Facts on Massage & New Approaches for Mid Back Pain

What is classed as mid-back pain?
A good starting point is anywhere above the pelvis and below the neck would be considered the mid-back area. Pain here can be dull, aching, stabbing, throbbing, and either constant or recurring. It is relatively common for this to be accompanied by stiffness and difficulty moving, as well.
What’s considered the mid-back?
The middle back refers to the area above the hips and below the ribs and, although the term thoracic back pain often is used interchangeably with middle back pain, there are notable differences between the two.


How do you fix mid-back pain?
There are several methods you can do at home to treat middle back pain:
  1. Ice the area and later apply heat. …
  2. Consider taking over-the-counter pain medications, such as ibuprofen (Advil) and naproxen (Aleve), to reduce swelling and pain.
  3. Stretch and strengthen the back muscles by doing exercises such as yoga.
How long does mid-back pain last?
Middle back pain is a common problem and while it can disrupt your life, it doesn’t usually last long. ¹ Most people start to get better within just two to four weeks. ¹ There are plenty of treatments that can help during this time, so you can stay active and live life to the full.
When should I worry about middle back pain?
Seek immediate medical care (call 911) if you, or someone you are with, have middle back pain accompanied by chest pain, difficulty breathing, loss of bladder or bowel control, or numbness or paralysis in the arms or legs.
What organs can cause middle back pain?
Kidney problems can cause pain in the middle back, just underneath the ribcage on either side of the spine. The most common causes of kidney pain are infections and kidney stones. Additional symptoms include fever.
Where is middle back pain located?
Middle back pain occurs below the neck and above the bottom of the rib cage, in an area called the thoracic spine. There are 12 backbones — the T1 to T12 vertebrae — located in this area. Disks reside between them. The spinal column protects the spinal cord.
How do you know if back pain is muscular?
These are typical symptoms you might experience:
  1. your back hurts more when you move, less when you stay still.
  2. pain in your back radiating down into your buttocks but not typically extending into your legs.
  3. muscle cramps or spasms in your back.
  4. trouble walking or bending.
  5. difficulty standing up straight.
How should I sleep with middle back pain?
Try sleeping with a pillow between or underneath your legs for extra support. If you sleep on your side, put the pillow between your knees and draw them up slightly toward your chest. If you like to sleep on your back, try the pillow under your knees, or roll up a small towel and place it under the small of your back.
How do you relieve upper middle back pain?
Home Treatment
  1. Rest. If your back hurts a lot, take a break. …
  2. Use over-the-counter pain medicines, such as acetaminophen (for example, Tylenol), and nonsteroidal anti-inflammatory drugs (for example, Advil, Aleve, aspirin, and Motrin). …
  3. Use a heating pad or ice pack. …
  4. Exercise. …
  5. Practice good posture
What can cause upper middle back pain?
Upper back pain is usually caused by soft tissue injuries, such as sprains or strains, or muscle tension caused by poor posture or looking downward for long periods. Poor posture and text neck can combine to wreck your upper back. Common behaviors and activities that can cause upper back pain include poor posture.
How do I know if my back pain is serious?
When you should go to the ER for back pain
  1. A sudden spike in pain, discomfort, weakness, or numbness.
  2. Loss of bladder function.
  3. High fever.
  4. Severe stomach pain.
  5. Unexplainable weight loss.
  6. The pain results from a fall or severe blow to your back.
How do you tell if lower back pain is muscle or disc?
Your doctor can perform a neurological exam to check muscle strength, reflexes, walking ability, and the ability to feel touch. Imaging tests may be ordered to diagnose the cause of your pain. A CT scan shows cross-sectional images of the spinal column and can pinpoint a herniated disc.

Benefits of Massage Therapy

Massage improves blood circulation, which aids in the recovery of muscle soreness from physical activity. Massage relaxes muscles for an improved range of motion. Muscle relaxation also helps with insomnia. Massage leads to increased endorphin levels. If you are finding chronic tightness is limiting your ability to move well or if you have muscle soreness, book a massage therapy treatment with me to specifically address these areas and to learn which self-release strategies you can use between treatments.

