Don's Home Health Pain Management

Treatment Procedures:
A wide range of treatment is available for low back pain (LBP), depending on what is causing the pain and how long it lasts. Most people find that their low back pain improves within a few weeks -- A few months for old people like me--. Chances are good that your pain will go away soon with some basic self-care. However if you have one of the symptoms that require immediate attention (diagnosis - surgery) you should see a doctor.

Over half, up to 80%, of people with back pain even from a herniated disc, will recover without surgery. With time most herniated discs will dehydrate and degenerate, absorbing the protruding cartilage.
Your family physician can help you decide whether to wait and see or visit a neurosurgeon or orthopedist for expert diagnosis. They will keep you under observation for muscle weakness, loss of reflexes, and other symptoms indicating as possible need for surgery.

My cousin, a physician who has seen a lot patients with lower back problems, including himself and his father, says "Even 'disproven' treatments help some people whether placebo or not. We all know that treatments with 'proven' benefit do not help many people. Muscle injuries at out age can often take months to heal. If triggered by underlying spinal abnormalities ( arthritis, micro fractures, etc. ) the annoying muscle pains can be recurring. "

There are are a variety of treatments:

• Traditional: Heat/Cold over the counter pain meds.
• Exercise: Yoga, Pilates, Back Specific Exercises, and Swimming are also recommended.
• Alternative meds and dietary supplements.
• Alternative therapies (Cryotherapy, Acupuncture, Red Light Therapy:)
• Chiropractors>Chiropractors
• Mental: Stress Reduction - Mindfulness
• Do it yourself devices: (Inversion Table:, Traction devices)
• Prevention

See relief below:

Yoga, Pilates, Swimming

• Yoga
  he average cost of single sessions at yoga studios across the country is $10 to $20 for a 1 hour group lesson.
  Senior Centers may have free or low cost group yoga.
  Yoga For Lower Back Pain Is Awesome (With 7 Poses To Prove It) - Pain Doctor

  Hot yoga (Bikram) is also recommended.
  It is performed in a hot room heated to approximately 105 degrees with 40 percent humidity to promote muscle relaxation.

• Pilates - Group courses cost about $10-$30 each for a 45-60 minute low-impact mat class.
• Swimming - YMCA memberships with pool privelages are about $45/month.
• End back pain. Move with freedom. Return to the active life you love. Achieve real relief with BACKFOREVER's proven exercise and lifestyle program, delivered via interactive online video for only $9.99 per month or 33 cents per day.
  Cure Back Pain Permanently Without Surgery - BackForever Program

Cannabidiol, commonly referred to as CBD, is a new and relatively understudied treatment for pain,
It is derived from the cannabis sativa plant and hemp.
It is not psychoactive like THC which is also produced from the canabis sativa plant (marijuana), although you can get CBD with THC in various ratios.

It comes in Creams and gels for topical use on the skin.
Oils which can be taken in oil-filled capsules or mixed into beverages.
Tinctures - A more concentrated form administered by the dropper.

You can also get a tincture which includes various ratios of CBD and THC which is available in states which allow marijuana.
These also come in a form which can be vaped. see 10 Things You Need to Know Before Vaping CBD Oil - Vaping360

See :
Understanding CBD (Cannabidiol) for Back Pain
CBD Oil For Medical Conditions: Unregulated, Unproven | AARP Bulletin
64 million Americans have tried CBD. Two-thirds said it helped their health issue all by itself, and 30 percent said CBD helped when combined with conventional medications."
Joseph Maroon, a professor at the University of Pittsburgh Medical Center, says his patients with joint and back pain get relief with over-the-counter CBD. "Any time there's inflammation, CBD may help," he says

What Are Omega-3 Fatty Acids?

Omega-3 fatty acids are found in fatty layers of cold-water fish and shellfish, plant and nut oils, English walnuts, flaxseed, algae oils, and fortified foods. You can also get omega-3s as supplements. Food and supplement sources of these fatty acids differ in the forms and amounts they contain.

There are the two main types of omega-3 fatty acids:

• Long-chain omega-3 fatty acids are EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). These are plentiful in fish and shellfish. Algae often provides only DHA.
• Short-chain omega-3 fatty acids are ALA (alpha-linolenic acid). These are found in plants, such as flaxseed. Though beneficial, ALA omega-3 fatty acids have less potent health benefits than EPA and DHA. You'd have to eat a lot to gain the same benefits as you do from fish.

Why not flaxseed oil? - Harvard Health Other Supplements:
I have a friend that was diagnosed with stenosis, who says taking magnesium supplements worked when epidurals, physical therapy and chiropractors did not.
See: Ending Back Pain With the Help of Magnesium from Jigsaw, a manufacturer
and Natural Calm / Magnesium Supplement at HerbsWest.net

There are a variety of medications, supplements for treating osteoporosis

• Muscle and joint pain relief - Reduced muscle pain, inflammation and cell damage. Anti-inflammatory proteins are released into the blood.<
• Increased Metabolism to burn calories and improve cold weather tollerance
• Weight loss - They claim you will burn 500 - 800 calories in 3 minutes. Metablolism may be increased for some time after treatment.
• Younger-looking skin - It helps in the anti-aging process by increasing collagen production which shrinks pores and smooths wrinkles. I couldn't fina any studies to verify this.
• Better mood and energy - Endorphins are released into the blood.

