June 24, 2022 by John Fernandez
Treating Back Pain Non-Surgically: Take Precautions Even With Over-the-Counter Meds
Chronic back pain can disrupt daily living, but there are non-surgical solutions — primarily medications and physical therapy — that can alleviate or eliminate the constant discomfort. However, it’s vital to consult your physician — even if you’re taking common, over-the-counter meds, explains Ronald Tolchin, D.O., medical director of Miami Neuroscience Institute’s Spine Center.
“If you are already experiencing back pain and there are no contraindications to utilizing an anti-inflammatory you can start with over-the-counter anti-inflammatories,” said Dr. Tolchin. “This could be ibuprofen like medication or naproxen sodium medications that are available over-the-counter.”
But there are also precautions that need to be taken because these over-the-counter meds can cause stomach ulcerations if abused, or elevations in blood pressure, or impairment to the kidneys, he stresses.
Take Precautions with Over-the-Counter Meds
“Therefore, they are not medications to be taken in a cavalier way but to be used judiciously and when necessary,” adds Dr. Tolchin. “In addition, they should be used under the guidance of your medical provider. These can also be prescribed through a pharmacy in a stronger dose form. There are other medications that can be useful. For example, if someone is having difficulty sleeping they could try a muscle relaxer at nighttime; however, there are also precautions and possible side effects with these medications, such as dizziness lethargy/fatigue or lightheadedness, and so on.”
Under the guidance of a physician/APP, there are stronger medications that require a prescription, including steroids to reduce inflammation of the spine.
“If there is nerve pain going down the lower extremity, then there are classifications of medications that can be used for nerve pain which are called neuroadjuvant agents,” said Dr. Tolchin. “Again, these need to be prescribed by a medical provider, and there are certainly potential side effects and risks of these medications as well.”
One key method to prevent ongoing back pain would be to maintain mobility, including stretches and strengthening exercises. You can also use ice if the back pain started relatively recently, within the first three to five days — and even heat after that, he said.
“However, it’s important to realize that you can easily be burned by heat or even have skin irritation from the ice if left on too long,” cautions Dr. Tolchin. “I would recommend no more than 10 to 15 minutes at a time, and not directly on the skin but using a barrier under the ice or heat.”
Injections for Pain
There are other ways to alleviate back pain and leg pain if a disc herniation, or bone spur compressing the nerve is the cause. These are called “interventional pain injections” — such as an epidural injection or facet joint block.
“These are generally performed by specialists in pain management such as physical medicine rehabilitation physicians or anesthesia/pain physicians,” explains Dr. Tolchin. “For further questions related to that I would recommend you talk with your primary medical provider first, and they can send you to the appropriate specialist to help perform these injections.”
Traction, which is therapeutic process to relieve pain by stretching and realigning the spine, can be helpful at times with a disc herniation, and physical therapy can be quite helpful as well.
Overcoming ‘Fear Avoidance Behavior’
It’s important to stay active and to increase mobility,” said Dr. Tolchin. “It is sometimes hard for people that have pain to begin to move for fear they are doing further damage. That is a well-known phenomenon called ‘fear avoidance behavior,’ and it’s important to try to work with someone that understands this and can keep you as active as possible — and moving properly to diminish this fear.”
“With traction, one home device called an ‘inversion table’ — where you use your body’s own weight to create a traction in the lower back can be helpful,” said Dr. Tolchin. “There are some precautions with using this equipment that require further investigation with your clinician if you are contemplating this. I would recommend talking to your primary care team about physical therapy, and they can give you further guidance for proper mechanics — such as bending and lifting, stretches, and strengthening exercise guidance.”
It’s best to start with a trained specialist in physical therapy so you don’t do the exercises improperly or too vigorously — and cause more damage.