Back pain

SAFE LONG-TERM PAIN RELIEF DOESN’T COME IN AN OPIOID BOTTLE.

The Centers for Disease Control and Prevention (CDC) recommends safer non-opioid approaches like physical therapy for the long-term treatment of most chronic pain. CDC Guideline for Prescribing Opioids for Chronic Pain – United States, 2016.

Common Symptoms & Conditions:

• Low Back Pain

• Lumbar Radiculopathy and Sciatica (Radiating pain down into the leg)

• Degenerative Disk Disease

• Herniated Disk

• Spinal Stenosis

So What Are The Best Approaches?

Recommended:

• Movement (including physical therapy and exercises)

  • Remaining active is usually preferable to rest and inactivity. Physical therapists are movement experts who can prescribe exercise programs to meet individual goals and needs.

• Education

  • Understanding pain and getting tips to self-manage pain can be beneficial for any kind of chronic pain.

• Cognitive behavioral therapy

  • This can be beneficial for any kind of chronic pain.

Appropriate:

• Yoga

  • Since yoga involves movement, it may be beneficial, though it should be combined with recommended treatments.

• Massage

  • Some patients feel short-term relief, but active movement-based therapy is more beneficial long term. This should be combined with recommended treatments.

• Acupuncture

  • Some patients feel short-term relief, but active movement-based therapy is more beneficial long term. This should be combined with recommended treatments.

• Spinal Manipulation

  • Some patients feel short-term relief that can improve function. This should be combined with other recommend treatments, particularly exercise and active treatments.

Rarely appropriate:

• Opioids

  • The Centers for Disease Control and Prevention guidelines recommend opioids for chronic pain only after lower risk treatments have been tried, and then only when dosed appropriately and combined with nonopioid treatments.

• Heat

  • Some patients feel short-term relief, but there is limited evidence to suggest significant long-term benefits. This should be combined with recommended treatments.

• Imaging scans (X-rays, MRIs, etc.)

  • Imaging is not recommended for routine treatment of low back pain and often leads to unnecessary treatment.

• Spinal injections

  • Injections do not appear to provide long-term benefits or reduce the likelihood of surgery.

• Surgery

  • Surgery is not recommended for most back pain.

Not appropriate:

• Bed rest

  • Bed rest and other inactivity can make back pain worse.

(The Lancet, March 2018)