Acute low back pain
Paracetamol (Doliprane, Efferalgan, Dafalgan.) Is often prescribed as first line. Do not hesitate to take enough (3 or 4 grams per day by spacing the catch of at least 4 hours).
Anti-inflammatory drugs (NSAIDs) are often used and have a generally superior efficacy to paracetamol. It is not recommended to continue them beyond 8 to 14 days without clinical reassessment .
Bed rest should no longer be prescribed. It is authorized if the intensity of the pain is such that it imposes it, but for a shortest possible duration, and intermittent rather than continuous. Indeed the resumption of activities is to be done as soon as possible: there is no risk of further injury, on the contrary.
Rehabilitation is not recommended in the first week. It can be useful in case of recurrent low back pain, by privileging an active program (and not simple massages).
Osteopathic vertebral manipulations showed their short-term effectiveness in the first 6 weeks of evolution. Infiltration in the spine is not a priori indication for acute low back pain in the absence of sciatica.
Chronic low back pain
When pain develops and persists, it should be done by treating the pain on one hand and the psychosocial factors underlying it.
Level 1 (paracetamol) or 2 (combination paracetamol and weak morphine) pain medications are proposed, possibly combined with NSAIDs (but without losing sight of the digestive or cardiovascular side effects that increase when they are used in a prolonged manner). Antidepressants may be helpful if there is an associated depressive syndrome.
Infiltrations of corticosteroids may be indicated as second-line therapy in the case of associated lumbar osteoarthritis. They can be performed in the doctor's office, or under radiographic or scanner control, which ensures a more precise administration.
The lumbar support belt or a custom corset can sometimes be indicated. Contrary to popular belief, we do not disassemble ourselves with a lumbar belt. However, the ideal is to strengthen his muscles, both vertebral and abdominal.
Multidisciplinary programs, true "schools of the back", have been developed. They combine medical management (treatment management, education), rehabilitation, behavior therapy, exercise training. These programs allow a return to work for about 60% of patients, without always having a very clear effect on the pain elsewhere. We therefore see the challenge of preventing the transition to chronic low back pain.
Regular physical exercise is often a guarantee of success. We must fight against false beliefs (such as rest is essential, the avoidance of activities with the fear of hurting oneself, the pain experienced as a signal of danger) that lead to a spiral of pain maintenance. .
The place of surgery is limited, but not totally absent. Arthrodesis consists of blocking two or more vertebrae, assuming that it is a precise disc that causes pain. The indication should be careful because while spine surgery often relieves sciatica pain, it is less consistently effective on back pain.
The disc prosthesis is an attractive technique, which allows to maintain the mobility of the spinal segment. However, it is still a method that is not widely practiced. In any case there is never any urgency to be operated, it is important to have understood the purpose of the intervention and its practical modalities.
To see: exercises to muscle the back in video
Follow the advice of our coach who shows you exercises to strengthen your back. Good to know: in addition to practicing exercises to strengthen the back, it is also very important to strengthen your abdominal muscles.
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