must always be taken. Potential benefits have to outweigh the potential risks. Often, a combination of medications will give the best result, particularly if the nervous system is involved.
It is easy to think that if a little medication is good, more will be better. Doctors are often happy to see a 30 to 40 per cent decrease in pain with medication. Higher doses often lead to more problems without additional benefit. Think of increasing ability to take part in activities as a sign of good pain control, rather than waiting for all pain to be gone.
It is easy to understand how chronic pain and compromised lifestyle changes can affect your relationships, career, social activities, sleep and moods. Ineffective treatments can reinforce a vicious cycle of pain, fear, loss of physical ability and further depression. Naturally, you search for other ways to treat your pain. This cycle must be interrupted and depression properly treated. This is best accomplished either at a clinic organized for this purpose, or through co-ordinated treatments arranged by your family doctor.
In fact, one of the hardest skills to learn is how to pace your activity. You must learn not to do too much or too little. Support groups and pain self-management programs can help you acquire this skill.
Learning to effectively manage your condition, combined with professional treatment, is the best way to return to fulfilling activities and feel less pain.