Back Pain Therapy – Treating Back Pain, Relieving Acute and Chronic Back Pain

Diagnosis is performed through

• a thorough clinical examination,
• X-rays of the lumbar spine, and
• magnetic resonance imaging (MRI).

These procedures can, for example, detect degenerative disc disease. Additional tests are sometimes necessary to rule out other conditions with similar symptoms. Such conditions include, for example,

• inflammation,
• tumors,
• osteoporosis.

Many people experience accelerated degeneration of the intervertebral discs. Causes include, for example,

• physiological aging processes, 
• improper posture, and
• genetic predisposition.

There is an intervertebral disc between each bony vertebral body in the spine. Intervertebral discs serve as cushions between the vertebral bodies. They consist of the annulus fibrosus and the elastic nucleus.

Very early on in the wear-and-tear process, small tears develop in the annulus fibrosus. The nucleus loses elasticity and volume and can eventually rupture completely. Material from the nucleus and parts of the annulus fibrosus protrude outward, resulting in a herniated disc. This puts pressure on the nerve roots in the spinal canal.

In addition to pain, this can also trigger sensory disturbances or muscle weakness. In the lumbar region, irritation of the sciatic nerve roots leads to sciatica. This is associated with pain and abnormal sensations in the foot, lower leg, and thigh.

With disc degeneration, the intervertebral discs become flatter and lose their mobility and cushioning effect. This indirectly leads to increased stress on the facet joints. Although the intervertebral disc is not primarily sensitive to pain, it becomes so as the degenerative process progresses.

The back extensor muscles attempt to compensate for the degeneration and straighten the collapsed spine. In the process, the muscles can become tense and painful. Additionally, the vertebral joints may develop osteoarthritis, which contributes to the onset of pain.

Typically, the pain begins during static loading. Patients initially complain of deep-seated back pain (lumbago, acute lumbago). It occurs

• while standing,
• when walking slowly, and
• occasionally while sitting

. The pain usually intensifies with

• leaning forward,
• impact (jumping, jogging), or
• rotational movements.

Lying down usually provides relief.

In the early stages, patients often report difficulty getting moving in the morning, accompanied by a feeling of stiffness in the lumbar spine.

In the advanced stage, the pain is also present at night. At this point, it can no longer be alleviated by movement or positions that relieve pressure.

Conservative Therapy

If disc degeneration is confirmed, conservative therapy is the first line of treatment. This includes both medication and physical therapy. Medications used include

• anti-inflammatory drugs,
• muscle relaxants, and
• pain relievers

are used.

Conservative therapy aims to maintain or restore physical activity. In cases of acute pain, treatment is supplemented with semi-invasive procedures (image-guided injections, etc.). Procedures for which there is a lack of scientific evidence of effectiveness are also frequently used at this stage. These include, for example,

• laser therapy,
• heat therapy for the intervertebral disc,
• catheter procedures.

Multimodal, outpatient rehabilitation programs provide support for persistent symptoms. These include medical treatment as well as training on managing symptoms or adapting work habits. In more than 80 percent of cases, symptoms improve after a few days. They should be completely gone after a maximum of four to six weeks.

Surgery for Back Pain

In about five percent of patients, the symptoms are at risk of becoming chronic despite conservative therapy. Since the pain is caused by a worn-out intervertebral disc and worsens with movement and strain, segmental fusion is often considered as a surgical treatment of last resort. In this standard spinal surgery procedure, the source of the pain (the intervertebral disc) is removed. The adjacent vertebral bodies are then “fused” by inserting rigid metal implants and bone (“cages”).

This eliminates the pain, but previously mobile sections of the spine become immobile and functionally rigid. Until now, this has been accepted as an unavoidable “side effect” of the treatment. Other risks and possible complications of this procedure include, for example,

• damage to the paravertebral muscles,
• symptoms resulting from bone harvesting,
• pseudoarthrosis,
• implant failure.

Late effects of segmental immobilization may include degeneration of adjacent segments or symptoms in the sacroiliac joint.

Given the availability of improved and better-tolerated modern surgical techniques (e.g., minimally invasive approaches), acceptance of these side effects has since declined.

With minimally invasive surgery, patients are allowed to get out of bed for the first time that same evening and are quickly mobilized without a brace. Postoperative care is “functional,” meaning that all pain-free movements are permitted.

The hospital stay is usually less than one week. During the first seven to ten days, medication therapy with pain relievers and anti-inflammatory drugs is routinely administered. After that, pain relievers are only necessary in exceptional cases.

Starting in the fourth week after surgery, an active rehabilitation program is recommended. The goal of this program is to reintegrate patients into their professional and social lives.

Results from recent years show success rates of over 82 percent. More than 60 percent of patients were able to return to work within six months at the latest. The vast majority of competitive athletes who underwent surgery were able to resume their sport. Even sports activities that place strain on the spine (e.g., marathon running, dancing, skydiving) can be resumed.

The prognosis for recovery is therefore very good compared to spinal fusion surgery. However, since this is an innovative procedure, no reliable long-term results are available yet.

It is important to stay active despite pain and to strengthen the back muscles. Exercises that force mobility through sheer strength interfere with any healing process.

Peak stresses caused by jumping or jarring impacts, as well as sports that require sudden evasive movements (martial arts, handball, soccer), are unsuitable. Swimming, cycling, and Nordic walking, on the other hand, are beneficial.

Back schools offer useful tips and information on managing back pain. The Rheumatism League’s functional training program helps motivate people to stay active without overexerting themselves.

As a general rule: Stay relaxed! Pain and anxiety reinforce each other. Relaxation techniques such as autogenic training, progressive muscle relaxation according to Jacobsen, or pain management training are often helpful. Individual psychotherapy can also reduce stress.

Chronic back pain and acute back pain differ significantly, but both fall under the umbrella of back pain and arise from different causes of back pain, with pain in the lower back, back pain, and pain in the lower region often related to the intervertebral disc, the vertebral body, and the lumbar spine.

Acute back pain, such as lumbago or pain occurring on one side, can cause severe pain that radiates or presents as radiating pain, while nonspecific back pain is often triggered by prolonged sitting, muscle tension, spinal degeneration, changes in the spine, or general wear and tear.

The treatment of back pain involves managing both acute and chronic pain to alleviate back pain, alleviate and reduce pain, for example through physical therapy, improved blood circulation, targeted pain relief, an appropriate medication, or medical treatment following a physical examination by an orthopedist.

Depending on the type and cause of back pain—that is, depending on the cause of the back pain, the specific types of back pain, such as low back pain or neck pain—further examinations, surgical therapy, or a procedure may be necessary if pain occurs in the affected area or if back pain leads to persistent symptoms.

People with back pain should seek medical treatment early on, as back pain is one of the most common complaints; Back pain affects all age groups; it often develops gradually. If back pain occurs regularly or its intensity increases, prevention can help avoid back pain and maintain quality of life in the long term.