I have a bad back, what do I do? Medicine to physical therapy through acupuncture and osteopathy, the choice is wide.Contents of this article
- Medications: moderation
- Osteopathy: to regain your mobility
- Chiropractic: lasting benefits
- Physiotherapy: prevention of relapse
- Acupuncture: for chronic pain of the cervical and lumbar
Who has not had back pain? "In 60% of cases the problem is mechanical and comes from the spine," says Dr. Jean-Yves Maigne, chief of physical medicine and osteopathic manual medicine of the Hôtel-Dieu hospital.
When their origin is benign, the pain does not last long. If back pain is too painful, solutions exist. Before you deliver your vertebrae at the hands of an osteopath or chiropractor, medical advice is often recommended.
They reduce pain but do not represent a long term solution.
For who ? For all types of "mild to moderate" pain.
How? You can go up to 4 grams per day. In the back pain, it is better chaining taken until reaching the maximum daily dose. A regular intake optimizes the analgesic effect. Avoid exceeding one week of treatment.
For who ? These medications are reserved for inflammatory pain: osteoarthritis, sciatica ... Their analgesic effect is effective.
How? Nonsteroidal anti-inflammatory drugs should be prescribed for a very short time, usually a week. They have many side effects and are cons-indicated in cases of digestive or cardiovascular history. The ibuprofen dose should not exceed 1200 mg daily. Efficiency is improved if catches are chained every six hours.
Namely: anti-inflammatory gels are less effective than drugs. Those can be based ketoprofen photosensitizers. These products, used in massages, were put under surveillance strengthened by the Agence française de sécurité sanitaire des produits de santé.
Muscle relaxants the
For who ? For pain due to spasm of a muscle, like lumbago or torticollis. But "their effectiveness is questionable," said Prof. Vautravers.
How? With caution ! All these drugs create a significant risk of drowsiness. Long prescribed tetrazepam, which belongs to the benzodiazepine family, was withdrawn from the French market in July 2013 due to potentially serious skin reactions. There are other molecules that can be used such as mephenesin, but their efficiency is less.
Namely: Some ointments containing menthol and methyl salicylate, sold without a prescription can locally relieve moderate pain. However, in certain uses, they can cause burns.
For who ? For type sciatic pain, intense and highly localized. Infiltrations are proposed when the anti-inflammatory treatment has failed. "The infiltrations can help the patient to take the shock," observes Dr. Maigne. The analgesic effect is fast, but it does not last more than a few months.
How? A potent anti-inflammatory derivative of cortisone, is injected directly into a joint or a painful nerve, sometimes under local anesthesia. The infiltration can be made to the office of rheumatologist. Ideally, the gesture is guided under radiological control.
43% of visits to the osteopath relate back pain and nearly half of the patients come in crisis, according to a study by the Trust for Research in osteopathy, conducted among 1556 patients between February and April 2012.
How? Gestures of osteopath "restore mobility to structures related to the painful area," says Thibault Dubois, director of the Union of French osteopaths. These gestures are usually mild and painless. For a simple backache, a maximum of three sessions is usually enough. They are not reimbursed by social security, but some offer mutual support.
Medical advice is essential
For who ? It is in the lower back pain that osteopathy showed more effectiveness. To intervene in type sciatica pain, the osteopath must first make sure there is no disc herniation. Medical advice is preferable. Also for neck pain, intervention is not done with the green light from a doctor, certifying the absence of indication-cons.
What risks? The greatest risk is at the cervical, fear of being torn vertebral artery. According to estimates, the number of accidents varies between 1 100 000 and 1 for three million. But for Thibault Dubois, "properly trained osteopaths are competent to identify risk situations. "
Where to find a good osteopath? Osteopathic schools provide a very heterogeneous training. The best professionals are from schools that meet the criteria of the World Health Organisation. The SFDO offers practitioners trained in these standards directory.
According to Inserm, chiropractic appears effective against lumbago and cervical pain, but no more than the usual treatments.
How? The practice is based on spinal manipulation. "It is this manipulation, improving joint mobility, will have an effect on pain," explains Philippe Fleuriau, president of the French Association of Chiropractic.
