Good News about Back Pain

Transcription

1 Good News about Back Pain Back Pain Good News Although 80% of Americans will experience back pain sometime in their lives the good news is that 90% of acute (new) back pain cases will get better within six weeks! Not-so-Good News If you have back pain once you are very likely to have it again in the future, so educating yourself now about back pain and how to treat it can help you be better prepared for what to do if it occurs again. This booklet provides tips on how to prevent future back pain. It will also help you learn what to do if your acute back pain does not get better and becomes chronic (recurs without resolution). Common Questions about Acute Back Pain 1. How can I tell if my back pain is a sign of something more serious? In general, back pain is not a sign of a serious medical condition. Loss of bowel or bladder control, urinary retention, or fever would require an immediate visit with your doctor as would signs of a broken bone/fracture. If you choose to see the doctor when you first experience back pain, your medical history and the physical exam will allow him/her to identify any signs of more serious conditions. 2. What is causing the pain? Most temporary back pain comes from problems with the position and/or strain to vertebra (the bones in your spine), discs (cushioning between the vertebra), and muscles, ligaments or nerves in the back. These can cause pain or stiffness. If nerves from the spine, which are connected to every part of the body, are irritated, then pain, numbness, or weakness may spread to other areas. 3. Did I do something to make this happen? Back pain can be caused by many things. Sometimes, you can pinpoint a specific activity or injury that caused back pain. Other times, there s no obvious reason for the pain. In either case, there are probably underlying causes which can include: A lack of exercise, which weakens the muscles that support the back. Improper body positions (lifting, sitting, working), which cause muscles or vertebra to be strained or rub against each other once or repeatedly over an extended period of time. Smoking and being overweight, which can put extra strain on the body and affect back health. Mental or emotional distress, which can also affect the back. Our minds and our bodies are all part of the same delicately balanced system, so stresses or unpleasant events can be felt in our bodies (such as muscle tension when you feel stressed). See Stress and Pain. Regardless of what may be causing your back pain, it is likely to get better. But back pain may return again unless you take care of the things that affect back health. Recovery doesn t happen overnight; you will need to find the approach that works best for you. 1

2 4. Do I need an x-ray or an MRI? These tests are not usually recommended unless your doctor notices unusual symptoms in your physical exam. Imaging tests expose you to unnecessary radiation and in most cases cannot diagnose the cause of back pain. Many/most people have abnormalities on spinal x-rays and MRI s, but research shows that treating these abnormalities through injections or surgeries does not make pain go away because the abnormalities actually are not causing the pain. 5. Do I need to stay in bed? Bed rest is not usually recommended because staying in bed may weaken your muscles and significantly slow your recovery. If bed rest is unavoidable, limit it to 3 days or less to decrease the pain. 6. What treatments are best for my back pain? In the first 48 hours of pain, applying a cold pack for 5-10 minutes may relieve discomfort. After 48 hours, a heating pad or a hot shower may help. A non-prescription medication (see below) taken regularly during the first days you have pain not only reduces the pain but can reduce the inflammation and stiffness that slows recovery. 7. Is it safe to go to work? Light activity will not cause further injury, even if you are experiencing pain. You may need to modify your work activities if they include prolonged sitting, heavy lifting or bending and twisting while lifting. Your outlook about work can have an affect on back pain too. If your work is especially stressful or unsatisfying, think about how you could make improvements in your work life that could also improve your back pain. Talking about this with a mental health counselor could also help you make decisions about things you can do to improve your situation. See Resources for more information. 8. Is it safe to exercise? It is safe, and even advisable, to continue gentle exercises, like walking or swimming. Sexual activity is fine, if you and your partner can find a comfortable position. Your healthcare provider might recommend specific back exercises to improve your back pain now and prevent flare-ups in the future. Remember that pain does not necessarily mean that you are harming your back. 9. Is it safe to lift? While you are healing, it might be wise to avoid any heavy lifting. To avoid future back pain, it is important to learn to lift things properly: bend your knees and use your leg muscles holding the object close to your body. Back belts and supports have not been shown to be of benefit, unless used as part of a back care training program or as an aid to recovery after back surgery. Ask your doctor or employer for information on proper lifting techniques, or ask for help when lifting something heavy. Visit our Online Pain Management Center at When should I see my doctor? If your pain worsens, or you suffer from urinary incontinence or retention, an unexplained fever or other worrisome symptoms, contact your doctor. Most pain will resolve itself in 6 weeks. As long as you are improving steadily over that time, you probably won t need to visit your doctor or visit your doctor again. 2

