Your aching back: Better pain relief

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Your aching back: Better pain relief

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If warmer spring weather lures you outside for heavy yard work, now's

a good time to learn about how to prevent and treat low back pain.

Four out of every five people have had low back pain at one time or

another. With symptoms ranging from a dull ache to absolute agony,

low back pain can put your life on hold. In fact, it's second only to

the common cold in causing missed work days for adults under age 45.

Most low back pain clears up in a few days or weeks with a

combination of rest, appropriate exercise, and over-the-counter pain

medicines. But pain that persists for more than three months --

chronic back pain -- is more difficult to treat, in part because

there are many different possible causes.

The lower, or lumbar, spine is a complex structure made up of

powerful muscles, ligaments, bones, and joints. It provides the

strength for standing, walking, lifting and other activities, and

allows the body to turn, twist, and bend.

Back pain can be caused by a number of things, from sports injuries

and other damage to simple wear and tear. If muscles are poorly

conditioned or overworked, they are more easily strained. Someone who

works all week at a desk, for example, can strain their back muscles

doing heavy yard work on the weekend. Likewise, if the ligaments that

help stabilize the low back are weak from inactivity or stiff from

overuse, a sudden wrenching movement can cause a ligament sprain.

Aging can also bring low back pain. Bones lose strength over time. In

someone with osteoporosis, the bones of the lumbar vertebrae can

break or compress in a fall or even during some everyday activities.

Arthritis can infl ame joints, causing pain and stiffness.

And " slipped disks, " in which the rubbery cartilage between disks

bulge outward, can press against the spinal nerves to cause pain.

Keeping your back healthy is the best way to prevent low back injury.

There are several practical things you can do:

• Don't try to lift objects too heavy for you. Lift by bending your

knees, not your back; keep your back straight and your head down and

in line with your back. Keep the object close to your body, and don't

twist when lifting.

• Regular, low-impact exercises like walking, swimming, or stationary

bike riding 30 minutes a day can increase muscle strength and

flexibility. Yoga can also help stretch and strengthen muscles and

improve posture. Always stretch before exercise or other strenuous

physical activity to prevent back injury.

• Try to practice good posture. Your back supports your weight most

easily when it is straight. Wear comfortable, low-heeled shoes. When

standing, keep your weight balanced on both feet. Keep your shoulders

back and don't slouch.

• When sitting, try to use a chair with good lower back support. A

pillow or rolled-up towel placed behind the small of your back might

help. Make sure your work surfaces, like your keyboard, are at a

comfortable height. If you have to sit for a long period of time,

rest your feet on a low stool or a stack of books. Switch sitting

positions often, and walk around the office and gently stretch your

muscles every so often to relieve tension.

• Sleeping on a firm surface on your side helps your back.

• Eat a healthy diet with enough calcium, phosphorus, and vitamin D

to help promote new bone growth.

• Keep extra weight off your waistline, where it can strain your

lower back.

• If you smoke, quit; smoking reduces blood fl ow to the lower spine

and causes the spinal discs to degenerate.

Since not every back injury can be prevented, researchers are always

looking for news ways to treat low back pain. For example, NIH's

National Center for Complementary and Alternative Medicine (NCCAM) is

funding the study of " chiropractic, " an ancient method of adjusting

and manipulating body parts, to see if it helps with low back pain.

So far, NCCAM says that studies of chiropractic treatment are not

conclusive. Chiropractic treatment and conventional medical

treatments seem to be about equally helpful. NCCAM is continuing to

study this and other alternative treatments.

Dr. Jon Levine, director of the NIH Pain Center at the University of

California at San Francisco, is particularly interested in the first

sensory nerve cell that begins the pain signal to the brain. Many

patients with pain, including chronic low back pain, say that

although their medication relieves pain, they don't want to take it

because of side effects like cloudy thinking, sleepiness, fatigue, or

even addiction. Levine explains that many of the side effects from

pain medications originate in the brain, not in the outlying areas of

the nervous system that reach out to various parts of the body.

" If we can make drugs that target mechanisms outside the brains such

as the first sensory nerve cell, " he explains, " we can prevent those

side effects. " His continuing work is supported by funds from NIH's

National Institute of Neurological Disorders and Stroke.

Another aspect of pain relief that Levine and his colleagues study is

how men and women respond differently to pain medications. They

discovered that one medication works at two different sites in the

brain, a pain-relieving site and a pain-enhancing site, and that men

have more of the pain-enhancing effect than women. They were able to

find the pain-enhancing receptor and block it, reducing the pain-

causing effect of the drug in men. This receptor-blocking technique

also helped relieve pain in women at lower doses of the drug than

before. Thanks to this research, a commercial biotechnology company

is now doing further studies to see if the new drug proves to be safe

and eff ective against pain.

Levine emphasizes that the cost of low back pain to society is

immense. " Our ability to understand and control this problem -- and

prevent the recurrence of back pain -- would be a major breakthrough

for public health in this country, " he says.

If you've hurt your back:

Apply ice and heat. As soon as possible after the trauma, apply ice

to the tender spot several times a day for up to 20 minutes. After

two to three days of cold treatment, apply heat (such as a heating

pad) for short periods to relax muscles and increase blood flow to

the area.

Get exercise. Back-healthy activities can include stretching,

swimming and walking. Ask your health care provider for advice about

gentle exercises.

Try bed rest, but only for a day or two. Too much bed rest can make

back pain worse, so get back to your regular activities as soon as

possible. The best position is on one side with a pillow between your

knees.

Take pain relievers. Over-the-counter pain relievers can ease mild to

moderate low back pain. For more than occasional use or more severe

pain, be sure to talk to your doctor.