Back pain therapy


What to do about severe back pain?

Self help at home

Self-help measures against back pain have fewer side effects than pharmacological therapy (especially during pregnancy and breastfeeding ) and can solve the cause of the symptoms.

The general recommendations and advice are intended to help patients return to normal daily activities as soon as possible.
However , excessive stretching of the lumbar spine and back-straining activities should be avoided.

Most experts agree that prolonged bed confinement prolongs the healing process; People who stay in bed for long periods are at risk of depression, blood clots in the legs, and a reduction in muscle tone. Few researchers recommend bed rest or reduced activity for more than 48 hours; in other words, the patient should stand up and move appropriately.

Sleeping on your side with a pillow between your knees may be more comfortable because it relieves tension on the external hip rotator muscles. Some doctors recommend lying on your back, with a pillow under your knees.

In the case of acute low back pain (lumbago), there are no special exercises that would relieve the pain or improve back functions.
Back exercises, on the other hand, are helpful for chronic pain so that patients can soon resume their normal everyday activities. An important aspect of this is strengthening and building up the abdominal, upper and lower back muscles.
Regular yoga and a variety of stretching exercises can successfully relieve chronic low back pain. Stretching plays an important role against back pain.

Over-the-counter medicines can provide temporary relief.
Ibuprofen is an excellent medication to treat short-term back pain. However, prolonged use increases the risk of ulcers and bleeding in the gastrointestinal tract , so in this case the doctor should be consulted first.
Paracetamol (eg Ben-u-ron) is just as effective as ibuprofen for relieving lower back pain .

Creams or gels that are massaged into the skin are not as effective as medications taken by mouth.

One of the tried and true home remedies is applying heat directly to the back; While the effectiveness of this form of treatment has not been scientifically proven, heat relaxes muscles and ligaments.
Ice packs, on the other hand, should be avoided because they can aggravate muscle tension .

If the pain occurs at night or in the morning after getting up, it could be caused by a mattress that is too soft or too hard. The slatted frame should consist of hard slats or wooden slats, the mattress must not sink under your body weight, but it must not be too hard either.

Memory foam mattresses, which are commercially available everywhere, can provide relief for morning back pain; but not everyone can sleep well on it, so it is definitely advisable to try it out extensively before you buy it.

Medical treatment for back pain

Initial treatment for low back pain (low back pain) is based on the assumption that 90% of those affected will have pain relief within a month. There are a variety of treatment options. Some therapies have proven to be very effective, others are rather questionable. In any case, all possible treatment methods should be discussed with the doctor.

Self-help measures are particularly recommended at the beginning of treatment. Bed rest is not recommended based on scientific research results, most experts advise a maximum of two days of bed rest or rest. Some patients with sciatica feel better after two or three days of rest. In some cases, local heat applications bring relief, it may be worth trying. Paracetamol and ibuprofen help with the pain.

Many studies have questioned the usefulness of current treatments for back pain. You don’t know if a particular therapy will be successful until you try it. The doctor may prescribe therapies that have been helpful in the past.

Medicines for back pain

The pharmaceutical options depend on the exact diagnosis of the back pain. The doctor decides which drugs to take based on medical history, allergies , and possible interactions with other drugs.

Anti-inflammatory drugs of the non-steroidal anti-inflammatory drug type, or NSAIDs for short, have proven effective for back pain because of their pain-relieving properties. The most commonly prescribed drugs include ketoprofen (Alrheumun) and diclofenac (Voltaren). Among the NSAIDs, no drug has so far proven a higher pain-controlling effect than another. Nevertheless, the doctor can switch within the NSAIDs to see which drug works better in individual cases. Prolonged use of NSAIDs can cause a variety of side effects, including stomach irritation and kidney damage.

COX-2 inhibitors , such as celecoxib (Celebrex), represent a subgroup of NSAIDs. Although they are expensive, the occurrence of equally expensive and life-threatening bleeding in the gastrointestinal tract as an undesirable side effect is lower with COX-2 inhibitors than traditional NSAIDs. The long-term consequences (increased risk of heart attack and stroke) are currently being investigated.

Paracetamol is an effective pain reliever for the treatment of acute low back pain.

Muscle-relaxing drugs (muscle relaxants) : Muscle spasms are not generally recognized as a cause of back pain and most muscle-relaxing drugs have no effect on muscle spasms; they may be more effective than a placebo (sugar) at treating back pain, but they have not been shown to be more effective than NSAIDs. Taking muscle relaxants and NSAIDs together is no more beneficial than taking NSAIDs alone. Muscle relaxant medications lead to fatigue
about 30% of the time . Regular use is not recommended.

Opioids : These drugs can be used to control pain in acute low back pain. However, taking these drugs can have serious side effects: dependence, sedation, decreased reaction times, nausea , and impaired judgment.
Undesirable side effects also include constipation ; it occurs in a high percentage of patients who take this type of drug for more than two days. Some studies support short-term use for temporary pain relief.
Taking opioids does not shorten recovery times from low back pain.

