Low Back Pain Shouldnt Sideline You

The Opioid Dilemma

Opioid analgesics are one type of pain reliever and they do not work for everybody, says Argoff.

Opioids often get a bad rap from media reports of addiction such as recent reports of talk show host Rush Limbaugh's abuse. Buts some experts in pain management argue that fear of addiction to these medications has lead to undertreatment of patients with Chronic Pain.

The first question that needs to be answered is do they work for this patient, Argoff says.

If we get past that and show there is benefit, doctors need to determine whether this patient is at-risk of becoming addicted, he explains.

"There is no shred of evidence that suggests the acquisition of drug addiction, but not every patient walks into doctor office and says, 'by the way, before you prescribe, I am a drug addict' or 'I have an addictive personality,' and we can't as health-care providers already know who has that risk," he says.

"Very few people not known to be abusers become abusers, but frequent follow-up, medication contracts, and multidiscipline therapies can help prevent addiction and/or abuse," he says.

Botox

Botox, the same toxin that doctors routinely use to eradicate fine lines and wrinkles, can also treat back pain, says Gary Starkman, MD, a clinical attending neurologist at Beth Israel Deaconess Medical Center and the medical director of New York Neurology Associates, both in New York City.

"I use Botox for selected patients with back pain when I suspect muscle spasm is involved," he says. In cases of Low Back Pain, Botox is usually injected into the muscles on either side of the spine in the area of pain.

"The results could last three or more months " he says, "but the pain relief is individual, and if it breaks the pain cycle, pain can go away for many months or completely." The only downside is the cost.

Botox may relieve Low Back Pain because it relaxes the back muscles, but Saper says it may alter various chemical pain mechanisms that have nothing to do with muscles.

No Pain, No Gain?

"We now recognize that with simple back strain (such as when you wake up with a backache), we want you to remain active rather than take to bed," Saper says. "We used to put people to bed; now we get them out of bed."

This is why a growing number of doctors including Brain W. Nelson, MD, an orthopedic surgeon and medical director of Physician's Neck and Back Clinic in Minneapolis, are recommending exercise programs to people with chronic back pain. Such programs are aimed at strengthening the back muscles, and often patients see results in about nine weeks, he says.

"There is a growing movement towards fitness as an approach to chronic back pain," Nelson says. "I've come to believe that this is the way to go for the vast majority of people with back pain [and] I think that 10 years from now, it will be the mainstay of treatment because it is so dramatically more cost-effective."

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