Adolescents with specific causes of back pain should be treated according to the diagnosis. For example, if a mechanical etiology is suspected, patients should be managed with conservative treatment such as short-term restriction of activity or modification of activity, followed by flexibility and strengthening exercises. Bracing can be helpful for some mechanical problems such as posterior verterbral arch stress fracture, spondylolysis, spondylolisthesis, or Scheuermann's disease (7,45,69). Only rarely is surgery required for adolescent mechanical back problems. Back pain due to arthritis and inflammation should be treated initially with NSAIDs, and if there is little or no response, other anti-rheumatic medications can be considered.
The appropriate treatment for nonspecific back pain is less clear, and only a limited number of studies have been carried out in adolescents. Most adolescent back pain is mild and self-limited, and does not require more than conservative treatment (8,70). Treatment recommendations are based on studies in adults, which are also controversial. Many studies have contradictory findings, and comparison between studies is difficult because of differences in methodology, study quality, and populations (13,71,72).
Although many medications have been used to treat adult LBP, only limited evidence supports their use. NSAIDs and acetaminophen may be beneficial for acute LBP, but their benefit for chronic LBP is less clear (13,71). Opioids and muscle relaxants have not been shown to be more effective than NSAIDs or acetaminophen (13). Tricyclic antidepressants have been shown to cause a small reduction in pain in patients with chronic LBP, but no consistent functional improvement has been found in those who are not depressed (73).
A recent review of 61 randomized controlled trials of exercise therapy found that exercise had no clear benefit for adult acute LBP, but was mildly helpful at decreasing pain and improving function in adults with chronic LBP (74). Bed rest is not advised for patients with LBP, and only has limited benefit for patients with sciatica (13). Conflicting results have been reported for other treatments such as physical therapy, spinal manipulation, TENS, acupuncture, biofeedback, and behavioral therapy (71,73). Although some treatments, such as spinal manipulation, can improve acute symptoms, no clear long-term benefit has been found (13). The combination of medical care with PT or manipulation may be slightly more effective than a single type of treatment in reducing pain and perceived disability (73). Multidisciplinary approaches combining physical rehabilitation with educational, psychological, and behavioral treatment have been reported to lead to improved outcome that is sustained over many months, but success varies depending upon the program and the patient population (13,71).
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Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.