Conservative
care for back pain
Introduction
For most people back pain tends to get better within
two weeks to three months. During this time period that
an episode of back pain is resolving, or if the back
pain is chronic, it is important to consider the appropriate
course of conservative treatment in order to:
-
reduce pain and spasm
-
provide conditioning for the back
-
assist in managing issues frequently associated
with back pain, such as sleeplessness or depression
Treatment options are considered "conservative"
when they are non-invasive (such as medication) or markedly
less invasive (such as injections) than surgery. In
general, surgery for lower back pain is considered if
conservative treatments fail and the lower back pain
(or leg pain) persists for an extended period of time.
For those patients who have back pain or neck pain,
but an anatomical reason cannot be found, surgery is
not advisable and conservative treatment is the only
recommended course of action.
Conservative treatment is not the first option of choice
is if the patient loses bowel or bladder control, or
develops progressive weakness in the legs — these
symptoms constitute a medical emergency and require
immediate surgery. However, surgical emergencies for
back pain are extremely rare and most episodes of back
pain can be treated conservatively.
The length of time that conservative treatment should
continue varies widely. In general, the more pain and
dysfunction a patient experiences, the earlier surgical
treatments will be considered. The morbidity (e.g. incidence
of post-operative discomfort) or extent of the surgery
must also be considered, and therefore a microsurgery
(small surgery using microscopes) will be considered
much earlier than a much more extensive fusion operation.
At the onset of lower back pain it is generally advisable
to try one or two days of bed rest to decrease muscle
spasm and allow the back to rest. More extensive bed
rest seems to be counterproductive because it leads
to further deconditioning (weakening) of the muscles
that provide critical support for the spine.
In addition to initial bed rest, either one or a combination
of several conservative treatment options is often recommended
in order to alleviate pain and rehabilitate the lower
back.
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