Coping with low-back pain

On Call

February 13, 1996|By Dr. Simeon Margolis | Dr. Simeon Margolis,SPECIAL TO THE SUN

I have had chronic low-back pain, with occasional flare-ups of worse pain, for at least five years. Examinations by my doctor and the tests he ordered have not found a herniated disk or any other obvious cause for the problem. I would be interested in any suggestions you might have to relieve my discomfort.

The agency for Health Care Policy and Research has published guidelines for adults with low-back problems. These guidelines describe some common treatments that don't work and some that do and include some advice on how to carry out everyday activities in ways that may help to reduce the recurrence of back pain.

Extended bed rest, for example, is not recommended for acute flare-ups because bed rest for more than four days can weaken back muscles and slow recovery. No sound evidence was found for the benefits of spinal traction, biofeedback, ultrasound, massage, acupuncture or injecting local anesthetics, steroids or other substances into the back. Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen and naproxen, were advocated for relief of pain. Muscle relaxants are generally no more effective than the NSAIDs and as many as a third of the people who take them are troubled by drowsiness or other side effects. Oral steroids and antidepressants are at times prescribed, but have not been proven effective.

Suggestions for avoiding recurrent lower-back problems:

* Avoid long periods of sitting or standing. Change positions frequently when standing; get up periodically when on airplane flights or working at a desk; and take periodic breaks for a short walk when on long drives. Put a rolled-up towel or pillow behind the small of the back during long drives.

* Store all frequently used items, particularly heavy ones, on a low-level shelf so that you won't have to reach up over your head or stand up on tiptoes to get them.

* Keep objects close to the body when lifting. Do not lift things while twisting or reaching. Keep your back straight and bend your knees to use your leg muscles when lifting things from the ground or floor.

* A desk or other work surface should be at a comfortable height so it is possible to type or carry out other tasks without hunching forward.

* When sitting or standing for a long period, rest one foot on a footstool.

* Wear comfortable shoes with low heels, especially if it is necessary to stand for long periods.

* Exercise regularly to strengthen back and stomach muscles.

* When moving any load, it is easier on the back to push rather than pull it.

* Sleep may be more comfortable with a pillow under the knees when sleeping on your back or between the knees if you sleep on your side.

* To avoid neck strain when sleeping, use a small down or feather pillow rather than those made of foam rubber.

* If you are overweight, lose weight to decrease the workload on your back.

Dr. Margolis is professor of medicine and biological chemistry at the Johns Hopkins School of Medicine.

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