Is it bad to get a massage when you have back pain?
Massage therapy can provide substantial healing and pain relief for many lower back problems. Specifically, for pain caused by a back strain, when the correct muscle is targeted, the pain can be controlled at its source—for quicker and lasting relief.
What’s the best massage for lower back pain?
Both structural massage (also called trigger point or structural integration massage) and Swedish massage (also called relaxation massage) has been proven to provide up to 6 months of relief from low back pain. Sports massage or deep tissue massage may also be helpful if the low back pain originated from an injury.

Deep tissue massage uses more pressure than a Swedish massage. It’s a good option if you have chronic muscle problems, such as soreness, injury, or imbalance. It can help relieve tight muscles, chronic muscle pain, and anxiety.
How often should you get a massage for back pain?
A regular massage may ease your back pain. One study showed that deep tissue massage performed daily for 30 minutes for 10 days reduced pain in patients.
What is the fastest home remedy for back pain?
7 Ways to Relieve Back Pain Naturally
  1. Enjoy an anti-inflammatory drink every day. …
  2. Fall asleep faster and sleep longer. …
  3. Avoid prolonged static posture. …
  4. Gently stretch your joints and soft tissues through yoga. …
  5. Try mindful meditation. …
  6. Support your body in a warm pool. …
  7. Keep a self-activating heat patch handy.
How should I sleep with lower back pain?
The best sleeping position for lower back pain is on your side with a partial bend in the knees. Keeping the knees bent helps balance the body and reduces pressure on the lumbar spine. Many people find it helpful to put a small pillow between their knees to make this position more comfortable.
Can massage release emotions?
YES! Most people who receive massage regularly report feeling relief, a sense of peace, or increased relaxation. However, some people may also experience a sudden rush of powerful emotion while receiving bodywork. Whether it is grief, euphoria, anger, fear, or sadness, the phenomenon is known as an emotional release.
Can emotions get trapped in the body?
The unresolved emotions get trapped in our body where they build and fester, draining our energy, leading to burnout, emotional imbalance, and eventually disease. When we chronically repress emotions, we create toxicity in our body, mind, and heart.
How do you stretch out lower back pain?
Lie on your back with both knees bent and your feet flat on the floor. Place your right ankle at the base of your left thigh. Then, place your hands behind your left thigh and pull up towards your chest until you feel a stretch. Hold this position for 1 to 3 minutes.
What is the best medicine for lower back pain?
  • Over-the-counter (OTC) pain relievers. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve), may help relieve back pain. …
  • Muscle relaxants. …
  • Topical pain relievers. …
  • Narcotics. …
  • Antidepressants.
Pro Massage by Nicola, LMT Specializing in Back Injuries, Santa Barbara, Goleta, Ca.

My Low Back Just Went Out- What do I do? Call Riktr PRO Massage for Low Back Pain

Back pain is a very common complaint. … Pain in the lower back may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdomen, and pelvic internal organs, and the skin around the lumbar area.

Upper Back Pain

What is the cause of back pain?

Repeated heavy lifting or a sudden awkward movement may strain back muscles and spinal ligaments. If you’re in poor physical condition, constant strain on your back may cause painful muscle spasms. Bulging or ruptured disks. Disks act as cushions between the bones (vertebrae) in your spine.

Mid Back Pain

Man with the enhanced spinal column, rearview (Digital Composite) Massage for Low Back Pain, Low Back Injuries, Santa Barbara, Goleta

Low Back Pain

What causes muscle spasms in the lower back? Heavy lifting is a common cause of back spasms. Any activity that puts excessive strain on the muscles and ligaments in the lower back can cause an injury. … A ruptured or bulging disk in the vertebrae may also pressure a nerve, which can result in back pain.

Heavy lifting is a common cause of back spasms. Any activity that puts excessive strain on the muscles and ligaments in the lower back can cause an injury. … A ruptured or bulging disk in the vertebrae may also pressure a nerve, which can result in back pain.

Causes of back pain

The human back is composed of a complex structure of muscles, ligaments, tendons, disks, and bones – the segments of our spine are cushioned with cartilage-like pads called disks. Problems with any of these components can lead to back pain. In some cases of back pain, its cause is never found. Problems with the spine such as osteoporosis can lead to back pain.

