From the Guidelines
Ang pasyente ay dapat magpatuloy sa mga sesyon ng physical therapy na may ibang protocol na nakatuon sa pagpapalakas ng core at pagpapalastas ng mga ehersisyo, kasama na ang paggamit ng mga non-steroidal anti-inflammatory drugs at muscle relaxants para sa pag-relief ng sakit. Ang mga ebidensya mula sa mga pag-aaral na ginawa noong 2017 1 ay nagpapakita na ang mga exercise regimen, tulad ng motor control exercise at Pilates, ay may mga benepisyo sa pagbawas ng sakit at pagpapabuti ng function sa mga pasyente na may chronic low back pain. Ang mga sumusunod na mga rekomendasyon ay base sa mga ebidensya:
- Non-steroidal anti-inflammatory drugs tulad ng ibuprofen 400-600mg three times daily with food o naproxen 500mg twice daily para sa pag-relief ng sakit
- Muscle relaxants tulad ng cyclobenzaprine 5-10mg at bedtime para sa mga muscle spasms
- Pagpapalakas ng core at pagpapalastas ng mga ehersisyo sa physical therapy
- Paggamit ng heat o cold packs para sa 15-20 minutes several times daily
- Pagpapanatili ng proper posture at ergonomics sa mga gawain araw-araw Ang mga rekomendasyon na ito ay base sa mga ebidensya mula sa mga pag-aaral na ginawa noong 2017 1 at ayon sa mga rekomendasyon ng American College of Physicians. Ang mga pasyente na may persistent low back pain ay dapat na magpatuloy sa mga sesyon ng physical therapy at magpatuloy sa mga rekomendasyon sa itaas para sa pag-relief ng sakit at pagpapabuti ng function. Kung ang mga sintomas ay patuloy na umiiral sa kabila ng mga interbensyon sa loob ng 4-6 na linggo, ang mga karagdagang pag-evaluate sa mga imaging studies tulad ng MRI ay maaaring kinakailangan upang matukoy ang mga posibleng sanhi ng sakit.
From the Research
Patient's Condition
- The patient has already seen Dr. Esperon and has been given medications.
- The patient underwent 4 sessions of physical therapy (P.T.) but was supposed to have 9 sessions.
- The patient stopped physical therapy after 4 sessions due to lack of improvement in low back pain.
- The patient experiences increased intensity of pain with prolonged walking.
- There is no urinary and fecal incontinence.
Treatment of Low Back Pain
- According to 2, physical exercise is recommended for non-specific low back pain, and early non-pharmacological treatment is endorsed.
- The aim of physical treatments is to improve function and prevent disability from getting worse.
- Active strategies such as exercise are related to decreased disability, while passive methods (rest, medications) are associated with worsening disability.
Medications for Low Back Pain
- 3 states that NSAIDs, antidepressants, and opioids may be superior to placebo for reducing pain in chronic low back pain, but opioids have an established profile of harms.
- Paracetamol, opioid analgesics, antibiotics, muscle relaxants, and antidepressants should only be prescribed following a discussion between the treating clinician and the patient, considering the risks and possible benefits.
- 4 found that combination therapy with cyclobenzaprine and ibuprofen was not superior to cyclobenzaprine alone in adult patients with acute neck and back pain with muscle spasm.
Physical Therapy for Low Back Pain
- 5 reports that patients with low back pain represented over 25% of all outpatient discharges from physical therapy practices, with an average episode of care extending over 5 weeks and consisting of 11 therapy visits.
- 2 recommends the use of exercise on its own, or in combination with other non-pharmacological therapies, such as tai chi, yoga, massage, and spinal manipulation.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) for Acute Low Back Pain
- 6 found that NSAIDs are slightly more effective than placebo for short-term reduction of pain intensity and disability in acute low back pain, but the magnitude of the effects is small and probably not clinically relevant.
- There is low quality evidence that NSAIDs are slightly more effective for short-term global improvement than placebo, but there was substantial heterogeneity between studies.