What to do for stubborn low back pain

A while back, I covered the updated evidence-based treatment guidelines for acute (less than four weeks) and subacute (less than twelve weeks) low back pain. I promised a post on chronic (more than twelve weeks) back pain.

Well, as I write this, I am suffering from a recurrence of my own low back pain, which radiates down my right leg at times. This has been literally and figuratively a pain in my rear end, for years.

Being a doctor who practices what I preach, I am putting all the advice I dispense to good use.

First, look for possible triggers

This fall, I had gotten away from my regular core-strengthening routine (nighttime planks, pushups, and abdominal exercises, on the carpet as the kids are going to sleep). At about the same time, I increased the consecutive hours spent sitting at my desk, typing away. Weakened core plus prolonged time seated at an ergonomically challenging workspace equals exacerbation of my chronic low back pain.

This situation is exceedingly common. I have both short-term and long-term solutions. For now, I get up and stand when my Fitbit buzzes (which is every 20 minutes). At least once an hour, I do toe-touches, side and back bends. I'm also adding in really quick and easy in-office core strengthening exercises. As a matter of fact, my nurse practitioners and I just practiced our chair squats, one-legged chair stands, and desk planks, as we sit here at our computers for hours at a time. Try this core workout you can do right in your office.

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

Some days and nights, the throbbing pain is so bad it's distracting, and I get irritable. What helps me are simple, holistic, evidence-based measures: ice packs alternating with heating pads, massage, gentle stretching including yoga poses, and deep breathing. These and other non-pharmacologic modalities such as tai chi, acupuncture, biofeedback, and spinal manipulation are supported by evidence and included in the updated guidelines for management of chronic low back pain.

I also use topical products that are sold over the counter: salves, usually containing menthol and camphor, and patches, usually 4% lidocaine. Salves can be massaged in to painful areas, and I feel that they are benign and truly soothe (though they have not been well-studied). Key is to keep these products away from children (camphor can be toxic to kids) and also out of your eyes (it can sting). Lidocaine patches are "numbing" and are great for focal pain, as well as widely available and inexpensive.

If I have to, I'll take a non-steroidal anti-inflammatory drug like naproxen (two 220-mg tablets with food and fluids). I had to take this one day, to get through my clinic. I didn't think patients would understand my getting up, stretching, and touching my toes during their visit! (NSAIDs are not without risk and their use should be limited. The elderly, people with a history of or risk factors for heart attacks and strokes, as well as those with kidney problems or a history of gastritis or ulcers should really avoid using these medications.) Studies suggest that muscle relaxants can also be helpful for some people.

Do what you can to keep it from flaring up again

I have done physical therapy in the past, which included guided stretching, lower back stabilization, and motor control exercises. The idea is to learn the exercises that work for you and keep doing them. Back before I had kids, I took formal yoga and Pilates classes at the gym. (Yes, I remember those days...) Nowadays, I rely on my home yoga and core exercises, with some of the moves I learned from physical therapy mixed in, all of which I really, really need to practice nightly. My routine takes all of five to 10 minutes, and also helps me to relax into sleep.

I'm two weeks into this latest bout of pain, and I find that any long car ride or day at work sets me back. I'm plugging away at it, as I know that almost all back pain goes away with time.

Sources

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline from the American College of Physicians. Annals of Internal Medicine, April 2017.