Treatments for Back conditions

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Book Excerpts: Treatment of Back conditions

• Treatment - Low Back Pain/Swelling
• Treatment - Scoliosis & Kyphosis
• Treatment - Back Pain
• Treatment - Scoliosis
• Emergency interventions - Back pain
• Treatment - Scoliosis
• Emergency interventions - Back pain
• Treatment - Scoliosis
• Nursing considerations - Back pain
• Patient counseling - Back pain
• Nursing considerations - Back pain

Treatments of Back conditions: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the treatments of Back conditions.

Low Back Pain/Swelling: Treatment
(In a Page: Signs and Symptoms)

• In absence of red flag symptoms, return to activity as soon as possible; rest has not been shown to improve recovery
• Acetaminophen, NSAIDs, opioids, and/or muscle relaxants for pain; epidural corticosteroid injections may be indicated for resistant pain
• Patient education (weight loss, exercise, proper back biomechanics and ergonomics)
• Physical therapy, including pain relief modalities (ice, heat, ultrasound), stretching, strengthening, aerobic conditioning, and relaxation therapy
• Surgery may be indicated for refractory disease, large neurologic deficits, unbearable pain, or significant limitations

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Source: In a Page: Signs and Symptoms, 2004

Scoliosis & Kyphosis: Treatment
(In a Page: Signs and Symptoms)

• Scoliosis
  –Treat underlying cause if applicable (e.g., tumor)
  –<20–25° of deformity: Observation
  –20–40° of deformity: Bracing (preferably to be worn 23 hours/day); bracing stops progression only; Milwaukee brace (includes neck ring) gives best results but poor compliance; lumbosacral orthosis (Boston brace) has poorer results but better compliance
  –>40° of deformity: Surgery (posterior spinal fusion with rods) is usually indicated; progression is very likely
  –More aggressive treatment is usually indicated if progression >5°, female, younger, or if secondary, treatment generally more aggressive
• Kyphosis: Bracing or surgery, similar to scoliosis
>

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Source: In a Page: Signs and Symptoms, 2004

Back Pain: Treatment
(In A Page: Pediatric Signs and Symptoms)

• Muscular strain: Muscle relaxants, NSAIDs, rest, and reduction of exacerbating activities
  
• Disk herniation: Physical therapy, surgery is rarely indicated in children and adolescents
• Spondyloarthropathy: NSAIDs, exercise
• Scoliosis: Conservative management with observation, NSAIDs, bracing or surgery if more severe
• Gynocologic etiologies
  –Menstrual cramps: NSAIDs, OCPs for severe cases
  –PID: Appropriate cultures, treatment with antibiotics
  –Endometriosis: hormonal therapy such as OCPs may be effective, surgical ablation is rarely required
• UTI: Antibiotics
• Urolithiasis: Pain management followed by high fluid intake
• Infection: Diskitis requires 4–6 weeks of IV antibiotics
  
• Tumors: Referral to oncologist

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Scoliosis: Treatment
(In A Page: Pediatric Signs and Symptoms)

• Treatment options include observation while child is growing, bracing, and surgery
  –Many curves do not progress enough to require treatment
  –Spinal curve progression may occur despite bracing; however, for idiopathic scoliosis, response to brace wearing is dose-related and many patients do not like to wear the brace
• Exercise and electrical stimulation have not been shown to alter natural progression of curve
• Bracing for curves in 20–40° degree range may slow curve progression but does not reduce the magnitude of curve despite a well-made brace and compliance
• Surgery is reserved for progressive curves >40° in skeletally immature (Risser scale 0–1) and >50° in skeletally mature patients

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Source: In A Page: Pediatric Signs and Symptoms, 2007

Back pain: Emergency interventions
(Handbook of Signs & Symptoms (Third Edition))

If the patient reports acute, severe back pain, quickly take his vital signs, and then perform a rapid evaluation to rule out life-threatening causes. Ask him when the pain began. Can he relate it to any causes? For example, did the pain occur after eating? After falling on the ice? Have the patient describe the pain. Is it burning, stabbing, throbbing, or aching? Is it constant or intermittent? Does it radiate to the buttocks or legs? Does he have leg weakness? Does the pain seem to originate in the abdomen and radiate to the back? Has he had a pain like this before? What makes it better or worse? Is it affected by activity or rest? Is it worse in the morning or evening? Does it wake him up? Typically, visceral-referred back pain is unaffected by activity and rest. In contrast, spondylogenic-referred back pain worsens with activity and improves with rest. Pain of neoplastic origin is usually relieved by walking and worsens at night.

