From the Guidelines
For patients with chronic lower back pain that worsens in winter, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction, or spinal manipulation, as these options have shown moderate to low-quality evidence of effectiveness. According to the American College of Physicians guideline 1, nonpharmacologic treatments are recommended as the first line of treatment for chronic low back pain.
Some key nonpharmacologic treatment options include:
- Exercise, which can help improve function and reduce pain
- Multidisciplinary rehabilitation, which combines physical and occupational therapy with other interventions
- Acupuncture, which has been shown to have moderate-quality evidence for reducing chronic low back pain
- Mindfulness-based stress reduction, which can help patients manage pain and improve overall well-being
- Spinal manipulation, which has low-quality evidence but may still be beneficial for some patients
If pharmacologic treatment is desired, nonsteroidal anti-inflammatory drugs (NSAIDs) should be considered as first-line therapy, as they have moderate-quality evidence for reducing chronic low back pain 1. However, it's essential to weigh the potential benefits and risks of NSAIDs, especially in patients with a history of gastrointestinal or cardiovascular disease.
In addition to these treatments, winter-specific strategies can help alleviate chronic lower back pain that worsens in winter. These include:
- Applying heat therapy using heating pads or warm baths for 15-20 minutes several times daily
- Staying physically active with gentle exercises like walking, swimming, or yoga
- Practicing proper stretching focusing on the lower back and hamstrings
- Considering physical therapy for personalized exercises
- Ensuring a warm and supportive sleeping environment with a medium-firm mattress
- Dressing warmly in layers and maintaining indoor warmth to reduce muscle tightening and stiffness.
From the FDA Drug Label
NSAIDs are used to treat pain and redness, swelling, and heat (inflammation) from medical conditions such as different types of arthritis, menstrual cramps, and other types of short-term pain.
The treatment options for chronic lower back pain that worsens in winter may include NSAIDs such as ibuprofen, as they can help alleviate pain and inflammation. However, it is essential to use NSAIDs exactly as prescribed, at the lowest dose possible, and for the shortest time needed to minimize the risk of adverse effects 2.
- Key considerations:
- Past medical history, such as stomach ulcers or bleeding
- Use of other medications, like corticosteroids or anticoagulants
- Age, smoking, and drinking habits
- Pregnancy or breastfeeding status
It is crucial to consult a healthcare provider before taking any medication, especially if you have any underlying medical conditions or concerns 2.
From the Research
Treatment Options for Chronic Lower Back Pain
Chronic lower back pain that worsens in winter can be managed through various treatment options. The following are some of the available treatments:
- Exercise: Exercise is a widely prescribed treatment for chronic low back pain, with demonstrated effectiveness for improving function and work 3. It can be prescribed with three distinct goals: to improve or eliminate impairments in back flexibility and strength, to reduce the intensity of back pain, and to reduce back pain-related disability.
- Pharmacological Management: Pharmacological management of back pain syndromes includes the use of analgesics, anti-inflammatories, and muscle relaxants 4. Non-steroidal anti-inflammatory drugs (NSAIDs) are widely used to treat people with low back pain, especially people with acute back pain 5.
- Physical Therapy: Physical therapy approaches, including education and self-management, and the recommencement of normal activities and exercise, can be effective in improving function and preventing disability from getting worse 6.
- Alternative Therapies: Alternative therapies such as tai chi, yoga, massage, and spinal manipulation may also be recommended in combination with other non-pharmacological therapies 6.
Medications for Chronic Lower Back Pain
The following medications may be used to manage chronic lower back pain:
- NSAIDs: NSAIDs are more effective than placebo in reducing pain intensity and disability in people with chronic low back pain 5.
- Opioids: Opioids may be necessary in patients with back pain due to neoplastic disease or osteoporotic fracture 4.
- Baclofen: Baclofen has been shown to improve pain and disability levels in patients with LBP 7.
- Duloxetine: Duloxetine has been shown to improve pain and disability levels in patients with LBP 7.
Important Considerations
When managing chronic lower back pain, it is essential to consider the following:
- Individualized Treatment: Treatment should be individualized based on the patient's specific needs and circumstances.
- Multidisciplinary Approach: A multidisciplinary approach, including physical therapy, pharmacological management, and alternative therapies, may be necessary to effectively manage chronic lower back pain.
- Potential Adverse Events: Potential adverse events associated with medication use should be carefully considered and monitored.