Strain – the most common causes of back pain are:

  • Strained muscles
  • Strained ligaments
  • A muscle spasm

Things that can lead to strains or spasms include:

  • Lifting something improperly
  • Lifting something that is too heavy
  • The result of abrupt and awkward movements

Back pain is a very common complaint. According to the Mayo Clinic, approximately 80% of all Americans will have low back pain at least once in their lives.

Back pain is a common reason for absence from work and doctor visits. Although back pain may be painful and uncomfortable, it is not usually serious.

Even though back pain can affect people of any age, it is significantly more common among adults aged between 35 and 55 years. Experts say that back pain is associated with the way our bones, muscles, and ligaments in our backs work and connect together.

Pain in the lower back may be linked to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdomen, and pelvic internal organs, and the skin around the lumbar area. Pain in the upper back may be due to disorders of the aorta, tumors in the chest, and spine inflammation.

Structural problems – the following structural problems may also result in back pain:

  • Ruptured disks – each vertebra in our spine is cushioned by disks. If the disk ruptures there will be more pressure on a nerve, resulting in back pain.
  • Bulging disks – in much the same way as ruptured disks, a bulging disk can result in more pressure on a nerve.
  • Sciatica – a sharp and shooting pain that travels through the buttock and down the back of the leg, caused by a bulging or herniated disc pressing on a nerve.
  • Arthritis – patients with osteoarthritis commonly experience problems with the joints in the hips, lower back, knees, and hands. In some cases, spinal stenosis can develop, which is the term used to describe when the space around the spinal cord narrows.
  • Abnormal curvature of the spine – if the spine curves in an unusual way the patient is more likely to experience back pain. An example is scoliosis, a condition in which the spine curves to the side.
  • Osteoporosis – bones, including the vertebrae of the spine, become brittle and porous, making compression fractures more likely.

Below are some other causes of back pain:

  • Cauda equina syndrome – the cauda equine is a bundle of spinal nerve roots that arise from the lower end of the spinal cord. People with cauda equine syndrome feel a dull pain in the lower back and upper buttocks, as well as analgesia (lack of feeling) in the buttocks, genitalia, and thigh. There are sometimes bowel and bladder function disturbances.
  • Cancer of the spine – a tumor located on the spine may press against a nerve, resulting in back pain.
  • Infection of the spine – if the patient has an elevated body temperature (fever) as well as a tender warm area on the back, it could be caused by an infection of the spine.
  • Other infections – pelvic inflammatory disease (females), bladder, or kidney infections may also lead to back pain.
  • Sleep disorders – individuals with sleep disorders are more likely to experience back pain, compared to others.
  • Shingles – an infection that can affect the nerves and may lead to back pain, depending on the nerves affected.
  • Bad mattress – if a mattress does not support specific parts of the body and keeps the spine straight, there is a greater risk of developing back pain.

Everyday activities or poor posture.

Back pain can also be the result of some everyday activity or poor posture. Examples include: Adopting a very hunched sitting position when using computers can result in increased back and shoulder problems over time.

  • Bending awkwardly
  • Pushing something
  • Pulling something
  • Carrying something
  • Lifting something
  • Standing for long periods
  • Bending down for long periods
  • Twisting
  • Coughing
  • Sneezing
  • Muscle tension
  • Over-stretching
  • Straining the neck forward, such as when driving or using a computer
  • Long driving sessions without a break, even when not hunched

Risk factors

A risk factor is something that increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2.

The following factors are linked to a higher risk of developing low back pain:

  • A mentally stressful job
  • Pregnancy – pregnant women are much more likely to get back pain
  • A sedentary lifestyle
  • Age – older adults are more susceptible than young adults or children
  • Anxiety
  • Depression
  • Gender–back pain is more common among females than males
  • Obesity and overweight
  • Smoking
  • Strenuous physical exercise (especially if not done properly)
  • Strenuous physical work.
Pro Massage by Nicola, LMT Specializing in Sports Injuries, Santa Barbara, Goleta, Ca.

Signs and symptoms

A symptom is something that the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

The main symptom of back pain is, as the name suggests, an ache or pain anywhere on the back, and sometimes all the way down to the buttocks and legs. Some back issues can cause pain in other parts of the body, depending on the nerves affected.

