Back Pain

Ask a Nurse
by Geraldine Bednash Ph.D., RN, FAAN, American Association of Colleges of Nursing (AACN)

(Page 5 of 5)

Back pain, triggered when you strain the muscles near your spine, is a very common condition, affecting some 80 percent of adults at some time in their lives. Back pain can occur anywhere in the spine, as well as in the neck, but it more commonly occurs in the lumbar spine, or lower back. Back pain is generally attributed to one of three factors or a combination of the three: strained or sprained muscles, or a problem with a facet joint (such as arthritis), bone disease (such as osteoporosis), or a problem with a spinal disk (such as a herniated, or "slipped," disk). A slipped disk occurs when the protective cushion surrounding the disk bulges out of its normal placement in the spine and presses on the spinal nerves. Back pain may be acute (severe and short-term) or chronic (long-term).

You're more at risk for back pain if you are overweight, sedentary, emotionally stressed, or have a job that requires a lot of lifting and forceful movements. Some people find that emotional stress directly affects their back — for example, problems at work intensify their back pain.

Symptoms: These depend on the type of back pain. Back pain caused by strains and sprains is dull and achy. Back pain caused by spasms is severe and piercing upon movement. Back pain caused by a slipped disk is pressing and may lessen when you stand up and worsen when you lean forward. If a disk ruptures, the pain is excruciating, and you may feel pain in your legs and feet. Back pain related to the facet joints feels like a constant muscle ache. If the facet joints break down, pain may shoot down your buttocks and legs (called sciatica). The pain worsens when you stand up and lessens when you lean forward.

If your pain is accompanied by fever or difficulty with urination or defecation, see your health care provider, says Connie Kartoz, MS, RN, FNP-C, of Rutgers, The State University of New Jersey in Newark. "These can signal bone infection or neurological problems."

Diagnosis: Back problems are diagnosed and treated by your primary care physician or by a practitioner who specializes in back pain, such as an orthopedist, a neurologist, an osteopath, or a chiropractor. A physical exam can determine how mobile you are, whether the pain comes from your disks, muscles, nerves, or other sources (such as infection or osteoporosis), and what part of your back is affected. If pain lasts for more than a month, diagnostic tools such as blood tests and imaging tests (X rays, magnetic resonance imaging, and CAT scans) may be used. An electromyogram, which measures the electrical impulses in your muscles, may be done if your health care provider suspects nerve damage.

Treatment: A variety of self-care measures (listed on page 69) can help ease back pain. Seek professional help if self-care provides no relief after two or three days. Your health care provider may prescribe corticosteroids, drugs that reduce pain and inflammation. They are used for a short period of time only because of such potential side effects as increased body hair, insomnia, muscle wasting, weight gain, and nervousness. If a muscle spasm is present, muscle relaxants may be needed, says Teri Kaul, MSN, ANP-CS, of Concordia University Wisconsin in Mequon. Christine B. Berding, RN, MSN, CCRN, of the Medical College of Georgia in Athens, notes that these medications may cause drowsiness. If you take them, she advises you to be careful when driving or performing manual activities. They are generally used for no longer than a week, says Paula Siciliano of Salt Lake City.

Treatments other than medication include physical therapy and ultrasound. In the case of a ruptured, or herniated, disk, a procedure called chemonucleolysis might be used: a practitioner injects an enzyme into the disk to shrink it, relieving pressure on the adjacent nerves. This is successful 75 percent of the time, but it may entail a painful recovery.

Sometimes surgery is necessary if back pain is caused by nerve damage, fractures, or dislocations. Two types of surgery are decompression and fusion. Decompression relieves pressure on a nerve or other spinal structure by removing all or a part of the offending disk. Fusion binds together a spinal structure to prevent painful or damaging movement. However, make sure that back surgery is the answer for you because many experts contend that the majority of surgeries performed are unnecessary. Discuss all the risks and benefits of the procedure and get a second opinion before you make a decision.

Self-care: Although several days of bed rest was once standard, recent research suggests that you shouldn't immobilize yourself unless you have to. "The worst thing you can do for back pain is stay in bed," says Sharon Johnson of San Francisco. Moderate activity is recommended.

• Resume regular activity as tolerated. Research indicates that this results in better recovery, improved function, and fewer missed days from work than a program of two days of bed rest and back conditioning exercises, says Judith C.D. Longworth, Ph.D., RN, CS, FNP, cochair of the family nurse-practitioner program at the University of Texas Health Science Center-San Antonio. "Try to maintain as regular a schedule as you can," agrees Amy Berndt of Reno.

• If you must rest, don't overdo it. Lying down for more than two days can make your muscles and bones weak. Periodically walk around during these days of rest even if your back hurts.

