成人腰痛-Low Back Pain in Adults

Do I need any tests?

Your doctor will normally be able to diagnose simple low back pain or nerve root pain from the description of the pain, and by examining you. In most cases, no tests are needed. For example, x-rays or scans of the back are not helpful and do not show anything abnormal if you have simple low back pain. Also, if you have sudden onset nerve root pain, and symptoms begin to settle over the next few weeks, then no tests are needed.

Tests such as x-rays or scans may be advised if nerve root pain persists or is severe, or if another serious cause of the pain is suspected.

What are the treatments for simple low back pain?

The following advice and treatment is commonly given for a sudden 'acute' bout of simple low back pain. Most people recover quickly.

Exercise and keep going
Continue with normal activities as far as possible. This may not be possible at first if the pain is very bad. However, move around as soon as possible, and get back into normal activities as soon as you are able. As a rule, don't do anything that causes a lot of pain. However, you will have to accept some discomfort when you are trying to keep active. Setting a new goal each day may be a good idea. For example, walking around the house on one day, a walk to the shops the next, etc.

In the past, advice had been to rest until the pain eases. It is now known that this was wrong. You are likely to recover more quickly and are less likely to develop chronic (persistent) back pain if you keep active when you have back pain rather than rest a lot. Also, sleep in the most naturally comfortable position on whatever is the most comfortable surface. (Advice given in the past used to be to sleep on a firm mattress. However, there is no evidence to say that a firm mattress is better than any other type of mattress for people with low back pain.)

Medication
If you need painkillers, it is best to take them regularly. This is better than taking them 'now and again' just when the pain is very bad. If you take them regularly the pain is more likely to be eased for much of the time and enable you to exercise and keep active.

• Paracetamol is often sufficient if you take it regularly at full strength. For an adult, this is 1000 mg (usually two 500 mg tablets), four times a day.
• Anti-inflammatory painkillers. Some people find that these work better than paracetamol. They include ibuprofen which you can buy at pharmacies or get on prescription. Other types such as diclofenac or naproxen need a prescription. Some people with asthma, high blood pressure, kidney failure, or heart failure may not be able to take anti-inflammatories.
• A stronger painkiller such as codeine is an option if anti-inflammatories do not suit or do not work well. Codeine is often taken in addition to paracetamol. Constipation is a common side-effect from codeine. This may make back pain worse if you need to strain to go to the toilet. To prevent constipation, have lots to drink and eat foods with plenty of fibre.
• A muscle relaxant such as diazepam is sometimes prescribed for a few days if the back muscles become very tense and make the pain worse. 醫(yī)學(xué)全.在線提供

Physical treatments
Some people visit a physiotherapist, chiropractor, or osteopath for manipulation and/or other physical treatments. It is debatable whether physical treatments would help all people with acute simple low back pain. However, physical treatments provide some short-term comfort and hasten recovery in some cases.

Other treatments
Treatment may vary, and the situation should be reviewed by a doctor if the pain becomes worse, or if the pain persists beyond 4-6 weeks, or if symptoms change. Other pain relieving techniques may be tried if the pain becomes chronic (persistent).

What are the treatments for back pain other than simple back pain?

Nerve root pain
In many cases, the treatment is the same as that described above for simple low back pain. Nerve root pain often eases and goes over a few weeks. Physical treatments such as spinal manipulation may provide some short-term comfort and hasten recovery in some cases. Some people with persistent back pain that is caused by prolapsed disc pressing on a nerve may benefit from an operation.

Other causes of back pain
Treatments depend on the underlying cause. For example, pain caused by types of arthritis may be treated by various anti-arthritis medicines.

Can further bouts of back pain be prevented?

Evidence suggests that the best way to prevent bouts of low back pain is simply to keep active, and to exercise regularly. This means general fitness exercise such as walking, running, swimming etc. There is no firm evidence to say that any particular 'back strengthening' exercises are more useful than simply keeping fit and active. It is also sensible to be 'back aware'. For example, do not lift objects when you are in an awkward twisting posture.

In summary - some points to remember

• Acute low back pain is usually not a serious condition - even if the pain is bad.
• Most people recover quickly - often within a week or so.
• Nerve root pains and 'slipped discs' are uncommon - and most of these get better by themselves anyway. More serious causes of back pain are even more uncommon. Surgery is only rarely needed.
• Stay as active as possible and return to normal activities as soon as possible, including work. People with back pain who get active, and back to normal activities as soon as possible (including work) are likely to recover more quickly and are less likely to develop chronic (persistent) back pain compared to those who rest and do little exercise.
• If the pain is very bad to start with you may have to rest in bed for a day or so - but get active as soon as possible. Bed rest does not promote recovery. You need to get your muscles going again rather than let them stiffen up by resting.
• You may have to put up with some pain whilst getting back to normal activities. With simple low back pain you will not do any 'damage' if you do normal activities or get back to work. On the contrary, you are less likely to develop long term problems.
• Painkillers taken regularly will ease pain whilst you are getting back to normal activities.
• See a doctor if the pain gets worse, or persists more than 4-6 weeks, or if you develop any worrying symptoms (which are listed above).

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