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Low Back Pain Shouldn't Sideline You

Explore the common but under treated and misunderstood issues that accompany chronic back pain in our Back Pain Series. Part 1 explains the latest treatments that could relieve that aching back.

Medication Milieu

For mild to moderate symptoms, over-the-counter painkillers such as acetaminophen, aspirin, or ibuprofen can help along with heat or cold applied to the back. Massage, acupuncture, and chiropractic treatment may also play a role for some people. Adjusting or modifying your activities may help; light activity may actually speed recovery.

 

Not for David. He has tried just about every medication and every alternative treatment for back pain, and nothing really did the trick for long. The new thinking is that "chronic back pain may be chemical and that's why some of the older treatments don't work," Saper explains. "There may be a chemical basis for sustaining the pain."

 

That said, there may be a role for treatments such as the tumor necrosis factor-alpha (TNF-alpha) blockers used to treat joint inflammation caused by rheumatoid arthritis. These medications, also known as biological response modifiers, neutralize specific chemicals that are key players in the inflammatory process.

 

The antidepressant Cymbalta (duloxetine) has been approved for chronic back pain as well. It's a serotonin-norepinephrine reuptake inhibitor, or SNRI, that was first approved by the FDA in 2004.

 

Richard D. Guyer, MD, spine surgeon at the Texas Back Institute in Plano, says different types of drugs like seizure medications including Topamax and Neurontin may also help relieve pain. "They are not for everybody, but they may have a role for people with previous spinal surgery and chronic leg or arm pain," he says.

 

Spinal cord stimulators can be implanted in the spine to help both back and leg pain, but they are better for leg pain, Guyer says. These medical devices work by sending low levels of electric stimulation to the spine to block the sensation of pain.

 

Also promising, but not yet FDA-approved for low back pain, is the lidocaine patch, says Charles E. Argoff, MD, director of the Cohn Pain Management Program of North Shore University Hospital in Manhasset, N.Y., and an assistant professor of neurology at New York University in New York City.

 

The lidocaine patch is worn on the skin like a bandage.

 

"It is a very simple, safe, topical analgesic and you can't hurt anyone with it," Argoff says, "In preliminary, non-randomized studies, it has shown great promise in treating both postsurgical low back pain and nonsurgical back pain."

The Opioid Dilemma

Opioid analgesics are one type of pain reliever and they do not work for everybody, says Argoff.

 

Opioids often get a bad rap from media reports of addiction such as recent reports of talk show host Rush Limbaugh's abuse. Buts some experts in pain management argue that fear of addiction to these medications has lead to undertreatment of patients with chronic pain.

 

The first question that needs to be answered is do they work for this patient, Argoff says.

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