Home' Trinidad and Tobago Guardian : June 30th 2013 Contents 6
Reducing Pain and Inflammation Is Key, but Not
All OTC Remedies Are Created Equal
Back pain is the second most common neurologic
ailment in the United States---only headache is more
common. Within a given year, up to 50% of adults suf-
fer from back pain and 85% of people younger than 50
years will experience at least 1 back pain episode each
Acute lower back pain (LBP) lasts from 1 day to 3
months; longer durations are classified as chronic.
Common causes include nerve irritation, bone and joint
arthritic conditions, lumbar radiculopathy (nerve irrita-
tion caused by herniated or damaged discs), and bony
encroachment (vertebrae can shift, pressing against
the spinal cord and nerves). Other causes may include
kidney stones, obesity, smoking, stress, poor posture,
and poor sleeping conditions.
Acute back pain's most common cause, however, is
lumbar strain---a stretch injury to the lower back's liga-
ments, tendons, and/or muscles. The injury creates
microscopic tears in these tissues, causing pain and
Most back pain is self-limiting, dissipating within
days. Treatment usually involves drugs that reduce
pain and inflammation, and muscle-strengthening
exercises to restore proper function and prevent recur-
rence. Most people turn to analgesics, topical oint-
ments, hot and cold presses, and/or back support gar-
ments to find relief.
OTC analgesics---nonsteroidal anti-inflammatory
drugs (NSAIDs) and acetaminophen---can reduce pain
and inflammation quickly.
Ibuprofen, diclofenac, and aspirin tend to work best
when taken on a regular schedule rather than waiting
until pain is severe. Choice is guided by assessing ben-
efits and gastrointestinal (GI) and cardiovascular risks
associated with each agent. Although aspirin is associ-
ated with cardiovascular benefits, it has higher GI toxi-
city and is generally avoided as a first-line treatment.
Coadministration of aspirin with ibuprofen or
naproxen is contraindicated, as it increases risk for
serious NSAID-related adverse effects. Regardless of
the NSAID used, risk for GI effects is highest among
those 65 years and older.
Acetaminophen is a slightly weaker analgesic and is
therefore a first-line treatment option because of its
more favourable side-effect profile and cost.
The lowest dose possible is recommended for all
NSAIDs because of their association with GI and car-
Rubefacient herbs e.g. Camphor (Cinnamomum
camphora) and capsacin, are a class of healing plants
which have a unique effect on the body when applied
to the skin. They are all powerful stimulants; some
have a 'warming' effect and others a 'cooling' effect.
Regardless if they are hot or cold, or simply irritating,
they all have an intense, localized impact where they
Camphor (Cinnamomum camphora) has a duel
action of hot and cold, which has a balancing effect on
the yin and yang energies. When first applied camphor
numbs and cools the peripheral nerve endings, then
warms the painful area as it stimulates circulation to
cold, stiff muscles and limbs. This analgesic effect of
camphor makes it a very useful ingredient to be used
in pain relieving blends as ointments or creams for
sore muscles, low back pain, and arthritic pain.
What do these herbs do that is so beneficial?
Rubefacients stimulate the dilation of capillaries. Blood
is drawn from deep within the body, increasing circula-
tion around the area of concern and speeding the heal-
ing process. While initially the sensation may be over-
whelming, it is ultimately an energizing, healing action.
Most OTC rubefacients direct the patient to rub the
agent directly on the tender area. Once the skin
absorbs the active ingredient, it desensitizes the indi-
vidual to pain by interfering with neural signals that
transmit pain sensations to the brain.
Although some people find them helpful, the use of
wide elastic belts and other support garments that can
be tightened to "pull in" lumbar and abdominal mus-
cles remains controversial. One landmark study found
no evidence that elastic belts and similar garments
reduced and/or prevented back injury or back pain.
People with LBP who continue their normal routine
function better than those assigned to bed rest. A
Cochrane report concludes, "Advice to rest in bed is
less effective than advice to stay active." Activity is
also associated with modest improvements in pain
and function. Bed rest alone may exacerbate back pain
because it decreases muscle tone and increases risk
for blood clots.
Because back pain is a recurring condition for many,
it helps to focus on prevention.
Patients with acute back pain turn to a number of OTC treatments to find relief,
including analgesics, topical ointments, hot and cold presses,
and back support garments.
Exercise strengthens back
muscles and is the most
effective way to a speedy
recovery and preventing
future muscle strain. Walking
is perhaps the best exercise
for preventing LBP.
"IMPORTANT: Please check with your medical
practitioner before taking medication, using exercise
aids or other therapeutic devices while pregnant."
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