• Managing Chronic Low Back Pain

    IMAGE If you have never suffered from low back pain, consider yourself one of the fortunate few. Back pain is a common reason for Americans under the age of 45 to limit their activity. It is also a common reason for visits to the doctor and for surgery. There is some good news, though. With or without medical treatment, most people recover from an acute episode in a few days or weeks. But for many people, low back pain becomes a chronic or recurrent condition, often resulting in considerable social and occupational disability.

    Why So Common?

    Many factors contribute to low back pain—inadequate fitness, heavy lifting, poor posture. But our evolutionary history is to blame for our susceptibility to this pain. At some point in the distant past, some of our ancestors decided to stand on two feet, presumably so their hands would be free to fashion tools and use them efficiently. While their reasons were good, going vertical was not without its drawbacks.
    Walking around on all fours distributes the force of gravity evenly over the length of the spine. Standing up, however, concentrates this force in one location—the lumbosacral region, just north of the buttocks. Our vulnerability to low back pain is the price we pay for bipedal locomotion.
    Several factors can contribute to persistent back pain:
    • Having a work-related injury, particularly if the work environment requires or allows use of improper body mechanics (eg, bending or twisting when lifting)
    • Having poor ergonomics for sedentary workers
    • Having a degenerative disease (eg, arthritis) of the spine
    • Being overweight or obese

    No Obvious Cause

    Most cases of chronic back pain are idiopathic, meaning they have no clear explanation. Without a known cause, treatment is very difficult and often unsuccessful. This leads many people to alternative therapies. Below are among the most commonly used therapies to treat chronic low back pain:
    There is some evidence that, at least in the short-term, each of these therapies may be effective at alleviating discomfort, improving function, and/or enhancing a sense of well-being. However, it is unclear if any one of these therapies is superior to the others or to physical therapy, the standard conventional treatment. Furthermore, it is unclear that any of these approaches provides more than short-term benefit.

    More Is Better

    So, what then is the best treatment for chronic low back pain? According to evidence, what seems to matter is not which one, but how many treatments you use. In other words, interventions that address not only the physical aspects of the pain, but also its psychological, social, and occupational influences seem to be the most effective. An effective rehabilitation program may encompass:

    Complex Solutions for Complex Problems

    This combination of therapies makes a lot of sense. It is well known that an enormously complex range of factors, affecting many aspects of life, contribute to our experience of chronic pain. It is hard to imagine, then, that any single intervention—alternative or conventional—could succeed. An alternative therapy, therefore, should be part of a multi-dimensional treatment strategy.

    Where Do We Go From Here?

    If you suffer from idiopathic chronic pain anywhere in your body consider the following steps:
    • Recognize that your condition is a complicated problem that cannot be treated in isolation. This is the first step to gaining control over your pain and your life.
    • Determine which facets of your pain have not been adequately addressed—psychological, social, occupational, and/or physical. Tackling this problem from only one perspective is unlikely to work.
    • Continue working with your doctor, and consider getting a referral to a doctor who specializes in physical medicine and rehabilitation. These doctors may be in the best position to coordinate a comprehensive, multi-disciplinary treatment plan, whether or not it includes alternative therapies.
    • Strive to restore your ability to function. Your goal should be to resume your normal activities, not only to reduce your pain. Although the two are closely linked, the evidence suggests that focusing on function is the key to recovery.
    • Look both ways. Look ahead to visualize what it will be like to have no pain or disability. But also look back to measure your progress. It is easier to succeed when you see how far you have come.

    RESOURCES

    American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org/

    American Society of Exercise Physiologists http://www.asep.org/

    CANADIAN RESOURCES

    Canadian Society of Exercise Physiology http://www.csep.ca/

    Health Canada http://www.hc-sc.gc.ca/index-eng.php/

    References

    Back pain. EBSCO Natural and Alternative Treatments website. Available at: http://www.ebscohost.com/healthLibrary/. Updated October 31, 2011. Accessed December 5, 2011.

    Slipman CW, Derby R, Simeone FA, Mayer TG. Interventional Spine: An Algorithmic Approach. Philadelphia, PA: Saunders Elsevier; 2008.

    1/15/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance: Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E. The association between obesity and low back pain: a meta-analysis. Am J Epidemiol. 2010;171(2):135-54.

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