|
If you have lower
back pain, you are not alone. Nearly everyone at
some point has back pain that interferes with work,
routine daily activities, or recreation. Americans
spend at least $50 billion each year on low back
pain, the most common cause of job-related disability
and a leading contributor to missed work. Back pain
is the second most common neurological ailment in
the United States
— only headache is more common. Fortunately, most
occurrences of low back pain go away within a few
days. Others take much longer to resolve or lead
to more serious conditions.
Acute or short-term
low back pain generally lasts from a few days to
a few weeks. Most acute back pain is mechanical
in nature — the result of trauma to the lower back
or a disorder such as arthritis. Pain from trauma
may be caused by a sports injury, work around the
house or in the garden, or a sudden jolt such as
a car accident or other stress on spinal bones and
tissues. Symptoms may range from muscle ache to
shooting or stabbing pain, limited flexibility and/or
range of motion, or an inability to stand straight.
Occasionally, pain felt in one part of the body
may “radiate” from a disorder or injury elsewhere
in the body. Some acute pain syndromes can become
more serious if left untreated.
Chronic back
pain is measured by duration — pain that persists
for more than 3 months is considered chronic. It
is often progressive and the cause can be difficult
to determine.
Top
What
structures make up the back?
The back
is an intricate structure of bones, muscles, and
other tissues that form the posterior part of the
body’s trunk, from the neck to the pelvis. The centerpiece
is the spinal column, which not only supports the
upper body’s weight but houses and protects the
spinal cord — the delicate nervous system structure
that carries signals that control the body’s movements
and convey its sensations. Stacked on top of one
another are more than 30 bones — the vertebrae —
that form the spinal column, also known as the spine.
Each of these bones contains a roundish hole that,
when stacked in register with all the others, creates
a channel that surrounds the spinal cord. The spinal
cord descends from the base of the brain and extends
in the adult to just below the rib cage. Small nerves
(“roots”) enter and emerge from the spinal cord
through spaces between the vertebrae. Because the
bones of the spinal column continue growing long
after the spinal cord reaches its full length in
early childhood, the nerve roots to the lower back
and legs extend many inches down the spinal column
before exiting. This large bundle of nerve roots
was dubbed by early anatomists as the cauda equina,
or horse’s tail. The spaces between the vertebrae
are maintained by round, spongy pads of cartilage
called intervertebral discs that allow for flexibility
in the lower back and act much like shock absorbers
throughout the spinal column to cushion the bones
as the body moves. Bands of tissue known as ligaments
and tendons hold the vertebrae in place and attach
the muscles to the spinal column.
Starting at the top,
the spine has four regions:
- the seven cervical or neck vertebrae
(labeled C1–C7),
- the 12 thoracic or upper back
vertebrae (labeled T1–T12),
- the five lumbar vertebrae (labeled
L1–L5), which we know as the lower back, and
- the sacrum and coccyx, a group
of bones fused together at the base of the spine.
The lumbar region
of the back, where most back pain is felt, supports
the weight of the upper body.
Top
What
causes lower back pain?
As people
age, bone strength and muscle elasticity and tone
tend to decrease. The discs begin to lose fluid
and flexibility, which decreases their ability to
cushion the vertebrae.
Pain can occur when,
for example, someone lifts something too heavy or
overstretches, causing a sprain, strain, or spasm
in one of the muscles or ligaments in the back.
If the spine becomes overly strained or compressed,
a disc may rupture or bulge outward. This rupture
may put pressure on one of the more than 50 nerves
rooted to the spinal cord that control body movements
and transmit signals from the body to the brain.
When these nerve roots become compressed or irritated,
back pain results.
Low back pain may
reflect nerve or muscle irritation or bone lesions.
