Update on the Treatment of Chronic Low Back Pain
Over the years, the treatment of acute low back pain (LBP) has changed from bed rest to activity. This advice may help prevent acute pain from becoming chronic pain.
But when chronic LBP does occur, what's the best way to manage it? In this article, Dr. B. H. McCarberg, the founder of Kaiser Permanente's chronic pain program summarizes what is the current evidence on this topic.
Treatment begins with medications such as analgesics (pain relievers) or antiinflammatories. Topical creams such as capsaicin may be used along with ice and/or heat. Some patients choose to see a chiropractor and seem very satisfied with the results.
Evidence from research supports exercise therapy, behavioral therapy, and acupuncture. Combining several treatment options through a multidisciplinary approach may be best. Some patients don’t have health coverage for outside help. Exercise remains the best and least costly tool.
There are still many treatments used by patients that haven't been fully investigated. These include trigger point, facet joint, or epidural injections. There is also a lack of evidence for the use of lumbar supports, antidepressants, and muscle relaxants.
There are some test measures that can help identify the source of the pain. This makes it more likely that the cause of the pain can be treated directly. Sometimes there is more than one problem generating pain signals.
In these cases, injections of the facet (spinal) joints or sacroiliac joint may pinpoint the exact location of the pain source. X-rays, MRIs, and CT scans can be used to look for arthritis, fractures, or tumors. Once the pain is under control, Physical Therapy can be helpful to restore normal motion, posture, strength, and gait (walking) pattern.
Sometimes conservative care is unable to relieve pain and restore sleep, function, and motion. At this point, surgery may be considered. Patient education is the key to avoiding unnecessary surgery. Weight loss, smoking cessation, exercising, and cognitive changes (the way the patient thinks about his or her pain) must be incorporated into the management first.
Bill H. McCarberg, MD, and Gladstone C. McDowell II, MD. Recent Advances in the Management of Chronic Low Back Pain. In Pain Medicine News. November 2007. Vol. 5. No. 6. Pp. 71-76.