Effect of cryotherapy on the lumbar spine in elderly men with back pain. - PubMed - NCBI says,
"A group of elderly men who participated in WBC showed significantly lower values of active potentials of erector spinae muscles in the lumbar part of the spine and a significant increase in the range of the lumbar spine mobility, in comparison to the group which did not use WBC." Cryotherapy: Can it stop your pain cold? - Harvard Health Blog - Harvard Health Publishing says,
There are no conclusive studies of WBC effectiveness.

The following conditions are contraindications to Whole Body Cryotherapy: Pregnancy, severe Hypertension (BP> 180/100), acute or recent myocardial infarction, unstable angina pectoris, arrhythmia, symptomatic cardiovascular disease, cardiac pacemaker, peripheral arterial occlusive disease, venous thrombosis, acute or recent cerebrovascular accident, uncontrolled seizures, severe Raynaud's Syndrome, fever, tumor disease, symptomatic lung disorders, bleeding disorders, severe anemia, infection, cold-allergy, acute kidney and urinary tract diseases.

Plan on weekly treatments until you start to see a benefit, then gradually lengthen the time until the next visit.

CMS Proposes to cover Acupuncture for Chronic Low Back Pain for Medicare beneficiaries enrolled in approved studies | CMS, July 2019
The Centers for Medicare & Medicaid Services (CMS) proposed to cover acupuncture for Medicare patients with chronic low back pain who are enrolled participants either in clinical trials sponsored by the National Institutes of Health (NIH) or in CMS-approved studies.

Acupuncture | WebMD says "One recent review of 22 acupuncture studies showed that it provided short-term relief from chronic back pain. Those studies also found that, compared to standard treatment, both actual acupuncture and sham acupuncture are more effective."
Acupuncture is worth a try for chronic pain - Harvard Health Blog - Harvard Health Publishing, 2013:
An international team team pooled the results of 29 studies involving nearly 18,000 participants. Some had acupuncture, some had "sham" acupuncture, and some didn't have acupuncture at all. Overall, acupuncture relieved pain by about 50%.
A 2016 Guardian article "Acupuncture for low back pain no longer recommended for NHS (National Health Service) patients"
Professor Mark Baker, clinical practice director for Nice (National Institute for Health and Care Excellence), said: "There is not enough evidence to show that acupuncture is more effective than sham treatment."

It is used for skin health, collagen production, physical performance & muscle recovery, sleep, joint pain, inflammation, and more.

There are several companies producing these: JOOVV has a wide selection of devices in a variety of sizes, light output, ... devices
NovoTHOR porduces a whole body device like a tanning bed.
Hooga also has a variety of smaller devices.

There are home led lights from $40 - $160. See Amazon.com: joovv red light therapy

A 2003 study of the "Journal of Bone and Joint Surgery" 85:975 (2003) compared 278 patients aged 18 to 65 years of age (mean age, 44 years; 53% women) with acute low-back pain or a recent episode (<72 hours) of chronic low-back pain (LBP) with spontaneous lumbar pain. Bed rest and normal daily activity were equivalent for recovery.

See also:
New Ways to Ease Back Pain, Consumer Reports 2022
Beating Back Pain | Consumer Reports Video 2016

For many years, chiropractors were labeled as quacks by the established medical community. Only in recent years have medical doctors started to work with chiropractors.
In the Consumer Reports reader survey below chiropractic had the best patient satisfaction.
According to Chiropractic Versus The AMA in EZineArticles.com: "There is no scientific evidence that supports chiropractic theories; All the studies made in support of chiropractic are basically testimonials from patients."
One friend suffered a burst disk after a chiropractor session.

See: The Chiropractic page for more information.

In a 2009 article "Relief for your aching back: What worked for our readers" (Article is no longer available) by Consumer Reports they found the percentage of people highly (completely or very) satisfied with their back-pain treatments and advice varied by practitioner visited and type of treatment.

Professional	Highly satisfied
Chiropractor D.C.	59%
Physical therapist	55%
Acupuncturist	53%
Physician (DO or MD), specialist	44%
Physician, primary-care doctor	34%

Treatment Type	Beneficial or Very helpful
Chiropractic treatments	58 %
Spinal injections	51%
Massage	48 %
Physical therapy	46 %
Prescription medications	45 %
Over-the-counter medication	22 %

Pain Relief | How to Get Relief from Chronic Pain - Consumer Reports 2019

Don't seek chiropractic adjustment if you have osteoporosis or signs or symptoms of nerve damage, such as numbness, tingling or loss of strength in an arm or leg.

If you believe Dr. Sarno's 1990 best selling book "Healing Back Pain: The Mind-Body Connection", the majority of back pain is psychosomatic caused by stress. i.e. the adult version of children's stomach ache. See stress reduction below.

