Severe back pain: Mechanical Low back pain. Useful recommendations.


Q: I've been having now for over two months an intense pain in a palm-sized area just to the left of my spine, approximately in the middle part of my back. It comes whenever I sit for more than 2 or 3 hours, it grows gradually and once settled it won't cease in any position. Walking helps but only as long as I keep doing it, and on days I don't sit it does not appear at all, but the mentioned area always feels a bit dull to the touch. I am a student and so do have to sit a lot, it has become a major problem. Pills with ketorolac, ibuprofen or metamizole sodium don't help at all, so far only Voltaren gel had some effect. I've been diagnosed years ago with scoliosis (not severe) and had, from time to time, mild back pains when fatigued, but nothing compared to this. Have also checked my kidneys which are ok. Thank you for any advice.


A:   Mechanical low back pain (LBP) is the second most common reason for seeing a physician in the United States. Of the US population, 85% will experience an episode of mechanical LBP at some point during their lifetime. Fortunately, the LBP resolves for the vast majority within 2-4 weeks. Sometimes it may complicate with a sciatic nerve inflammation and the healing process takes longer, this might be your case so, here are some ways to ease the pain at home or at work: Do not bend, lift, or sit in a soft, low chair because your pain will get worse. Over-the-counter pain medicines such as acetaminophen (Tylenol), or ibuprofen (Advil, Motrin IB) will probably help ease the pain. Try a cold pack to see if it helps to ease the pain. If you don't have a cold pack, use a large bag of frozen vegetables; it makes a good first aid cold pack. Or have someone close to you massage you in a triangular pattern with an ice cube over the sore areas, no more than 15-20 minutes at the time.  After the cold massages, try alternating with heat from an electric heating pad to see if it helps the pain. If you don't have an electric heating pad, put a hand towel under hot water, wring it out, and place it on your back. Sometimes the moist heat penetrates more deeply and gives better relief of pain. You may feel better lying on your back on a firm surface with a pillow under your knees. Another option is lying on your side with a pillow between your knees to keep your back straight. Also, you might find that a recliner chair is helpful. Finally, take it easy, but do not lie in bed for longer than 2 days because this has been shown to worsen the condition. Try to do activities that you are able to tolerate, and the most important: be patient and do not expect to feel better overnight. The suggested conservative medical treatment would be: a physical therapy program aimed to: control the pain and the inflammatory process, relative rest, flexion and extension exercises of the spine to reduce the nerve tension, correction of wrong postures and habits, exercises that improve the muscular strength and endurance of lumbar muscles.

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