If you are one of the millions of Americans who have experienced low back pain at some point in your life you might have turned to Google for some advice on how to manage your condition. A quick search can bring up more than 1,350,000,000 answers with responses that range from surgery and stopping smoking to posture trainers and platelet rich plasma injections. It can be overwhelming and hard to know where to start.
What’s more, if you ask friends and family for advice, you are sure to hear things like, “take it easy” or “take some Advil”. Pain is a highly subjective condition and what works for one person doesn’t always work for another. With that being said, there are some tried and trusted remedies that are based on scientific evidence and that are backed by extensive clinical data. International guidelines can be a great source of verified treatments that you can do on your own, or with the help of a licensed healthcare provider.
Common Treatments For Chronic Low Back Pain
Some of the most recommended treatments for low back pain include Physical Therapy, Yoga, Acupuncture, Massage Therapy, heat and ice treatments and some over the counter pain medications. These are very effective treatments and they are backed by solid scientific evidence. Many people who offer advice mean well and are eager to share how they overcame their lower back pain problems, but while their intentions are good, there are still some common misconceptions and myths that surround this condition.
This blog takes a look at some surprising things that can help lower back pain, and addresses some of the myths around things that were believed to help in the past. They might surprise you!
1. You Should Avoid Resting
One of the most common pieces of advice that people hear when asking questions about managing low back pain is to get some rest. Bed rest has often been prescribed by doctors but there is not a lot of clinical data to support this treatment. Resting or staying active can also depend on who is doing the resting, and for how long. Military recruits that have low back pain have been found to recover faster when they get some bed rest, compared to those who stayed active. Some studies have found that two days of bed rest was just as good for people as seven days and actually reduced the days taken off from work. So what are we supposed to think and what exactly does the evidence say?
The North American Spine Society did extensive research around some of the most common questions about the management and treatment of low back pain and put together evidence-based clinical guidelines for spine care.
Based on considerable evidence, the society recommended that for patients with acute low back pain, those that exercised more at baseline, and who used exercise to facilitate recovery are predicted to have better functional outcomes over time than patients who do not exercise or those who use bed rest to help with recovery. Based on “abundant data for other spinal disorders that result in back pain, it is the work group’s opinion that remaining active is preferred and likely results in better short-term outcomes than does bed rest”.
The Importance Of Exercise
It is important to note that when you have lower back pain, staying active doesn’t mean doing intense Crossfit classes or running marathons. A good place to start is with low-impact activities that slowly and gradually increase your strength and stability. Low impact activities such as yoga and water aerobics, or swimming, can help support the weight of your body while allowing you to build up some strength.
It is also important to talk with your doctor or physical therapist before you start any type of new exercise program. Using proper techniques and keeping good form are key to helping prevent further injuries. If you start experiencing any type of acute pain then you should stop and see your doctor right away.
2. You Don’t Need An MRI
Probably one of the next most common things that people with low back pain hear is, “let’s get an x-ray to see what’s going on”. When you are suffering from an acute low back pain spasm those words can seem comforting. Of course you want to see what is happening and what is causing your pain so that you can fix it and get better.
Advanced diagnostic images like MRIs (magnetic resonance imaging), CT scans (computerized tomography) and ex-rays are often ordered by doctors when a patient presents with low back pain. Interestingly enough, these tests can often pick up structural abnormalities in back pain patients, but these things can also be found in patients who don’t have low back pain.
The Costs Of Unnecessary Imaging
A study conducted in 2014 by Schwarts et al., estimated that 'annual medicare spending on imaging for uncomplicated low back pain ranged from $82 million to $226 million' - excluding costs associated with follow-up testing and care. Disc herniations and disk degeneration are actually present in a large proportion of those who don’t even have low back pain. One study found that patients who received an MRI early in their treatment were actually more likely to have “prolonged disability, higher medical costs, and greater utilization of surgery”.
For some time now, healthcare providers have been cautioned about the improper use of advanced imaging for individuals with low back pain. The American Association of Neurological Surgeons and Congress of Neurological Surgeons actually recommend “withholding all imaging of the spine in patients with nonspecific acute low back pain and without “red flags”. It is important to note that there are certain instances where imaging is appropriate and necessary and doctors should definitely keep that in mind.
3. Your Mind Is More Powerful Than You Think
When it comes to reducing pain, your brain can be one of the most powerful tools available to you. Studies have found that in patients with low back pain, cognitive behavioral therapy (CBT) and psychosocial interventions/neuroscience are highly effective tools to decrease pain and they help people get back to work faster.
Cognitive behavioral therapy is a type of psychotherapy that targets negative thought patterns that people have about themselves (and the world) and challenge those in order to modify unwanted behaviors or mood disorders.
The NASS recommends that healthcare providers use CBT, in combination with physical therapy, to help improve pain levels.
Depression can also play a major role in low back pain. Patients with chronic low back pain have three to four times the rate of major depression than the general population. Studies done on depression and chronic low back pain have suggested that tricyclic antidepressants and CBT approaches are effective in treating chronic pain patients with depression.
More studies are needed to investigate the role of depression on pain but the science does indicate that treating depressive symptoms should be considered as an important part of chronic pain management. Using tools like mindfulness-based stress reduction (MBSR) and CBT are effective ways to help reduce levels of pain in chronic low back pain individuals.
Conclusions
With so many products available on the market and so many different types of therapies to treat the condition, it can be difficult to know which ones to trust. One way to make a decision is to follow the evidence and listen to the guidelines that have reviewed this evidence extensively.
Trusted therapies such as exercise, cognitive behavioral therapy and mindfulness have a lot of clinical data to support their use, while things like bed rest and MRIs don't have much evidence to support their use in managing low back pain. For more information on any of these treatments check out our other blogs in our library.