Lower Back Pain? Reaching for the Pill Bottle? Not So Fast, Say Experts.

Studio shot of a mature man experiencing muscular strain

Recent research from the University of Sydney in Australia found that lower back pain is the leading cause of disability worldwide, and is the second most common reason people visit their family doctor. It is a leading cause of early retirement and lower income among seniors. It can have a very negative effect on a person’s quality of life—and can even shorten the life of patients whose lower back pain is chronic.

Not so long ago, many doctors assured senior patients that if they took prescription opioid medications to treat their pain, there was a low potential for addiction. But we know now that this belief was based on faulty research. Today’s opioid epidemic has hit the over-50 age group hard, and many of these addicts began taking those drugs not to get high, but because their doctor prescribed them—often, to treat lower back pain.

Recent studies show that among seniors, overdoses of prescription drugs cause more deaths than illicit drugs, such as heroin and cocaine. So today, if you experience lower back pain—and practically everyone will at some time or another—you’re much less likely to receive a prescription for, OxyContin or Vicodin. Does that mean more patients will be in more pain? Actually, report experts from the American Academy of Anesthesiologists, opioids aren’t even terribly effective in fighting lower back pain; most patients reported only moderate to no improvement in their pain, but plenty of negative side effects, such as sleepiness, constipation and confusion.

What causes lower back pain?

Our modern lifestyle is partially to blame. We didn’t evolve to sit at a desk all day, or on the couch at night. Age is also a factor, as changes in our muscles and bones increase the incidence of back pain as we grow older. Lower back pain might be caused by a specific injury—we lift a heavy object and “tear a muscle,” or we’re in a car accident, or we overdo it during the first golf game of the season. More often, it develops gradually and we’re not sure what’s going on until our doctor evaluates the cause—perhaps a strained muscle, a problem with a disc or bone, muscle spasms, arthritis or a similar condition, a herniated or ruptured disc, or compression or inflammation of a nerve.

Getting the right diagnosis helps the doctor devise the best treatment. It’s also psychologically important. Pain isn’t “just in your head,” but the way we think about our pain makes a difference. For example, appropriate exercise can lessen back pain, but maybe we’re experiencing some discomfort as we work out. Fear and anxiety cause us to tense up, and the pain is worse. But with the reassurance that what we’re doing isn’t causing harm, we’ll experience substantially less pain.

Shot of a skilled physiotherapist addressing his mature patient's back pain in the rehabilitation center

When to seek help

If back pain is severe and sudden, or accompanied by fever, chills, or loss of bowel or bladder control, don’t wait—call the doctor right away. This is an emergency.

And don’t ignore a nagging backache if it persists. Temporary pain can settle into long-term, chronic pain if untreated. But today, doctors are less likely to send a patient home with a prescription for an opioid medication, instead recommending treatments such as:

Physical therapy. Physical therapists offer a wide array of hands-on treatment options, such as massage, ultrasound, hot and cold treatments, bracing, biofeedback and electrical stimulation. They prescribe and supervise appropriate exercises for each patient’s condition. Physical therapists also provide body mechanics training. The things we do each day—getting in and out of a chair, lifting objects, standing and sitting—can take a toll on our back. Studies show sitting on our wallet (or today, our smartphone) can be the culprit. Experts from Binghamton University in New York even recommend that Muslim, Jewish and Christian patients practice good body mechanics during prayer rituals to avoid back strain!   

Medications. In April 2017, the American College of Physicians noted that “most patients with acute or subacute low back pain improve over time, regardless of treatment,” and they recommended other treatments over medications—but, if medications are prescribed, they recommend limiting them to over-the-counter drugs, such as nonsteroidal anti-inflammatory drugs (NSAIDs), topical ointments and creams. Antidepressant medications also can be helpful for chronic pain. Spinal injections may also offer some relief. If the doctor does prescribe an opioid medication, close supervision is important.

Exercise. When our back hurts, we might be tempted to stretch out on the couch and stay there. Bad idea! Safe, appropriate exercise is one of the best ways to recover from back pain, and to prevent a recurrence. The American Academy of Orthopaedic Surgeons says that exercises that strengthen our back and core muscles are especially effective.

A healthy diet for a healthy weight. Every pound we carry in our midsection burdens our back muscles more. Along with exercise, eating a healthy diet can help us keep off the pounds. A back-healthy diet also includes calcium, potassium and vitamin D to support bone health.

Meditation, yoga and tai chi.  A few years ago, these mindfulness practices barely made the list when it came to back pain treatment, but a host of recent studies show that they can really help.  Researchers from Seattle’s Group Health Research Institute found that mindfulness-based stress reduction, along with appropriate yoga poses, was an effective practice. University of Maryland researchers also found that patients could lower their pain level with yoga.

Surgery. In some cases, for example, if a patient has a ruptured disk or nerve pressure caused by certain changes in the spine, surgery may be recommended if other treatments have provided an unsatisfactory relief.

Ultimately, say many experts, the main treatment for many cases of back pain is time, and a patient’s back will improve no matter what they do. But losing weight, exercising and practicing good body mechanics will all lower the risk of a future bout of back pain, so keep it up even as your back recovers.

The information in this article is not intended to replace the advice of your healthcare provider. Never begin a new exercise program or change the way you take your medications without first discussing it with your doctor.

Source: Assisting Hands Home Care in association with IlluminAge. Copyright © IlluminAge, 2018.

Home care can be of great help in managing pain. To learn more, read “How Home Care Supports Pain Control for Senior Clients” in the February – March 2017 issue of the Assisting Hands Hand in Hand newsletter.