Nonsurgical Treatment Options for Low Back Pain: What Really Works? скачать в хорошем качестве

Nonsurgical Treatment Options for Low Back Pain: What Really Works?

Join this channel to get access to perks:    / @nabilebraheim   Non-surgical management of low back pain is a cornerstone in treating this widespread condition. Low back pain affects individuals across all demographics—regardless of age, gender, ethnicity, or socioeconomic status. While it can occur at any age, the highest prevalence is among individuals aged 35 to 55. In cases of acute low back pain, approximately 90% of patients return to work within 12 weeks. After this period, the return to function tends to slow. Fortunately, most patients experience full recovery without long-term complications. However, in chronic low back pain, outcomes become variable and unpredictable. There are two main types of low back pain: acute and chronic. Acute pain lasts up to three months, while chronic pain persists beyond three months. The natural history and treatment strategies differ significantly between the two. The progression from acute to chronic remains poorly understood. Chronic cases often demonstrate little improvement despite adequate treatment—particularly in the absence of a clear diagnosis. Mild chronic pain may not significantly affect functional capacity, and many patients continue to experience low-level discomfort for extended periods even after treatment. In chronic low back pain, alterations in central pain modulation may occur. These patients often report sleep disturbances, which may be linked to underlying depression. Antidepressants may be beneficial in such scenarios. Evaluation strategies depend on the suspected underlying cause. Further diagnostic workup, including imaging, is essential in cases involving spinal fracture, neoplasm, or infection. So, what is the treatment approach? In acute cases, most patients improve within the first month, regardless of the intervention. Selecting the right treatment can be difficult due to the range of available options. Non-surgical treatment is typically initiated before a definitive diagnosis is confirmed. If the exact cause is unclear, treatment focuses on reducing pain and restoring function—except in cases of cauda equina syndrome, which requires immediate surgical intervention confirmed by urgent MRI. The first critical question when evaluating a patient with back pain is: “Do you have bowel or bladder dysfunction?” If present, suspect cauda equina syndrome. This condition requires emergent surgical decompression, usually due to a central disc herniation compressing multiple nerve roots and impairing bladder and bowel control. Various non-surgical therapies exist, each offering moderate benefit. No single treatment has proven superior; therefore, a multimodal approach is generally more effective. Treatment Options Include: 1. Patient Education Patients must avoid negative beliefs that hinder recovery. Education on the favorable natural history of back pain, proper posture, spinal mechanics, and safe lifting techniques is essential. Patients should also learn how positions like sitting and forward bending can significantly increase intervertebral disc pressure. 2. Medications NSAIDs (non-steroidal anti-inflammatory drugs), muscle relaxants, and antidepressants. Muscle relaxants are helpful short-term in acute cases, usually combined with NSAIDs. 3. Oral Steroids Low-dose oral steroids can be effective in patients with sciatica, for short-term use. 4. Topical Analgesics Creams, heating pads, and lidocaine patches can provide symptom relief. 5. Activity Modification . Prolonged bed rest is harmful; active patients tend to recover faster. 6. Physical Therapy Passive modalities include cold packs and ultrasound, used initially. Heat therapy is typically introduced after two weeks to relax muscle tension. 7. Spinal Manipulation Commonly performed by chiropractors or osteopaths, spinal manipulation has shown benefit within the first six weeks. Its effectiveness increases when combined with other therapies. 8. Traction and Pleurotherapy Evidence does not support their use in low back pain. 9. Sacroiliac (SI) Joint Injections These are only indicated when SI joint dysfunction is suspected. 10. Orthotic Devices Bracing has no proven value in treating acute or chronic low back pain, though some serve as proprioceptive aids during lifting. 11. Acupuncture May be helpful as part of a multimodal treatment plan for select chronic pain patients. 12. Cognitive Behavioral Therapy (CBT) CBT addresses negative thoughts, medication dependency, and maladaptive behavior. It improves quality of life and reduces reliance on medication in chronic cases. 13. Injections Facet joint injections: Useful for chronic mechanical low back pain. Trigger point injections: Beneficial in myofascial pain syndrome. Epidural steroid injections: Effective short-term in chronic pain; long-term benefit is limited. Transforaminal injections: Best suited for patients with radicular symptoms.