On average, three sessions are enough to relieve simple back pain. Count seven sessions in cases of sciatica with disc herniation.
For who ? In case of lumbago, studies have shown comparable results to standard treatment in acute crisis. For chronic pain, the satisfaction index is better in patients regularly monitored by a chiropractor.
A relief, rare risks
For neck pain, a US study published in 2012 in the Annals of Internal Medicine found that after twelve weeks of treatment, 57% of patients followed by a chiropractor saw their pain decrease of 75%. After one year, 53% were still relieved against 38% of those who had taken painkillers or relaxants.
What risks? The most serious but also the most rare is tearing of an artery during cervical manipulation. Again, the figures are vague: between 1 case per 400 000 1 case per 5,000,000.
Where a chiropractor? All professionals are trained in six years according to international standards. The association provides an online directory on its website. There is also a list of mutuals that support chiropractic lack of reimbursement by the social security system.
She has long existed even if, according to scientists, nothing proves effective. "Physiotherapy is an empirical method that seeks to enter the scientific circle trying to validate its efficacy by the evidence, but today we have very little evidence" confirms Françoise Escarment, President of the Afrek.
For who ? According to the Health Authority, physical therapy is indicated for lumbago in relapse prevention, but not treatment crisis. In this case, Medicare reimburses fifteen sessions, renewable once with its prior agreement.
For a non-paralyzing attack of sciatica, the McKenzie method has demonstrated its effectiveness. List of professionals on the website of the French Association McKenzie.
Other methods physiotherapy
Other techniques can be proposed as the Mezieres method: stretching postures that relax the muscle chains. The physios have several strings to their bow they adapt depending on the type of pain and its location.
Massages: "This is the essential technique. If no scientific study has the support of many elements used to accredit its efficiency, including its analgesic effect, "says Françoise Escarment. An undeniable relief varies from people.
Rehabilitation: in back pain, rest is harmful. The patient must learn to move without getting hurt. On the program: strength training, stretching and postural exercises.
Analgesic Electrotherapy: Tens of technique is effective on all types of pain, with a good level of scientific evidence. The passage of a low frequency electric current boosts endorphins by the body, calming hormones that reduce pain.
Ultrasound: high frequency vibrations through the muscles, tendons, ligaments ... A technique for which we do not really scientific validation.
Hot / cold: immediate effect
Applying heat to a painful area dilates vessels and increases blood circulation, "which probably helps muscles release toxins," says Dr. Maigne. This is a great relaxant. But his action remains local and temporary.
Some people are more sensitive to the sedative effect of the cold. "His vasoconstrictor effect prevents inflammation from spreading. It is absorbed faster, "said Francoise Escarment.
Physiotherapists alternatively use hot or cold. Also found in commercially valuable products.
Acupuncture entered in large hospitals, especially for the treatment of pain.
For who ? Rather for chronic pain, if one believes a meta-analysis published in September 2012 in the journal Archives of Internal Medicine. According to this research on 18,000 patients, acupuncture has superior efficacy to analgesics in chronic pain of the cervical and lumbar.
"For acute low back pain, the research is promising. Chinese Studies show that more pain is early treat - in a period less than three days - more acupuncture is effective, "said Dr Olivier Goret, President of the Study Group and acupuncture research.
Acupuncture benefits associated with other solutions
Moreover, it seems that acupuncture increases the power of analgesic physiotherapy or spinal manipulation. Associated with pain medications, it helps to decrease the doses.
How? Fine needles are stuck into four to eight points. In case of severe pain, electro-acupuncture increases the analgesic effect. "This technique can be used for sciatica crisis," says Dr. Goret. Consider a session of twenty minutes a day for three days.
For chronic pain, moxibustion combines needle heat from burning sagebrush sticks. Ten to fifteen sessions are recommended for two week.
Where to find a good acupuncturist? "It is important to ensure that he is a doctor and holding an acupuncture degree, acquired in three years," said Dr Goret. Directory available on the Acudoc-Pro site.