Ohhhh! My aching… back!

[An installment in a planned group of articles on managing common aches and pains….]

One of the most common reasons people go to a doctor or miss work is back pain; nearly one in five patients will present with this problem sometime in life. But while back pain accounts for more than $100 billion spent only 5 percent of back pain patients account for ¾ of that cost–which means the vast majority of back pain sufferers get well with little expense. The good news is that the overall outcome of back pain is encouraging.
The common causes of back pain besides trauma include deconditioning or weakness of the muscles due to disuse, poor posture, overuse, awkward or sudden shifts in position such as twisting while lifting, incorrect lifting technique or heavy lifting, overweight and (surprise!) aging. Muscle spasm, sprains and strains are common causes. (Other causes such as cancer, infection, and trauma will not be addressed here.)
With sudden (“acute”) back pain, reach for ice in the first 48 hours. Apply 20-30 minutes 3-4 times daily for the first two days. After that ice or heat can help—use what feels good, no rule there. Ice can come in the form of a bag of frozen peas, heat as hot towels, heating pads or warm baths. Avoid actually sleeping on a heating bad to avoid burns.
Avoid bed rest longer than a day or two. Reducing activity has been shown to increase pain and lengthen time to recovery. It can also contribute to depression, blood clots and loss of muscle mass and tone, all of which lengthens recovery. Start moving, stretching and returning to normal activity as soon as possible. Sleep with a pillow between the legs or under the knees to further reduce strain.
Exercise itself is the most effective treatment for back pain: gentle stretches and a strengthening program speed recovery. Begin cardiovascular exercise as soon as you can tolerate it: swimming walking, physical therapy exercises.
Alternative approaches can offer relief and may include massage, chiropractic manipulation, acupuncture, biofeedback, nerve stimulation, and traction, among others. See your doctor for guidance.
Medications play a small role in managing pain, and are most helpful in the early management of back pain. Anti-inflammatory medicines such as ibuprofen or naprosyn at higher doses (see your doctor) for 2-4 weeks and a muscle relaxant if indicated can offer much pain relief without the use of narcotics. Narcotics (hydrocodone, oxycodone, morphine among them) may address only about 30% of your pain; these habit-forming drugs should be used judiciously and under the care of a physician.
Perhaps most interestingly, attitude counts. Studies show patients with high expectations for recovery fare much better than those who don’t or those who are depressed. In fact, predictors of acute pain turning into chronic disabling pain include poor coping skills or behaviors, poor overall health and depression or emotional distress.
Finally, the most important management of back pain is the prevention of it in the first place. Regular exercises, proper lifting and carrying technique, good workplace ergonomics go a long way to prevent pain.
Here are some quick tips for a healthier back:
Cardiovascular exercise. Consider swimming, cycling, speed waking for 30 minutes most days of the week. Yoga or Pilates can improve balance and posture. Follow any period of prolonged inactivity, with a program of regular low-impact exercises.
Ergonomics. Have your work space evaluated for ergonomics—even tiny adjustments can have big effects on your body mechanics. A proper supportive chair can save days of pain. Remember to get up and move throughout the day. Use good posture! Put a pillow or rolled towel behind you and a book or low stool to lift your feet. Wear appropriate (low-heel) footgear.
Technique. Ask for help with any heavy lifting and use proper technique.
Diet. A healthy diet improves your reserve and builds bone and muscle strength. Consider Vitamin D (1,000-2,000 units daily) for bone health too.
And, of course, quit smoking if you smoke.
You only get one back… Take care of it and it will give you more pain-free years!

Dr Hoffman

Dr. Rebecca Hoffman is a Family Practitioner and works at Kaiser Permanente in Salmon Creek, which is in Vancouver, Washington. Interests include using diet and healthy living to stay healthy and attending to mental health and its physical manifestations. Personal interests include hiking, jogging, music (she plays the harp), dance, theater, storytelling and writing. She lives with her husband and two daughters.

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