In most cases, signs, and symptoms clear up on their own within a short period.

If any of the following signs or symptoms accompany back pain, people should see their doctor:

  • Weight loss
  • Elevated body temperature (fever)
  • Inflammation (swelling) of the back
  • Persistent back pain – lying down or resting does not help
  • Pain in the legs
  • Pain reaches the knees
  • A recent injury, blow, or trauma to your back
  • Urinary incontinence – you pee unintentionally (even in small amounts)
  • Difficulty urinating – passing urine is hard
  • Fecal incontinence – you lose your bowel control (you poo unintentionally)
  • Numbness around the genitals
  • Numbness around the anus
  • Numbness in the buttocks

According to the British National Health Service (NHS), the following groups of people should seek medical advice if they experience back pain:

  • People aged less than 20 and more than 55 years
  • Patients who have been taking steroids for a few months
  • Drug abusers
  • Patients with cancer
  • Patients who have had cancer
  • Patients with depressed immune systems

Benefits of Deep Tissue Massage for back pain

  • Treats Chronic Back Pain.
  • Helps Lower High Blood Pressure.
  • Reduces Stress, Anxiety, and Muscle Tension.
  • Breaks Up, Scar Tissue.
  • Improves Athletic Recovery and Performance.
  • Can Help with Labor Pain and Delivery.
  • Reduces Arthritis Symptoms.
  • Finding a Trained Deep Tissue Massage Therapist:

Massage therapy is becoming more widely accepted in the medical community as a credible treatment for many types of back pain and/or as an adjunct to other medical treatments. Research shows that massage therapy has several potential health benefits for back pain sufferers, including:

  • Increased blood flow and circulation, which brings needed nutrition to muscles and tissues. This aids in the recovery of muscle soreness from physical activity or soft tissue injury (such as muscle strain).
  • Decreased tension in the muscles. This muscle relaxation can improve flexibility, reduce pain caused by tight muscles, and even improve sleep.
  • Increased endorphin levels–the “feel good” chemicals in the brain. This mood enhancer can ease depression and anxiety, which can help reduce pain and speed recovery–particularly important for those suffering from chronic back or neck problems.

What’s the Bottom Line?

How much do we know about massage?

A lot of research on the effects of massage therapy has been carried out.

What do we know about the effectiveness of massage?

While often preliminary or conflicting, there is scientific evidence that massage may help with back pain and may improve the quality of life for people with depression, cancer, and HIV/AIDS.

What do we know about the safety of massage?

Massage therapy appears to have few risks if it’s used appropriately and provided by a trained massage professional.

What is Deep Tissue Massage and what to expect?

Deep tissue massage is a massage that is designed to get into the connective tissue of the body, rather than just the surface muscles. As a massage therapist when I perform deep tissue I use a variety of techniques to deeply penetrate the muscles and fascia, loosening them and releasing tension. Most clients have a more intense experience with a deep tissue massage but also feel that it is more beneficial because it addresses deep-seated muscle pains. Deep tissue is beneficial when undertaken on a regular basis so that I can work together with the client to correct long-term problems, relax the body, and prevent injury.

To get a truly good deep tissue massage you need to find someone who specializes in deep tissue, like Nicola.  Most spas have several massage therapists who can offer a basic deep tissue massage integrating a number of techniques and styles customized for your body for maximum impact. Experiment by trying several deep-tissue massage therapists to find the one that is the right fit for you and your body.

One of the defining differences between deep tissue and regular massage is the use of tools. A standard massage usually only involves the hands and lower arms of the therapist. During deep tissue, however,  I use elbows and fingers for deep, penetrating work in the muscle. A deep tissue massage also tends to be very slow, and I will use long, flowing strokes to ease in and out of the muscle. Going in too quickly can cause the muscle to tense up, which is not the desired reaction. I also maintain firm pressure at trouble spots for several minutes to achieve muscle release before moving on to the next area of the body.

