Help For Your Aching Back

When it comes to addressing back pain, Dr. Joerg Ermann, a rheumatologist at Harvard-affiliated Brigham and Women’s Hospital, emphasizes the significance of understanding the duration of the pain—whether it’s a short-term (acute) issue or a chronic condition that persists for months or even years. Distinguishing between these scenarios is crucial, as it greatly influences the potential causes of the pain and, consequently, the appropriate management strategies.

What to do for acute pain

When confronted with what medical professionals term an acute episode of back pain, an abrupt onset is characteristic, and this discomfort often dissipates within a few days or weeks. Dr. Joerg Ermann emphasizes the prevalence of this type of back pain, stating that approximately 80% of individuals will encounter it at some point in their lives. The etiology of such common back pain is often elusive, with the specific cause remaining unidentified in many cases.

A typical scenario contributing to acute back pain involves engaging in strenuous activities like shoveling snow, resulting in severe back pain emerging later in the day or the following day. Dr. Ermann attributes this occurrence to muscle strain or ligament sprain in the back.

For those who find themselves in this situation and are otherwise in good health, adopting a watchful waiting approach for a few days may be reasonable before seeking medical attention. In the interim, there are several strategies for pain management that prove beneficial.

One such strategy involves the use of medication and heat. Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen are recommended to alleviate pain, complemented by the application of heat to the affected area.

Encouraging movement is another crucial facet of managing acute back pain. Dr. Ermann emphasizes that the prevailing approach favors maintaining mobility, as immobilization is generally not the prescribed treatment for back pain. However, exceptions exist, such as in cases involving fractures or conditions that contraindicate movement.

Maintaining a positive mindset during the recovery process is highlighted as an essential component. Dr. Ermann notes that most instances of acute back pain tend to resolve autonomously within a few days or weeks, with individuals typically returning to their previous state. While no specific strategy has demonstrated a superior ability to hasten recovery, staying active remains a fundamental guideline.

Despite the self-limiting nature of most acute back pain cases, certain circumstances necessitate prompt medical attention. Indications that it’s time to consult a doctor include debilitating and worsening pain that impedes daily activities, the presence of additional symptoms such as fever, weakness in the legs, difficulty walking, or urinary incontinence. Individuals with pre-existing health conditions, such as undergoing cancer treatment or being on immunosuppressant medications, should be particularly vigilant, as sudden severe back pain in such contexts may signal a more serious issue like a fracture or infection, according to Dr. Ermann.

Is your back pain a sign of an overlooked condition?

Chronic back pain can sometimes be attributed to less common conditions, with one noteworthy example being axial spondyloarthritis, also referred to as ankylosing spondylitis. This chronic inflammatory condition arises from an immune system dysfunction, resulting in symptoms such as persistent back pain and stiffness.

Contrary to past perceptions, axial spondyloarthritis was previously considered a predominantly male disease. However, advancements in diagnostic approaches over the last decade have led to a shift in this perception. Dr. Joerg Ermann, a rheumatologist at Brigham and Women’s Hospital, notes that with improved methods for identifying patients, it has become evident that the prevalence of this condition is comparable in both men and women. The earlier bias toward male prevalence stemmed from the observation that men often exhibit more severe and rapidly progressing disease, making it more discernible on X-rays.

Indicators that axial spondyloarthritis may be the cause of back pain include stiffness and discomfort in the morning, which tend to ameliorate with physical activity. Additionally, individuals with a family history of this condition should be particularly vigilant, as there is a strong hereditary component associated with axial spondyloarthritis. If these signs resonate with an individual’s experience, seeking medical evaluation is crucial for accurate diagnosis and appropriate management.

What to do for chronic back pain

Chronic back pain, defined as pain persisting for three months or longer, often requires distinct management strategies compared to acute back pain. Dr. Joerg Ermann emphasizes the importance of consulting with a healthcare professional if chronic back pain is interfering with daily life and necessitates medication. Here are several strategies your doctor might recommend for managing chronic back pain:

1. Work with a Physical Therapist: Seeking guidance from a physical therapist and incorporating regular exercises at home, especially core-strengthening exercises, can alleviate pressure on the spine and help relieve symptoms.

2. Adjust Your Posture: Poor posture can contribute to lasting back pain. Making simple changes, such as improving desk ergonomics and taking breaks to stretch, can have a significant impact on symptoms.

3. Try, Try Again: Chronic pain can lead to pain sensitization, and medications like certain antidepressants may be prescribed to address changes in the brain’s response to pain signals. Finding the right medication or combination often involves trial and error.

4. Be Patient: Recognizing that chronic back pain may take time to improve, Dr. Ermann emphasizes the need for patience with interventions like medication or physical therapy.

5. Consider Alternatives: Exploring alternative therapies, such as chiropractic care, may be beneficial for some individuals. However, Dr. Ermann suggests an active approach like physical therapy, empowering muscles and promoting strength.

6. Document Your Progress: Keeping a record of interventions, noting what works and what doesn’t, can provide valuable insights. Maintain records of reports and digital images for the back pain specialist to review.

7. Get a Second Opinion: Surgery may be recommended in certain cases, but it’s essential to seek a second opinion, especially considering that surgery may not be a cure for many back conditions, and pain may persist post-surgery.

Individuals experiencing chronic back pain should communicate openly with their healthcare providers to explore a tailored and comprehensive approach to managing their condition.