Most low back pain follows injury or trauma to the
back, but pain may also be caused by degenerative
conditions such as arthritis or disc disease, osteoporosis
or other bone diseases, viral infections, irritation
to joints and discs, or congenital abnormalities
in the spine. Obesity, smoking, weight gain during
pregnancy, stress, poor physical condition, posture
inappropriate for the activity being performed,
and poor sleeping position also may contribute to
low back pain. Additionally, scar tissue created
when the injured back heals itself does not have
the strength or flexibility of normal tissue. Buildup
of scar tissue from repeated injuries eventually
weakens the back and can lead to more serious injury.
Occasionally, low
back pain may indicate a more serious medical problem.
Pain accompanied by fever or loss of bowel or bladder
control, pain when coughing, and progressive weakness
in the legs may indicate a pinched nerve or other
serious condition. People with diabetes may have
severe back pain or pain radiating down the leg
related to neuropathy. People with these symptoms
should contact a doctor immediately to help prevent
permanent damage.
Top
Who
is most likely to develop low back pain?
Nearly everyone has
low back pain sometime. Men and women are equally
affected. It occurs most often between ages 30 and
50, due in part to the aging process but also as
a result of sedentary life styles with too little
(sometimes punctuated by too much) exercise. The
risk of experiencing low back pain from disc disease
or spinal degeneration increases with age.
Low back pain unrelated
to injury or other known cause is unusual in pre-teen
children. However, a backpack overloaded with schoolbooks
and supplies can quickly strain the back and cause
muscle fatigue. The U.S. Consumer Product Safety
Commission estimates that more than 13,260 injuries
related to backpacks were treated at doctors’ offices,
clinics, and emergency rooms in the year 2000. To
avoid back strain, children carrying backpacks should
bend both knees when lifting heavy packs, visit
their locker or desk between classes to lighten
loads or replace books, or purchase a backpack or
airline tote on wheels.
Top
What
conditions are associated with low back pain?
Conditions that may
cause low back pain and require treatment by a physician
or other health specialist include:
Bulging
disc (also called protruding, herniated,
or ruptured disc). The intervertebral discs
are under constant pressure. As discs degenerate
and weaken, cartilage can bulge or be pushed into
the space containing the spinal cord or a nerve
root, causing pain. Studies have shown that most
herniated discs occur in the lower, lumbar portion
of the spinal column.
A much more serious
complication of a ruptured disc is cauda equina
syndrome, which occurs when disc material
is pushed into the spinal canal and compresses
the bundle of lumbar and sacral nerve roots. Permanent
neurological damage may result if this syndrome
is left untreated.
Sciatica
is a condition in which a herniated or ruptured
disc presses on the sciatic nerve, the large nerve
that extends down the spinal column to its exit
point in the pelvis and carries nerve fibers to
the leg. This compression causes shock-like or
burning low back pain combined with pain through
the buttocks and down one leg to below the knee,
occasionally reaching the foot. In the most extreme
cases, when the nerve is pinched between the disc
and an adjacent bone, the symptoms involve not
pain but numbness and some loss of motor control
over the leg due to interruption of nerve signaling.
The condition may also be caused by a tumor, cyst,
metastatic disease, or degeneration of the sciatic
nerve root.
Spinal
degeneration from disc wear and tear
can lead to a narrowing of the spinal canal. A
person with spinal degeneration may experience
stiffness in the back upon awakening or may feel
pain after walking or standing for a long time.
Spinal
stenosis related to congenital narrowing
of the bony canal predisposes some people to pain
related to disc disease.
Osteoporosis
is a metabolic bone disease marked by progressive
decrease in bone density and strength. Fracture
of brittle, porous bones in the spine and hips
results when the body fails to produce new bone
and/or absorbs too much existing bone. Women are
four times more likely than men to develop osteoporosis.
Caucasian women of northern European heritage
are at the highest risk of developing the condition.
Skeletal
irregularities produce strain on
the vertebrae and supporting muscles, tendons,
ligaments, and tissues supported by spinal column.
These irregularities include scoliosis,
a curving of the spine to the side; kyphosis,
in which the normal curve of the upper back is
severely rounded; lordosis, an abnormally
accentuated arch in the lower back; back extension,
a bending backward of the spine; and back flexion,
in which the spine bends forward.
