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Recent research (The Lancet, March 21, 2018) suggests that many people with back pain are getting risky treatments that may not work, including potentially addictive opioid painkillers and surgery. The same study points to a combination of physical and psychological therapies as helpful when it comes to easing discomfort and improving function. David Thomas, MD, PhD, professor of medicine and rehabilitation medicine at Mount Sinai, agrees that “conservative care” measures should be your first approach, and points to guidelines from the American College of Physicians (ACP) as the ideal treatment blueprint. The ACP recommends a range of non-drug approaches, including physical therapy, heat, massage, acupuncture, yoga, mindfulness meditation, biofeedback, and cognitive behavioral therapy.
A new study (Health Services Research, May 23, 2018), suggests that people with back pain are better off seeing a physical therapist (PT) first. Compared to study participants who saw a PT later or never, those who saw a PT first had an 89 percent lower probability of being prescribed opioids, a 28 percent lower risk of being referred for imaging tests, and a 15 percent lower risk for visiting the Emergency Department. While PT patients had a 19 percent greater risk for hospitalization, the researchers say this is likely because PTs were appropriately referring these individuals to specialized care if needed. “If your doctor doesn’t suggest PT to treat your back pain, ask for a referral to a physical therapist who can draw up an individualized exercise program for you,” Dr. Thomas advises.
In a small 2014 study, people with acute low back pain reported that heat therapy, in combination with the nonsteroidal anti-inflammatory drug (NSAID) naproxen (Aleve), eased their discomfort better than coldpacks used in combination with naproxen. “It is possible the application of heat inhibits pain signals to the brain, but the benefits are also likely due to the fact heat relaxes tight muscles,” Dr. Thomas says. You can purchase heatpacks at pharmacies—alternatively, use a folded towel soaked in hot water.
A 2017 study found that people with low back pain who did yoga had less pain after 12 weeks. The improvements persisted for more than a year, and some of the participants were able to stop taking painkillers. Your local senior center and gym likely offer yoga sessions with gentle poses geared towards seniors.
A 2015 study suggested that people who treated their back pain with acupuncture were more likely to report a benefit if they believed acupuncture would work. Conversely, people who had low expectations before they began treatment reported less pain relief from it.
Mindfulness meditation may be particularly effective for long-term back pain, according to 2016 research. The study included 300 older adults; half were assigned to take part in a two-month mindful meditation course with weekly sessions, and the other half took part in a health education program that included simple stretching exercises. At the end of the study, all of the participants reported better mobility, but 80 percent of the meditation group reported that their back pain had eased compared with 37 percent of the health education group.
Cognitive Behavioral Therapy (CBT) helps you learn how to recognize and modify negative thoughts and your psychological and physical responses to these. A recent review of 22 studies (JAMA Internal Medicine, May 7) found that CBT reduced chronic pain in older adults, and improved their ability to cope with any pain they continued to experience. “It also boosted their mood and helped them avoid ‘catastrophizing’ their pain in ways that limited their mobility and function,” Dr. Thomas notes. “An example of catastrophizing would include believing you should avoid physical activity in case it aggravates your pain.” You can find a therapist who specializes in CBT via the Academy of Cognitive Therapy.
Massage can help ease chronic pain, which develops in about 15 percent of people who suffer back pain. In a 2017 study, 100 people suffering from chronic back pain were referred to experienced massage therapists for 10 treatment sessions. More than half of the participants reported less pain after 12 weeks, and many continued to report reduced pain after this period. Massage was most effective in people aged 50 and older. Traditional Medicare doesn’t cover massage therapy (although you may receive it as part of physical therapy, which is covered by Medicare). Medicare Part C Medicare Advantage plans may offer extra services, so check with your provider. Since not all types of massage are suitable for seniors, be sure to consult a licensed massage therapist with experience of treating seniors—you can find one via the American Massage Therapy Association.
Biofeedback teaches you to consciously control your body’s response to stressors, including pain. A 2017 review of 21 studies found that biofeedback can lead to improvements in short and long-term back pain, both as a standalone treatment and alongside other conservative therapies. The study also found that biofeedback helped reduce depression caused by back pain. Many pain centers offer biofeedback therapy, and you also can find a qualified therapist via the Biofeedback Certification International Alliance.
Try to Avoid Strong Painkillers
Dr. Thomas says that strong painkillers and surgical treatment should be a last resort for treating your back pain. “If you do need to take painkillers, discuss with your doctor what is the best option for you,” he says. While most older adults are advised to take acetaminophen (Tylenol) for pain relief, there is evidence that the drug may not be as effective for acute back pain as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) and naproxen (Aleve). However, Dr. Thomas cautions that NSAIDs are associated with potentially serious side effects (including gastrointestinal bleeding) in older adults. “NSAIDs should be used in the lowest dose for as little time as possible,” he advises.
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