Steps to Identifying the Right Lower-Back Pain Treatment for You
Lower-back pain treatment can gradually and unwittingly devolve into expensive, invasive and often unnecessary procedures, often with questionable outcomes. Overall, severity of pain dictates which treatment methods a patient will seek. Pain gradually worsen from mild to severe. It can also become severe very suddenly with high force trauma (car accident), or even bending or twisting the wrong way. Therefore, a pain scale from 0-10 (10 being worst) is frequently used to help understand the severity of pain. While the pain scale is very subjective, it can be a good tool to use to measure progress. Typically, the worse the pain, the lower the functional capacity of the patient. In fact, these are both important measures of progress.
Breaking Down Lower-Back Pain Treatment
This is how I describe the pain scale to my patients:
- 0/10 – No pain whatsoever. No functional restrictions. Feeling great.
- 5/10 – The pain is severe enough that other people can tell you are hurting: facial grimacing, limping, holding your back, etc.
- 10/10 – These patients are in the hospital. Think of lightning bolts in your back or having a finger cut off.
Now that we have a pain scale, let’s discuss the type of treatment options patients investigate or are referred to based upon their pain levels.
Mild Pain 1-3/10
Probably at this point, pain is annoying but usually not severe enough to seek medical attention. As a result, home remedies are often sought for relief.
- Ice/Heat Applications
- Self-massage or mechanical massager
- Over-the-counter pain medication: NSAIDS/Tylenol etc.
- Stretches/Yoga/Palates
- More Rest/Less Stress
- Untested/questionable online remedies: Lemon juice extract, milk, basil tea etc.
Moderate Pain 4-7/10:
By this time, the pain is much more severe and inhibits function. Probably, home remedies may have been tried but with unsuccessful outcomes. Finally, if pain lasts long enough, outside attention is sought.
- Massage, Trigger-Point Work, Stretches etc.
- Acupuncture Session (s)
- Needle points and herbs
- Chiropractic Care
- Adjustments
- Physical therapy modalities, such as: ultrasound, laser, muscle stimulation, heat/ice, stretches, exercises, traction, etc.
- Ergonomics
- Physical Therapy – without adjustments
- Primary Care Physician Visit
- Prescription strength pain medication, muscle relaxer, opioids
- Stretches/exercises
- Referrals, such as to chiropractic, physical therapy, psychologist, physiatrist or orthopedist
- Psychologist – Cognitive-Behavioral-Therapy (CBT)
- Physiatrist (Pain Management) Appointment(s)– Often requires a referral
- Various medications or spinal injections, including cortisone
- Orthopedic Specialist/Spine Surgeon – Often requires a referral
Severe Pain 8-9/10: This pain is all-consuming. As a result, medical attention is almost always the first-line treatment.
- Similar to above, excluding massage or acupuncture.
Severe Pain 10/10: This pain is the worst imaginable and persistent. Nothing helps. Also, patient may feel a sense of impending doom. At this point, emergency medical attention is first-line treatment.
- Hospital Emergency Room
- Assessment and observation
- Imaging: X-ray/MRI/CT scans
- Ruling out of life-threatening conditions
- Prescription medication(s)
- Referral to primary care, orthopedic, neurology or physiatrist, once the patient is stable.
Of course these are only guidelines and there is no strict order of treatment options – just a general progression from the most conservative therapy (home treatment) to the most aggressive therapy (spine surgery).
Frequently, the best therapy is education, but few doctors and therapist receive insurance payments for teaching. So, instead of deepening their understanding of a situation, they perform procedures. Some HMOs only pay for chiropractic adjustments. As a result, many pursue this course even when lacking a conclusive assessment. Chiropractic adjustments are probably the last thing you need if you have an unstable and painful spine. Lumbar flexion-traction will feel good on the low back muscles, but will aggravate the lumbar discs, if you are flexion intolerant. The treatment must match the condition.
In conclusion, which treatment is the right one for you? This depends on what tissues are aggravated. Consequently, the next time you see your therapist or doctor, you should inquire about the following:
- What movements, loads or postures cause lower-back pain?
- How can you eliminate pain triggers? As a result, how can you alter your specific daily activities and routines?
- What postures and movements minimize spinal loads?
- Which stabilizing exercises can you engage without lumbar flexion/extension/rotation?
- How could you benefit from a brisk walking plan?
- How does mobilizing the hips help the back?
In our next blog, we will walk through a typical patient anecdote when battling lower-back pain. You may recognize yourself or your pain struggles in these steps. In conclusion, if you’re ready to truly identify the source of your pain and the correct lower-back pain treatment for a fuller, richer, pain-free life, a deeper understanding of your pain must be achieved. Contact Dr. Kai Tiltmann at Financial District Chiropractic.
