woman with lower back pain

The American College of Physicians has just made some important changes in its guidelines for treating lower back pain.  This condition is one of the most common reasons Americans seek medical care. The new guidelines are for back pain that started recently with no obvious cause. Such pain is limited to the back and does not radiate down the leg.

The Trouble with Drugs for Lower Back Pain:

Previous guidelines recommended pain medication as the first-line treatment. But the experts now say that there is no good evidence that acetaminophen is helpful in relieving lower back pain. Cortisone-type drugs were equally disappointing. There was insufficient evidence to recommend antidepressants, sedatives, antiseizure drugs or opioids.

Treating Back Pain Without Drugs:

The guidelines now emphasize nondrug approaches for acute lower back pain. The American College of Physicians recommends alternatives such as heat, massage, mild exercise, physical therapy, acupuncture or spinal manipulation. There is evidence that such treatments are at least somewhat effective.

Although the guidelines don’t mention yoga, some studies suggest it is helpful.

If patients request medications, the suggestion is to try a nonsteroidal anti-inflammatory drug. Although the results from clinical trials have been inconsistent for NSAID medications such as diclofenac, ibuprofen or naproxen, these drugs appear to be safer than opioids. Finding ways to reduce inappropriate opioid use might have inspired the guideline revision.

Clinicians are urged to reassure patients that low back pain usually goes away on its own.

Qaseem et al, Annals of Internal Medicine, Feb. 14, 2017

A few years ago, we interviewed Dr. David Hanscom, an orthopedic spine surgeon practicing at Swedish Neuroscience Specialists in Seattle, Washington. In the interview and in his book, Back in Control, he describes a number of effective nondrug approaches to overcoming chronic back pain.

 

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  1. mary
    st charles county, mo
    Reply

    I’m writing about my husband, who, I believe, has the deadly combination of REAL lower and now upper– back pain and depression/anxiety, which intensifies the pain. He was a high-school athlete– basketball and track (and, he says, high-jumping into sand which, when wet, was more like rock than soft sand.

    He entered the army (drafted) during ‘peacetime’ and was ‘lucky’ enough to be stationed in Hawaii, where he learned to love surfing. He was on the base basketball team and was injured during a game (fell flat on his back during a struggle for the ball). He spent time ‘in traction’ (and by the way, learned smoking ‘as a way to relax’). When the traction was unsuccessful, surgery was done on his lowest disks.

    Being ‘a man’s man, he was ‘Mr. Fixit’ at home and in the neighborhood, continued playing some sports and worked in retail– on his feet most of the time. He left retailing about 10 years later for sales-travel, and had his next back surgery (repairing the 4 disks above the previous surgery) in 1986, which was ‘successful’ (per the doctor) but was not followed by any rehabilitation– ‘just rest.’ More back pain, less sports, depression and anxiety are quite obvious.

    Still sales-travel, n-saids, anti-depressants, yet another surgery in 1994– the disks above the others– see a pattern here?? He ended up having two more surgeries, the final one in 2006– with metal from his neck down to his lower spine: rods and screws. . . he carries a letter in case he needs an explanation. He worked from 1995 to 1999 back in retailing, ‘retiring’ (and applying for disability) in 1999. He finally got it with an attorney’s help.

    But his work had given him an identity, so the depression and anxiety, which had flared up occasionally were now daily companions to his chronic pain. And his stomach wouldn’t tolerate the nsaids, so he was moved to opioids. To his credit, he has never overdosed on them– even tries to use them less than prescribed, but, as I said, he has that ‘deadly combination.’ Because of his ‘checkered’ work history and my worklife with non-profits, we didn’t set aside a huge amount of money for ‘retirement.’ Now that ‘authorities’ are saying that acupuncture is better than many medications for back pain, will Medicare reimburse it at a higher rate?? That would certainly add to my husband’s (and my) quality of life.

  2. Gina
    Indiana
    Reply

    Yoga helps! I’ve tried muscle relaxers and pain meds but exercise in moderation and yoga seem to help the most. It takes a few weeks but it kicks in. After it gets better, I do crunches to strengthen my abs. My problem is that I don’t keep up on the ab work and the pain returns.