Deep tissue massage is designed to relieve severe tension in the muscle and the connective tissue or fascia. This type of massage focuses on the muscles located below the surface of the top muscles. Deep tissue massage is often recommended for individuals who experience consistent pain, are involved in heavy physical activity, such as athletes, and patients who have sustained physical injury. It is also not uncommon for receivers of Deep Tissue Massage to have their pain replaced with a new muscle ache for a day or two. Deep tissue work varies greatly. What one calls deep tissue another will call light. When receiving deep tissue work it is important to communicate what you are feeling.

When you go to get a deep tissue massage, you should talk with the therapist about any issues you might have and like to see addressed during your massage. I am happy to concentrate on a single body part for an entire massage to achieve lasting results and in fact, half of my clients want just that! It is also important to communicate with me about pain; The massage may be intense, but if a client starts to feel pain, he or she should communicate that immediately. I work on a scale of 1 – 10, where 7 is on your comfortability edge for that day and 10 is very uncomfortable pain. A lot of my clients take deep tissue pain or even like the pain in order to get the quickest results for their body type.  At the end of the session, lots of water should be consumed to help the body express the toxins released during the massage. You will probably be sore for a few days after the intense deep tissue treatment but that’s normal. Remember that ice is your friend.

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New Approaches Show Promise in Helping People With Low-Back Pain

Researchers say nonsurgical interventions can be more effective and less expensive than surgical treatments



Often there is no clearly identifiable physical cause for low-back pain, leaving patients to veer from one ineffective treatment to another

Millions of adults struggle for years with chronic low-back pain—a disabling ailment that has no easy fix.

Common causes include injury, arthritis, and degenerative changes in the spine. It tends to start at midlife with the natural wear and tear of aging. But often there is no clearly identifiable physical cause, leaving patients to veer from one ineffective treatment to another—including highly addictive prescription opioids.

Now, researchers are working on personalized treatment plans that can address physical, emotional, and psychological traits in individual patients that influence the pain they are experiencing. Physical therapy, exercise, diet, and lifestyle choices often play a role. Some research is also looking at ways to retrain the brain to think differently about pain.

To be sure, low-back pain can be a sign of something life-threatening, such as cancer, or a severe spine condition that requires surgery. As a result, chronic low-back pain needs to be fully evaluated. But once “red flags” are eliminated, doctors need a more precise way to determine what will work for individual patients, says Dr. Matt Mauck, a researcher and pain-medicine physician at the University of North Carolina Chapel Hill’s UNC Pain Management Center.

UNC is part of the Back Pain Research Consortium, or Bacpac, funded by the National Institutes of Health as part of a broader effort to improve the understanding, treatment, and management of pain and reduce opioid abuse and addiction. In a study at multiple sites nationwide, researchers are testing the effectiveness of four nonsurgical treatments in connection with specific personal traits of patients. Each treatment has been shown to work, though not equally well for everyone.

The four treatments: acceptance-and-commitment therapy, which helps people learn new skills for dealing with pain; duloxetine, a medication used for depression, anxiety, and chronic musculoskeletal pain; an online program with personalized messages to teach lifestyle skills for pain management; and a form of exercise therapy with stretches, strength training and hands-on treatment by a physical therapist or chiropractor.

Participants in the study are randomly assigned to an initial treatment for three months, which could then be modified depending on how they respond. That may include switching to another treatment or combining two treatments.

Discuss in-depth the research and science of acceptance-and-commitment therapy related to back pain

Acceptance and Commitment Therapy (ACT) is a form of psychotherapy that combines cognitive and behavioral strategies with mindfulness and acceptance strategies. It has been increasingly applied to various psychological and physical health conditions, including chronic pain, such as back pain. In the context of back pain, ACT focuses on helping individuals accept their pain and commit to actions that align with their values, rather than attempting to eliminate the pain itself.

Here’s an in-depth discussion of the research and science related to ACT for back pain:

1. Theoretical Foundation of ACT:

  • Hexaflex Model: ACT is based on the Hexaflex Model, which includes six core processes: Cognitive Defusion, Acceptance, Present Moment Awareness, Self-as-Context, Values Clarification, and Committed Action. These processes work together to promote psychological flexibility, which is the ability to be open, adaptable, and effective in the presence of difficult emotions or thoughts.