• Until your back improves and you are given the okay by your health care provider, avoid heavy lifting, extreme physical activity, and sitting for long periods of time. "Sitting puts a tremendous amount of pressure on your spine," Christine Berding says. "It is much better to stand or lie down."

• During an acute back spasm, sleep on your side in a fetal position or on your back with a pillow under your knees to prevent strain on your lower back, suggests Christine Berding. "The worst position to sleep in is on your stomach. When you get up, roll to your side and slide your legs off the bed first." And make sure your mattress is firm, says Paula Siciliano.

• During the first 24 hours after the pain begins, apply a cold pack for 15 to 20 minutes every two to four hours to numb the area and reduce inflammation, Amy Berndt says. After the initial period has passed, switch to moist heat to increase blood flow to the area for healing. Hot baths and showers are also beneficial at this time. "Adding a quart of Epsom salts to your bathwater will help relieve inflammation," says Berding.

• Exercise. Gentle movement exercises can improve the elasticity and strength of tense, weakened muscles, says Longworth. Exercise also releases endorphins (natural painkillers) in the body and improves the flow of blood and oxygen throughout the body. But if exercise makes back pain worse, don't do it, says Berding.

• Berding suggests swimming and gentle stretches such as lying on your back, pulling your knees up to your chest, and holding them for a couple of seconds before lowering them, keeping your knees bent. Longworth says your health care provider can suggest other back and abdominal exercises for maintaining strong back muscles. "Strengthening abdominal muscles also helps support back muscles by building a natural 'girdle' of muscles around the lower back and abdomen," explains Diane E. Witt, RN, MA, CNP, of Minnesota State University-Mankato.

• Add pineapple to your diet, suggests Kathy Niemeyer of Allendale, Michigan. It contains an anti-inflammatory substance.

• Apply a compress of comfrey and cayenne pepper directly to the painful area, Niemeyer suggests, adding that the heat causes the blood vessels to dilate and improves blood flow.

• Consider spinal manipulation (in which manual pressure is applied to the spine to readjust it), which can be done by osteopaths and chiropractors. "Research has shown that seeking chiropractic care for lower back pain may help significantly," Berding says. However, spinal manipulation should be done only by a trained professional.

• Try massage therapy and acupuncture to treat back pain.

Over-the-counter treatment: Pain relievers such as acetamino- phen, aspirin, or other NSAIDs can provide some relief. See "Arthritis" for more information about these medications. Counterirritants may also provide relief. Those used for pain other than arthritis pain include the following:

capsaicin
brand name: Capzasin-P

Mentholatum Menthacin
Sloan's Liniment
Zostrix
Zostrix-HP

eucalyptus oil
menthol
brand names:
Absorbine Jr.
Absorbine Jr. Extra Strength
Ben-Gay Daytime Pain Relieving Gel/Vanishing Scent Formula
Eucalyptamint Muscle Pain Relief
Pain Gel Plus
Therapeutic Mineral Ice

mustard oil
brand name: Numol

oil of wintergreen
brand names:
Ben-Gay Extra Strength
Ben-Gay Greaseless Formula
Ben-Gay Original Formula
Ben-Gay Ultra Strength
Exocaine Medicated Rub, Heet
Mentholatum Deep Heating Rub
Sports Spray Extra Strength

trolamine salicylate
brand names:
Aspercreme
Sportscreme

turpentine oil
brand name: Sloan's Liniment

Prevention: "Back pain can become chronic," says Teri Kaul, who recommends that you start a back protection program.

Her suggestions for this program include:

• Exercise daily.
• Warm up before exercising.
• Rearrange your work station if necessary.
• Avoid prolonged sitting.
• Wear good-fitting shoes.

"Proper back mechanics are essential to preventing both initial and re- current problems," says Connie Kartoz of Newark, New Jersey. "Your health care provider or physical therapist can review how to avoid damage to your back." Diane Witt suggests these preventive body "mechanics":

• When lifting, pivot rather than twist, bend at your knees (not at your waist), and hold objects close to the body, near your center of gravity.

• Size up what you're intending to lift. Know what your limits are. If it is an awkward or heavy object, use equipment to lift it or get someone to help you.

• Don't reach for objects over your head. Use a step stool or a ladder.

• Stretch your muscles before doing any heavy lifting.

Copyright © 2001 by American Association of Colleges of Nursing and People's Medical Society

About the Author

Geraldine Bednash Ph.D., RN, FAAN, Has been the executive director of the AACN since 1989. She serves as the vice president of nursing of Health Professions Education Council of the Association of Academic Health Centers and is a member of the editorial boards of several nursing publications.

The American Association of Colleges of Nursing (AACN) represents 550 schools of nursing at public and private universities and senior colleges nationwide.