Inflammatory Back Pain: Diagnosis and Medication Options

When you have back pain, the goals of treatment are to make you feel better and to get you moving freely and easily again.

Your treatment options will depend on where your pain is and whether it's acute -- sharp and sudden, caused by something specific -- or chronic -- lasting more than 6 months, perhaps lingering after an injury or illness has healed.

Diagnosis and Tests

Unless you can't move at all because of an injury, your doctor probably will test your range of motion, check how your nerves are working, and press on your back to zero in on the problem area. You might have blood and urine tests to rule out other problems, like an infection or a kidney stone.

Doctors generally use imaging tests for checking out ongoing pain, if your back was hit by something, when you also have a fever, or you have nerve problems such as weak or numb arms or legs, too:

  • X-rays help pinpoint broken bones or other trouble with your spine.
  • An MRI or CT scan can show your doctor what's going on with soft-tissue damage, such as a herniated disk.
  • An electromyogram (EMG) helps find nerve and muscle damage.

But there's not always a direct link between the results of these tests and how much it hurts.

Imaging tests typically aren't done when it's the first time you've had back pain or your back hurts because you overdid it.

Your diagnosis will help your doctor decide what to do next.

Treatment at Home

The basic way to relieve a strain or minor injury is to take it easy for a while. Use an ice pack and an over-the-counter pain reliever such as acetaminophen, aspirin, ibuprofen, or naproxen. After the inflammation calms down, a heating pad or pack can help soothe muscles and connective tissue.

If you have chronic back pain, sleep on a medium-firm mattress.

Pay attention to your posture. Slouching puts stress on your back.

Exercise and Physical Therapy

Bed rest, which used to be what doctors advised for back pain, may do more harm than good. It could slow your recovery and cause new problems.

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With acute pain, you should be able to start normal, easy activity, like walking, within a few days. After that, gradually ramp back up to your usual exercise level.

Strengthening both your abdominal and back muscles helps stabilize your spine. Pilates exercises build these core muscles. You can help prevent further back injury by learning -- and doing -- gentle stretching exercises and the right way to lift things.

Exercising in the water is especially safe for a sore back. The water supports some of your weight, which can make you more comfortable, and it offers gentle resistance, which builds your strength. Aquatic therapy can make you more flexible and lessen pain for chronic low back problems.

Yoga may help your flexibility, strength, and sense of balance. It's good for stress relief, which will also help you deal with the pain.

Physical therapy uses a tailored exercise program along with a variety of techniques that could include:

Medication

If you're struggling to get through a normal day, your doctor may prescribe stronger pain medicines or muscle relaxants. But you have to be careful. Some of these prescription medicines can make you drowsy. You could also become dependent on hydrocodone/acetaminophen (Vicodin), oxycodone/acetaminophen (Percocet), or other medications with opioids in them.

The antidepressant duloxetine (Cymbalta) may help with arthritis and chronic lower back pain. Doctors sometimes prescribe antidepressants and anticonvulsants for pain related to irritated nerves. Steroids that you swallow usually aren't recommended for acute low back pain.

A back or pain specialist may inject steroids or other drugs directly into your back to help control the pain.

Chiropractic and Osteopathic

Spinal manipulation can work for acute low back pain, but it may not be as effective for chronic back pain.

Getting chiropractic adjustments soon after you've hurt your back may prevent chronic problems later.

Osteopaths often combine drug therapy with spinal manipulation or traction, followed by physical therapy and exercise.

Acupuncture

This ancient Chinese healing practice may bring relief for people with chronic low back pain. Gently placing thin, dry needles into your skin at specific points may trigger the release of endorphins, your body's natural painkillers, or it may change your brain chemistry so you have a higher pain tolerance. You should use it along with other treatments.

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Nerve Stimulation

These treatments are intended for long-standing back pain and nerve damage.

Radiofrequency ablation electrically stimulates specific nerves to make them less sensitive to pain. It can also zap the nerve to destroy it and prevent further pain.

TENS, or transcutaneous electrical nerve stimulation, may help block pain signals or trigger your body to make endorphins. A small battery-powered device sends a signal through electrodes taped to your skin to give you a tingling feeling.

Counseling

Cognitive behavioral therapy (CBT) can often lessen back pain, change how you think about your levels of pain and disability, and even lift depression. People have been able to take less medication while improving their outlook.

If your lower back pain is related to muscle tension or spasm, biofeedback can help you train your muscles to respond better to stress and movement. It may lessen the pain intensity and the need for drugs.

Surgery

For most chronic back pain, this is a last resort. You may need surgery when you have a herniated disk or a pinched nerve from the spinal cord.

Rhizotomy -- surgically cutting a nerve -- stops it from sending pain signals to your brain. The surgery can fix the symptoms caused by extremely damaged nerves and rubbing surfaces in a spinal joint, but it doesn't address other problems, like herniated disks.

WebMD Medical Reference Reviewed by Carol DerSarkissian on 3/, 017

Sources

SOURCES:

Oh, W.; Shim J. The Clinical Journal of Pain January/February 2004.

Friedman, F. Outwitting Back Pain: Why Your Lower Back Hurts and How to Make It Stop, Lyons Press, 2004.

News release, FDA.

American College of Physicians.

UpToDate.

American Academy of Neurology.

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