Mechanical low back pain is the second leading cause for individuals to visit a health care provider. Approximately 80 percent of Americans will develop mechanical low back pain at least once in their lives. It most commonly occurs between 20 and 40 years of age, American Family Physician reported. Unfortunately, recurrent low back pain re-occurs in 25 to 62 percent of adults within one to two years of initial onset, making this a perpetual cycle. Generally, medical intervention is not needed; however, there are certain “red flag” symptoms in which emergent medical treatment is necessary.
“Serious red flags include significant trauma related to age (i.e., injury related to a fall from a height or motor vehicle crash in a young patient, or from a minor fall or heavy lifting in a patient with osteoporosis or possible osteoporosis), major or progressive motor or sensory deficit, new-onset bowel or bladder incontinence or urinary retention, loss of anal sphincter tone, saddle anesthesia, history of cancer metastatic to bone, and suspected spinal infection.”
Chronic pain can impair all aspects of an individual’s life. It causes severe problems for the individual — not only physical challenges, but emotional and mental difficulties as well. “Chronic pain impairs an individual’s social, vocational and psychological well-being,” according to a University of Florida presentation. “Among psychological factors, chronic pain has been frequently associated with depression, which may vary from minor to severe. Depression also appears to intensify chronic pain.”
Chronic low back pain can prevent individuals from partaking in their favorite physical activities and prevent them from going to work resulting in lost wages. It can affect their home life and potentially cause them an economic burden between lost wages and expensive treatment modalities.
For typical low back pain, regular activity, anti-inflammatory medications and time have been the mainstay of treatment. NSAIDs, acetaminophen and muscle relaxants such as cyclobenzaprine are the mainstay pharmaceutical approaches to this type of pain. Narcotics are not in the initial treatment regimen and should not be prescribed initially without following the appropriate step-up approaches.
“Opioids are commonly prescribed for patients with severe acute low back pain; however, there is little evidence of benefit. Three studies showed no difference in pain relief or time to return to work between oral opioids and NSAIDs or acetaminophen, and there is risk of harmful dose escalation over time with opioids, especially with purer formulations.” In addition, bed rest should be avoided, as this can prolong the healing time.
The treatment for chronic low back pain is controversial, as there are many different schools of thought. Some professionals believe in the pharmaceutical approach while others believe in physical therapy and Eastern medicine alternatives such as yoga and acupuncture.
A recent study in The Journal of the American Medical Association (JAMA) evaluated 342 adults aged 20 to 70 years with chronic low back pain. The researchers compared alternative treatments such as cognitive behavioral therapy (CBT) and mindfulness-based stress reduction (MBSR) to standard treatments such as pain relief from pharmaceuticals and exercise. MBSR focused on training in mindfulness and yoga therapy. Meditations included sitting meditation, breathing exercises, and paying attention to present thoughts and emotions without trying to change them. CBT focused on training that helped channel pain-related thoughts into positive outcomes.
Specifically, individuals were educated on:
The results demonstrated greater improvement in individuals who received CBT and MBSR compared to conventional therapy. There was no difference in between the outcomes for CBT and MBSR respectively. This study is still in the experimental phase and has not been rigorously evaluated.
Sovereign Health of Texas stays up-to-date on the latest research to provide our patients with the best evidence-based treatments possible. Our El Paso treatment center offers programs for substance use disorders and co-occurring disorders. If you or a loved one is struggling, please do not hesitate to contact us via our 24/7 helpline.
Kristen Fuller, M.D., is a medical writer at Sovereign Health, who enjoys writing about evidence-based topics in the cutting-edge world of medicine. She is a physician and author, who teaches, practices medicine in the urgent care setting and contributes to medicine board education. She is also an outdoor and dog enthusiast. For more information and other inquiries about this article, contact the author at firstname.lastname@example.org.
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