What is the treatment of Lumbar pain?
Human body has an remarkably well-engineered structure of interconnecting bones, joints, nerves, ligaments, and muscles which works together so as to provide support, strength, and flexibility to the human body, It is due to this structure the human body is able to gain a posture and is able to do activities like standing, sitting etc. This structure is called as Lumbar spine. But some patients may experience pain in this lumbar spine which can be caused due to numerous reasons like injury, due to some disease, weakness in muscle joints, misalignment of the spine, due to structural problems, dull muscle ache etc. This pain in the lumbar spine area is known as lumbar pain. The pain can affect one’s ability to bend over or stand up straight. It may hinder walking properly, it can reduce leg strength, it can reduce the sensation in legs and thus can be painful in nature. It thus requires that the root cause of the pain is diagnosed and then the treatment is done in accordance to the diagnosis.
Generally a human body can feel pain due to stress, hectic work flow, or working by sitting or standing for long hours. Not all pain can be categorized as lumbar pain. But if there is pain in the lower back region and the does not improve within two weeks of developing it is thus advised to consult the doctor immediately.
The conditions can be complex if the patient also has associated problems like
- loss of bowel or bladder control
- there is a numbness or tingling, or weakness in one or both legs
- intense, constant pain that gets worse at night
- facing weight loss
- presence of fever
If such conditions also prevail than the patient is advised to consult the doctor immediately.
The various causes of the lumbar pain are as follows:
- if the pain is bearable and is not long-lasting then it could have been caused by torn or pulled muscle and/or ligament.
- if the pain is chronic then it can be caused due to numerous reasons like:
- Lumbar herniated disc.
- Degenerative disc disease.
- Facet joint dysfunction.
- Osteoarthritis. : Abnormalities of the skeleton can also cause back pain. This includes scoliosis or narrowing of the spinal canal due to arthritis.
- loss of nerve function called as cauda equina syndrome
- fungal or bacterial infection of the spine,
- cancer or nonmalignant tumor in the spine
How is the treatment done?
The doctor shall examine the root cause of the pain and this require through examination. This may include:
- Physical examination: where in the doctor shall ask the patient to walk, stand and sit so as to test the patient ability to stand and walk, to test the spine’s range of motion, to examine the reflexes to find the leg strength and to detect sensations in the patient’s legs.
- The patient history is recorded
- The patient daily activities, sleeping activities, posture, injuries details are collected and analysed.
- The patient may be asked to bend or twist in certain positions. Through these activities positions that worsen or recreate pain, is examined.
- Some imaging tests can be asked for diagnosis which may include:
- CT Scan
- fluoroscopic-directed injections of local anesthetic and steroid medication into specific anatomic structures. They are helpful in confirming the source of the pain.
- electromyography (EMG) to test nerve conduction
Based on the outcome of the diagnosis the treatment is carried out which can include following options:
- Life style change: If the pain is within the controllable limits, the doctor may ask the patient to change the walking posture, activity pattern, do some exercise, and can suggest to use heat or ice therapy for pain relief.
- Medication: The patient may be given nonsteroidal anti-inflammatory medications for reliving the back pain episodes. Some of them are : ibuprofen, naproxen, etc. Pain relievers, or analgesics, such as acetaminophen (Tylenol), are also an option, though they don’t have as much anti-inflammation properties. For nerve related pain the patient may be given gabapentin or amitriptyline, a tricyclic antidepressant. Cortisone steroid injections can be prescribed for severe back pain.
- Back Braces; patients may be given braces so as to support the spine and thus relieve them from the pain.
- Surgery: This is considered to be the last resort to treat the pain. This is done if the other procedures do not relieve the patient from pain for more than 12 weeks. Some of the surgery options are as follows:
- Decompression surgery: This surgery aims in removing whatever is pressing on a nerve root from the spinal column so as to relive the pain.
- Fusion surgery: This surgery basically removes the soft tissues between two or more adjacent vertebral bones and replaces them with bone or metal.
