Often when we consider back pain, our minds go to the type of back pain that occurs from heavy lifting or manual labor. And truthfully, that will be the only type of back pain that most of us experience. However, there are numerous other causes for back pain we need to be aware of and prepare to be able to treat. Those other causes of back pain will be addressed in another post. For today we’ll focus on lower back pain we experience due to injury.
First off, however, when trying to help a loved one in an austere situation, we have to rule out the possibility of the back pain being due to internal causes. Back pain due to internal causes is serious, and there is the risk of death if it is not identified and treated promptly. Keep in mind that musculoskeletal causes for back pain include acute injuries (which are most common in young people), chronic injuries, and degenerative conditions (which are most common in the elderly).[1]
Family physicians see a lot of patients with lower back pain, generally on an almost daily basis. This topic is best addressed in Armageddon Medicine. In her book Dr. Koelker presents an excellent list of questions to ask a patient seeking relief from lower back pain. They’ll also help differentiate whether the pain is musculoskeletal or internal so correct and timely treatment can be offered. Remember that backache may not develop until several days later, so patients need to be quizzed on their activities up to a week prior to onset of pain.
QUESTIONS TO ASK
· Was there an acute injury (fall, strain, twisting, blow)? When? Some injuries take time to produce pain. While pregnant with baby #5, I was out taking the dog for a walk when he suddenly decided it was time to chase a cat or something like that. It was a sudden jerk and really tweaked me at the time, but the pain soon dissipated. The next morning, however, when I got a gallon of milk out of the fridge, I suddenly found myself in excruciating pain at the exact spot that the dog tweaked the day previous.
· Is there a chronic injury? Even if someone regularly lifts heavy weights, over time injury may occur.
· Where does it hurt? Most musculoskeletal pain is below waist level. Mid- to upper back pain may issue from the stomach, heart, lungs, or kidneys.
· How much does it hurt? More than asking a patient to rate their pain on a scale of 1-10, doctors look at whether a patient is able to function. A patient who cannot function is in greater pain than one who is chatting on his phone.
· How long has it hurt? If the pain has been there a long time but only recently worsened, it’s probably nothing new or serious.
· Has the patient experienced this previously? If so, it’s probably chronic and less concerning.
· What makes the pain worse? What makes it better? Musculoskeletal pain almost always worsens or improves with a change in position. This is far less common with internal problems. Is the pain better if the patient is sitting or standing? Is it worse or better with urinating? Worse or better with eating? Fatty foods may make gallbladder pain worse. Deep breathing is painful with pleurisy.
· Has the patient taken any pain relievers? Pain meds may relieve most pain. They may worsen an ulcer.
· Does the pain radiate anywhere? Internal causes generally radiate pain into the abdomen. Musculoskeletal causes may radiate pain into the legs.[2]
RISK FACTORS
Risk factors for developing lower back pain include the following:
· Age
· Excess weight
· Improper lifting
· Lack of exercise
· Psychological conditions
· Smoking[3]
IDENTIFICATION
Strain/sprain. Lower back pain that is worse the day after heavy lifting or straining may be a sprain.[4] A strain/sprain is a tiny tear in a muscle, ligament, or tendon, and in the back it usually affects one of the large muscles. [5] The pain does not travel down to the legs.
Slipped disc. Severe lower back pain that occurs suddenly when lifting or twisting may be a slipped disc, particularly if one leg or foot becomes painful or numb and weak. This arises from a pinched nerve and usually consists of pain in the leg as well as the back. [6]
Sciatica is a type of lower back pain that also shoots down the back of the leg, especially if it includes numbness or tingling. Patients report that a change of position usually helps, as does keeping moving. Lying down may worsen the pain. [7]
TREATMENT
The pain associated with a lower back injury is telling the body it needs to rest to allow the injury to heal. Tissues heal more rapidly when they aren’t constantly being stressed.
Doctors advise the following to relieve pain:
· Relative rest (avoid the activity that initiated the problem as well as all heavy lifting and repetitive bending)[8]
o One to two days of bed rest may help, but is not advised any longer than that[9]
· Pain relievers[10]
o Ibuprofen 200-800 mg, 3x/day (the higher dosage is prescription strength)
o Naproxen sodium 200-400 mg, 2x/day (the higher dosage is prescription strength)
o Tylenol 500-1000 mg, every 4-6 hours.
o Tylenol may be combined with naproxen sodium or ibuprofen for greater pain relief[11]
o Always take these medications with food.
o Patients that are adversely affected by these pain relievers may take Pepcid or Prilosec as well to combat stomach pain.
o Vicodin, Percocet or Tylenol-3 may also be used[12]
· Back massage, including heat or ice[13]
· Sleeping on the side with a pillow between the knees[14]
· Exercise
o Slow to moderate paced walking[15]
o Swimming or walking in chest deep water[16]
o Have the patient lie on the bed or floor and curl the upper back backwards while pushing up with their arms (like a pushup from the waist, the goal being to curve the back, not keep it stiff). Repeat 5-10 times, 2-3 times per day. [17]
Finally, keep in mind that most back pain will eventually resolve without any intervention after adequate rest.
Links to related posts:
[1] Cynthia Koelker, Armageddon Medicine, 2012, 378.
[2] Cynthia Koelker, Armageddon Medicine, 2012, 379.
[3] “Back Pain,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906 (accessed 4 January 2022).
[4] David Werner, Where There Is No Doctor, 1992, 173.
[5] Cynthia Koelker, Armageddon Medicine, 2012, 378.
[6] David Werner, Where There Is No Doctor, 1992, 173.
[7] Cynthia Koelker, Armageddon Medicine, 2012, 381.
[8] Cynthia Koelker, Armageddon Medicine, 2012, 379.
[9] Cynthia Koelker, Armageddon Medicine, 2012, 380.
[10] Cynthia Koelker, Armageddon Medicine, 2012, 379.
[11] Cynthia Koelker, Armageddon Medicine, 2012, 379.
[12] Cynthia Koelker, Armageddon Medicine, 2012, 273.
[13] Cynthia Koelker, Armageddon Medicine, 2012, 380.
[14] Cynthia Koelker, Armageddon Medicine, 2012, 380.
[15] Cynthia Koelker, Armageddon Medicine, 2012, 380.
[16] Cynthia Koelker, Armageddon Medicine, 2012, 273.
[17] Cynthia Koelker, Armageddon Medicine, 2012, 382.
I have Sciatica and it sucks. The first time it hit was in 2006. A sharp, electric pain shooting down my left leg all the way down to my big toe. I fell over in pain. Thanks to a chiropractor and an industrial-strength TENS machine, the Sciatica was gone until Mid-December 2021. It's was my body's Christmas gift to myself.
ReplyDeletePills did very little to help. Heat and massage did help a little.
Can you get back in to the chiropractor? We have a TENS unit here. However, I hope we never need it. Back pain is something I worry about.
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