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Overtreatment is common

For common back pain, exercise may be best



Almost everyone will experience lower back pain at some point in life. But the approaches to treat the condition can vary.

For many it comes in the form of temporary aching, burning, stabbing, sharp or dull pain in the lower back that lasts four weeks or less in the absence of any direct injury or trauma. Non-traumatic causes usually involve a back strain or sprain as a result of twisting or lifting something improperly, lifting something too heavy or overstretching. A physical exam can usually identify any serious conditions that may be causing the pain and help determine treatment.

“Early intervention can reduce a patient’s chance of developing chronic lower back pain,” said Dr. Eric Warren of Novant Health Waxhaw Family & Sports Medicine in Waxhaw, North Carolina. “The sooner a patient can be evaluated by a medical professional, the sooner he or she can be given a treatment plan.”

Warren said physical therapy and activity modification are great treatment options compared to bed rest.

“We want people to keep moving and doing their daily activities,” Warren said. “Studies have shown that people who lie in bed with back pain do worse overall.”

Physical therapy can include a movement assessment, stretches and exercises.

“Home exercises are one of the best things you can do,” Warren said. “Customized stretches and exercises can help a person recover at home and complement their physical therapy appointments.”

Warren said heat, massage and over-the-counter medications like acetaminophen and ibuprofen can also provide relief from lower back pain.

In some cases, treatment may not be necessary. To improve patient care, Novant Health formalized a standard approach to treating adults who suffer from acute (as opposed to chronic), non-traumatic lower back pain.

 “Under certain circumstances, X-rays may be ordered to rule out specific causes of lower back pain but in most cases they are not warranted,” Warren said. “Unfortunately, across the industry, X-rays for lower back pain are highly overused ordered too early in the treatment process. This is a considerable problem as it drives up unnecessary health care costs, can expose the patient to radiation unnecessarily, and often isn’t in the best interest of the patient.”

Reducing unnecessary imaging is one place that many health care systems find to be an area of opportunity as they look to reduce patients’ health care costs and improve quality of care.

Novant Health and other health systems are educating providers about appropriate use of imaging and the benefits of a good physical exam and physical therapy.

“Through our research, we have not seen significant scientific evidence that injection therapies or the use of lidocaine patches, anticonvulsants, antidepressants or steroids are beneficial for patients with acute lower back pain,” Warren said. “Physical therapy appears to be an early helpful treatment option and is often indicated within the first month of experiencing pain.”

Novant Health’s physical therapy team has developed specific protocols to treat patients with acute lower back pain. However, if pain persists after three treatment sessions, Warren recommends that patients undergo a follow-up medical examination.  At that time, an X-ray may be necessary to identify if any underlying medical conditions exist, such as infection, kidney stones or even cancer.




Published: 12/15/2016