Oral cortisone can help treat acute sciatica. Injections of steroids into the epidural space have not been proven to improve symptoms or regain functionality and are not currently recommended for the treatment of acute low back pain other than sciatica.
As far as the effect on chronic low back pain with sciatica is concerned, opinions differ. Injections into the posterior joints, i.e. the facet joints, can be helpful for those suffering from pain caused by sciatica.
Infiltrations into the trigger points show no proven effect on acute back pain.
Injections of steroids and local anesthetics into trigger points are helpful for chronic low back pain, but their use remains controversial.

Surgical measures for lower back pain

Surgical intervention is only considered in the rarest of cases for acute pain in the lumbar spine, with the exception of sciatica and cauda equina syndrome. Surgery can be helpful for patients with progressive nerve pathologies related to disc herniation.

Other therapies

Osteopathic or chiropractic vertebral manipulation is helpful for the first month after symptoms appear. The studies on this subject have brought conflicting results. The manipulations have also had opposite effects on patients with chronic back pain. The effectiveness of this treatment remains unknown. No benefit from manipulation was found in people with neurological pathologies.

Acupuncture : Current knowledge does not support the treatment of acute low back pain with acupuncture. There are no scientifically valid studies. The effectiveness of acupuncture remains controversial.

In transcutaneous electrical nerve stimulation ( TENS ), electrical impulses are transmitted to the surface of the skin via electrodes. It has no proven benefit in acute low back pain. Two smaller studies show inconclusive results trending towards improvement in TENS. In the case of chronic back pain, there are conflicting statements with regard to their pain-relieving effect. One study shows a slight benefit after the first week, but no difference after three months and beyond. There is no proven benefit for sciatica .

Range of motion exercises : For acute back pain, there is currently no evidence that targeted back exercises , such as Pilates, are any more successful than rest in restoring back function and reducing pain. For chronic pain, studies show benefit from muscle strengthening exercises and Pilates. The physical therapy can be carried out by a trained physiotherapist.

It is important to realize that incorrect posture is caused by muscle tension affecting body alignment. There are some specific exercises that stretch and relax the main back muscles. Meditation and other forms of mental relaxation are a way for some people to relax their back muscles as well. Many people find that treatments and activities such as massage therapy , chiropractic care, osteopathic manipulation, yoga, tai chi, or a regular exercise program at the health club are helpful in relaxing muscles and improving posture.

Kinesio – Taping for back pain, herniated disc , piriformis syndrome and contracture of the quadratic lumbar muscle
This taping is used for all pain syndromes that affect the lumbar region of the back. Effect: tension-relieving. Shape: four “I” stripes. Length: 25cm.
The tapes are applied without tension just to the side of the spine while the patient bends forward. Always attach on both sides.

Herbal remedies are not particularly effective for pain in the lumbar region or sacrum.

The control

After the first visit to the doctor for back pain, the doctor’s instructions should be followed as closely as possible. This includes taking medication and performing recommended activities. The back pain will most likely get better after a few days. Don’t get discouraged if you don’t see an immediate improvement. Almost all patients recover within a month of the onset of pain.

Back pain prevention

Opinions differ on how to prevent back pain. For a long time it was thought that physical exercise and a healthy lifestyle could prevent back pain. That’s not necessarily correct. Numerous studies show that the wrong exercises, such as particularly intense activities, increase the likelihood of back pain.
Nevertheless, exercise is important for general health and should not be avoided; Here are some tips for a healthy back:

  • Back-friendly activities like swimming, walking, and cycling keep you fit without straining your lower back.
  • Specific exercises: the doctor can give instructions on how to perform the exercises correctly.
  • The crunch (abdominal exercise) is highly recommended; when done correctly, it strengthens the abdominal muscles, which helps prevent back pain from recurring.
  • While they don’t help relieve low back pain, stretching exercises and yoga can help stretch tight back muscles and help prevent back pain.
  • Pelvic movements help stretch shortened and contracted back muscles.
  • Lumbar Support Belts: Occupations that involve frequent lifting of heavy loads often involve the wearing of support belts. There is no evidence that these harnesses prevent lumbar injuries. A study even proves that they increase the risk of injury.
  • Exercise precautions: those suffering from back pain or sciatica should avoid certain exercises and equipment, such as squats and leg presses; Cyclists should avoid inclines.

Back pain prognosis

The outlook for people with acute back pain depends on the cause of the pain.
In 90% of cases, back pain is gone within a month if there are no other health problems.
In about half of the population, back pain can come back.
About 80% of people suffering from sciatica can fully recover with or without surgery. The recovery times here are considerably longer than with acute low back pain without complications.
Staying active and limiting bed rest to two days will recover faster.

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