INSIGHT INTO ACUTE LOW BACK PAIN
By Susan L. Calvert-Cramer, M.D.
Low back pain affects virtually everyone at some time during their life. Surveys indicate 50 percent of working-age adults report symptoms yearly. Other studies find 90 percent of individuals will have low back pain at some time during their life. Low back pain ranks as the number two reason for physician office visits and is extremely costly in terms of medical treatment, lost productivity and diminished ability to perform or enjoy usual activities. If you experience low back pain the first thing to remember is that about 90 percent of patients with acute low back pain (symptoms of less than three months duration) will spontaneously recover within one month.
Traditional remedies.
The traditional treatment of an acute low back injury is similar to that of other musculo-skeletal injuries: rest, ice and non-steroidal anti-inflammatory drugs. Icing your back after an acute injury for 20 minutes, three times a day can provide relief to the area as well as help to decrease local inflammation.
Rest is important, too, but must not be overdone. Studies have shown that prolonged bed rest (greater than three days) actually causes more morbidity than no rest at all. Most doctors advocate one to three days of rest then resuming normal daily activities, except for heavy or strenuous physical activity.
There are many anti-inflammatory products on the over the counter market which can provide the patient easy and early access to helpful medicines prior to seeing their physician. However, one must be careful taking these medicines.
Persons with a history of peptic ulcer disease or gastritis should avoid taking them, especially for a prolonged period of time, prior to speaking with their physician. Anti-inflammatories, for the most part, are excreted for the body by the kidneys. Therefore, persons with a history of renal disease should not take these medicines without first consulting their physician. Finally, those on coumadin (a blood thinner), those taking more than one aspirin a day, those on prescription anti-inflammatories or arthritis medicines, and those with bleeding disorder also need to contact their physician prior to taking these over-the-counter medications.
Red flags
There are some classic “red flags” that may indicate a serious cause of your back pain and necessitate an urgent doctor’s visit. These are: major trauma such as a fall from a height or a serious car accident, a personal history of cancer, recent fever or chills or unexplained recent weight loss, recent onset of loss of bowel or bladder control, or severe progressive weakness or numbness in the leg.
If you do not have one of these “red flags” and your pain is persistent beyond one week, it may be prudent for you to contact your doctor. Your doctor can prescribe more “potent” anti-inflammatories, muscle relaxants, pain killers, if needed, and order appropriate x-ray studies and physical therapy. Susan L. Calvert-Cramer is a doctor with the practice of physical medicine and rehabilitation at the Neurological Institute on Hilton Head Island.