  3. Richard
    West Palm Beach
    Reply

    When I experienced several severe episodes of back pain. While in Germany teaching at a training center for physical therapist in Hanover, Germany. I experienced referring pain from my back to my heart with such intensity I sought a EKG and Cardiologist. I thought I might have a heart problem. The test were negative. But I found no therapist or orthopedist able to offer me relief. A nurse/osteopath offered me her SI joint treatment : 800mg of Ibuprofen 3 X daily. I took 200mg and could not preform my job nor drive a car.

    I resorted to Acupuncture (self-treated) and received CranioSacral sessions. I got lasting relief from a massage therapist who released my Psoas, QL, Obliques, TFL, and iliacus muscle. My relief was 95% plus in sixty minutes of treatment. and I am still in debt to her. Since then I have learned and use preventative exercise (Yoga and Tai Chi, Chi Gong). Nearly any movement done mindfully is suffice.

    I have also learned how to palpate these various muscle and treat them myself and I share this information with my patients. I am biased being an acupuncture physician, massage therapist and teacher of CranioSacral Therapy, all for over 30 years. But the stories are true and even with my training treatment and self help for back pain is demanding of commitment to fitness or the problem will often return. Eat Less, Move more and use Hi Touch therapies

  4. Scott
    Reply

    Having routinely experienced lower back pain since my 20s (40 years ago), I finally gained relief with monthly visits to a chiropractor starting in my late 30s. Then, about 3 or 4 years ago, my chiro suggested I roll around on a styrofoam sausage. This proved nearly miraculous! Since then, I’ve had virtually no discomfort, no serious problems, and just 1 visit to my chiro, who expresses no regrets over the lost business due to his recommendation! I simply put it under my lower back and roll back and forth for about 30 seconds, then repeat on upper back, only 4 or 5 times a week.

    • Barbara
      Florida
      Reply

      Is a styrofoam sausage one of those styroform “noodles” kids use in swimming pools? If not, what are they and where can they be purchased?

  5. Parrish
    Reply

    I have had lower back muscle pain off-and-on for over 50 years. My father and my son, with similar builds to mine, have had the same problem. First, let me say that the strength-building exercises do work as prevention.

    I have great success with spinal manipulation, but 30 years ago, when a chiropractor started putting me on his inversion contraption, I bought one. I hang so my upper-body weight pulls on my lower back for about 20 seconds twisting from side-to-side. As soon as I feel a twinge, I treat myself. It makes a big difference – in prevention and cure.

  6. David
    Vancouver, WA
    Reply

    Keep in mind that one third to one half of Americans over 65 are taking a statin drug and one of the most common side effects of taking this drug is lower back pain. Statin induced muscle pain is not very responsive to NSAIDS.

    Also, many people take CoQ10 for heart health and to offset the effect that statins have in lowering production of this very important coenzyme. So taking a CoQ10 supplement can be a good thing but it can easily be taken to extremes. I have personally experienced that taking over 100 mg of CoQ10 a day can cause me lower back pain and I have confirmed this potential side effect in the literature.

    It is important to discover the root cause of your back pain. Is could be simple muscle spasm or a pinched nerve but it could also be a side effect from a medication or supplement for which exercise may only exacerbate the pain.

  7. Jan
    Reply

    So……..you’d better hope that you do not get hit with severe back pain, especially if you can’t take anti-inflammatories. Even the People’s Pharmacy says they can be dangerous. There needs to be some middle ground here for suffering patients. With a muscle relaxer and opioid for a few days you can at least get a little relief, possibly return to work while your back is beginning to heal. I fear that the pendulum has swung too far in the direction of no pain relief for people with acute pain. Those with long term pain deserve to be treated by a pain specialist who can guide them to alternative therapies and perhaps several weeks of pain relief, before recommending surgery.

  8. Jan
    VA
    Reply

    So. . . you’d better hope that you do not get hit with severe back pain, especially if you can’t take anti-inflammatories. Even the People’s Pharmacy says they can be dangerous. There needs to be some middle ground here for suffering patients. With a muscle relaxer and opiod for a few days you can at least get a little relief, possibly return to work while your back is beginning to heal. I fear that the pendulum has swung too far in the direction of no pain relief for people with acute pain. Those with long term pain deserve to be treated by a pain specialist who can guide them to alternative therapies and perhaps several weeks of pain relief, before recommending surgery.

