One of the most common problems seen in a primary care medical practice is low back pain. It accounts for more discomfort, lost work and productivity, and frustration for many patients than any other malady. Some think it is the price we, as humans, pay for walking upright. The lower back is a complex structure made of bone, muscles, connective tissue and nerves that, along with our legs, hold us erect, allow us to bend, run, twist, catch a football, or just lay down and rest. However, once a problem arises, the complexity of its structure makes pain in the lower back difficult to diagnose and treat. The lower back consists of a spinal column from the lumbar region of the mid-back down to the tail bone or coccyx. The spinal column consists of 5 lumbar vertebrae which are cylindrical bony structures with a ring like component behind the cylinder also made of bone. In between the vertebrae are disc shaped cushions filled with a gelatinous central core known as the nucleus pulposis
Narcotics, or opioids (pronounced OH-pee-oydz), provide the main relief for this level of pain. There are both long-acting and short-acting opioid pain medicines:
Long-acting opioids include:
oxycodone (brand names: Roxicodone, OxyIR, OxyContin)
fentanyl (brand name: Duragesic)
morphine (brand names: MS Contin, Oramorph, Avinza, Kadian, Roxanol)
methadone (brand name: Dolophine)
Short-acting opioids include:
morphine (brand name: MSIR)
oxycodone (brand name: Percocet)
hydrocodone (brand names: Vicodin, Vicoprofen, Lortab, Lorcet, Hycodan, Zydone)
hydromorphone (brand name: Dilaudid)
fentanyl—rapid acting (brand name: Actiq)
meperidine (brand name: Demerol)
Dosage is adjusted to suppress your pain around-the-clock. Long-acting medication helps so that most of your day is pain free, and ideally you won't need to get up in the middle of the night to take another dose. Short-acting drugs are used to treat episodes of breakthrough pain.
There are many different opioids to try f...
References Anema JR, Steenstra IA, Bongers PM, et al. Multidisciplinary rehabilitation for subacute low back pain: graded activity or workplace intervention or both? A randomized controlled trial. Spine . 2007;32(3):291-298; discussion 299-300. Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Arch Intern Med . 2009;169(9):858-66. Chou R, Atlas SJ, Stanos SP, Rosenquist RW. Nonsurgical interventional therapies for low back pain: a review of the evidence for an American Pain Society clinical practice guideline. Spine . 2009;34(10):1078-93. Review. Chou R, Baisden J, Carragee EJ, Resnick DK, Shaffer WO, Loeser JD. Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine . 2009;34(10):1094-109. Review. Chou R, Fu R, Carrino JA, Deyo RA. Imaging strategies for low-back pain: systematic review and meta-analysis. Lancet . 2009;373(9662):463-72. R...
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