New Recommendations for Back Pain Explored

It can occur gradually or suddenly, but whenever it strikes, lower back pain can be intolerable.

And sufferers have long sought relief with over-the-counter, prescription medication, or just about anything that will provide some comfort and a good night’s rest.

Now, the U.S. National Library of Medicine reports that those with lower back pain should try drug-free remedies — from simple heat wraps to physical therapy — before resorting to medication.

The recommendations for lower back pain, which is among the most common reasons Americans visit doctors, emphasize nondrug therapies more than in the past.

The library stresses that powerful opioid painkillers like OxyContin and Vicodin should be a last resort in some cases of long-lasting back pain.

The new recommendations, published in February, also note that when medication is needed, common over-the-counter pain pills containing acetaminophen such as Tylenol are no longer recommended.

So what’s a person to do?

“Staying active is now recommended,” said Meredith Hutter Chamorro, a Yoga Tune Up teacher and lifestyle design coach. “Interestingly, my classes combine yoga, mindfulness, self-massage with Yoga Tune Up therapy balls, and corrective exercise to help people live better lives.”

Chamorro said she focuses on a balance of mobility and stability.

“Pain science shows us that pain is actually produced in the brain, so learning to relax and changing our relationship to pain can create a positive outcome for many,” she said.

Lower back pain causes more than 2.5 million visits to American emergency departments each year. The standard of care often involves prescribing a combination of nonsteroidal anti-inflammatory drugs, such as naproxen, and benzodiazepines, such as diazepam, said Dr. Benjamin Friedman, an emergency medicine physician at Montefiore Health System in New York.

“There is little evidence to suggest that taking diazepam in addition to naproxen is more effective for alleviating low back pain than taking naproxen alone,” Friedman said.

In a study spearheaded by Friedman using patients aged 21 to 69 who had been experiencing lower back pain for less than two weeks and did not have a history of frequent back pain, individuals were given 20 tablets of naproxen, to be taken twice daily, and 28 tablets of the investigational medicine, which was either diazepam or an identical placebo.

All patients also received a standardized 10-minute lower back pain educational session before discharge.

“Patients were contacted at one week and again at three months’ post-discharge and reported their pain levels and medication use,” he said. “Differences in functional outcomes between the groups were neither clinically nor statistically significant.”

Those who suffer from lower back pain should keep in mind that for every visit to a general practitioner, about six to eight of those patients are in for spine-related problems and patients with headaches, shoulder, arm or hand pain can be related to cervical spine problems, said Dr. Alfred O. Bonati, founder and chief orthopedic surgeon at the Bonati Spine Institute in Florida.

Hip problems or pain associated with legs, knees or feet could be a situation with the lumbar spine. A large herniated disc could result in incontinence problems due to compression of the nerves, Bonati said.

“All of these things can be associated with the spine and patients need to understand that the diagnosis done by a general practitioner can be compromised if you don’t look at the specialties of the body,” he said.

“The use of narcotic drugs to treat the pain has become a problem not because doctors are bad doctors, but because they have a desire to remove the pain and calm the patient,” Bonati said. “However, if the general practitioner is not familiar with the spine, they are going to recommend unnecessary treatments.”

If a patient is one to two weeks into an injury, it requires conservative treatments such as physical therapy, manipulation by a chiropractor or injections of cortisone. Regardless which of these therapies it is, an initial approach must be more hands-on, Bonati said.

“In terms of the spine, the best treatment is to understand it as a mechanical problem and treat it mechanically,” he said. “The hands-on treatments are going to be the answer to treat those problems.”

Still, the beauty of osteopathic medicine is that it appreciates the interconnectedness of the body and back pain is the classic example of a condition that is not a diagnosis, said Dr. Binyamin Rothstein, an osteopathic physician who practices near Philadelphia.

“If your back hurts, then you have back pain — [that] is [just] a description of symptoms and does little to help the patient,” Rothstein said. “The doctor has to determine the cause of the pain and why it is there. By looking at the body as a whole, a diagnosis can be made and the patient can be truly healed.

“Having treated thousands of patients with low back pain, I have found that rarely is the problem in the back,” he said. “Anything from TMJ to injured knees can cause back pain.

“Old scars, when they heal can put a tension on the body that can evolve into back pain,” Rothstein said. “When patients ask why my success rate is so high, I tell them that when the body is treated as a whole the likelihood of relieving pain and suffering can exceed 90 percent.”

Stacy M. Brown

I’ve worked for the Daily News of Los Angeles, the L.A. Times, Gannet and the Times-Tribune and have contributed to the Pocono Record, the New York Post and the New York Times. Television news opportunities have included: NBC, MSNBC, Scarborough Country, the Abrams Report, Today, Good Morning America, NBC Nightly News, Imus in the Morning and Anderson Cooper 360. Radio programs like the Wendy Williams Experience, Tom Joyner Morning Show and the Howard Stern Show have also provided me the chance to share my views.

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