Fibromyalgia
is a chronic disorder characterized by widespread
musculoskeletal pain, fatigue, and multiple “tender
points,” particularly in the neck, spine, shoulders,
and hips. Additional symptoms may include sleep
disturbances, morning stiffness, and anxiety.
Spondylitis
refers to chronic back pain and stiffness caused
by a severe infection to or inflammation of the
spinal joints. Other painful inflammations in
the lower back include osteomyelitis (infection
in the bones of the spine) and sacroiliitis
(inflammation in the sacroiliac joints).
Top
How
is low back pain diagnosed?
A thorough medical
history and physical exam can usually identify any
dangerous conditions or family history that may
be associated with the pain. The patient describes
the onset, site, and severity of the pain; duration
of symptoms and any limitations in movement; and
history of previous episodes or any health conditions
that might be related to the pain. The physician
will examine the back and conduct neurologic tests
to determine the cause of pain and appropriate treatment.
Blood tests may also be ordered. Imaging tests may
be necessary to diagnose tumors or other possible
sources of the pain.
A variety of diagnostic
methods are available to confirm the cause of low
back pain:
X-ray
imaging includes conventional and
enhanced methods that can help diagnose the cause
and site of back pain. A conventional x-ray,
often the first imaging technique used, looks
for broken bones or an injured vertebra. A technician
passes a concentrated beam of low-dose ionized
radiation through the back and takes pictures
that, within minutes, clearly show the bony structure
and any vertebral misalignment or fractures. Tissue
masses such as injured muscles and ligaments or
painful conditions such as a bulging disc are
not visible on conventional x-rays. This fast,
noninvasive, painless procedure is usually performed
in a doctor’s office or at a clinic.
Discography
involves the injection of a special contrast dye
into a spinal disc thought to be causing low back
pain. The dye outlines the damaged areas on x-rays
taken following the injection. This procedure
is often suggested for patients who are considering
lumbar surgery or whose pain has not responded
to conventional treatments. Myelograms
also enhance the diagnostic imaging of an x-ray.
In this procedure, the contrast dye is injected
into the spinal canal, allowing spinal cord and
nerve compression caused by herniated discs or
fractures to be seen on an x-ray.
Computerized
tomography (CT) is a quick and painless
process used when disc rupture, spinal stenosis,
or damage to vertebrae is suspected as a cause
of low back pain. X-rays are passed through the
body at various angles and are detected by a computerized
scanner to produce two-dimensional slices (1 mm
each) of internal structures of the back. This
diagnostic exam is generally conducted at an imaging
center or hospital.
Magnetic
resonance imaging (MRI) is used to
evaluate the lumbar region for bone degeneration
or injury or disease in tissues and nerves, muscles,
ligaments, and blood vessels. MRI scanning equipment
creates a magnetic field around the body strong
enough to temporarily realign water molecules
in the tissues. Radio waves are then passed through
the body to detect the “relaxation” of the molecules
back to a random alignment and trigger a resonance
signal at different angles within the body. A
computer processes this resonance into either
a three-dimensional picture or a two-dimensional
“slice” of the tissue being scanned, and differentiates
between bone, soft tissues and fluid-filled spaces
by their water content and structural properties.
This noninvasive procedure is often used to identify
a condition requiring prompt surgical treatment.
Electrodiagnostic
procedures include electromyography
(EMG), nerve conduction studies, and evoked potential
(EP) studies. EMG assesses the electrical activity
in a nerve and can detect if muscle weakness results
from injury or a problem with the nerves that
control the muscles. Very fine needles are inserted
in muscles to measure electrical activity transmitted
from the brain or spinal cord to a particular
area of the body. With nerve conduction studies
the doctor uses two sets of electrodes (similar
to those used during an electrocardiogram) that
are placed on the skin over the muscles. The first
set gives the patient a mild shock to stimulate
the nerve that runs to a particular muscle. The
second set of electrodes is used to make a recording
of the nerve’s electrical signals, and from this
information the doctor can determine if there
is nerve damage. EP tests also involve two sets
of electrodes — one set to stimulate a sensory
nerve and the other set on the scalp to record
the speed of nerve signal transmissions to the
brain.
