Pain in the back or spine is a very common condition and can be due to varied reasons. The pain can be in the upper back or middle region or low back or all over the spine. The most frequent site of back pain is low back region which is the area most affected by mechanical causes like bending, weight lifting etc and also is the common site for prolapsed disc. The pain may be associated with considerable restriction of movements and nature of pain varies according to the cause. The treatment is decided based on history and underlying cause of the condition. Apart from pathology to bones and joints of spine, the pain can arise from muscles, ligaments and nerves also. Tendency for having back pain increases as we age.
- Accidents and fall or any such injuries
- Prolonged sitting
- Nature of work which involves lifting weight and other postures that strains the spine
- Medical conditions like arthritis, spondylolisthisis, ankylosing spondylitis, kidney stones, endometriosis, tumor, disc prolapse etc
The cause of back pain can be diagnosed by any of the following:
- Physical examination
- Blood tests
- X ray
- MRI scanning
- CT scanning
Pain is an attribute of aggravated vaatha dosha and hence pacifying vaatha dosha is the base of management. Depending upon the symptoms associated, derangement in other doshas is understood.
Various internal medications and external therapies are done to attain a long term relief. Reducing inflammation associated with the pain is the initial step. Strengthening the spinal column, supporting muscles, ligaments and tendons is to be done with suitable therapies (poorva Karma and panchakarma) yoga and exercises. When the condition is not very severe, pacification therapy or samana chikitsa is indicated. It includes:
- Application of paste of medicinal powder mixed in suitable liquid over the area affected, for a period of 30 to 45 minutes, twice a day, will reduce the inflammation associated with back pain. This procedure is called as pichu.
- Application of suitable medicated oil in the low back and steaming for a period of about 30 minutes. The procedure may be done twice a day (morning and evening). This will relax the muscles which are tight and inflexible.
- Internal administration of medicated decoctions which can reduce the inflammation and pain.
- Katee vasthi: A procedure where oil is made to stay in the low back for some time. It lubricates the area and removes the dryness and roughness thereby improving mobility.
- Internal administration of medicated oil and ghee is indicated.
- Application of dry heat along the course of pain is effective to reduce pain.
- When the condition is very severe with strong pain, elimination therapy is required to obtain satisfactory relief from the condition. This is achieved by any of the five cleansing therapies or panchakarmas like:
- Vasthi or enema therapy, where medicine is administered through rectum, is the treatment of choice.
- The number of vasthi’s to be done is subjective based on the symptoms.
- Emetic therapy can be done prior to Vasthi if required
- Virechana or purgation therapy is also effective.
- Suitable inertnal medications are given during the course of elimination therapy.
Poorvakarmas are procedures done prior to panchakarmas. They are essential to augment the action of panchakarmasand make them effective. Apart from this, they are also by themselves muscle relaxing and strengthening therapies. Commonly done poorvakarmas in Back pain are:
- Rubbing of medicinal powder in body or Udvartana: This procedure is appreciated for its ability to remove underlying inflammation. It also reduces excess fat and bestows pleasantness to skin.
- Oiling the body and steaming (abhyanga and ooshmasweda): This procedure is very relaxing and soothing to the muscles, ligaments and tendons. It improves flexibility of joints.
- Pouring of medicinal oil or liquid from a short height all over body in a systematic pattern for a fixed duration along with light massage (kaaya seka or pizhichil): It is a highly effective and widely applied procedure that can reduce pain and improve mobility.
- Application of a poultice filled with medicine over body (kizhi): Regular systematic application of the poultice on body, after heating it, is the procedure. It is a very efficient process to relieve pain, stimulate the nerve endings and improve circulation.
- Duration of hospitalization in chronic back pain: 3 weeks to 3 months depending upon and severity of symptoms.
- Follow up: A regular follow up on an annual basis consecutively for three years is considered good to prevent the recurrence chronic back pain and obtain a considerable relief.
- Regular exercise is the ky to keep muscles strong and maintain flexibility of joints.