From the Guidelines
If you're experiencing continued back pain, you should see a primary care physician first, who can evaluate your condition and refer you to specialists if needed, as recommended by the American College of Physicians 1. For persistent or severe back pain, specialists like orthopedists, neurologists, rheumatologists, or pain management specialists may be appropriate. While waiting for an appointment, you can try over-the-counter pain relievers like acetaminophen (Tylenol) at 500-1000mg every 6 hours (not exceeding 4000mg daily) or NSAIDs like ibuprofen (Advil, Motrin) at 400-600mg every 6-8 hours with food, as these are first-line medication options for low back pain 1. Non-medication approaches include:
- Applying ice for 20 minutes several times daily during the first 48 hours, then switching to heat therapy
- Gentle stretching
- Maintaining good posture
- Avoiding activities that worsen pain These specialists can provide targeted treatments because back pain has many potential causes including muscle strain, disc problems, arthritis, or nerve compression, each requiring different approaches. Seek immediate medical attention if your back pain is accompanied by fever, unexplained weight loss, loss of bladder/bowel control, or weakness/numbness in the legs. Clinicians should provide patients with evidence-based information on low back pain with regard to their expected course, advise patients to remain active, and provide information about effective self-care options, as this is a strong recommendation with moderate-quality evidence 1. For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation, as recommended by the American College of Physicians 1.
From the FDA Drug Label
The efficacy of pregabalin for the management of neuropathic pain associated with spinal cord injury was established in two double-blind, placebo-controlled, multicenter studies Treatment with pregabalin 150–600 mg/day statistically significantly improved the endpoint weekly mean pain score, and increased the proportion of patients with at least a 30% and 50% reduction in pain score from baseline. The fraction of patients achieving various levels of improvement in pain intensity from baseline to Week 12 is presented in Figure 11 Some patients experienced a decrease in pain as early as week 1, which persisted throughout the study Study SCI 2: This 16-week, randomized, double-blind, placebo-controlled, parallel-group, multicenter, flexible dose (150–600 mg/day, in increments of 150 mg) study compared the efficacy, safety and tolerability of pregabalin with placebo. Treatment with pregabalin statistically significantly improved the endpoint weekly mean pain score, and increased the proportion of patients with at least a 30% and 50% reduction in pain score from baseline. The fraction of patients achieving various levels of improvement in pain intensity from baseline to Week 16 is presented in Figure 12 Clinical Studies Eight double-blind controlled clinical studies were performed in 642 patients comparing cyclobenzaprine hydrochloride 10 mg, diazepam, and placebo The efficacy of cyclobenzaprine hydrochloride tablets 5 mg was demonstrated in two seven-day, double-blind, controlled clinical trials enrolling 1405 patients Primary endpoints for both trials were determined by patient-generated data and included global impression of change, medication helpfulness, and relief from starting backache Comparisons of cyclobenzaprine hydrochloride tablets 5 mg and placebo groups in both trials established the statistically significant superiority of the 5 mg dose for all three primary endpoints at day 8.
Management of Continued Back Pain:
- Pregabalin: may be effective in managing neuropathic pain associated with spinal cord injury, with a significant reduction in pain score from baseline.
- Cyclobenzaprine: may be effective in relieving back pain, with a significant improvement in global impression of change, medication helpfulness, and relief from starting backache. The choice of treatment should be based on the individual patient's condition and medical history, and should be made under the guidance of a healthcare professional 2 3.
From the Research
Treatment Options for Continued Back Pain
- Patients with continued back pain can be treated with various options, including pharmacologic therapy and conservative management 4, 5.
- Pharmacologic management of acute pain should be tailored for each patient, including a review of treatment expectations and a plan for the time course of prescriptions 4.
- Acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) are first-line treatment options for most patients with acute mild to moderate pain 4.
- Topical NSAIDs are recommended for non-low back, musculoskeletal injuries 4.
- Adjunctive medications may be added as appropriate for specific conditions if the recommended dose and schedule of first-line agents are inadequate 4.
Conservative Management
- Conservative management of low back pain includes patient education, therapeutic exercises, and bracing 5.
- A multi-modal regimen focused on strengthening postural muscles, specific spine manipulation, and specific Mirror Image® traction can improve spine integrity and reduce pain 6.
- Chiropractic BioPhysics® rehabilitation has been shown to be effective in treating abnormal spinal alignment and posture 6.
Comparison of Treatment Options
- A study comparing ibuprofen plus acetaminophen versus ibuprofen alone for acute low back pain found no significant difference in pain and functional outcomes between the two groups 7.
- The importance of using appropriate conservative care in the management of low back pain has been increasingly stressed in recent years 8.