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Understanding Back Pain -- Diagnosis and Treatment

What Are the Treatments for Back Pain? continued...

If back pain keeps you from normal daily activities, your doctor can help by recommending or prescribing pain medications. Over-the-counter painkillers such as acetaminophen (Tylenol), aspirin, or ibuprofen (Motrin, Advil) can be helpful. Your doctor may prescribe prescription strength anti-inflammatories/pain medicines. For severe pain, he or she may prescribe combination opioid/acetaminophen pain medications such as hydrocodone/acetaminophen (Vicodin) or oxycodone/acetaminophen (Percocet). Some doctors also prescribe muscle relaxants. But beware, pain medications and muscle relaxants affect the brain, and often cause drowsiness and dependence. Other medicines such as antidepressants and anticonvulsants are sometimes prescribed to help with pain related to irritated nerves. Although sometimes used, steroids taken by mouth are not recommended by the American College of Physicians (ACP) for the treatment of acute low back pain.

When back pain is chronic, pain modifying medications, such as the antidepressant Cymbalta (duloxetine), may be helpful. Cymbalta, a serotonin-norepinephrine reuptake inhibitor, or SNRI, is FDA approved for the treatment of chronic pain related to the muscles and skeleton, including pain from arthritis and chronic lower back.

If your primary doctor isn't able to help you control back pain, he or she may refer you to a back specialist or a pain specialist. Sometimes, these doctors will use injections of steroids or anesthetics directly into the back to help control the pain. In cases where there is a herniated disc or pinching of the nerve from the spinal cord, surgery may be indicated.

A medium-firm mattress has been shown to be helpful in the treatment of chronic back pain.

For those patients with long-standing back pain and nerve damage, some newer treatments have been developed recently to help with the treatment of pain. One of these is radiofrequency ablation, a process of delivering electrical stimulation to specific nerves to make them less sensitive to pain, or by delivering enough electricity to actually destroy the nerve to prevent further pain. More research is needed to see if this approach is effective.

Some physicians advocate using a transcutaneous electrical nerve stimulator (TENS), although whether TENS is clearly helpful for back pain has not been resolved. Electrodes taped to the body carry a mild electric current that may help relieve pain. TENS is not painful, and it may be effective therapy to mask pain such as diabetic neuropathy. However, TENS for chronic low back pain is not recommended, according to the American Academy of Neurology (AAN), because its effectiveness has not been proven.

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