Bone
scans are used to diagnose and monitor
infection, fracture, or disorders in the bone.
A small amount of radioactive material is injected
into the bloodstream and will collect in the bones,
particularly in areas with some abnormality. Scanner-generated
images are sent to a computer to identify specific
areas of irregular bone metabolism or abnormal
blood flow, as well as to measure levels of joint
disease.
Thermography involves
the use of infrared sensing devices to measure
small temperature changes between the two sides
of the body or the temperature of a specific organ.
Thermography may be used to detect the presence
or absence of nerve root compression.
Ultrasound
imaging, also called ultrasound scanning
or sonography, uses high-frequency sound waves
to obtain images inside the body. The sound wave
echoes are recorded and displayed as a real-time
visual image. Ultrasound imaging can show tears
in ligaments, muscles, tendons, and other soft
tissue masses in the back.
Top
How
is back pain treated?
Most low back pain can be treated
without surgery. Treatment involves using analgesics,
reducing inflammation, restoring proper function and
strength to the back, and preventing recurrence of
the injury. Most patients with back pain recover without
residual functional loss. Patients should contact
a doctor if there is not a noticeable reduction in
pain and inflammation after 72 hours of self-care.
Although ice and
heat (the use of cold and hot compresses) have
never been scientifically proven to quickly resolve
low back injury, compresses may help reduce pain
and inflammation and allow greater mobility for
some individuals. As soon as possible following
trauma, patients should apply a cold pack or a cold
compress (such as a bag of ice or bag of frozen
vegetables wrapped in a towel) to the tender spot
several times a day for up to 20 minutes. After
2 to 3 days of cold treatment, they should then
apply heat (such as a heating lamp or hot pad) for
brief periods to relax muscles and increase blood
flow. Warm baths may also help relax muscles. Patients
should avoid sleeping on a heating pad, which can
cause burns and lead to additional tissue damage.
Bed rest
— 1–2 days at most. A 1996 Finnish study found that
persons who continued their activities without bed
rest following onset of low back pain appeared to
have better back flexibility than those who rested
in bed for a week. Other studies suggest that bed
rest alone may make back pain worse and can lead
to secondary complications such as depression, decreased
muscle tone, and blood clots in the legs. Patients
should resume activities as soon as possible. At
night or during rest, patients should lie on one
side, with a pillow between the knees (some doctors
suggest resting on the back and putting a pillow
beneath the knees).
Exercise
may be the most effective way to speed recovery
from low back pain and help strengthen back and
abdominal muscles. Maintaining and building muscle
strength is particularly important for persons with
skeletal irregularities. Doctors and physical therapists
can provide a list of gentle exercises that help
keep muscles moving and speed the recovery process.
A routine of back-healthy activities may include
stretching exercises, swimming, walking, and movement
therapy to improve coordination and develop proper
posture and muscle balance. Yoga is another way
to gently stretch muscles and ease pain. Any mild
discomfort felt at the start of these exercises
should disappear as muscles become stronger. But
if pain is more than mild and lasts more than 15
minutes during exercise, patients should stop exercising
and contact a doctor.
Medications
are often used to treat acute and chronic low back
pain. Effective pain relief may involve a combination
of prescription drugs and over-the-counter remedies.
Patients should always check with a doctor before
taking drugs for pain relief. Certain medicines,
even those sold over the counter, are unsafe during
pregnancy, may conflict with other medications,
may cause side effects including drowsiness, or
may lead to liver damage.
- Over-the-counter
analgesics, including nonsteroidal
anti-inflammatory drugs (aspirin, naproxen,
and ibuprofen), are taken orally to reduce stiffness,
swelling, and inflammation and to ease mild
to moderate low back pain. Counter-irritants
applied topically to the skin as a cream or
spray stimulate the nerve endings in the skin
to provide feelings of warmth or cold and dull
the sense of pain. Topical analgesics can also
reduce inflammation and stimulate blood flow.