If the patient describes deep lumbar pain unaffected by activity, palpate for a pulsating epigastric mass. If this sign is present, suspect a dissecting abdominal aortic aneurysm. Withhold food and fluid in anticipation of emergency surgery. Prepare for I.V. fluid replacement and oxygen administration. Monitor the patient's vital signs and peripheral pulses closely.

If the patient describes severe epigastric pain that radiates through the abdomen to the back, assess him for absent bowel sounds and for abdominal rigidity and tenderness. If these occur, suspect a perforated ulcer or acute pancreatitis. Start an I.V. for fluids and drugs, administer oxygen, and insert a nasogastric tube while withholding food.

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Source: Handbook of Signs & Symptoms (Third Edition), 2006

Scoliosis: Treatment
(Professional Guide to Diseases (Eighth Edition))

Only two treatments effectively treat scoliosis: spinal bracing and surgery. If monitored closely, a properly constructed and fitted brace can successfully halt progression of a curve in approximately 70% of cooperative patients. Most braces should be worn over a long T-shirt or similar article of clothing for 23 hours a day. However, mild curvatures may require less. Exercises must be done daily both in and out of the brace to maintain muscle strength. Patients should be seen for follow-up and brace adjustment every 3 months. Radiographs should be repeated at 6-month intervals. As the skeleton matures, as seen radiographically, brace wear should be gradually decreased until it’s worn only at night.

The primary indications for surgery are relentless curve progression (usually curves over 40°) or significant curve progression despite bracing. Surgery corrects lateral curvature by posterior spinal fusion and internal stabilization with metal rods. A distraction rod on the concave side of the curve “jacks” the spine into a straight position and provides an internal splint. An alternative procedure, anterior spinal fusion, corrects curvature with vertebral staples and an anterior stabilizing cable. Some spinal fusions may require postoperative immobilization in a brace. Postoperatively, periodic checkups are required for several months to monitor stability of the correction.

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Source: Professional Guide to Diseases (Eighth Edition), 2005

Back pain: Emergency interventions
(Professional Guide to Signs & Symptoms (Fifth Edition))

If the patient reports acute, severe back pain, quickly take his vital signs; then perform a rapid evaluation to rule out life-threatening causes. Ask him when the pain began. Can he relate it to any causes? For example, did the pain occur after eating? After falling on the ice? Have the patient describe the pain. Is it burning, stabbing, throbbing, or aching? Is it constant or intermittent? Does it radiate to the buttocks or legs? Does he have leg weakness? Does the pain seem to originate in the abdomen and radiate to the back? Has he had a pain like this before? What makes it better or worse? Is it affected by activity or rest? Is it worse in the morning or evening? Does it wake him up? Typically, visceral-referred back pain is unaffected by activity and rest. In contrast, spondylogenic-referred back pain worsens with activity and improves with rest. Pain of neoplastic origin is usually relieved by walking and worsens at night.

If the patient describes deep lumbar pain unaffected by activity, palpate for a pulsating epigastric mass. If this sign is present, suspect dissecting abdominal aortic aneurysm. Withhold food and fluid in anticipation of emergency surgery. Prepare for I.V. fluid replacement and oxygen administration.

If the patient describes severe epigastric pain that radiates through the abdomen to the back, assess him for absent bowel sounds and for abdominal rigidity and tenderness. If these occur, suspect a perforated ulcer or acute pancreatitis. Start an I.V. line for fluids and drugs, administer oxygen, and insert a nasogastric tube while withholding food.

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Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Scoliosis: Treatment
(Handbook of Diseases)

The severity of the deformity and potential spine growth determine appropriate treatment, which may include such noninvasive measures as close observation, exercise, or a brace. For more serious deformity, surgery or a combination of methods may be needed. To be most effective, treatment should begin early, when spinal deformity is still subtle.

Noninvasive measures

A curve of less than 25 degrees is mild and can be monitored by X-rays and an examination every 3 months. An exercise program that includes sit-ups, pelvic tilts, spine hyperextension, push-ups, and breathing exercises may strengthen torso muscles and prevent curve progression. A heel lift also may help.

A curve of 25 to 39 degrees requires management with spinal exercises and a brace. (Transcutaneous electrical nerve stimulation may be used as an alternative.)

A brace halts progression in most patients but doesn’t reverse the established curvature. Such devices passively strengthen the patient’s spine by applying asymmetric pressure to skin, muscles, and ribs. Braces can be adjusted as the patient grows and can be worn until bone growth is complete.

Surgery

A curve of 40 degrees or more requires surgery (spinal fusion with instrumentation) because a lateral curve continues to progress at the rate of 1 degree a year even after skeletal maturity.

