Low Back Pain

Low back pain affects 60 to 80 percent of the adult U.S. population at one time or another. Low back problems affect the spine's flexibility stability and strength which can cause pain discomfort and stiffness.

Signs and Symptoms

• Tenderness pain and stiffness in the lower back
• Pain that radiates into the buttocks or legs
• Difficulty standing erect or standing in one position for a long time
• Discomfort while sitting
• Weakness and leg fatigue while walking

What Causes It?

Low back pain is usually caused by strain from lifting twisting or bending. However some low back pain can be a symptom of a more serious condition such as an infection a rheumatic or arthritic condition or ovarian cysts. It may be caused by a ruptured or bulging disk the strong spongy gel-filled cushions that lie between each vertebra. Compression fractures of the bones in the spine can also cause low back pain especially in older women with osteoporosis. In addition poor overall fitness smoking and general life dissatisfaction increase a person's risk for low back problems.

What to Expect at Your Provider's Office

Your health care provider will ask you to stand sit and move. He or she will likely check your reflexes and perhaps your response to touch slight heat or a pinprick. He or she may also recommend strength testing on a treadmill. You may also need a blood test X rays a magnetic resonance imaging scan or computed tomography scan.

Treatment Options

Treatment Plan

Low back pain can often be relieved and prevented with lifestyle changes. Exercising to strengthen your muscles maintaining a healthy weight and practicing good posture lowers your risk. Physical therapy helps relieve pain for some people. For more severe or long-term back pain your provider may recommend medication or surgery.

Drug Therapies

Prescription

• Muscle relaxants—for pain relief especially at the onset of pain; various side effects
• Nonsteroidal anti-inflammatory drugs—used continuously for chronic pain; various side effects
• Oral or epidural steroids—reduce inflammation and can have dramatic results for pain relief but have little lasting benefit; less effective with repeated use; various side effects

Over the Counter

• Aspirin or acetaminophen (Tylenol)—for pain relief; used continuously for chronic pain; various side effects

Complementary and Alternative Therapies

Alternative therapies can be effective for easing muscle tension correcting spinal imbalances relieving discomfort and averting long-term back problems by improving muscle strength and joint stability.

Nutrition

• B-complex: B₁ (50 to 100 mg) B₂ (50 mg) B₃ (25 mg); B₅ (100 mg); B₆ (50 to 100 mg); B₁₂ (100 to 1 000 mcg) folate (400 mcg per day) all reduced with stress and pain
• Vitamin E (400 IU per day) vitamin C (1 000 to 3 000 mg per day)
• Calcium (1 500 to 2 000 mg) and magnesium (700 to 1 000 mg) to regulate muscle contraction and ease spasm
• Bromelain: (250 to 500 mg three times per day on an empty stomach) anti-inflammatory works especially well with turmeric

Herbs

Herbs may be used as dried extracts (capsules powders teas) glycerites (glycerine extracts) or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers;10 to 20 minutes for roots. Mix three to six of the following (one cup tea or 30 to 60 drops of tincture three to six times per day).

• Relaxants: Black haw (Viburnum prunifolium) relaxant; petasites (Petasites hybridus) acute muscle spasm not for long-term use; valerian (Valeriana officinalis) antispasmodic especially with sleeplessness; wild yam (Dioscorea villosa) antispasmodic especially with joint pains and long-term stress; turmeric anti-inflammatory especially with digestive problems; Jamaican dogwood (Piscidea piscipula) relaxant
• Pain relief: White willow bark (Salix alba) anti-inflammatory and analgesic; devil's claw (Harpagophytum procumbens) analgesic anti-inflammatory; St. John's wort (Hypericum perforatum) anti-inflammatory
• Circulatory stimulants: rosemary leaves (Rosemariana officinalis) especially with digestive problems; gingko (Ginkgo biloba) especially with poor circulation
• Topical treatment may be helpful for acute problems. Mix one to two drops of essential oil or 5 to 10 drops of tincture into 1 tbsp. vegetable oil and rub into the affected area. St. John's wort for nerve pain; leopard's bane (Arnica montana) anti-inflammatory external use only; lobelia (Lobelia inflata) antispasmodic

Homeopathy

Some of the most common remedies for this condition are listed below.

• Aesculus for dull pain with muscle weakness
• Arnica montana especially with pain as a result of trauma
• Colocynthis for weakness and cramping in the small of the back
• Gnaphalium for sciatica that alternates with numbness
• Lycopodium for burning pain especially with gas or bloating
• Rhus toxicodendron for stiffness and pain in the small of the back

Physical Medicine

• Chiropractic or osteopathic manipulation can help relieve pain.
• Contrast hydrotherapy. Alternate hot and cold applications. Alternate three minutes hot with one minute cold. Repeat three times. This is one set. Do two to three sets per day.
• Castor oil pack. Apply oil directly to skin cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 to 60 minutes.

Acupuncture

May help relieve spasm and increase circulation to the affected area.

Massage

Massage may be helpful both acutely and to prevent chronic problems.

Special Considerations

Chronic low back problems can interfere with everyday activities sleep and concentration. When symptoms are severe your mood and sexuality may be affected. While depression is usually not the cause of chronic low back pain it often complicates treatment.

Supporting Research

Balch JF Balch PA. Prescription for Nutritional Healing. 2nd ed. Garden City Park NY: Avery Publishing Group; 1997:149–150.

Bartram T. Encyclopedia of Herbal Medicine. Dorset England: Grace Publishers; 1995:238–239 277–278.

Blumenthal M ed. The Complete German Commission E Monographs. Boston Mass: Integrative Medicine Communications; 1998:81–82 136–137 183 197 222–223 226–227 230–231.

Gruenwald J Brendler T Jaenicke C et al eds. PDR for Herbal Medicines. Montvale NJ: Medical Economics Company; 1998:662–663 786–787 871–872

Kitade T Odahara Y Shinohara S et al. Studies on the enhanced effect of acupuncture analgesia and acupuncture anesthesia by D-phenylalanine (2nd report): schedule of administration and clinical effects in low back pain and tooth extraction. Acupunct Electrother Res. 1990;15:121–135.

Kruzel T. The Homeopathic Emergency Guide. Berkeley Calif: North Atlantic Books; 1992:30–38.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany Calif: Hahnemann Clinic Publishing; 1993:36–39 59–61.

Mowrey D. The Scientific Validation of Herbal Medicine. New Canaan Conn: Keats Publishing; 1986:223–227.

Murray MT Pizzorno JE. Encyclopedia of Natural Medicine. Rocklin Calif: Prima Publishing; 1998:338.

Snider RK ed. Essentials of Musculoskeletal Care. Rosemont Ill: American Academy of Orthopaedic Surgeons; 1997.

Werbach M. Nutritional Influences on Illness. New Canaan Conn: Keats Publishing Inc.; 1987:1987: 342-345.

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.