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Part III: Creating Hope for Tomorrow
Oh, My Aching Back: Low Back Pain – Part III
by Professor Visser, Churack Chair of Pain Management

Your Back Pain checklist:

  • Education and information: Providing ‘helpful’ messages about back pain is very important. There’s a lot of misinformation out there, especially on the internet. This may cause undue worry and lead to ineffective and often expensive treatments.
  • The PainHealth© website: Type PainHealth into Google and it will come up. This is an excellent resource about pain developed by universities and pain clinics in WA.
  • Get a check-up from your GP: if your back pain is getting worse, especially after a fall, or if you have weakness or numbness in your legs, or problems with bladder or bowel function, please see your doctor. 
  • Paracetamol (eg. Panadol™, Panadol Osteo™) is effective and inexpensive-consider taking ‘regular’ doses. 
  • Stronger pain medications: Sometimes your doctor may prescribe a stronger medication such as tramadol, tapentadol (Palexia™) or a pain ‘patch’ such as Norspan™. Panadeine forte™ may help in some cases, but causes constipation-the dose should never be more than 4 tablets per day.
  • Older persons with back pain due to arthritis in the spine may benefit from small doses of stronger morphine-based pain medications. However, persons under 60 with back pain hardly-ever respond to strong pain relievers and should avoid them due to side effects.
  • In older persons, there is very little risk of becoming hooked or addicted on stronger pain relievers. 
  • We try to minimise medication side effects such as sleepiness, confusion, falls, nausea and constipation. The good news is that side effects are usually mild and settle down after a week or so.
  • With pain medications, ‘start low (dose) and go slow’; the trick is to building-up the dose once a week or so, with the help of your GP. 
  • Anti-inflammatory (arthritis) pain relievers such as ibuprofen, meloxicam or celecoxib are effective for back pain flare-ups but should not be used long-term because of the risk of high blood pressure, heart, kidney or stomach problems.
  • Heat therapy (heat wraps) are effective for treating flare-ups of acute back pain. 

 If you have back pain, a good physiotherapist should become your best friend.

They are trained to keep you moving.

Remember, ‘motion is lotion’ so stay as active as possible.

  • Physiotherapy: Gentle activities such as walking, hydrotherapy or swimming are unlikely to ‘damage’ to your back, even if you experience some pain at the time.
  • Exercise: Walks, stretches, swimming or hydrotherapy are best. Be guided by your physiotherapist.
  • Spinal core stability: ‘Core muscles’ of the abdominal wall and the back support and stabilize the spine. ¨  Strengthening these muscles may reduce back pain and improving mobility. Some physiotherapists use an ultrasound machine so you can see your own core muscles contracting, which helps you to ‘train them up’.
  • Spinal manipulation: May help acute back pain ‘flare-ups’ but not chronic back pain.
  • Massage: Reduces muscle tension and discomfort in the lower back, but it’s usually a temporary measure (hours-to-days).
  • ‘Trigger point’ release: Loosening-up painful muscle ‘knots’ (trigger points) in back using physiotherapy, ‘dry needling’ or local anaesthetic injections, may be helpful in some cases.
  • Acupuncture: The jury is still out, but acupuncture may help acute back pain flare- ups for short periods. As a general rule, if five sessions of acupuncture have not done anything, it’s unlikely more sessions will help. 
  • TENS machine: This is an electrical stimulator (the size of a transistor radio) applied to the back, which produces an ‘electrical buzzing sensation’ that turns-off the pain signal. It’s the same effect as ‘rubbing’ your arm if it hurts. There’s not a lot of evidence that TENS helps back pain, but its drug free, low risk and relatively cheap.
  • Spinal injections: Occasionally, pain relieving spinal injections such as facet joint injections, ‘rhizotomies’ or trigger point injections may help back pain in 1 in 3 cases. Your doctor may arrange for you to go to an x-ray clinic or pain specialist for these. Injections are not a cure but they can switch-off pain signals for weeks or months, giving other treatments like physiotherapy a better chance to work long-term.
  • Spinal operations (fusions, laminectomies): Surgery should always be a last resort for back pain—good spinal surgeons will tell you this. For leg pain (sciatica) due to a disc compressing a spinal nerve, surgery may be helpful in some cases. For the treatment of back pain alone, the success rate is much lower.
  • Glucosamine, cartilage supplements, fish oil, magnetic therapies, spinal corsets and back braces generally DO NOT help low back pain.
  •  ‘Stressing the stress’: The main factor that predicts a person’s risk of developing long-term (chronic) back pain is not what the MRI scan shows— it’s the amount of stress a person-in-pain has in their life, such as depression, anxiety, financial or family stresses and work issues.

 The more stress you have to deal with, the longer it takes for your back pain to improve.

 Next in the series...
Clinical Psychology  - Dealing with Stress and Worry with Back Pain

Disclaimer: General information only–not intended as specific clinical advice or treatment. The author cannot take responsibility for any outcomes related to this information. Always see your health care professional if you have concerns about your back pain.

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