AMERICAN LACK PAIN- new treatment strategy

Posted by Doctor Bui Hanh Tam - Department of Anesthesiology and Anesthesia, Vinmec Times City International General Hospital

Low back pain, muscle tension and spasticity localized in the back from the lower flank to the upper lumbar region with or without reference pain to the back of the thigh or to the leg.

Called acute pain if pain persists for up to 12 weeks (3 months). 90% of acute low back pain is nonspecific pain with no life-threatening warning signs requiring emergency surgical management. Only about 10% of the rest are low back pain accompanied by neurological signs such as: cauda equina syndrome (muscle weakness, decreased or lost sensation in the legs, urinary and bowel disorders), vertebral collapse or spinal stenosis. Central or unilateral causing acute compression, ankylosing spondylitis of the back. In addition, there is a small percentage related to trauma or malignancy causing spinal fracture or acute compression of nerves and spinal cord (1-2%).
Clinically, nonspecific acute low back pain includes 3 recognizable signs: pain, spasticity of back muscles and fear - fear of moving.
The rate of acute back pain is high, often occurring in all ages, especially working age, so people used to use the word "acute back pain epidemic" to refer to its prevalence in the community. Pain affects life activities, so a Quebec scale was developed with 20 signs such as: unable to get out of bed, waking up in the middle of the night, unable to turn over in bed, unable to fold blankets curtains, can't drive, can't stand for long, can't sit still in a chair, can't carry heavy objects, can't put on socks...

Acute nonspecific low back pain affects about 70% of the population in developed countries at some point in life. However, 90% recover on their own in 2 to 6 weeks and only 10% become chronic pain (lasting more than 3 months)
This type of back pain limits personal activities such as work, travel, sports, sexual activity. The pain level will be reduced by 50-80% in the early stages, but the recurrence rate is very high. In the following years, about one-third of people with back pain still have moderate pain and 15% have severe pain.
Acute low back pain is the leading cause of unemployment in the United States for young people < 45 years of age, the 2nd leading cause of absenteeism, and the 5th most common reason people need to see a doctor. .
Acute back pain causes 40% of patients to quit practicing sports such as jogging, tennis, table tennis, golf, gym, gymnastics, dance sports...
20% of parents I can't play with my kids because of back pain.
12% of people with back pain are unable to sustain sexual activities.

Patients get effective pain relief when they can walk normally without pain.
Acute low back pain is likely to resolve spontaneously in 2 to 6 weeks, especially in young people. Conventional treatment is rest, medication, and physical therapy.
The use of oral or injectable medications that relieve pain when lying still or sitting still. Conventional oral medications such as paracetamol, anti-inflammatory pain relievers or anticonvulsants have no effect on pain relief when the patient turns or moves, so they do not help return the patient to a normal rhythm of life. Sometimes the use of anticonvulsant pain relievers makes the patient feel drowsy, tired, weak, and do not want to do anything all day.

However, a recent 2017 study published in the journal Internal Pain Medicine found that with acute low back pain:
Acetaminophens are ineffective Muscle relaxants are effective short-term but cause side effects. Side effect is sedation Corticosteroids do not appear to be effective There is no evidence of acute low back pain relief with anticonvulsants. So, how to quickly relieve acute low back pain?
Based on the mechanism of pain: 2 phenomena occur at the pain site: stiff muscles of the back muscles, including 3 muscles, caused by:
Mechanism of mechanical injury caused by overload, using Overuse causes excessive stretching of muscles and ligaments. Mechanism of mechanical trauma occurs at the same time causing severe pain causing pressure and loss of strength. Pain and difficulty moving the back due to uneven muscle spasms on both sides of the spine cause spinal twisting like the image of a bicycle wheel being "turned to the rim" according to folklore. Therefore, the general principle of pain treatment intervention is to quickly relax the low back muscles to help create a new balance of the back mass on both sides of the low lumbar spine to help relax, thereby reducing muscle pain. and easier to maneuver.
An injection that blocks the somatosensory nerve branch of the dorsal muscle mass itself emanating from the dorsal spinal nerve root that provides immediate pain relief is called an erector spinae plane block injection (Erector Spinae). Plane Block, ESPB)

An acute condition of low back pain associated with excessive contracture and stretching of the muscle mass and capsule. Therefore, if the pain is work- or activity-related, avoid triggering movements, e.g., avoid carrying heavy objects, correct posture while working, and avoid stooping and turning columns. live at the same time, avoid driving, long-distance motorbike riding.
Before doing strenuous work related to the back muscles, it is necessary to prepare good posture, if you practice, you should warm up enough time to warm up the muscles, avoid sudden movements, overload.
The most important thing is to practice regularly to have strong, balanced and flexible back muscles with breaststroke movements.
At Vinmec International General Hospital, a new, non-specific, new occurrence of acute low back pain will be examined and evaluated by pain specialists, excluding other obvious causes first. when deciding to block a dose of anesthetic - reduce inflammation. This work is performed by a pain doctor in a short time, under the guidance of a specialized ultrasound machine for pain treatment, bringing the injection to the position to be blocked and the patient can sit up, walk and home the same day.

Therefore, if taking oral or injectable drugs does not relieve pain or the patient has recurrent back pain, you or your loved ones do not hesitate to contact the Pain Clinic for prompt care. Time to help bring patients back to their daily routine as quickly as possible.
To register for examination and treatment at Vinmec International General Hospital, you can contact the nationwide Vinmec Health System Hotline, or register online HERE.