Many of these compounds contain salicylates,
the same ingredient found in oral pain medications
containing aspirin.
- Anticonvulsants
— drugs primarily used to treat seizures — may
be useful in treating certain types of nerve
pain and may also be prescribed with analgesics.
- Some antidepressants,
particularly tricyclic antidepressants such
as amitriptyline and desipramine, have been
shown to relieve pain (independent of their
effect on depression) and assist with sleep.
Antidepressants alter levels of brain chemicals
to elevate mood and dull pain signals. Many
of the new antidepressants, such as the selective
serotonin reuptake inhibitors, are being studied
for their effectiveness in pain relief.
- Opioids
such as codeine, oxycodone, hydrocodone, and
morphine are often prescribed to manage severe
acute and chronic back pain but should be used
only for a short period of time and under a
physician’s supervision. Side effects can include
drowsiness, decreased reaction time, impaired
judgment, and potential for addiction. Many
specialists are convinced that chronic use of
these drugs is detrimental to the back pain
patient, adding to depression and even increasing
pain.
Spinal
manipulation is literally a "hands-on"
approach in which professionally licensed specialists
(such as chiropractors and physical therapists)
use leverage and a series of exercises to adjust
spinal structures and restore back mobility. These
specialists do not prescribe drugs or use surgery
in their treatment of low back pain.
When back pain does
not respond to more conventional approaches, patients
may consider the following options:
Acupuncture
involves the insertion of needles the width of a
human hair along precise points throughout the body.
Practitioners believe this process triggers the
release of naturally occurring painkilling molecules
called peptides and keeps the body’s normal flow
of energy unblocked. Clinical studies are measuring
the effectiveness of acupuncture in comparison to
more conventional procedures in the treatment of
acute low back pain.
Biofeedback
is used to treat many acute pain problems, most
notably back pain and headache. Using a special
electronic machine, the patient is trained to become
aware of, to follow, and to gain control over certain
bodily functions, including muscle tension, heart
rate, and skin temperature (by controlling local
blood flow patterns). The patient can then learn
to effect a change in his or her response to pain,
for example, by using relaxation techniques. Biofeedback
is often used in combination with other treatment
methods, generally without side effects.
Interventional
therapy can ease chronic pain by blocking
nerve conduction between specific areas of the body
and the brain. Approaches range from injections
of local anesthetics, steroids, or narcotics into
affected soft tissues, joints, or nerve roots to
more complex nerve blocks and spinal cord stimulation.
When extreme pain is involved, low doses of drugs
may be administered by catheter directly into the
spinal cord. Chronic use of steroid injections may
lead to increased functional impairment.
Traction
involves the use of weights to apply constant or
intermittent force to gradually “pull” the skeletal
structure into better alignment. Traction is not
recommended for treating acute low back symptoms.
Transcutaneous
electrical nerve stimulation (TENS)
is administered by a battery-powered device that
sends mild electric pulses along nerve fibers to
block pain signals to the brain. Small electrodes
placed on the skin at or near the site of pain generate
nerve impulses that block incoming pain signals
from the peripheral nerves. TENS may also help stimulate
the brain’s production of endorphins (chemicals
that have pain-relieving properties).
Ultrasound
is a noninvasive therapy used to warm the body’s
internal tissues, which causes muscles to relax.
Sound waves pass through the skin and into the injured
muscles and other soft tissues.
Minimally invasive
outpatient treatments to seal fractures of the vertebrae
caused by osteoporosis include vertebroplasty
and kyphoplasty. Vertebroplasty uses three-dimensional
imaging to help a doctor guide a fine needle into
the vertebral body. A glue-like epoxy is injected,
which quickly hardens to stabilize and strengthen
the bone and provide immediate pain relief. In kyphoplasty,
prior to injecting the epoxy, a special balloon
is inserted and gently inflated to restore height
to the bone and reduce spinal deformity.