- Other surgeries include removal and replacement of the disks and vertebrae.
Who is eligible for the treatment? (When is the treatment done?)
The lumbar pain is a pain experienced in the lower back spine area of the body. Any patient who is constantly facing this problem of pain can consult the doctor. Thus, any person who is experiencing a constant pain in their lower back area of the body is eligible for the treatment. But the mode of the treatment shall vary from the diagnosis of the pain by the doctor. Surgery shall be performed if essential and if all other various modes of treatment fails.
Who is not eligible for the treatment?
Those who are having no pain or are having a pain that is not constant and which is manageable through change in lifestyle activities are thus not eligible for the treatment.
Are there any side effects?
The Side effects associated with the treatment of lumbar pain are:
The medications for muscle relaxant and nerve relaxant can produce following side effects:
- Drowsiness and sedation
- Itching and hives allergies
- Mood swings
- Allergic reactions etc.
- Except for the medicine of acetaminophen, all the other medications should be taken with food because as these medicines can irritate the stomach lining.
- Ibuprofen can be risky if you have kidney problems or stomach ulcers.
- Surgeries may require long term bed rest and that can cause mental trauma.
Apart from the above if one is experiencing any sort of discomfort while undergoing the treatment it is highly recommended to consult the doctor immediately.
What are the post-treatment guidelines?
The post-treatment guidelines for lumbar pain are:
- Bring changes in the lifestyle
- Adapt to the exercise and diet routine as suggested by the doctor.
- Adapt to the sleeping and other habits as suggested by the doctor.
- Always follow the correct position and mainly in standing position maintain your weight balanced on your feet.
- Maintain proper procedures
- Some nerve relaxing medication can cause drowsiness and can cause sedation. It is thus advised not to drive or indulge in hard work.
- Maintain proper nutrition and diet to reduce and prevent excessive weight gain, especially weight around the waistline that taxes lower back muscles.
- Take diet with sufficient intake of calcium, phosphorus, and vitamin D helps to promote new bone growth.
- Take bed rest and get physiotherapy done as per the guidelines after the surgery.
- It is advised not to lift heavy objects and not do to heavy physical exercise after the surgery.
- Patients in recovery are typically advised to take a short period of rest while the spine and surrounding tissues heal.
How long does it take to recover?
The recovery period from lumbar pain is nearly about six months. If the problem is not so severe than the 75 percent of the problem shall resolve in two to three weeks. If the treatment is taken in the earlier stage of lumbar pain then it doesn’t take so much time. The time period of recovery from the surgery of lumber pain requires approximately 4-6 months on the other hand, more wide surgeries may take more months to cure. Pain relief from steroid injections usually wears off by around three months. But the recovery time shall vary from patient to patient condition and the mode of the treatment opted.
What is the price of the treatment in India?
In India the price of the treatment of lumbar pain is depend upon person to person and place to place where the treatment is taken by the patient. The cost of surgery is higher than the medicines. The approximate cost of this treatment is INR 1000 to INR 20000 and the cost of surgery is INR 1.5 lac to INR 4 lac.
Are the results of the treatment permanent?
The results of the lumbar pain is dependent upon the patient condition because if the patient executes the proper guidelines after the treatment like diet, lifestyle changes, exercise and medication on time then the result of this treatment is permanent but on the other hand if a person can follow their doctor instructions in very good manner then the result of this treatment may not yield best in results and may worsen the situation.
What are the alternatives to the treatment?
There are some alternative therapies that can help in bringing relief from the lumbar pain and also gives good results for the patients. The alternative therapies for lumbar pain are as follows:
- relaxation techniques,
- cognitive behavioral therapy,
- Ayurveda therapies etc.
- Ice packs and hot heat packs are very helpful and may relieve discomfort and it also help in reducing inflammation.
But if there is no relief from any of these treatment and still the pain persist for more than 2 to 3 weeks it is advised to consult the doctor immediately.