Lower Back Pain

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Have you heard Trevor on the radio? Listen to 730 CKDM Tuesday Mornings at 8:35 am! We now have most of the articles published in the Parkland Shopper on our Website www.dcp.ca

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

You are pretty weak. And you’re slow. Your teeth are dull, your claws are non-existent, your hide is very thin and you have no fur to keep you warm. How on Earth have you lived this long? This is how I imagine an average wolf, coyote, cougar, bear or for that matter elk or moose looks at us humans. Even if you look closer on our family tree, picture a human next to a chimpanzee. If you put a human and a chimp in hand to hand combat, the chimp could literally pull the human’s arms off. It is odd when you think that humans with no natural weapons or effective defenses now live in nearly every corner of the planet.

So how have we become so dominant on the planet? Big brains, opposable thumbs, tools and fire undoubtedly all helped. But arguably one of the first things we did right as a species was to start walking on our back legs. Walking up right helped us do simple things like collect stuff in one place and bring it back to another. It helped us do more complicated things like use tools and run while poking things with sharp sticks. As helpful as standing upright has been, it puts a lot of stress on our lower backs.

I’ve read stats that say up to 85% of us will get lower back pain during our lifetime. It is very common. And it can start with what seem to be minor injuries. People have come into the pharmacy saying they hurt themselves tying their shoes or just sleeping funny. So what should you do? Let’s start with non-drug measures.

The physiotherapists and chiropractors will remind you to prevent lower back pain. You should remain active, lift with you legs, work on keeping your stomach muscle strong and avoid twisting and lifting. After your back is already sore, physios and chiros can recommend different exercises, stretches and/or manipulations to help you. As for exercise in general after your back is sore, the 2007 guidelines from the American College of Physicians and the American Pain Society say you should keep moving. In general, bed rest is not recommended for lower back pain.

Another non-drug measure you can use is heat. Whether it is a warming blanket, a gel pack you put in the microwave or a hot water bottle, heat can help lower back pain. An interesting category of products in the pharmacy are the 8 heat hour patches. These have iron in them that slowly oxide or burn for 8 to 12 hours. They can be put over the sore area and worn all day.

Once we more into the medication zone we always recommend acetaminophen first. This is because acetaminophen is generally the safest pain medication. However, acetaminophen only treats pain. It doesn’t reduce inflammation. A lot of the discomfort in lower back pain is due to inflammation in the muscles or possibly even the nerves. So I usually point people towards ibuprofen. It is a good pain killer and antiiflammatory. Naproxen sodium or aleve would work as well.

The problems with over the counter antiinflammatory pain killers like ibuprofen are stomach, blood, and kidneys. Now I don’t want to scare you. Medications like ibuprofen are safe for most people, most of the time. However, if you have problems with ulcers in your stomach, are on blood thinners, or have kidney problems let your pharmacist know before taking them. Between you and your pharmacist you can decide if the ibuprofen like drug will have a benefit that will out weigh the risk in your case.

The other over the counter medication that is often used for back pain is a muscle relaxant. Some common brand names are Robaxacet, Robaxasol, and Robax Platinum. These all have the same muscle relaxant in them, but one has acetaminophen, one has ASA and the last has ibuprofen. The over the counter muscle relaxants can work very well, but they can make you sleepy. I usually suggest that a patient take the first dose at home when they don’t have to do anything that requires a lot of attention. That way they can see how it effects them. And definitely don’t mix muscle relaxants with alcohol.

When should you see the doctor? Well if your lower back pain is very severe, go immediately. In general, though, we expect lower back pain to go away in 4-6 weeks. If yours lasts longer, stop treating it with over the counter medications and it is probably time to see your family doctor.

So as we evolved to stand up right. This has allowed us to hold a beverage and popcorn and still walk to our seats at a Kings game. However our evolutionary advantage can be a pain in the back.

As always if you have any questions or concerns about these products, ask your pharmacist.