There is increasing evidence that regular mindfulness practice reduces a person's pain experience. In 2015, Fadel Zeidan, Ph.D., and his colleagues conducted a study to investigate the effectiveness of mindfulness practice in pain management. Brain images of participants who received mindfulness as treatment had less activation in the parts of their brains that manage pain messages.
Source: Use mindfulness to cope with chronic pain - Mayo Clinic Health System

Neurogenic Pain: Can be treated with Epidural Steroid Injections with or without lidocane, narcotics or tranquilizer type substances.
Other injections: Selective nerve root block (SNRB), Facet joint block, Sacroiliac Joint Injections.

See: Guide to spinal injections

Radiofrequency ablation (or RFA) uses radio waves to heat up a small area of nerve tissue, destroying the nerves ability to transmit pain signals. It is frequently used for arthritic or inflames facet joints which can cause chronic pain radiating to the buttocks or back of the leg.

Typically muscle relaxants and pain medication are used for short episodes of acute back pain. See Relief and Prevention below.

It is based on the principal that when you invert your body, the amount of weight pulling on each level of your spine is directly proportional to the amount of force needed to produce proper alignment.

Here's how it works: The weight of your head exerts just the right amount of pull for your cervical spine. The weight of your head, neck, chest, shoulders and arms is exactly the right amount of combined weight needed for the thoracic spine. The same goes for the lumbar spine: See: Do Inversion Tables Really Work? at LoseTheBackPain.com
Spinal Decompression Treatment for Lower Back Pain and Sciatica
and www.inversion-table-direct.com/

Pedicle screws and rods
• Home traction devices
• Cervical collar therapy and halter cervical traction are sometimes used to reduce cervical vertebrae pain. See: Inflatable traction device.
• Exercise: Swimming, stretching, T'ai chi

Other conservative treatments are listed under Relief and Prevention below.

Relief:

• Take over-the-counter pain medicine if needed, such as acetaminophen (Tylenol, for example) or nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin, naproxen (Aleve), and ibuprofen (Advil, Motrin). I take it before I start an activity which may stress my back.
• Some people get relief from pain by using treatments such as massage, spinal manipulation (chiropractic or osteopathic manipulation), or acupuncture.
• Ice or Heat:
  Many recommend (and it works best for me) ice as often as you can for the first 2-5 days. 20 min on and 20 min off. There are a variety of ways to do this; Crushed ice in a zip-loc bag with a little water, a bag of frozen peas, ... Always protect skin from tissue damage by using a cover (some use a wet paper towel) over the ice pack.
  See: Should You Use Ice or Heat to Treat Back Pain?
  After 2-3 days, choosing ice or heat is really up to you. Try using a heating pad on a low or medium setting, or a warm shower, for 15 to 20 minutes every 2 or 3 hours. You can also buy single-use heat wraps that last up to 8 hours.
• Stay Hydrated - Drink plenty of water to help flush away acidic waste products from the muscles especially if you are having muscle spasms. High levels of acidic waste products (byproducts of muscular activity) in the muscles can cause muscle irritation and pain.
• Furniture - There are a variety of furniture, back rests, lumbar supports for your car to help relieve back pain.
  See Furniture, Beds, Back Rests for Back Pain.
• Mattresses - Traditional wisdom was that a firm mattress was best for your back. What you want is a mattress which allows you back to rest in a normal position. You want it to avoid sag but to be soft enough for your shoulders and hips to sink in when on your side. A medium firm mattress is usually best.
  See Mattress Firmness
• Sleep on your side with your knees bent or on your back with pillows under your knees.

• Exercise to strengthen core muscles
• Practice good posture when you sit, stand, and walk. Put one foot up on a stool when standing for a long time. (That was the purpose of bar rails.)
• Don't depend on a "back belt" to protect your back. Studies have not shown these belts to be effective in reducing back injuries. The most they can do is to help remind you to use good techniques for lifting.
• Lifting:
  • place your feet apart for good balance
  • bend your knees
  • keep the load close to the centre of your body
  • lift gradually, smoothly, and without jerking
  • do not twist your back while lifting, pivot with your feet
• Driving
  • get out of the car every hour and walk around for a few minutes
  • position the seat forward so that knees are bent
  • place a cushion at the small of the back
  • if the tilt of a car's seats can be adjusted, change the angle slightly every so
  often.
• Links:
  Medicine: Some Dos and Don'ts for Back Care
  Low Back Care
  Back Injury Prevention at DocsToc.com
  Ergonomic Guidelines for Labs - Lawrence Berkeley National Laboratory
  backcare-ergonomics.com - Comfort Solutions for Everybody
  

Stress Reduction:
According to an article in the January 2007 issue of Health Psychology. Biofeedback or cognitive-behavioral therapy (CBT) can actually reduce feelings of pain by about 30 percent, in patients with chronic back pain.
"That approach teaches patients to divert their attention from pain and to think about it in a less alarming manner. For instance, pain often triggers waves of fear because we associate a sudden twinge with damage to bone, muscle, or skin."
The senior author of the study, Robert Kerns, a psychologist at the Veterans Administration Connecticut Healthcare System and a professor at Yale University says. "Now it's clear these therapies affect the intensity of the pain itself."
See: U.S.News article "Psychological Treatments Are a Balm for Back Pain"