Management Back pain

1 management

1.1 pain
1.2 procedures
1.3 surgery
1.4 doubtful benefit
1.5 chronic pain
1.6 alternative medicine

management

the management goals when treating pain achieve maximal reduction in pain intensity rapidly possible, restore individual s ability function in everyday activities, patient cope residual pain, assess side-effects of therapy, , facilitate patient s passage through legal , socioeconomic impediments recovery. many, goal keep pain manageable level progress rehabilitation, can lead long-term pain relief. also, people goal use non-surgical therapies manage pain , avoid major surgery, while others surgery may quickest way feel better.

not treatments work conditions or individuals same condition, , many find need try several treatment options determine works best them. present stage of condition (acute or chronic) determining factor in choice of treatment. minority of pain patients (most estimates 1% - 10%) require surgery.

pain

heat therapy useful spasms or other conditions. review concluded heat therapy can reduce symptoms of acute , sub-acute low-back pain. patients find moist heat works best (e.g. hot bath or whirlpool) or continuous low-level heat (e.g. heat wrap stays warm 4 6 hours).
cold compression therapy (e.g. ice or cold pack application) may effective @ relieving pain in cases.
use of medications in chronic pain controversial. short term use of muscle relaxants effective in relief of acute pain. opioids have not been shown better placebo chronic pain when risks , benefits considered. non-steroidal anti-inflammatory drugs (nsaids/nsaias) have been shown more effective placebo, , more effective paracetamol (acetaminophen). there insufficient clinical trials determine if injection therapy, corticosteroids, helps in cases of low pain.
school intervention consists of both education , physical exercises. 2016 cochrane review found evidence concerning school low quality , not able make generalizations whether school effective or not.
there limited evidence massage may lower pain. massage may give short-term pain relief, not functional improvement, acute lower pain. massage may give short-term pain relief , functional improvement long-term (chronic) , sub-acute lower pack pain, benefit not appear sustained after 6 months of treatment. there not appear serious adverse effects associated massage.
exercises can effective approach reducing pain, should done under supervision of licensed health professional. generally, form of consistent stretching , exercise believed essential component of treatment programs. however, 1 study found exercise effective chronic pain, not acute pain. study found back-mobilizing exercises in acute settings less effective continuation of ordinary activities tolerated.
education , attitude adjustment focus on psychological or emotional causes - respondent-cognitive therapy , progressive relaxation therapy can reduce chronic pain.

procedures

for pain sciatica, injecting spine steroids epidural space under x-ray guidance may improve pain , reduce need surgery.

for sacroiliac joints radiofrequency neurotomy of unclear benefit.

surgery

surgery may appropriate people with:

lumbar disc herniation or degenerative disc disease
lumbar spinal stenosis lumbar disc herniation, degenerative joint disease, or spondylolisthesis
scoliosis
compression fracture

surgery last resort in treatment of pain. recommended if other treatment options have been tried or in emergency situation. 2009 systematic review of surgery studies found that, diagnoses, surgery moderately better other common treatments, benefits of surgery decline in long term.

the main procedures used in pain surgery discetomies, spinal fusions, laminectomies, removal of tumors, , vertebroplasties.

there different types of surgical procedures used in treating various conditions causing pain. nerve decompression, fusion of body segments , deformity correction surgeries examples. first type of surgery performed in older patients suffer conditions causing nerve irritation or nerve damage. fusion of bony segments referred spinal fusion, , procedure used fuse 2 or more bony fragments of metalwork. latter type of surgery performed correct congenital deformities or caused traumatic fracture. in cases, correction of deformities involves removing bony fragments or providing stability provision spine. procedure repair common intervertebral disc lesions may offer rapid recovery (just few days) involves simple removal of fibrous nucleus of affected intervertebral disc. various techniques, such in following paragraph, described in literature.

a discectomy performed when intervertebral disc have herniated or torn. involves removing protruding disc, either portion of or of it, placing pressure on nerve root. disc material putting pressure on nerve removed through small incision made on particular disc. recovery period after procedure not last longer 6 weeks. type of procedure in bony fragments removed through endoscope called percutaneous disc removal. microdiscetomies may performed variation of standard discetomies in magnifier used provide advantage of smaller incision, shorter recovery process.

spinal fusions performed in cases in patient has had entire disc removed or when condition has caused vertebrae become unstable. procedure consists in uniting 2 or more vertebrae using bone grafts , metalwork provide more strength healing bone. recovery after spinal fusion may take 1 year, depending on age of patient, reason why surgery has been performed , how many bony segments needed fused.

in cases of spinal stenosis , disc herniation, laminectomy can performed. during procedure, pressure on nerves reduced, thereby relieving pain. designed exercise program during recovery can increase functional status , decrease low pain compared common recommendation stay active .

back surgery can performed prevent growth of benign , malignant tumors. in first case, surgery has goal of relieving pressure nerves caused benign growth, whereas in latter procedure aimed prevent spread of cancer other areas of body. recovery depends on type of tumor being removed, health status of patient , size of tumor.

doubtful benefit

cold compression therapy advocated strained or chronic pain , postulated reduce pain , inflammation, after strenuous exercise such golf, gardening, or lifting. however, meta-analysis of randomized controlled trials cochrane collaboration concluded evidence application of cold treatment low-back pain more limited, 3 poor quality studies located. no conclusions can drawn use of cold low-back pain .
bed rest recommended can exacerbate symptoms, , when necessary limited 1 or 2 days. prolonged bed rest or inactivity counterproductive, resulting stiffness leads more pain.
inversion therapy useful temporary relief due traction method or spreading of vertebrae through (in case) gravity. patient hangs in upside down position period of time ankles or knees until separation occurs. effect can achieved without complete vertical hang (90 degree) , noticeable benefits can observed @ angles low 10 45 degrees.
ultrasound has been shown not beneficial , has fallen out of favor.

chronic pain

people pain lasting 3 months or more @ risk of physical, psychological , social dysfunctions. such individuals experience less pain , disability if receive multidisciplinary intervention. typically involves combination of physical, psychological , educational interventions delivered team of specialists different skills. such multidisciplinary treatment programs quite intensive , expensive. more appropriate people severe or complex problems.

people have chronic pain may have limited range of motion and/or tenderness upon touch. if pain continues worsen, or red flags might indicate variety of serious conditions present further testing may recommended. these red flags include weakness, numbness or tingling, fever, weight loss or problems bowel and/or bladder control.

alternative medicine

studies of manipulation suggest approach has benefit similar other therapies , superior placebo. manipulation assistance of medication or anesthesia; 2013 review concludes there lack of support use chronic spine pain.
acupuncture has proven benefit pain however, recent randomized controlled trial suggested insignificant difference between real , sham acupuncture.
electrotherapy, such transcutaneous electrical nerve stimulation (tens) has been proposed. 2 randomized controlled trials found conflicting results. has led cochrane collaboration conclude there inconsistent evidence support use of tens. in addition, spinal cord stimulation, electrical device used interrupt pain signals being sent brain, has been studied various underlying causes of pain.
it unclear if low level laser therapy useful low pain.
a 2017 systematic review found tai chi , mindfulness-based stress reduction effective interventions.




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