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Are you getting the best treatment for your low back pain?

Dr. Rahimian, an orthopedic surgeon specializing in spine fellowship, shares evidence-based treatments and understanding of low back pain. Learn about the causes, self-help tips, red flags, treatment options, and the outlook for recovery.

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Are you getting the best treatment for your low back pain?

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  1. Are you getting the best treatment for your low back pain? Dr.Rahimian Orthopedic surgon Spine fellowship resident

  2. Why are we here? • To update you on the best evidence for the treatments available • To give you a better understanding of low back pain

  3. Have you had low back pain? • How many of you have ever had back pain? • How many of you seek help for your back pain? • How many of you have ever had treatment for your back pain?

  4. What causes back pain? Most cases, cause is unclear • poor posture • lack of exercise • muscle strains and sprains(70%) Some conditions have specific causes • Spondylosis (10%) • Herniation(4%) • Stenosis (3%)

  5. How can I help myself? • Regular exercise e.g. swimming, walking, pilates, yoga, going to gym • Check posture frequently • Lift things correctly • Watch your weight • Stay at work if possible • Keep positive think!

  6. What is the outlook for back pain? • 75 – 90% recover within in a few weeks • Relapses are common • Most lead normal life and able to work • Emotional response to back pain important to recovery e.g. worried, depressed,….

  7. Red Flags • History of cancer • Unexplained weight loss • Intravenous drug use • Prolonged use of corticosteroids • Older age • Major Trauma • Osteoporosis • Fever • Back pain at rest or at night • Bowel or bladder dysfunction

  8. What treatments are there for back pain? • guideline • specific exercise • manual therapy • Acupuncture • Combined psychological and physical therapy • Surgery or injections may be considered

  9. Treatment Options for Back Pain

  10. Exercise & Bed Rest • Advice to stay active: • ‘There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica.’ • One or two days of bed rest if necessary • Light activity, avoiding heavy lifting, bending or twisting . • No data on any particular exercises

  11. What if my back pain is affecting my work? Work is good for you! – financial and social • Stay at work or get back as soon as possible. • Discuss what can be done to help you when you return e.g. light duties, changing hours

  12. Medications • Anti-inflammatory medications (NSAID’s): • Beneficial; no differences; watch side-effects • Tylenol: • Narcotic Pain Relievers: • No more effective than NSAID’s • Many side effects • Muscle Relaxants : • Can decrease pain and improve mobility • 70% with drowsiness/dizziness

  13. Antidepressants • Anticonvulsants • Corticosteroids • Topical analgesics

  14. Treatment Strategies for LBP Moskowitz MH. Curr Pain Headache Rep. 2003;7:178-187.

  15. Massage • Might be beneficial • More quality research is needed • Different types of massage

  16. Acupuncture • Very little quality research and data • Seems to indicate that acupuncture is not effective for the treatment of back pain

  17. Injections • Epidural injections: • Insufficient and conflicting evidence • Facet joint injections: • No improvement • Local/Trigger point injections: • Possibly some benefit

  18. Role of Radiology • Usually unnecessary and not helpful • Plain X-ray: • Age>50 years • No improvement after 6 weeks • Red flag • MRI: • After 6 weeks if have sciatica • Red flag

  19. Other Modalities • Back Brace/Corset/Lumbar Support • Injections • Hot/Cold • Ultrasound

  20. Surgery • Discectomyimproves pain in short term but not long term (ie. 10 years) • Fusion • Decompression

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