What to do for Stubborn Low Back Pain

Some time ago, I discussed the latest evidence-based treatment guidelines for acute (lasting less than four weeks) and subacute (lasting less than twelve weeks) low back pain. I committed to providing information on chronic (lasting more than twelve weeks) back pain, and as I write this, I am currently experiencing a recurrence of my own low back pain, accompanied by radiating discomfort down my right leg at times. This ongoing struggle has been a literal and metaphorical pain in my rear end for years.

As a physician who practices what I preach, I am diligently applying all the advice I routinely share.

First, look for possible triggers

During this fall, I deviated from my regular routine of core-strengthening exercises, such as nighttime planks, pushups, and abdominal workouts on the carpet, typically done while the kids are going to sleep. Concurrently, I found myself spending longer hours sitting at my desk, typing away. The combination of a weakened core and extended periods of sitting in an ergonomically challenging workspace resulted in the exacerbation of my chronic low back pain.

This scenario is all too familiar and prevalent. Fortunately, I have both short-term and long-term solutions in mind. Currently, I make a conscious effort to stand up when my Fitbit reminds me every 20 minutes. Additionally, at least once an hour, I incorporate toe-touches, side and back bends into my routine. To address the root cause, I’ve introduced quick and easy in-office core strengthening exercises. In fact, my nurse practitioners and I recently engaged in chair squats, one-legged chair stands, and desk planks, recognizing the need to counteract the hours spent sitting at our computers. Consider trying this office-friendly core workout that you can conveniently perform right at your desk.

Next, find a way to ease the pain (ideally without medication)

On certain days and nights, the persistent throbbing pain becomes so intense that it becomes a distraction, leading to irritability. To cope with this discomfort, I turn to simple, holistic, and evidence-based measures, including the alternating use of ice packs and heating pads, massage, gentle stretching (often involving yoga poses), and deep breathing exercises. These non-pharmacologic modalities align with updated guidelines for managing chronic low back pain and are supported by evidence. Additionally, modalities such as tai chi, acupuncture, biofeedback, and spinal manipulation have shown efficacy.

In my approach, I also incorporate over-the-counter topical products, such as salves containing menthol and camphor, and patches with 4% lidocaine. I find that massaging salves into painful areas provides soothing relief, although these products haven’t been extensively studied. It’s crucial to keep these items away from children (as camphor can be toxic to kids) and avoid contact with the eyes (as it can cause stinging). Lidocaine patches, known for their numbing effect, are particularly beneficial for focal pain, widely available, and cost-effective.

When necessary, I resort to non-steroidal anti-inflammatory drugs (NSAIDs) like naproxen (two 220-mg tablets with food and fluids). There was a day when I had to take this to navigate through my clinic, as I felt patients might not understand my need to get up, stretch, and touch my toes during their visit. However, it’s essential to acknowledge that NSAIDs are not without risks, and their use should be limited. The elderly, individuals with a history of or risk factors for heart attacks and strokes, those with kidney problems, or a history of gastritis or ulcers should exercise caution in using these medications. Studies also suggest that muscle relaxants may offer relief for some individuals.

Do what you can to keep it from flaring up again

In the past, I underwent physical therapy that encompassed guided stretching, lower back stabilization, and motor control exercises. The focus was on acquiring a personalized set of exercises and incorporating them into my routine for sustained benefit. In my pre-parenting days, I participated in formal yoga and Pilates classes at the gym, reminiscing about those times. Nowadays, my go-to consists of home-based yoga and core exercises, incorporating movements learned from physical therapy. It’s a nightly routine that takes only five to 10 minutes, contributing not only to physical well-being but also aiding in relaxation for a better night’s sleep.

Currently, I am two weeks into grappling with this latest episode of pain. I’ve observed that extended car rides or prolonged hours at work tend to exacerbate my condition. Despite these setbacks, I persist in my efforts, recognizing that the majority of back pain tends to resolve with time.