Low back pain affects 60 - 80% of the adult U.S. population. Low back problems affect the spine's flexibility, stability, and strength, which can cause pain, discomfort, and stiffness.

Back pain is the leading cause of disability in Americans under 45 years old. Each year 13 million people go to the doctor for chronic back pain. It is estimated that the condition leaves 2.4 million Americans chronically disabled and another 2.4 million temporarily disabled.

Back pain is the second most common reason why individuals in the U.S. seek medical care from their primary care doctors.

• Tenderness, pain, and stiffness in the lower back
• Pain that radiates into the buttocks or legs
• Difficulty standing erect or standing in one position for a long time
• Discomfort while sitting
• Weakness and leg fatigue while walking

Low back pain is usually caused by and injury - strain from lifting, twisting, or bending. However, in some cases low back pain can be a sign of a more serious condition, such as an infection, a rheumatic or arthritic condition, or a tumor.

A ruptured or bulging disk, the strong, spongy, gel-filled cushions that lie between each vertebra, and compression fractures of the bones in the spine can also cause low back pain, especially in older women with osteoporosis.

Age, poor overall fitness, heredity, smoking, and general life dissatisfaction increase a person's risk for low back problems.

Your doctor will ask you to stand, sit, and move. Your health care provider will check your reflexes and perhaps your response to touch, slight heat, or a pinprick. Other tests may include strength testing on a treadmill, blood tests, x-rays, a magnetic resonance imaging (MRI) scan, and computed tomography (CT) scan.

Lifestyle changes can often help relieve and prevent low back pain. You can lower your risk of back problems by exercising, maintaining a healthy weight, and practicing good posture. Learning to bend and lift properly, sleeping on a firm mattress, sitting in supportive chairs, and wearing supportive shoes are other important factors.

For long-term back pain, your doctor may recommend stronger medications or surgery.

Medications used to treat low back pain include nonsteroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Motrin, Advil), opiates such as hydrocodone (Lortab, Vicodin), steroids such as prednisone (Deltasone), muscle relaxants such as carisoprodol (Soma), and oral or epidural steroids that reduce inflammation.

Complementary and Alternative Therapies

Alternative therapies can be effective for easing muscle tension, correcting spinal imbalances, relieving discomfort, and averting long-term back problems by improving muscle strength and joint stability.

Nutrition and Dietary Supplements

Following these nutritional tips may help reduce symptoms:

• Eliminate all suspected food allergens, including dairy, wheat (gluten), soy, chocolate, corn, preservatives and food additives; avoid alfalfa sprouts, and onions. Your health care provider may want to test for food sensitivities.
• Eat more antioxidant rich foods (such as green leafy vegetables) and fruits (such as blueberries, pomegranates and cherries).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise moderately at least 30 minutes daily, 5 days a week.

Nutritional deficiencies may be addressed with the following supplements:

• Omega-3 fatty acids, such as flaxseed and fish oils, 1 - 2 capsules or 1 tablespoonful oil daily, to help decrease inflammation.
• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-vitamins and trace minerals such as magnesium, calcium, zinc and selenium.
• Glucosamine/chondroitin, 500 - 1,500 mg daily, for connective tissue support.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant effects.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Calcium/vitamin D supplement, 1 - 2 tablets daily if taking corticosteroids.
• Methylsulfonylmethane (MSM), 3,000 mg twice a day, to help prevent joint and connective tissue breakdown.
• Melatonin, 2 - 5 mg before bed, for sleep and immune system regulation.

Herbs

Herbs are generally available as standardized, dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).

• Ginkgo (Ginkgo biloba) standardized extract, 40 - 80 mg three times daily, for antioxidant and immune support.
• Green tea (Camelia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant and immune effects. Use caffeine free products. You may also prepare teas from the leaf of this herb.
• Bromelain (Ananus comosus) standardized, 40 mg three times daily, for pain and inflammation.
• Turmeric (Curcuma longa) standardardized extract, 300 mg three times a day, for pain and inflammation.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for inflammation.
• Devil's claw (Harpagophytum procumbens) standardized extract, 100 - 200 mg one to two times daily, for inflammation.
• Willow bark (Salix alba) standardized extract, 500 mg up to three times daily.

Capsaicin (Capsicum frutescens) cream

Capsaicin is the main component in hot chili peppers (also known as cayenne). Applied to the surface of the skin, it is believed to deplete stores of a substance that contributes to inflammation and pain such as found in low back pain. Pain reduction generally begins 3 - 7 days after applying the capsaicin cream to the skin.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following treatments to alleviate respiratory symptoms (such as those experienced from cystic fibrosis) based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Some of the most common remedies for this condition are listed below:

• Aesculus for dull pain with muscle weakness
• Arnica montana, especially with pain as a result of trauma
• Colocynthis for weakness and cramping in the small of the back
• Gnaphalium for sciatica that alternates with numbness
• Lycopodium for burning pain, especially with gas or bloating
• Rhus toxicodendron for stiffness and pain in the small of the back

Hydrotherapy

Contrast hydrotherapy may help. Alternate hot and cold applications. Alternate 3 minutes hot with 1 minute cold. Repeat three times to complete one set. Do two to three sets per day.

Castor Oil Packs

Apply oil directly to skin, cover with a clean soft cloth and plastic wrap. Place a heat source over the pack and let sit for 30 - 60 minutes. Repeat this procedure for 3 consecutive days.

Acupuncture

Reviews of clinical studies have found some support for the use of acupuncture for low back pain. In addition, acupuncturists frequently report success in treating low back pain, and the National Institutes of Health recommend acupuncture as a reasonable treatment option for this condition. An acupuncturist's management of low back pain often involves a comprehensive approach including specialized massage, application of warming herbal oils, and patient education.

Treating low back pain with acupuncture can be complex because many meridians (including the kidney, bladder, liver, and gallbladder) affect this area of the body. Local treatment to the painful areas and related sore points is often performed as well, with needles or moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points).

A clinical study using acupuncture in 1,162 patients aged 18 - 86 years with a history of chronic low back pain found that at 6 months, low back pain was improved after acupuncture treatment --almost twice that of conventional therapy. Patients underwent ten 30-minute acupuncture sessions, generally two sessions per week.

Chiropractic

Spinal manipulation is among the most extensively studied and accepted forms of treatment for acute low back pain. According to a comprehensive review conducted by the Agency for Healthcare Research and Quality, spinal manipulation and nonsteroidal anti-inflammatory drugs (NSAIDs) are the two most effective treatments for acute low back pain. Of these, only spinal manipulation was judged to both relieve pain and restore function. Spinal manipulation also appears to be effective for chronic low back pain, but the evidence is less conclusive.

Massage

Massage may helpful for the prevention and treatment of short and long-term back problems.

Chronic low back problems can interfere with everyday activities, sleep, and concentration. Severe symptoms may affect mood and sexuality. While depression is usually not the cause of chronic low back pain, it often complicates treatment.

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