In the most serious
cases, when the condition does not respond to other
therapies, surgery may relieve pain caused by back
problems or serious musculoskeletal injuries. Some
surgical procedures may be performed in a doctor’s
office under local anesthesia, while others require
hospitalization. It may be months following surgery
before the patient is fully healed, and he or she
may suffer permanent loss of flexibility. Since
invasive back surgery is not always successful,
it should be performed only in patients with progressive
neurologic disease or damage to the peripheral nerves.
- Discectomy
is one of the more common ways to remove pressure
on a nerve root from a bulging disc or bone
spur. During the procedure the surgeon takes
out a small piece of the lamina (the arched
bony roof of the spinal canal) to remove the
obstruction below.
- Foraminotomy
is an operation that “cleans out” or enlarges
the bony hole (foramen) where a nerve
root exits the spinal canal. Bulging discs or
joints thickened with age can cause narrowing
of the space through which the spinal nerve
exits and can press on the nerve, resulting
in pain, numbness, and weakness in an arm or
leg. Small pieces of bone over the nerve are
removed through a small slit, allowing the surgeon
to cut away the blockage and relieve the pressure
on the nerve.
- IntraDiscal Electrothermal
Therapy (IDET) uses thermal energy
to treat pain resulting from a cracked or bulging
spinal disc. A special needle is inserted via
a catheter into the disc and heated to a high
temperature for up to 20 minutes. The heat thickens
and seals the disc wall and reduces inner disc
bulge and irritation of the spinal nerve.
- Nucleoplasty
uses radiofrequency energy to treat patients
with low back pain from contained, or mildly
herniated, discs. Guided by x-ray imaging, a
wand-like instrument is inserted through a needle
into the disc to create a channel that allows
inner disc material to be removed. The wand
then heats and shrinks the tissue, sealing the
disc wall. Several channels are made depending
on how much disc material needs to be removed.
- Radiofrequency lesioning
is a procedure using electrical impulses to
interrupt nerve conduction (including the conduction
of pain signals) for 6 to12 months. Using x-ray
guidance, a special needle is inserted into
nerve tissue in the affected area. Tissue surrounding
the needle tip is heated for 90-120 seconds,
resulting in localized destruction of the nerves.
- Spinal fusion
is used to strengthen the spine and prevent
painful movements. The spinal disc(s) between
two or more vertebrae is removed and the adjacent
vertebrae are “fused” by bone grafts and/or
metal devices secured by screws. Spinal fusion
may result in some loss of flexibility in the
spine and requires a long recovery period to
allow the bone grafts to grow and fuse the vertebrae
together.
- Spinal laminectomy
(also known as spinal decompression) involves
the removal of the lamina (usually both sides)
to increase the size of the spinal canal and
relieve pressure on the spinal cord and nerve
roots.
Other surgical procedures
to relieve severe chronic pain include rhizotomy,
in which the nerve root close to where it enters
the spinal cord is cut to block nerve transmission
and all senses from the area of the body experiencing
pain; cordotomy, where bundles of nerve fibers
on one or both sides of the spinal cord are intentionally
severed to stop the transmission of pain signals
to the brain; and dorsal root entry zone operation,
or DREZ, in which spinal neurons transmitting
the patient’s pain are destroyed surgically.
Top
Can
back pain be prevented?
Recurring back pain resulting
from improper body mechanics or other nontraumatic
causes is often preventable. A combination of exercises
that don't jolt or strain the back, maintaining correct
posture, and lifting objects properly can help prevent
injuries.
Many work-related
injuries are caused or aggravated by stressors such
as heavy lifting, contact stress (repeated or constant
contact between soft body tissue and a hard or sharp
object, such as resting a wrist against the edge
of a hard desk or repeated tasks using a hammering
motion), vibration, repetitive motion, and awkward
posture. Applying ergonomic principles — designing
furniture and tools to protect the body from injury
— at home and in the workplace can greatly reduce
the risk of back injury and help maintain a healthy
back. More companies and homebuilders are promoting
ergonomically designed tools, products, workstations,
and living space to reduce the risk of musculoskeletal
injury and pain.