  9. Lena Tawlks
    Ro
    Reply

    I have found that sleeping on the side aggravates the pain. Sleeping in a good recliner using a tempurpedic back support pillow works well for me.

  10. Marie
    Reply

    I had not had lower back pain and was surprised when it occurred. When I started walking a mile 5-6 times a week at a 3 percent grade, eliminated baked goods from my diet, and lost 15 pounds, I noticed my pain all but disappeared. When it reoccurs, I put on my walking shoes, grab my walking stick, and head outdoors. I always feels better when I return. Walking on level ground doesn’t seem to help me as much as walking on an incline. I also think that it helps not to be carrying around that extra weight.

  11. Antonia
    Vancouver, BC
    Reply

    I had lower back pain for many years and could not stand for any length of time. In general, I was always uncomfortable. The reason, as I eventually found out, was scoliosis. When I did some serious weight-training with a trainer, who emphasized good posture and introduced stretching into my routine, my pain disappeared and stayed away.

  12. Joan
    St. Cloud, MN
    Reply

    Now if the insurance companies would cover massage…

  13. Candy
    NC
    Reply

    I have spondylolisthesis, lower back. I tried meds, back brace, yoga. Tried to get stronger abs. I found that Pilates classes have stopped the pain. The classes are designed to get you not only strengthen core muscles, but also the way to achieve correct posture and keep it. Correct posture isn’t what most people think it is. Your core muscles are ALL the muscles that hold you together from you neck to your hips. Sit-up work on abs only. Not your core.

  14. H.F.
    Anaheim Ca
    Reply

    This current “news” about back pain is the result of doctors over prescribing opiods and now we have a rush to stop them because people are dying from overdose. The average person suffering from years of constant back pain is not the addict who is going to overdose and die, and these people are the ones being punished by the new prescription rules. These people fall into the category of people whose backs have structural defects.

    Severe stenosis of the spine, bulging discs pressing on nerves, vertebrae that have been pushed forward or backward, etc etc. Surgery is an answer for some, but all in all doctors have no solutions so they write the Rx to give the patient some relief. Unfortunately the doctor has no way of knowing which patient has that gene that makes them a potential addict and might wind up on the street seeking heroin or dying from overdose.

    The studies give the impression that manipulation (and it got me thru for a long time), acupuncture, exercise , yoga etc etc are the magic answers for back pain. Period. They are not. It was a constant battle for years to get chiropractic care paid for by insurance companies. They would argue over a $40 adjustment, but happily pay for an MRI, endless M.D. bills and useless physical therapy that dragged on for weeks with no results. The same stigma applies to acupuncture treatment. Medicare should be covering that treatment because it does help some people. I don’t know about using marijuana but I’m not confident enough to try it.

    I have severe stenosis which has become worse as I age which in turn causes other problems because there is simply no room for defects of the spine when the canal is so narrow. I got thru years of chiropractic and missed very little work, even tho there were days when I stood up as opposed to sitting at my desk. But backs age with the rest of one’s body and treatment that has worked simply does not continue to work. I never took strong pain killers until the last year or so.

    A prescription of 60 opiod pills lasted me for one year after I was hospitalized. They are for the worst times or those times when I have a really hard time getting to a standing position and doing what I need to do. An occasional epidural buys me some periods of doing more things with less pain. I am simply not a potential addict and there are many of us out here. Back pain has altered our lifestyle completely.

    And all the various non-medication approaches simply don’t work. Years and years of books, studies, etc etc will continue to roll out, but an answer does not look promising. Millions of dollars have been made by people writing books about back pain I’m sure. M.D.s have made millions too, but they should not be taking all the blame for overprescribing and causing the opiod epidemic. We need some tools to tell them who the potential addict is before they prescribe.

  15. John
    Florida
    Reply

    Physical Therapy was and is a big help for my back pain. Continuing to strengthen my core as I age has relieved a lot of pain.

