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Back pain is one of the most common causes of doctor’s
visit and one of the leading reasons why people miss work. Usually, an
episode of back pains lasts anywhere from a few days to a few weeks. The
condition becomes chronic when it lasts longer than 12 weeks.
What
causes chronic back pain?
Chronic back pain is
often attributed to degenerative changes or traumatic conditions of the
spine. Additionally, it is also associated with various conditions,
including fibrositis, inflammatory spondyloarthropathy, and metabolic
bone conditions.
There is no definitive cause of chronic back
pain but epidemiologic data suggests the following risk factors:
1) Cigarette
smoking
2) Morbid obesity
3) Occupations that require repetitive lifting
4) Forward
bending
5) Twisting positions
6) Exceeding physical capacity
7) Exposure
to vibration caused by motor vehicles or industrial machinery
How
do you treat chronic back pain?
Chronic back pain may be treated
without resorting to surgery. An uncontrolled study conducted by Saal et
al showed that 90% of patients with herniated lumbar disk and
radiculopathy (symptoms of chronic pain) were successfully treated with
aggressive rehabilitation and medical therapy. This only goes to show
that surgery is not an absolute necessity when it comes to treating
chronic back pain.
Most healthcare professionals suggest a
three-phase treatment plan for chronic back pain, consisting of the
following:
1) Bed rest
2) Medications
3) Physical therapy
Bed
rest for chronic back pain is only advisable for two days. Several
studies have shown that two-day bed rest is more effective than 7-day
rest period in increasing a person’s recovery rate. In addition, it has
been found that prolonged bed rest can make chronic back pain worse
instead of better as the long bout of inactivity may cause secondary
complications to arise. An inactive patient with chronic back pain may
experience deleterious physiologic effects, which could lead to
shortened muscles and other soft tissues, decreasing flexibility and
range of motion and reduce muscle strength.
Medications for
chronic back pain includes tricyclic antidepressants that can alleviate
insomnia, enhance endogenous pain suppression, reduce painful
dysesthesia, and eliminate other painful disorders such as headaches.
Additionally, anticonvulsant medications (useful for reducing paroxysmal
or neuropathic pain) and calcium channel blockers and alpha-adrenergic
antagonists (for treating complex regional pain syndrome) may also be
used for treating chronic back pain.
Physical therapy for chronic
back pain may be divided into passive and active categories. For passive
therapies, the patients are subjected to the ministrations of a
physiotherapist, often with the aid of modalities (like ultrasound,
electric muscle stimulation, etc.) and manual therapy. Active therapy,
on the other hand, involves exercises which a person with chronic back
pain may perform to help build up and maintain muscle strength and
increase recovery rate.
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