The use of wide elastic
belts that can be tightened to “pull in” lumbar
and abdominal muscles to prevent low back pain remains
controversial. A landmark study of the use of lumbar
support or abdominal support belts worn by persons
who lift or move merchandise found no evidence that
the belts reduce back injury or back pain. The 2-year
study, reported by the National Institute for Occupational
Safety and Health (NIOSH) in December 2000, found
no statistically significant difference in either
the incidence of workers’ compensation claims for
job-related back injuries or the incidence of self-reported
pain among workers who reported they wore back belts
daily compared to those workers who reported never
using back belts or reported using them only once
or twice a month.
Although there have
been anecdotal case reports of injury reduction
among workers using back belts, many companies that
have back belt programs also have training and ergonomic
awareness programs. The reported injury reduction
may be related to a combination of these or other
factors.
Top
Quick
tips to a healthier back
Following any period of prolonged
inactivity, begin a program of regular low-impact
exercises. Speed walking, swimming, or stationary
bike riding 30 minutes a day can increase muscle strength
and flexibility. Yoga can also help stretch and strengthen
muscles and improve posture. Ask your physician or
orthopedist for a list of low-impact exercises appropriate
for your age and designed to strengthen lower back
and abdominal muscles.
- Always stretch before exercise
or other strenuous physical activity.
- Don’t slouch when standing or
sitting. When standing, keep your weight balanced
on your feet. Your back supports weight most
easily when curvature is reduced.
- At home or work, make sure your
work surface is at a comfortable height for
you.
- Sit in a chair with good lumbar
support and proper position and height for the
task. Keep your shoulders back. Switch sitting
positions often and periodically walk around
the office or gently stretch muscles to relieve
tension. A pillow or rolled-up towel placed
behind the small of your back can provide some
lumbar support. If you must sit for a long period
of time, rest your feet on a low stool or a
stack of books.
- Wear comfortable, low-heeled
shoes.
- Sleep on your side to reduce
any curve in your spine. Always sleep on a firm
surface.
- Ask for help when transferring
an ill or injured family member from a reclining
to a sitting position or when moving the patient
from a chair to a bed.
- Don’t try to lift objects too
heavy for you. Lift with your knees, pull in
your stomach muscles, and keep your head down
and in line with your straight back. Keep the
object close to your body. Do not twist when
lifting.
- Maintain proper nutrition and
diet to reduce and prevent excessive weight,
especially weight around the waistline that
taxes lower back muscles. A diet with sufficient
daily intake of calcium, phosphorus, and vitamin
D helps to promote new bone growth.
- If you smoke, quit. Smoking
reduces blood flow to the lower spine and causes
the spinal discs to degenerate.
Top
What
research is being done?
The National Institute
of Neurological Disorders and Stroke, a component
of the National Institutes of Health (NIH) within
the U.S. Department of Health and Human Services,
is the nation’s leading federal funder of research
on disorders of the brain and nervous system and
one of the primary NIH components that supports
research on pain and pain mechanisms. Other institutes
at NIH that support pain research include the National
Institute of Dental and Craniofacial Research, the
National Cancer Institute, the National Institute
on Drug Abuse, the National Institute of Mental
Health, the National
Center
for Complementary and Alternative Medicine, and
the National Institute of Arthritis and Musculoskeletal
and Skin Diseases. Additionally, other federal organizations,
such as the Department of Veterans Affairs and the
Centers for Disease Control and Prevention, conduct
studies on low back pain.
Scientists are examining
the use of different drugs to effectively treat
back pain, in particular daily pain that has lasted
at least 6 months. Other studies are comparing different
health care approaches to the management of acute
low back pain (standard care versus chiropractic,
acupuncture, or massage therapy). These studies
are measuring symptom relief, restoration of function,
and patient satisfaction. Other research is comparing
standard surgical treatments to the most commonly
used standard nonsurgical treatments to measure
changes in health-related quality of life among
patients suffering from spinal stenosis. NIH-funded
research at the Consortial
Center
for Chiropractic Research encourages the development
of high-quality chiropractic projects. The Center
also encourages collaboration between basic and
clinical scientists and between the conventional
and chiropractic medical communities.
