Managing Your Chronic Back Pain
It’s estimated that more than 100 million Americans suffer from chronic back pain. If you’re one of them, you understand it all too well.
Chronic back pain is defined as pain lasting more than 12 weeks. For many patients, it persists, and can even become a lifelong problem.
When considering treatment options for this problem, it’s important to keep an open mind, explore all options, and have a realistic expectation about the degree of pain relief.
The following is a systematic approach to the treatment of chronic back pain.
- Medication management. There are numerous choices available to patients at the pharmacy. Over-the-counter medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like Advil or Aleve and/or Tylenol, may be beneficial. Other adjunct medications, such as muscle relaxants, anti-depressant or anticonvulsant drugs approved for the treatment of neuropathic pain (nerve pain), may also be prescribed. Current guidelines recommend opioids only after an adequate trial of multiple non-narcotics.
- Physical medicine. Physical rehabilitation is an integral part of the treatment for low back pain and encompasses multiple methods across several fields of medicine. Traditionally, physical therapy focused on strengthening the core and paraspinal muscles is recommended, as well as another form of therapy known as McKenzie exercises. Additionally, occupational therapy can be helpful to teach patients energy conservation and provide an activities of daily living (ADL) assessment and modification. Although these remain an important part of treatment, new evidence points to additional benefits from yoga, chiropractic medicine, massage, osteopathic manipulation, and acupuncture. Ultimately, physical medicine should improve function and may reduce pain.
- Behavioral medicine. Quality psychological counseling plays an important role in the management of chronic pain. Patients should be evaluated for untreated or undertreated depression and anxiety as these can amplify pain. Additionally, patients should engage in individual or group sessions to learn coping skills and strategies to reduce the stressors in their lives that exacerbate their pain.
- Interventional procedures and surgery. There are many procedures and surgeries that may be beneficial in the treatment of chronic back pain. They can range from nerve blocks and steroid injections to implantable devices that block the transmission of pain signals from the body the brain, and more.
However, identifying a patient’s pain generator is the first priority before surgery or an interventional procedure can be offered. These should only be considered after a patient has begun physical medicine and medication management. Learn about what to expect at your first appointment.
A multi-system approach is often best, as no single intervention is likely to reduce the majority of a patient’s chronic pain. It’s equally important to understand that despite advances in medicine and treatment options, some underlying pain may persist.
About the Author:
Keith Scarfo, DO, MS
Keith-Austin Scarfo, DO, MS, is a board certified physician in both Anesthesiology and Pain Medicine. Dr. Scarfo is the co-director at the Norman Prince Spine Institute and holds a faculty appointment as an Assistant Professor – Department of Neurosurgery, The Warren Alpert Medical School of Brown University.
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