Back Pain Therapy

2023 Author: Wallace Forman | [email protected]. Last modified: 2023-08-25 11:04

Back pain: therapy

Depending on the stage of the non-specific back pain - acute or chronic - different therapies are prescribed. It is important to have medical controls of the course in order to recognize warning signs for specific causes, to initiate further diagnostic measures and to adjust the treatment if necessary.

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If the diagnosis does not reveal a clearly identifiable cause or a serious illness, the doctor assumes that the back pain is not specific. In around nine out of ten patients, the pain subsides within six weeks.

Acute back pain

The drug therapy for acute non-specific back pain aims to relieve the symptoms. The patient should be supported in being able to pursue their usual everyday activities with as little restrictions as possible. Pain relievers (analgesics) are prescribed for a short time (for a maximum of two weeks).

The following drugs are available, for example:

• Non-steroidal anti-inflammatory drugs (NSAIDs), e.g. with the active ingredients diclofenac, ibuprofen or naproxen,
• Medicines from the active ingredient group of coxibs, e.g. etoricoxib, celecoxib

Information and medical control

In addition to the drug therapy, the patient is informed about the likely course of the symptoms and possible influencing factors such as the living and work situation are discussed.

The success of the treatment should be checked by the doctor after a few days. If these drugs do not provide relief, other drugs, such as muscle relaxants or opioids, may be prescribed. Passiveness or physical rest are not recommended, as the muscles are weakened and the pain may increase or healing may be delayed. Physical activity promotes rapid improvement in symptoms and prevents chronic disease progression.

Non-drug therapies

The doctor can also prescribe non-drug therapies. These include:

• Manual therapy: It relieves pain and improves mobility. The therapist moves the joint slowly or with small, jerky movements within the natural range of motion.
• Heat treatment (thermotherapy): Alone and in combination with movement exercises, heat treatment can reduce pain and functional impairment in the short term. Hot-water bottles, grain pillows, warming plasters, envelopes, etc. are used.
• Exercise therapy or physical therapy is no more effective for acute, non-specific low back pain than maintaining normal everyday activities.

Chronic back pain

If acute back pain has not improved after about five weeks, the risk of developing chronic back pain increases. Several causes usually play together. The doctor will increasingly consider psychosocial aspects, e.g. stressful situations, stress and lifestyle, when managing treatment. Possible specific causes are now also being investigated in more detail. A combination of several therapeutic measures is effective for chronic, non-specific back pain.

According to medical guidelines, the following drugs can be used for drug therapy, depending on the severity and duration of the non-specific chronic back pain:

• Painkillers: If used for longer than two weeks, the pain-relieving effect and possible undesirable side effects must be weighed.
• Antidepressants: Drugs from the group of non-selective monoamine reuptake inhibitors (NSMRI) are recommended for pain reduction in addition to painkillers.
• Pain plaster with the ingredient capsaicin with a local circulation-promoting, pain-relieving effect.

Note The administration of analgesics with injections or infusions is not recommended for both acute and chronic non-specific back pain.

The following are available as non-drug therapies for non-specific chronic back pain:

• Physical therapy, exercise therapy and functional therapy, e.g.

  • Manual therapy in combination with exercise therapy
  • Medical trainings therapy
  • Back school: holistic program for the prevention of back pain. It includes movement exercises, theoretical knowledge of movement sequences and back-friendly behavior in everyday life, relaxation techniques, etc.
  • Occupational therapy, preferably in combination with other treatments such as behavioral therapy.
  • Massage as a combined treatment with exercise therapy.
  • Transcutaneous Electrical Nerve Stimulation (TENS): In this electrotherapy, nerves are stimulated by electrodes attached to the skin. This should have a positive effect on the perception of pain. The effectiveness for chronic back pain has not been clearly proven. Best in combination with other measures.
  • Heat treatments can provide relief. Best in combination with other measures.

• Psychological treatment, psychotherapy or behavioral therapy, e.g.

  • Relaxation training,
  • Pain management programs,
  • Coping with stress,
  • Training of social skills,
  • Acupuncture (weak evidence of effectiveness).

According to the guidelines, the following measures are not recommended for treatment - mostly due to the lack of evidence of effectiveness: interference current therapy, short wave diathermy, laser therapy, magnetic field therapy, ultrasound therapy or aids to immobilize the body.

Note For specific back pain, the treatment depends on the diagnosed disease. Depending on the cause and urgency, a surgical procedure may be necessary. The assessment and establishment of the indication is carried out by a specialist.

rehabilitation

Chronic back pain can lead to longer sick leave. In this case, an outpatient or inpatient rehabilitation may be requested.

Whom can I ask?

For the treatment of non-specific back pain, you can contact the following offices, for example:

• General practitioner (general practitioner)
• Specialist in orthopedics
• Specialist in physical medicine and general rehabilitation
• Specialist in neurology
• Specialist in internal medicine and rheumatology.

How are the costs going to be covered?

All necessary and appropriate diagnostic and therapeutic measures are taken over by the health insurance carriers. Your doctor will generally settle accounts directly with your health insurance provider. With certain health insurance providers, however, you may have to pay a deductible (BVAEB, SVS, SVS). However, you can also use a doctor of your choice (ie doctor without a health insurance contract).

For certain examinations (e.g. MRI), a doctor's approval may be required. For certain non-drug treatments (e.g. physical therapy), approval from the health insurance provider may be required. For certain services (e.g. inpatient stays, medical aids and medical aids) - depending on the health insurance provider - patient co-payments are provided. The prescription fee has to be paid for medication on a “prescription”. For information on the respective provisions, please contact your health insurance provider, which you can find on the social security website.

For more information, see Medication Coverage, Costs, and Deductibles.