Are you getting the best treatment for your low back pain?

Are you getting the best treatment for your low back pain? Dr.Rahimian Orthopedic surgon Spine fellowship resident

Why are we here? • To update you on the best evidence for the treatments available • To give you a better understanding of low back pain

Have you had low back pain? • How many of you have ever had back pain? • How many of you seek help for your back pain? • How many of you have ever had treatment for your back pain?

What causes back pain? Most cases, cause is unclear • poor posture • lack of exercise • muscle strains and sprains(70%) Some conditions have specific causes • Spondylosis (10%) • Herniation(4%) • Stenosis (3%)

How can I help myself? • Regular exercise e.g. swimming, walking, pilates, yoga, going to gym • Check posture frequently • Lift things correctly • Watch your weight • Stay at work if possible • Keep positive think!

What is the outlook for back pain? • 75 – 90% recover within in a few weeks • Relapses are common • Most lead normal life and able to work • Emotional response to back pain important to recovery e.g. worried, depressed,….

Red Flags • History of cancer • Unexplained weight loss • Intravenous drug use • Prolonged use of corticosteroids • Older age • Major Trauma • Osteoporosis • Fever • Back pain at rest or at night • Bowel or bladder dysfunction

What treatments are there for back pain? • guideline • specific exercise • manual therapy • Acupuncture • Combined psychological and physical therapy • Surgery or injections may be considered

Treatment Options for Back Pain

Exercise & Bed Rest • Advice to stay active: • ‘There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica.’ • One or two days of bed rest if necessary • Light activity, avoiding heavy lifting, bending or twisting . • No data on any particular exercises

What if my back pain is affecting my work? Work is good for you! – financial and social • Stay at work or get back as soon as possible. • Discuss what can be done to help you when you return e.g. light duties, changing hours

Medications • Anti-inflammatory medications (NSAID’s): • Beneficial; no differences; watch side-effects • Tylenol: • Narcotic Pain Relievers: • No more effective than NSAID’s • Many side effects • Muscle Relaxants : • Can decrease pain and improve mobility • 70% with drowsiness/dizziness

Antidepressants • Anticonvulsants • Corticosteroids • Topical analgesics

Treatment Strategies for LBP Moskowitz MH. Curr Pain Headache Rep. 2003;7:178-187.

Massage • Might be beneficial • More quality research is needed • Different types of massage

Acupuncture • Very little quality research and data • Seems to indicate that acupuncture is not effective for the treatment of back pain

Injections • Epidural injections: • Insufficient and conflicting evidence • Facet joint injections: • No improvement • Local/Trigger point injections: • Possibly some benefit

Role of Radiology • Usually unnecessary and not helpful • Plain X-ray: • Age>50 years • No improvement after 6 weeks • Red flag • MRI: • After 6 weeks if have sciatica • Red flag

Other Modalities • Back Brace/Corset/Lumbar Support • Injections • Hot/Cold • Ultrasound

Surgery • Discectomyimproves pain in short term but not long term (ie. 10 years) • Fusion • Decompression

Are you getting the best treatment for your low back pain?