3 11. Are there other healthcare providers who might help me? Acupuncture, chiropractics and physical therapy have been shown to shorten the duration of low back pain. Ask your physician if he/she feels this is appropriate for you. Although it is rarely needed for most types of back pain, your doctor will refer you to a specialist such as an orthopedist, physiatrist (physical medicine doctor) or surgeon if he/she feels it is appropriate. 12. What can I expect if I go to physical therapy? You should expect that virtually all of your PT (physical therapy) visits will include active therapeutic exercise at the PT Clinic. In addition, you will be given a home exercise program that will help you maintain your improvements between visits. To make progress, it is essential that you take responsibility for your exercise program and follow the plan that you and your therapist have outlined. Do not rely on passive physical therapy treatments like heat and ultrasound or having a physical therapist move your muscles by moving your limbs. 13. What other things can I do to alleviate my pain? Before deciding on any treatments, learn as much as you can about the pros and cons. And remember - though it can be disappointing to learn that there may not be a lot that medical science can do for chronic back pain, doctors and treatments are not the only hope. There are many things you can do yourself to improve your life and lessen your pain including: Use Heat and Cold Along with taking NSAIDS (non-steroidal anti-inflammatory medications such as ibuprofen or naproxen), for the first few days after you have neck or back pain, you can apply an ice pack to the area for minutes every 1-2 hours. This helps decrease inflammation & provides a localized anesthetic effect. Always protect your skin and wrap the ice pack with a small towel or cloth. Warm, moist heat can also provide beneficial effects. Use heat after using ice for the first few days. Try this simple moist heat application method: take a towel, soak it in warm (not hot) water, and wring it out; place towel in a sealable plastic bag; wrap bag in another towel and place on affected area. Sitting in a warm bath or spa is another option that can produce similar effects. Remember to protect your skin from direct heat to prevent burning. Use Non-prescription Medications Consistently While in Pain Acetaminophen (Tylenol) and non-steroidal anti-inflammatories (Ibuprofen, Naproxen Sodium) can help reduce lower back pain. Avoid muscle relaxants and narcotics, as these are rarely successful in reducing pain. If you think your back pain is causing you more distress due to emotional stresses or low mood, discuss this with your doctor or a mental health counselor. Some people with low mood benefit from anti-depressant medications. Your doctor will be able to help you decide if this is right for you. Use your Mind to Heal your Body Emotions can make a painful situation worse. Its normal to feel angry, depressed, frustrated or anxious when you have pain, research has demonstrated that emotions such as these affect a person s health and can result in an increase in pain. There also are mind/body techniques that can reduce your pain. See Resources - Podcasts, Neurobehavioral Pain Program, Journaling, and Managing Pain class information. 3

4 Try acupuncture or chiropractic treatments If you do not have a benefit for this your PCP can ask Hill Physicians to authorize a few trial visits for you to see if it is helpful. Keep moving. Hurt does not equal harm. Find gentle exercise that works for you like walking or swimming. What can I do now to prevent back pain in the future? Exercise now to reduce pain and avoid future flare-ups. Staying active will improve your muscle strength. Ask your doctor for a PT referral to learn appropriate home exercises. Hill Physicians offers discounts on yoga classes. See Resources Yoga. Take action to improve your lifestyle 1. Keep your weight at an appropriate level for your build. 2. If you smoke find ways to stop smoking now. 3. Lift properly and practice safe positioning and movement at work and at home. Manage your stress Life s daily hassles or stressful events are strongly associated with increased pain. These stressful events can contribute to starting or worsening a large number of painful diseases such as heart disease, arthritis, ulcers and chronic pain. Stress and Pain How much stress do you experience in your life? Family? Marriage? Work? Finances? Rate your stress level on a scale from one to ten. Low High Past stressful events can impact your current response to pain. One result of a stressful childhood can be chronic muscle tension, headaches and stomach problems as an adult. Did you spend your childhood on high alert? Rate your childhood stress exposure from one to ten. Low High If your childhood was a highly stressful one it may be beneficial to contact your mental health provider to get help with stresses left over from your past. A mental health counselor can assist you in processing your feelings and learning to deal with negative feelings from the past. If you experience a lot of stress in your life, try learning specific relaxation or breathing techniques along with body awareness exercises. You can train your mind and body to work together to decrease your pain and to increase your quality of life. See Resources Neurobehavioral Programs and Stress Management Podcasts, as well as our online pain management center at 4

5 Try writing a daily feelings journal. Take a few minutes a day to jot down feelings you experience. Set aside time at the end of each week to go over your entries. Pay attention to any experiences, emotional and/or physical, that you can connect with an increase/decrease in your pain. Use this valuable information as a tool to help you reduce pain and improve your quality of life. See Resources Journaling. 14. What if my acute back pain does not improve? When pain does not improve after three months it begins to be called chronic pain. Asking for help with chronic pain early is important. Hill Physicians case managers are familiar with all the resources available to help patients when acute back pain does not improve within the first 3 months. Working together with you and your PCP, a case manager can help you to access these resources efficiently and appropriately. Call customer service at (800) or (925) to connect with the case manager for your area. 5

6 Resources Online Pain Management Center Hill Physicians website contains links to the wide variety of information and services available to help with pain management all in one place. Stress Management Podcasts Hill Physicians offers a variety of short audio programs you can listen to online or download into a personal listening devise. Neurobehavioral Programs Your PCP or a specialist can request authorization for patients to be trained in-person or over the phone in the NBP technique that allows people to turn off pain using a simple mind/body method. Manage Pain Before it Manages You Classes These group classes can help you learn new techniques to work with pain. They combine meditation skills, NBP training (see above) with cognitive behavioral tools to help with the causes and effects of both physical and emotional pain. Call Community Psychiatry at Mental Health Counseling If you are interested in counseling services, please contact your health plan (see insurance card) or Community Psychiatry at for a referral to a provider. Hill Physicians members can self-refer for behavioral health services. Discounted Yoga Classes and Discounted Massage Therapy Hill Physicians members receive discounts with some providers of these services. Contact Member Health Improvement: (800) Journaling: Emotional Wellness Hill Physicians website includes a short videos, including one on the why s and how s of journaling We re Here for You Hill Physicians Member Health Improvement can help you find the right resource for you. Call (800) or health@hpmg.com. This pamphlet is provided by Hill Physicians Medical Group for informational purposes only. It is not intended to replace the advice or care given by your physician. Talk to your doctor if you are experiencing symptoms or have questions or concerns. 6