Treating back pain without medication

Up to 90 per cent of Australians will experience back pain in their lifetime.

While back pain can affect a person at any age, Professor Chris Maher, a global expert on the topic, says, “We used to think back pain is more common in older people, however current evidence would suggest that’s not true,” says Professor Maher. “The difference is that it tends to be more severe or disabling in older people.”

Low back pain is the leading cause of disability worldwide. In one study among Australians aged 45-64 years, it was found that almost half the study participants had retired because of a chronic health condition, most commonly a back problem.  

Osteopath Chris Reeves, says the most common concerns among his over 50 patients are poor mobility and stiffness. “Basically, day to day tasks become a bit of a chore or hassle,” he says. We all know that feeling. But is there relief in easy reach? 

Paracetamol ineffective for back pain
While many people will reach for over-the-counter medications in the first instance, research published in the British Medical Journal in April 2015, concludes the most common remedy – paracetamol – is not the best option.

“We’ve shown that paracetamol is ineffective for back pain,” says Professor Maher, one of the researchers from the George Institute for Global Health who led the landmark study.

The study reviewed the effect of paracetamol on back pain based on 13 trials involving more than 5,000 patients worldwide. While current clinical practice guidelines recommend that people suffering from low back pain should be given paracetamol in the first instance, researchers are now calling for a review of the guidelines based on these recent findings.  

“There is evidence that other medications such as NSAIDs work,” says Professor Maher. “But my advice would be to talk to the pharmacist or GP, because there are side effects. You need to take it wisely.”

Types of back pain
The most common type of back pain is what experts refer to as non-specific low back pain. This is pain that usually lasts less than three months and is most likely caused by stress or strain in the muscle, ligament or disc. There is usually no underlying medical condition.

Sciatica is pain that runs down the leg, caused by pressure on nerves in the lower back. It can be caused by a slipped disc, pinched nerve or arthritis. Sciatica usually resolves without any intervention within three months.

There are some diseases that occur in older people that develop into back pain, such as spinal stenosis, which is most commonly caused by osteoarthritis. You may experience trouble walking long distances, pain in the legs, or find that you need to lean forward to relieve pressure on your lower back, says Professor Maher.

There are also some back problems that are associated with ‘red flag’ conditions, according to Professor Maher. These include fractures, some cancers and ankylosing spondilitis, which is a type of arthritis. However, these conditions are uncommon, affecting less than 1 per cent of people presenting with back pain.

Get moving to prevent and manage back pain
To prevent general low back pain, it’s best to incorporate gentle exercises and to slowly build up to strengthening activities.  

“The classic example is to get out and get walking. It’s cheap, and easy, and you can slowly increase your distance and pace as you get comfortable. Aquatic exercises and swimming are great non-weight bearing exercises,” says Dr Reeves.

Professor Maher agrees: “The guidelines [for back pain] are pretty clear that exercise and physical activity are important. Exercise works for the whole of your body. It’s good for preventing respiratory and cardiovascular conditions, diabetes, and in controlling obesity as well.”

Exercises to strengthen the core are also very important. These muscles help to maintain posture and relieve excess pressure on spinal joints, thereby reducing pain.

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Rebecca Harwin, a nutritionist, chiropractor and co-author of Conquer Your Back Pain Naturally, says walking, yoga, dancing and swimming are ideal as they all work the core muscles. Depending on fitness levels, Dr Harwin also suggests simple at-home exercises to strengthen the core.

“These can be performed by standing and pulling your belly button slightly upward and toward your spine. Hold for 5-10 seconds, and repeat three times,” she says.

You can also try lying on your back with your knees bent and feet resting comfortably on the floor. Then place one hand under the edge of the small of your back, and the other on your lower abdomen. Tighten until you feel your lower hand slightly compressed and your stomach muscles contract. Hold this for 5-10 seconds and repeat three times, Dr Harwin recommends. 

It’s especially important to remain active even while experiencing back pain. “The pain may alter your approach, but not exercising will result in de-conditioning and a worsening of your problem,” says Dr Harwin.

Diet and healthy weight
Maintaining an ideal weight is also proven to aid in the management of back pain. The more weight pressing down on a damaged or dysfunctional joint, the more likely a pain response will be elicited.

Certain foods can also help, says Dr Harwin. Foods high in magnesium, such as bananas, nuts, passionfruit and spinach, can help to reduce cramping and spasm. Omega three fats, such as fish, flax seed oil, walnuts and walnut oil can help to reduce the pain associated with inflammation in the lower back.

Do you suffer from back pain? What kinds of things have you tried and have they worked?

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