What is the best treatment for back pain?

November 17, 2017
Jamie Belcastro RPh
Belmora LLC
There are many treatments for back pain, including pills, patches, belts, compresses, and topical treatments. Which is best for you?
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Back pain is the second most common neurologic ailment in the United States—only headache is more common. Within a given year, up to 50% of adults suffer from back pain and 85% of people younger than 50 years will experience at least 1 back pain episode each year.1-3

Acute lower back pain (LBP) lasts from 1 day to 3 months; longer durations are classified as chronic. Common causes include nerve irritation, bone and joint arthritic conditions, lumbar radiculopathy (nerve irritation caused by herniated or damaged discs), and bony encroachment (vertebrae can shift, pressing against the spinal cord and nerves).4 Other causes may include kidney stones, obesity, smoking, stress, poor posture, and poor sleeping conditions. Acute back pain’s most common cause, however, is lumbar strain—a stretch injury to the lower back’s ligaments, tendons, and/or muscles. The injury creates microscopic tears in these tissues, causing pain and inflammation.4

Treatment
Most back pain is self-limiting, dissipating within days. The most effective treatment are anti-inflammatories, apply topical analgesics, and muscle-strengthening exercises to restore proper function and prevent recurrence.
The pain threshold is often misunderstood. Your pain threshold is the point at which your body experiences pain due to an external or internal stimulus. It is NOT constant and changes over time and even within a given day. Why? Your body experiences varying degrees of stress over time and even within a day.
Single Agent Treatments
Since your body’s pain threshold is dynamic it is unlikely you will experience back pain relief from a single treatment. A multi-agent approach is necessary given the numerous nerves and tissues that comprise the back and the varying degrees of stress that is placed on your back during the day.

Anti-Inflammatories
The ideal anti-inflammatory is one that has a long half-life or duration of action. Flanax Pain Reliever tablets is one such agent. In addition, it is wise to choose an anti-inflammatory with the lowest side effects. Of all NSAIDs studied, naproxen(Flanax) had the lowest risk profile.7

Topical Analgesics
Most OTC topical analgesics direct the patient to rub the agent directly on the tender area. They appear to relieve pain by causing a counterirritant effect, producing either a burning or cooling sensation. The most common active ingredient in OTC rubefacient products is capsaicin, which is derived from chili peppers. Once the skin absorbs capsaicin, it desensitizes the individual to pain by interfering with neural signals that transmit pain sensations to the brain. Other products contain methyl salicylates, wintergreen, or eucalyptus oil.
The ideal topical analgesic would contain a combination of active ingredients such as Flanax Liniment which contains capsaicin, menthol, and methyl salicylate.

Hot and Cold Compresses
Hot and cold presses are scientifically unproven to provide a speedy recovery from acute back pain, but they can help temporarily reduce pain and inflammation but will not provide any further benefit with chronic use.
Belts
Although some people find them helpful, the use of wide elastic belts and other support garments that can be tightened to “pull in” lumbar and abdominal muscles remains controversial. One landmark study found no evidence that elastic belts and similar garments reduced and/or prevented back injury or back pain.1

Bed Rest
People with back pain who continue their normal routine function better than those assigned to bed rest. A Cochrane report concludes, “Advice to rest in bed is less effective than advice to stay active.”12Activity is also associated with modest improvements in pain and function.13 Bed rest alone may exacerbate back pain because it decreases muscle tone and increases risk for blood clots.

Final Thought
Because back pain is a recurring condition for many, it helps to focus on prevention Exercise strengthens back muscles and is the most effective way to a speedy recovery and preventing future muscle strain. Walking is perhaps the best exercise for preventing LBP.1,14 PT

References
1. National Institute of Neurological Disorders and Stroke. Low back pain fact sheet. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm. Accessed January 8, 2011.

2. US Spine Care. Facts about back pain. http://www.usspinecare.com/back-pain-facts.html. Accessed January 10, 2011.

3. Perina D. Back pain, mechanical. http://emedicine.medscape.com/article/822462-overview. Accessed January 10, 2011.

4. Shiel W. Lower back pain (lumbar back pain). http://www.medicinenet.com/low_back_pain/article.htm. Accessed January 8, 2011.

5. Chou R, Qaseem A, Snow V, et al. Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Ann Intern Med. 2007;147:478-491.

6. Herndon CM, Hutchison RW, Berdine HJ, et al. Management of chronic nonmalignant pain with nonsteroidal anti-inflammatory drugs. Joint opinion statement of the Ambulatory Care, Cardiology, and Pain and Palliative Care Practice and Research Networks of the American College of Clinical Pharmacy. Pharmacotherapy. 2008;28:788-805.

7. Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011;342:c7086. doi: 10.1136/bmj.c7086.

8. Gandey A. All nonsteroidal anti-inflammatory drugs have cardiovascular risks. http://www.medscape.com/viewarticle/735672.

9. Roelofs PD, Deyo RA, Koes BW, et al. Nonsteroidal anti-inflammatory drugs for low back pain: an updated Cochrane review. Spine. 2008;33:1766-1774.

10. Lowes R. FDA limits acetaminophen in prescription analgesics. http://www.medscape.com/viewarticle/735738. Accessed January 18, 2011.

11. Matthews P, Derry S, Moore RA, McQuay HJ. Topical rubefacients for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009(3):CD007403. DOI: 10.1002/14651858.CD007403.pub2. http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD007403/frame.html.

12. Hagen KB, Hilde G, Jamtvedt G, Winnem M. WITHDRAWN: Bed rest for acute low-back pain and sciatica. Cochrane Database Syst Rev. 2010(6):CD001254.

13. Vega C. For acute low back pain, staying active may be better than bed rest. http:/medscape.org/viewarticle/724386. Accessed January 10, 2011.

14. WebMD. Low back pain – treatment overview. http://www.webmd.com/back-pain/tc/low-back-pain-treatment-overview. Accessed January 10, 2011.

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