Other researchers
are studying whether low-dose radiation can decrease
scarring around the spinal cord and improve the
results of surgery. Still others are exploring why
spinal cord injury and other neurological changes
lead to an increased sensitivity to pain or a decreased
pain threshold (where normally non-painful sensations
are perceived as painful, a class of symptoms called
neuropathic pain), and how fractures of the
spine and their repair affect the spinal canal and
intervertebral foramena (openings around the spinal
roots).
Also under study
for patients with degenerative disc disease is artificial
spinal disc replacement surgery. The damaged disc
is removed and a metal and plastic disc about the
size of a quarter is inserted into the spine. Ideal
candidates for disc replacement surgery are persons
between the ages of 20 and 60 who have only one
degenerating disc, do not have a systemic bone disease
such as osteoporosis, have not had previous back
surgery, and have failed to respond to other forms
of nonsurgical treatment. Compared to other forms
of back surgery, recovery from this form of surgery
appears to be shorter and the procedure has fewer
complications.
Top
For more information
on neurological disorders or research programs funded
by the National Institute of Neurological Disorders
and Stroke, contact the Institute's Brain Resources
and Information Network (BRAIN) at:
BRAIN
P.O. Box 5801
Bethesda, MD
20824
(800) 352-9424
www.ninds.nih.gov
Information also
is available from the following organizations:
|
American
Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA
95677-0850
ACPA@pacbell.net
http://www.theacpa.org
Tel: 916-632-0922 800-533-3231
Fax: 916-632-3208 |
National
Chronic Pain Outreach Association (NCPOA)
P.O. Box 274
Millboro,
VA 24460
http://www.chronicpain.org
Tel: 540-862-9437
Fax: 540-862-9485 |
|
American
Pain Foundation
201 North Charles
Street
Suite 710
Baltimore, MD
21201-4111
info@painfoundation.org
http://www.painfoundation.org
Tel: 888-615-PAIN (7246)
Fax: 410-385-1832 |
National
Institute
of Arthritis
and Musculoskeletal and Skin Diseases Information
Clearinghouse
1 AMS Circle
Bethesda, MD
20892-3675
NIAMSinfo@mail.nih.gov
http://www.niams.nih.gov
Tel: 877-22-NIAMS (226-4267) 301-565-2966
(TTY)
Fax: 301-718-6366 |
|
American
Association of Neurological Surgeons
5550 Meadowbrook
Drive
Rolling Meadows, IL
14209-1194
info@aans.org
http://www.aans.org
Tel: 847-378-0500/888-566-AANS (2267)
Fax: 847-378-0600 |
American
Academy
of Orthopaedic
Surgeons/ American Association of Orthopaedic Surgeons
6300 North River
Road
Rosemont, IL
60018
hackett@aaos.org
http://www.aaos.org
Tel: 847-823-7186
Fax: 847-823-8125 |
|
American
Academy
of Family Physicians
11400 Tomahawk
Creek Parkway
Leawood,
KS 66211-2672
fp@aafp.org
http://www.aafp.org
Tel: 913-906-6000/800-274-2237 |
Alzheimer's
Association
225 North Michigan
Avenue
17th Floor
Chicago,
IL 60601-7633
info@alz.org
http://www.alz.org
Tel: 312-335-8700 800-272-3900
Fax: 312-335-1110 |
|
American
Academy
of Neurological
and Orthopaedic
Surgeons
10 Cascade Creek
Lane
Las Vegas, NV
89113
aanos@aanos.com
http://www.aanos.org
Tel: 702-388-7390
Fax: 702-388-7395 |
American Academy
of Physical Medicine & Rehabilitation
One IBM Plaza
Suite 2500
Chicago, IL 60611-3604
info@aapmr.org
http://www.aapmr.org
Tel: 312-464-9700
Fax: 312-464-0227 |
|