CLINICAL TIP: Some surgeons may prescribe Cotrel dynamic traction for 7 to 10 days for preoperative preparation. This traction consists of a belt-pulley-weight system. While in traction, the patient should exercise for 10 minutes every hour, increasing muscle strength while keeping the vertebral column immobile.

Surgery corrects lateral curvature by posterior spinal fusion and internal stabilization with a Harrington rod or other fixation devices. A distraction rod on the concave side of the curve “jacks” the spine into a straight position and provides an internal splint.

An alternative procedure, anterior spinal fusion with instrumentation, corrects curvature with vertebral staples and an anterior stabilizing cable. Some spinal fusions may require postoperative immobilization in a brace.

Postoperatively, periodic checkups are required for several months to monitor stability of the correction.

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Source: Handbook of Diseases, 2003

Back pain: Nursing considerations
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Monitor the patient closely if the type and location of back pain suggest a life-threatening cause. Stay alert for increasing pain, altered neurovascular status in the legs, loss of bowel or bladder control, altered vital signs, sweating, and cyanosis.

Until a tentative diagnosis is made, withhold analgesics to avoid masking symptoms. Withhold food and fluids until it’s determined whether the patient requires surgery. Once a medical emergency is ruled out, make him as comfortable as possible by elevating the head of the bed, placing a pillow under his knees, and administering pain medications. Prepare the patient for a rectal or pelvic examination, routine blood tests, urinalysis, computed tomography scan, biopsies, and X-rays of the chest, abdomen, and spine.

Fit the patient for a corset or lumbosacral support. Refer him to a physical therapist, occupational therapist, massage therapist, or psychologist, as indicated.

Patient teaching

Explain all tests and procedures. Instruct the patient not to wear a lumbosacral support in bed. Describe such pain-relief measures as cold therapy, warm baths, mattress choices, and backboards. Instruct the patient and his family about relaxation techniques, such as deep breathing, biofeedback, and transcutaneous electrical nerve stimulation.

If the patient has chronic back pain, reinforce instructions about bed rest, analgesics, anti-inflammatory medications, and exercise. (See Exercises for chronic low back pain, page 41.) Help him recognize the need to make lifestyle changes, such as losing weight or correcting poor posture. Advise the patient with acute back pain secondary to a musculoskeletal problem to continue his daily activities as tolerated rather than staying on total bed rest.

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Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Back pain: Patient counseling
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

If the patient has chronic back pain, reinforce instructions about bed rest, analgesics, anti-inflammatories, and exercise. Also, suggest that he take daily warm baths to help relieve pain. Help the patient recognize the need to make necessary lifestyle changes, such as losing weight or correcting poor posture. Advise patients with acute back pain secondary to a musculoskeletal problem to continue their daily activities as tolerated, rather than staying on total bed rest.

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Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Back pain: Nursing considerations
(Nursing: Interpreting Signs and Symptoms)

▪ Monitor the patient closely if the back pain suggests a life-threatening cause.

▪ Be alert for increasing pain, altered neurovascular status in the legs, loss of bowel or bladder control, altered vital signs, sweating, and cyanosis.

▪ Withhold food and fluids in case surgery is necessary.

▪ Administer analgesics, as ordered, and evaluate their effect.

▪ Make the patient as comfortable as possible by elevating the head of the bed and placing a pillow under his knees.

▪ Encourage relaxation techniques such as deep breathing.

▪ Anticipate diagnostic testing, such as routine blood tests, urinalysis, a computed tomography scan, magnetic resonance imaging, appropriate biopsies, and X-rays of the chest, abdomen, and spine.

▪ Fit the patient for a corset or lumbosacral support.

▪ Provide heat or cold therapy, a backboard, a convoluted foam mattress, or pelvic traction, as ordered.

▪ Refer the patient to other professionals, such as a physical therapist, an occupational therapist, or a psychologist, if indicated.

Patient teaching

▪ Explain pain-relief measures to the patient.

▪ Teach him about alternatives to analgesic drug therapy, such as biofeedback and transcutaneous electrical nerve stimulation.

▪ Provide information about use of anti-inflammatory drugs and analgesics.

▪ Discuss lifestyle changes, such as weight loss or correcting posture.

▪ Teach relaxation techniques such as deep breathing.

▪ Instruct the patient on correct use of corset or lumbosacral support.

▪ Explain diagnostic tests and procedures.

▪ Teach the patient about the cause of his back pain and the treatment plan.

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Source: Nursing: Interpreting Signs and Symptoms, 2007

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