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The most common causes of low back pain (LBP) not caused by injury are age-related, and most cases are people age 65 and over. LBP may also be caused by arthritis, aging, bone spurs, or cancer.
LBP is either acute or chronic. Acute LBP comes on suddenly and is caused by an injury, such as muscle strain. It can last for 6 to 12 weeks. The best way to help acute LBP pain is to stay active. Taking an over-the-counter drug like acetaminophen (Tylenol) can help the pain. Using physical therapy and relaxation can also help to relieve acute LBP. Chronic LBP is pain that lasts longer than 12 weeks. Some causes of chronic LBP are arthritis, herniated or "bulging" disks, degenerative disk disease, and spinal stenosis (narrowing of the spinal canal). In fact, some experts say that 95% of people will have degenerative disk disease by age 50. Patients with chronic LBP have daily pain that can affect their quality of life.
As people age, their backs become weaker. Some older patients develop osteoporosis, and their bones can fracture easily. Other patients develop arthritis. Bone spurs can develop at the edges of the vertebrae and compress the spinal nerves. This type of pain can be felt down the leg causing severe pain, sometimes called sciatica.
Other types of LBP can be caused by disk herniation, accidental injury, or back surgery that did not help the original cause of LBP. For these patients, chronic pain can affect their ability to work, maintain relationships, and enjoy life. Depression is common in patients with chronic LBP. Along with getting treatment for chronic LBP, patients may also need treatment to cope with the daily pain.
Acetaminophen (Tylenol) is an over-the-counter medicine that helps relieve LBP. Take the drug as directed and don't exceed the daily dose limit. Long-term use and high doses of acetaminophen can affect the liver. If you drink alcohol regularly or have liver disease, talk to your healthcare provider before taking acetaminophen.
Other medicines that help relieve pain and decrease inflammation include the over-the-counter pain medicine ibuprofen (Motrin) and celecoxib (Celebrex), which must be prescribed by a healthcare provider. Although these medicines are good, you should be aware of the risks. These drugs can affect heart and kidney function so be sure to take the lowest dose for the shortest time possible. Gastrointestinal (GI) bleeding is also a risk. If you have had cardiac disease, a heart attack, a stroke, or GI bleeding consult your NP before taking these medicines.
Other medicines like tramadol (Ultram) or opioids such as oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin) can be tried after acetaminophen and ibuprofen are unsuccessful. These medicines should be used only if the pain is severe and disabling.
Some patients are afraid that if they take these medicines for long periods of time they will become addicted to them. Patients who take opioids regularly to control daily pain are considered to be dependent on the medication rather than addicted. Addicts on the other hand crave their drug, continue to use it despite harm, and have no control over their drug use. Talk to your healthcare provider if you have any concerns.
Other medications can be helpful for patients who have nerve pain that is part of chronic LBP. For these patients, healthcare providers use antidepressant or antiseizure medications.
Medication alone is not enough to treat LBP. Physical therapies, such as exercise and massage therapy, are used to provide added pain relief. Acupuncture and viniyoga style yoga can produce positive outcomes. Progressive relaxation can be done with either a live therapist or through tapes and CDs. Spinal manipulation and interdisciplinary rehabilitation are also options for additional pain management.
There are some types of therapy that have not been proven to work for chronic LBP. These include transcutaneous nerve stimulation, steroid injections, and prolotherapy. Prolotherapy is only helpful when used with a rehabilitation program.
There are many ways to treat LBP. The best results are obtained when different types of therapies, such as exercise and massage, are combined and used together. Using medication to help with the discomfort of physical therapy or relaxation to help you sleep can provide the best methods of pain relief.
Risk factors for LBP are:
1. poor physical condition with no regular exercise
2. being over age 55
3. workers who lift heavy loads or do hard physical labor
5. limited access to regular healthcare.
Starting at the top, the spine has four regions:
* the seven cervical or neck vertebrae (labeled C1-C7)
* the 12 thoracic or upper back vertebrae (labeled T1-T12),
* the five lumbar vertebrae (labeled L1-L5), which is known as the lower back
* the sacrum and coccyx, a group of bones fused together at the base of the spine.
The lumbar region of the back, where most back pain is felt, supports the weight of the upper body.
LBP is one of the most common pain problems in the United States. Many people miss work because of LBP and every year, thousands of people visit their healthcare provider for help with LBP.
Don't be afraid of trying gentle activity when you experience LBP. You should try to be active soon after noticing pain, and gradually increase your activity level. Not being active enough can lead to loss of flexibility, strength, endurance, and then to more pain.
- National Institute of Neurological Disorders and Stroke. Low back pain fact sheet. http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm.
- WebMD. Low back pain - treatment overview. http://www.webmd.com/back-pain/tc/low-back-pain-treatment-overview.
- American Chronic Pain association. http://www.theacpa.org/.
- American Pain Society. Low back Pain Guidelines. http://www.ampainsoc.org.
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