Monday, December 22, 2014

What are the treatment options for back pain?

In the vast majority of cases back pain resolves itself without medical help - just with careful attention and home treatment. Pain can usually be addressed with OTC (over-the-counter, no prescription required) painkillers. Resting is helpful, but should not usually last more than a couple of days - too much rest may actually be counterproductive. 

Usually back pain is categorized into two types:

  • Acute - back pain comes on suddenly and persists for a maximum of three months. 

  • Chronic - the pain gradually develops over a longer period, lasts for over three months, and causes long-term problems.
A considerable percentage of patients with back pain experience both occasional bouts of more intense pain as well as more-or-less continuous mild back pain, making it harder for the doctor to determine whether they have acute or chronic back pain. 

Injecting cells to regenerate spine discs - scientists from Duke University, North Carolina, developed new biomaterials that can deliver a booster shot of reparative cells to the nucleus pulposus, effective eliminating pain caused by degenerative disc disease.

If home treatments do not give the desired results, a doctor may recommend the following: 

1) Medication 

Back pain that does not respond well to OTC painkillers may require a prescription NSAID (nonsteroidal anti-inflammatory drug). Codeine or hydrocodone - narcotics - may also be prescribed for short periods; they require close monitoring by the doctor. 

Some tricyclic antidepressants, such as amitriptyline, have been shown to alleviate the symptoms of back pain, regardless of whether or not the patient has depression

2) Physical Therapy (UK: physiotherapy)

The application of heat, ice, ultrasound and electrical stimulation, as well as some muscle-release techniques to the back muscles and soft tissues may help alleviate pain. As the pain subsides the physical therapist may introduce some flexibility and strength exercises for the back and abdominal muscles. Techniques on improving posture may also help. The patient will be encouraged to practice the techniques regularly, even after the pain has gone, to prevent back pain recurrence. 

3) Cortisone injections 

If the above-mentioned therapies are not effective enough, or if the pain reaches down to the patient's legs, cortisone may be injected into the epidural space (space around the spinal cord). Cortisone is an anti-inflammatory drug; it helps reduce inflammation around the nerve roots. According to The Mayo Clinic, the pain-relief effect will wear off after less than six weeks. 

Injections may also be used to numb areas thought to be causing the pain. Botox (botulism toxin), according to some early studies, are thought to reduce pain by paralyzing sprained muscles in spasm. These injections are effective for about three to four months. 

4) Surgery 

Surgery for back pain is very rare. If a patient has a herniated disk surgery may be an option, especially if there is persistent pain and nerve compression which can lead to muscle weakness. Examples of surgical procedures include:

  • Fusion - two vertebrae are joined together, with a gone graft inserted between them. The vertebrae are splinted together with metal plates, screws or cages. There is a significantly greater risk for arthritis to subsequently develop in the adjoining vertebrae. 

  • Artificial disk - an artificial disk is inserted; it replaces the cushion between two vertebrae. 

  • Discectomy (partially removing a disk) - a portion of a disk may be removed if it is irritating or pressing against a nerve. 

  • Partially removing a vertebra - a small section of a vertebra may be removed if it is pinching the spinal cord or nerves.
5) CBT (Cognitive Behavioral Therapy) 
According to some studies, CBT can help patients manage chronic back pain. The therapy is based on the principle that the way a person feels is, in part, dependent on the way they think about things. People who can be taught to train themselves to react in a different way to pain may experience less perceived pain. CBT may use relaxation techniques as well as strategies to maintain a positive attitude. Studies have found that patients with CBT tend to become more active and do exercise, resulting in a lower risk of back pain recurrence. 

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