  16. Carla
    NE Ohio
    Reply

    John Sarno’s books, “Mind Over Back Pain” and “Healing Back Pain,” cured me when I had been flat on my back for 3 weeks with an acute back attack that neither pain medication nor chiropractic manipulation could touch. Just get Sarno’s books — they’re all most people need to deal with back pain.

  17. Marc
    Little Suamico, WI
    Reply

    I had this problem a few months ago and also did not want a drug solution. The doctor prescribed some exercises specific for lower back pain which did help a little. My Wife who is from Russia remembered a treatment that she had many years ago that involved an elastic wool type back brace with a velcro fastener which she brought here and gave it to me to try and it worked much better and quicker than the exercises did.

  18. Al
    Reply

    Lifted too many rocks in designing front yard and lower discs were herniated. Got Physical Therapy and stopped the pain. Still doing exercises to prevent.

  19. Rhonda
    Dallas, TX
    Reply

    There are so many different reasons why people have lower back pain. I have severe arthritis in my SI joint so it will never go away. This article doesn’t really cover chronic lower back pain and isn’t really helpful for those of us that will live with that pain for the rest of our lives.

  20. Michael
    N Central Nebraska
    Reply

    It seems that the medical community has its own addiction: to oversimplified answers. The experience of back pain does not always lead to an easy answer as to the cause. Nerve pain? maybe acupuncture will help, or shiatsu. Do you sit a lot? Have a trained neuromuscular therapist look at the psoas muscle. Did you twist while you picked something up? The quadratus lumborum muscles can fail when you do this. Is one hip cocked out a little? Perhaps it is the piriformis muscle or one of the other hip rotators. And so on. The important thing is to look at the body, the muscles, the spinal alignment, hey, even the person’s daily water consumption. Put drugs and surgery off if you can and sidestep the serious risks that come with following that path. Physicians can often provide a diagnosis but their understanding of treatment options is usually very limited.

  21. Fran K.
    NY
    Reply

    I had pain for months from spinal stenosis and other disc issues. I tried cortisone injections, physical therapy, acupuncture, heat, etc. The only thing that dulled the pain and allowed me to sleep was oxycodone. Though I was against surgery I finally made up my mind to have it done because I could not deal with the pain any longer.

    The highly regarded orthopedic surgeon who I saw, said that the surgery would be more complicated than I was originally told by other physicians and health professionals and suggested that I try aquatherapy. I cannot describe how that changed my life. Within a month I no longer needed my cane and I was able to function normally. The other people who come to the aquatherapy sessions also say that it has made a big difference in their lives, which is why we are continuing with this therapy.

  22. MM
    Westchester County, New York
    Reply

    I swear by chiropractic care. Of course, as with anything else, choose a good, reputable chiropractor who does functional chiropractic.

  23. Anne
    Wisconsin
    Reply

    Physical therapy and the right kind of exercise and stretching have made a huge difference for me.

  24. Thomas M
    Missouri
    Reply

    A lot of this info is erroneous. Yoga in fact has been recently been found to put enormous strain on the back. Aerobic exercise too – in fact there is evidence now to suggest that the aerobics fitness craze of the eighties actually caused spinal damage.

    As for painkillers not working or delaying healing, this is nothing short of ridiculous. This includes the new fad of Ibuprofen bogie calling.

    If you have suffered spinal nerve root impingement you will know that only surgery to release the nerve roots and opioid painkillers are of the slightest benefit.

  25. Martin
    Great Neck, N.Y.
    Reply

    It is apparent that the writer of this condescending article never experienced real back pain. I have spondylolisthesis, various bulging discs, and spinal stenosis. As a result of these conditions, besides severe pain, I also experience an itch on the top of my right arm, that is indescribable. I brought these symptoms to my internist, who sent me to a dermatologist, who extracted about $500 from me. I moved on to an allergist, who said it was not an allergy. Now what?

    I went on the internet and searched, and studied, and realized that I needed a neurologist. In 5 minutes, he put me on gabapentin, which took care of most of my symptoms. About 2 years later, the gabapentin stopped working for the itch. The Dr. then put me on Lyrica, which takes care of the itch (90%). It is not as good with the back pain. This is where I am today.

    Maybe, I’ll try Yoga tomorrow.

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