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Thursday, May 15, 2008

The Four Stages of Low Back Pain Care and Recovery : Part 1

Treatments for low back pain fall into four main categories or stages. The vast majority of patients can achieve full recovery with Stage I care. You become a candidate for Stage II care and beyond only if you are among the roughly 20% of low back pain sufferers who do not heal during Stage I. Each additional stage of care is in turn appropriate for a smaller and smaller patient pool.

Stage I Care

Stage I care is for just about everyone with low back pain. It involves a sequenced combination of rest, medications (anti-inflammatories, muscle relaxants, and pain relievers as needed), heat and ice, and gentle rehabilitative exercise. Back Rx is a comprehensive program of Stage I care.

This first stage of care can resolve 80% or more of all low back problems. It should not be bypassed or curtailed, unless surgery is indicated as described on page 17. When other treatments are tried, Back Rx or a similar program of Stage I care should almost always be continued, or resumed as soon as possible afterward, in order to realize their full benefits.

Stage I care may be complemented by traditional physical therapy, osteopathy, medical massage, chiropractic, acupuncture, or some combination of these. For more information on these treatments and how to decide if they’re right for you, see the rest of this chapter and Chapter 11.

Stage II Care
For severe, ongoing low back pain that does not respond to Stage I care, Stage II offers three minimally-invasive, nonsurgical procedures:
* In cases of low back pain without leg pain, paravertebral, or trigger point, injections of a saline solution to inflamed, tender areas.
* Selective nerve root epidurals under fluoroscopy, also known as guided epidurals. These injections deliver a carefully calibrated dose of lidocaine and corticosteroid directly to the inflamed nerve that is the source of the pain, as determined with the aid of fluoroscopy. (Fluoroscopy is a form of X-ray guidance.) These injections are used for low back pain with leg pain (sciatica) and have a high, long-lasting success rate when combined with icing and an exercise regimen like Back Rx.
* Facet and sacroiliac (SI) joint injections are also done under fluoroscopy for pain that is deemed to originate from these deep structures. The drawback of these injections is that their effect may be temporary, even if combined with icing and proper exercise.

Stage III Care
For low back pain that does not respond to Stage II care, Stage III care offers three nonsurgical, and two surgical, procedures:
* Radio Frequency Denervation, which halts pain in the facet and SI joints by heating the nerves, which innervates these joints, making the nerves inactive for a couple of years. The procedure can then be repeated.
* Intradiscal Electrothermal Therapy (IDET), which heats the annulus, the hard outer portion of an injured disc.
* Nucleoplasty, which heats the nucleus pulposus, the softer inner portion of an injured disc.
* Micro-discectomy and laminectomy, two very similar surgical procedures in which the herniated portion of a disc is removed.

Stage IV Care
Stage IV care options remain limited, for the present, to spinal fusions, which can be effective in cases of combined back and leg pain. But within the next two to three years artificial disc replacement, which is now being studied in U.S. Food and Drug Administration (FDA) trials, should become widely available.

For more information on Stage II to Stage IV care options, and which ones may be appropriate for you, see Chapter 12. For now, keep in mind that well over 95% of all low back pain cases can be healed without surgery. Surgery is indicated only
* To stop the progressive loss of neurological function
* To restore bowel and bladder function
* To end intractable pain.

If you’ve hurt your back and find that you’re losing an increasing amount of feeling and sensation in the leg or elsewhere in the body, that you can’t go to the bathroom (this is no joke, but a potentially life-threatening problem), or that severe pain persists no matter what you do, you should put down this book and seek an evaluation from a qualified physician as soon as possible.

The potential for such complications is frightening, and in the immediate aftermath of back injury or reinjury, when the pain is overwhelming, it can be hard not to fear the worst. But once again, please remember that almost all low back pain sufferers can achieve a full and lasting recovery with a sound program of Stage I care like Back Rx, especially if they have the right caregivers in their corner.

Excerpted from

Back Rx: A 15-Minute-a-Day Yoga-and Pilates-Based Program to End Low-Back Pain
by Vijay Vad
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