For treatment of patients with chronic low back pain, the guidelines recommend the use of:
NSAIDs and antidepressants
In my opinion, clinically, Acute low back pain does respond well to NSAIDs when combined with a good explanation of the presenting injury and some strapping of the lumbar area with sports tape. Persistent low back pain on the other hand can respond well to medications/ antidepressants as prescribed by your GP in combination with pain education and guided exercises by your Physiotherapist or Exercise Physiologist.
Exercise Therapy
The best exercise for managing your back pain is the one you would like to do. Activities like going for a walk or riding your bike or going for a swim may help your back pain. Once you have the correct diagnosis given by your Physiotherapist, you can discuss what is the best exercise for you to manage your back pain. Physiotherapist’s also work with Exercise Physiologists to design the best possible program customised for your needs.
Exercises like yoga, Pilates, tai chi and gym or home based exercises all have shown to be helpful to manage low back pain. Your Physiotherapist will guide you as to what movements you must avoid while still being able to do the above activities to manage your symptoms.
Psychosocial interventions
In addition, to the above-mentioned strategies, people suffering from persistent back pain can benefit from cognitive behavioural therapy and speaking with a counsellor or Psychologist. You are twice as likely to suffer from back pain if you are depressed. And treating the source of back pain is the mainstay of a long term solution to the problem. If being in pain for longer periods has affected your mental well-being, speaking about it to someone will help. The clinicians in the Hills Integrated Pain Team work with people who are struggling with persistent or “chronic” pain, as well as emotional difficulties that can accompany pain.
The WHO (World Health Organisation) defines health as a state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
Visit Chronic Pain education online for more information.
Social Isolation is common in people suffering from Chronic or Persistent low back pain. There are various reasons for the same. Common reasons being fear avoidance, fatigue, unemployment, not having transport, financial struggles, depression & anxiety.
To combat social isolation, simple steps can be taken, like inviting friends to your home, planning budget friendly get-togethers, and organising physical activity on your good days. Social well-being will help you to manage your back pain better.
Referral to a specialist
Referral to a specialist is recommended in case of suspicion of specific pathologies or radiculopathy or if there is no improvement after 4 to 6 weeks.
What we expect to see generally is some improvements in the intensity or frequency of your pain. Whether your symptoms settle down quicker than before seeking our help, If your weakness is improving with small gains in strength. In case, after trying conservative management with your Physiotherapist at MyPhysioSA, we do not achieve results as expected in a reasonable time-frame you may be referred to see a Spinal Physician or Surgeon to get their opinion.
On the other hand, when you get assessed by your Physiotherapist, and they find some red flags like the ones discussed above (Incontinence/Significant weakness in Lower limbs) you may directly referred to see a Specialist.
By Neel Pangaonkar
Physiotherapist Payneham, myPhysioSA
