Treatments for back pain: Basis, indications and risk

Treatments Basis, indications and risk Patient information Postural hygiene Exercise Maintaining level of Activity Bed rest Pharmacological therapy Neuroreflexotherapy (NRT) Spinal column surgery Surgery for Pain and Pain Clinics Vertebral manipulation Behavioral treatment Epidural injections Facet joint infections Trigger point and ligament infections Rhizotomy Corsets and lumbar belts Traction Physical therapy/physiotherapy Electromyografic Feedback TENS: Transcutaneous electrical Nerve Stimulation Shoe insoles and shoe lifts Acupunture Recommended treatments

Patient information

1. Information and counseling is given to patients: Information: Including, for example, what is the most probable cause of his/her back pain and what treatment is recommended in each particular case, and prognosis.
2. Counseling: Including, for example, the grade of activity that is advisable during and after pain episodes, (see "Indications" in this section).

Objective

To provide patients with sufficient information for them to recognize their condition and the existing solutions, with specific advice to help them cope with pain while advising them on how to decrease the episode's duration and avoid the risk of recurrence.

Theoretical base

The underlying rationale is that if the patient is aware of his/her condition, it is likely that he/she will actively cooperate in his/her recovery, avoiding risk factors and taking due measures to prevent the onset of pain. Also, the greater his/her knowledge of back pain and prognosis is, the lesser his/her anxiety will be, thus guaranteeing a better quality of life.

Evidence of efficacy

The existing recommendations based on scientific evidence have taken into account research studies that reveal that providing patients with appropriate information and advice lessens anxiety and increases the satisfaction level with the health care provided.

Risks

Initially, there are no risks involved. If the information is provided from a negative point of view, the final effect may be self-defeating, increasing patients' anxiety or creating an obsession with back pain if there is a tendency to hypochondria.

Indications

The existing recommendations, based on scientific evidence, advise providing all patients who suffer from back pain, with appropriate information and advice. Some of the existing recommendations state that obviously apprehensive patients, those with longer recovery time, or those with radiating pain may require a more detailed explanation and reassurance.

The recommended general advice from the existing recommendations based on scientific evidence is listed below:

1. Avoid bed rest
   1. The existing recommendations coincide in stating that bed rest is not effective in treating back pain. For example, a scientific study showed that the group of patients who had bed rest for a period of 2 to 7 days had a worse evolution than the group who maintained the level of activity that the intensity of pain allowed.
   2. The existing recommendations state that pain severity may force some patients to stay in bed during a few days, usually no more than 4, especially those patients with radiated pain. Bed rest should be considered as a consequence of pain but not as a treatment, since it has no beneficial effect on the duration of the episode.
   3. Bed rest is counter productive. The existing recommendations emphasize that bed rest, especially if longer than 4 days, has potential debilitating effects and increases the difficulty for the patient's rehabilitation.
2. Maintaining normal activity
   1. The existing recommendations recommend that patients with back pain keep the level of activity that pain permits, that is, patients should try to maintain normal daily activities with a gradual increase until improvement of symptoms, and then return to work as soon as possible.
   2. Have a positive attitude toward pain and avoid becoming obsessed by it. Do not permit it to condition your life.
3. Avoid back overloads

The existing recommendations advise that patients gradually increase their activity without overloading the back with undue effort, following guidelines of postural hygiene.