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Suggest Treatment For Lumbar Pain

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Posted on Wed, 6 May 2015
Question: What More can I do for the pain I have daily?
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Answered by Dr. Dr. Matt Wachsman (43 minutes later)
Brief Answer:
Quite a bit.

Detailed Answer:
You imply by your previous questions that it is lumbar pain.
Let us start at the most brutal treatments and work upward.

Surgical interventions do not have a great track record with you nor with my patients. Indeed, the literature would suggest a dose response inverse curve: the more intense the surgery the worse its results--probably including that the best results are not doing surgery. The least invasive, and least problematic surgical option is injection of anti-inflammatories and/or anti-pain drugs as epidural injection. They rarely produce either long term success nor long term disasters. Implanting a TENS unit is another surgical option but one that I have no experience with directly nor indirectly.

Narcotic medications have efficacy. I am not sure that aspirin like drugs do. The narcotic pain medications have problems. A partially active narcotic with a narcotic blocker not only works on pain but in my experience seems to reset people's pain responses in a good direction. SUBOXONE has it's points. It is very safe. Other narcotic pain medications have higher addiction/withdrawal and overdose risks. Methadone by pain clinics is especially dangerous since its 'high' is somewhat blunted while it's potential for overdose is if anything worse than most. People go up on it and it doesn't have a safety margin. Suboxone has likely the highest safety margin. BOTH suboxone and methadone are long acting. This is mostly bad. Back pain goes up and down. If you want something for a short pulse of pain, methadone and suboxone not only can't be taken that way, they make it very tricky to take anything else with them.

Anything that dampens nerves helps back pain. This includes drugs with novocaine like effects (amitryptiline), anti-epileptics (gabapentin and pregabalin), muscle relaxers (half of which work on spinal NERVES), and tens and accupuncture.

Chiropracty helps a significant number of people.

Then, here's the real stuff. The back is not going to ever be normal. Adaption to the situation is the really beneficial intervention. There's a lot.
Adjustment of movement. Tai chi, yoga, ballroom dance make people move more gracefully. This lowers the strain on the back. I've only had one person actually follow this advice....
The physical therapy person I use does ballroom dance. He isn't good at it, but is very good at physical therapy. This helps pain and movement. Also builds supportive muscle tone around the back. helpful.
Also helpful is bicycling. I cannot fully explain why and it's been 4/4 very very helpful in people with seriously bad backs.
But the real helpful part of physical therapy, tai chi, yoga are putting the pain into another context in which you are working on something other than just the pain and focusing on something other than the pain.
Note: For more detailed guidance, please consult an Internal Medicine Specialist, with your latest reports. Click here..

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Dr. Matt Wachsman

Addiction Medicine Specialist

Practicing since :1985

Answered : 4214 Questions

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Suggest Treatment For Lumbar Pain

Brief Answer: Quite a bit. Detailed Answer: You imply by your previous questions that it is lumbar pain. Let us start at the most brutal treatments and work upward. Surgical interventions do not have a great track record with you nor with my patients. Indeed, the literature would suggest a dose response inverse curve: the more intense the surgery the worse its results--probably including that the best results are not doing surgery. The least invasive, and least problematic surgical option is injection of anti-inflammatories and/or anti-pain drugs as epidural injection. They rarely produce either long term success nor long term disasters. Implanting a TENS unit is another surgical option but one that I have no experience with directly nor indirectly. Narcotic medications have efficacy. I am not sure that aspirin like drugs do. The narcotic pain medications have problems. A partially active narcotic with a narcotic blocker not only works on pain but in my experience seems to reset people's pain responses in a good direction. SUBOXONE has it's points. It is very safe. Other narcotic pain medications have higher addiction/withdrawal and overdose risks. Methadone by pain clinics is especially dangerous since its 'high' is somewhat blunted while it's potential for overdose is if anything worse than most. People go up on it and it doesn't have a safety margin. Suboxone has likely the highest safety margin. BOTH suboxone and methadone are long acting. This is mostly bad. Back pain goes up and down. If you want something for a short pulse of pain, methadone and suboxone not only can't be taken that way, they make it very tricky to take anything else with them. Anything that dampens nerves helps back pain. This includes drugs with novocaine like effects (amitryptiline), anti-epileptics (gabapentin and pregabalin), muscle relaxers (half of which work on spinal NERVES), and tens and accupuncture. Chiropracty helps a significant number of people. Then, here's the real stuff. The back is not going to ever be normal. Adaption to the situation is the really beneficial intervention. There's a lot. Adjustment of movement. Tai chi, yoga, ballroom dance make people move more gracefully. This lowers the strain on the back. I've only had one person actually follow this advice.... The physical therapy person I use does ballroom dance. He isn't good at it, but is very good at physical therapy. This helps pain and movement. Also builds supportive muscle tone around the back. helpful. Also helpful is bicycling. I cannot fully explain why and it's been 4/4 very very helpful in people with seriously bad backs. But the real helpful part of physical therapy, tai chi, yoga are putting the pain into another context in which you are working on something other than just the pain and focusing on something other than the pain.