NEW YORK—The first thing to do when your low back starts to hurt is relax—both your back and your mind.
“The majority of back pain usually only lasts two to four weeks; 75–80 percent ... will resolve on its own in two to four weeks without any treatment, just rest,” said Dr. Damon Noto, a pain-management and rehabilitation specialist who focuses on non-invasive treatment methods.
During the first couple weeks, applying ice can be helpful, and if the pain is severe, you might need an anti-inflammatory, Dr. Noto said.
He advises if you feel pain, you can also try acupuncture or chiropractic care because both offer relatively gentle pain relief and help stimulate the body’s natural healing processes.
Red Flags
If your pain comes with the onset of weakness or numbness in your legs or feet, it raises the possibility that a nerve is involved, and Dr. Noto recommends you consult a doctor.
If you notice a change in bladder control or you start experiencing balance difficulties, it could mean something is irritating your spinal cord, and you probably want to get an MRI to be safe.
If there is no obvious cause of your low back pain (known as insidious onset), and you wake up in the middle of the night with pain that’s worse than during the day, this is another red flag.
This kind of discomfort can indicate something more serious is going on that could involve the bone. For this type of pain, he said it’s often best to get an MRI and even some blood work.
If you have insidious onset low back pain plus night sweats, this can indicate an infection, which may require injections or antibiotics to treat.
And if your back pain lasts beyond four weeks, he said, then you should definitely go to your primary care doctor for a physical exam.
Let the Body Heal
Experience has shown Dr. Noto that given the right support, the body has great capacity to heal itself.
At a young age, he watched his grandfather, who suffered from heart disease, rehabilitate himself through exercise and diet. This made a “pretty long-lasting impression on me,” Dr. Noto said, and ultimately lead him to specialize in physiatry, a field of medicine that focuses on helping people who’ve been injured return to health.
In his practice now, Dr. Noto uses a variety of approaches: nutritional therapies, acupuncture and Chinese herbal medicine, regenerative methods like platelet rich plasma (PRP) therapy, and encouragement and emotional support to help patients heal low back pain without surgery.
A big key to effective treatment is making sure emotional issues are addressed, especially if pain has lasted over six months because studies show that depression and anxiety can make it a lot harder for the body to heal, he said.
“It’s not something a patient should be ashamed of. Anybody who’s going through a chronic injury ... it gives you a lot of stress,” he added.
On the physical side, diet changes, nutritional supplements, and herbs are part of his first line of defense against low back pain.
Herbals like white willow bark, curcumin, and ginger are very good natural anti-inflammatories. He’s had patients come to him after experiencing back pain for over a year, and when he started them on herbal supplements, they were able to stop pharmaceuticals.
“They were able to come off their prescription medication and were using the natural remedies instead, and felt [these were] just as effective,” Dr. Noto said.
Choose Treatment With Care
The first step in any treatment plan is to assess how serious your condition is. After assessment, Dr. Noto works out detailed personal treatment plans that connect patients with a network of physical therapists, chiropractors, personal trainers, nutritionists, and other acupuncturists.
If this level of treatment does not produce the desired results, he said patients can consider injection-based treatments, which are a little more aggressive.
For conditions that still don’t heal well, usually arthritis or traumatic injuries, Dr. Noto said treatments with stem cells and the blood plasma-based therapy PRP, are good options. These treatments are part of the emerging field of regenerative medicine, which uses growth factors to stimulate healing in the body.
“It’s a good way to avoid surgery, especially in people with more advanced arthritis or degenerative conditions,” he said.
And sometimes surgery is the most effective option.
The key to treating low back—or any type of pain—according to Dr. Noto, is really to figure out what will work best for you. “Patients respond differently and resonate with different treatments,” he said.
“My philosophy is always to do the least invasive thing to get the best results. So … I look for the most natural, least invasive methods to get that person back to optimal health.”
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