New guidelines for treating lower back pain avoid prescription painkillers.

Lower Back Pain: What If It’s Not My Facet Joints?

Nearly a quarter of American adults report that during the past three months they had lower back pain lasting more than one day. The American College of Physicians (ACP) has recently released new guidelines for the management of lower back pain related to skeletal muscles.

Muscle pain is different than the pain resulting from osteoarthritis of the spinal facet joints. When the cartilage of the facet joints deteriorates, complex nerve, bone and spinal cord problems can result in local and radiating pain. If an examination, imaging and testing determines that fact joints are not the source of pain, what else could it be? It could be muscular pain from tension, poor posture/movement, a sudden injury or an accident. Whatever the source, intense back pain affects the quality of your daily activities. Simple tasks that are normally taken for granted (getting out of bed, bending to pick something up, commuting to work, physical labor, long hours in front of a computer)become grinding chores. Your doctor will want to know how long the pain has been there:

Acute pain means intense but short-lived (less than 4 weeks)

Subacute pain refers to lingering discomfort (4-12 weeks)

Chronic pain is long-lasting (more than 12 weeks)

Many people see their doctors in hopes of getting a heavy-duty prescription with opioids that will make the pain go away. The ACP’s new guidelines will probably disappoint them. Thorough analysis of published data persuaded ACP’s members that pharmaceutical interventions are rarely effective; similar to the common cold, muscular back pain eventually goes away on its own.

The ACP now recommends that doctors steer their patients to nonpharmaceutical interventions first, noting that opioid painkillers have dangerous side effects and “should be avoided as much as possible.”¹ Here are some of their suggestions:

1. Exercise
2. Multidisciplinary rehabilitiation/physical therapy
3. Acupuncture
4. Superficial heat
5. Yoga or Tai Chi
6. Progressive relaxation
7. Mindfulness-based stress reduction
 
In other words, get rid of the stress and tension that’s leading to muscle pain. And, if there is no response to these interventions, over-the-counter products such as acetaminophen or ibuprofen (nonsteroidal pain relief) and muscle relaxants prescribed by the doctor are suggested. Opioids are viewed as a last resort.

It goes without saying that a correct diagnosis is important. In many cases of facet joint pain, the person has developed associated muscle pain by moving in an unusual or distorted manner to compensate for the arthritic pain. Or, a herniated or damaged disk in the spine can result in compression that in turn erodes the facet joint and puts pressure on nerves (the source of radiant pain). Any back pain that is chronic and severe is a warning sign that something beyond tense or injured muscles may be going on.

The Sperling Medical Group offers MRI diagnosis and MRI-guided Focused Ultrasound (MRgFUS) for muscular and facet join pain in the neck and lower back. For more information, contact the Sperling Medical Group.

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¹ “Do I Really Have to Wait Out this Back Pain?” Univadis, Feb. 15, 2017. https://www.univadis.com/viewarticle/do-i-really-have-to-wait-out-this-back-pain-490788