2. Application to Chronic Pain:

  • Acceptance of Pain: One of the fundamental aspects of ACT is the acceptance of pain. Instead of focusing on pain reduction, individuals are encouraged to accept the reality of their pain without judgment or avoidance.
  • Mindfulness and Present Moment Awareness: Mindfulness practices in ACT help individuals become aware of their thoughts and sensations in the present moment, promoting a non-judgmental awareness of pain.

3. Research on ACT for Back Pain:

  • Several studies have investigated the effectiveness of ACT for chronic pain conditions, including back pain.
  • A meta-analysis published in the “Journal of Contextual Behavioral Science” in 2016 found that ACT is effective in improving physical functioning, depression, and pain interference in individuals with chronic pain.
  • Another study in the “Journal of Pain Research” (2017) showed that ACT was associated with significant reductions in disability and pain-related distress in individuals with chronic lower back pain.

4. Psychological Flexibility and Pain Outcomes:

  • Psychological flexibility, a key outcome of ACT, has been linked to better pain-related outcomes. Research suggests that individuals with higher levels of psychological flexibility report lower levels of pain-related disability and distress.

5. Comparison with Other Treatments:

  • Some studies have compared ACT with other interventions, such as cognitive-behavioral therapy (CBT) or standard medical care. Results have shown that ACT can be as effective as or more effective than traditional approaches in improving functioning and reducing disability associated with chronic pain.

6. Implementation Challenges and Considerations:

  • While there is promising evidence for the effectiveness of ACT in managing back pain, challenges include the need for trained therapists and the potential variability in treatment outcomes. Tailoring interventions to individual needs and preferences is crucial.

7. Integration with Medical Care:

  • ACT is often used as part of a multidisciplinary approach to pain management, integrating with medical care, physical therapy, and other interventions.

8. Long-Term Outcomes:

  • Research has started exploring the long-term effects of ACT on back pain. Longitudinal studies are essential for understanding the sustainability of treatment effects over time.

In conclusion, the research on ACT for back pain suggests that it can be a valuable therapeutic approach, focusing on improving psychological flexibility, acceptance, and commitment to meaningful actions despite the presence of pain. However, ongoing research is necessary to further understand the mechanisms of action and to optimize the implementation of ACT in the context of back pain management.

Discuss in-depth the research and science of duloxetine related to back pain
Duloxetine is a medication that belongs to a class of drugs known as serotonin-norepinephrine reuptake inhibitors (SNRIs). It is primarily used as an antidepressant, but it has also been investigated and prescribed for the management of chronic pain conditions, including back pain. Here’s an in-depth discussion of the research and science related to duloxetine for back pain:

1. Mechanism of Action:

  • Serotonin-Norepinephrine Reuptake Inhibition (SNRI): Duloxetine works by increasing the levels of serotonin and norepinephrine in the brain. These neurotransmitters are involved in the modulation of pain signals and may play a role in the perception of pain.

2. Clinical Trials and Studies:

  • Efficacy in Chronic Pain: Several clinical trials have investigated the efficacy of duloxetine in various chronic pain conditions, including chronic low back pain.
  • A randomized controlled trial (RCT) published in the “Journal of Pain” in 2010 demonstrated that duloxetine was more effective than placebo in reducing pain severity and improving function in patients with chronic low back pain.
  • Another study published in “Pain Medicine” in 2013 found that duloxetine was effective in reducing pain intensity and improving quality of life in patients with chronic low back pain, particularly in those with a neuropathic pain component.

3. Neuropathic Pain Component:

  • Effectiveness in Neuropathic Pain: Duloxetine has been found to be effective in conditions with a neuropathic pain component. Neuropathic pain is often characterized by abnormal nerve function, and duloxetine’s modulation of neurotransmitters may be particularly beneficial in such cases.

4. Duration of Treatment:

  • Gradual Onset of Action: It’s important to note that the pain-relieving effects of duloxetine may take some time to become apparent. Studies often involve several weeks of treatment before significant improvements are observed.

5. Comparison with Other Treatments:

  • Comparative Studies: Some studies have compared duloxetine with other medications commonly used for chronic pain, such as pregabalin or tricyclic antidepressants. Results suggest that duloxetine may be comparable in efficacy to these agents but with a different side effect profile.

6. Patient Selection and Individual Response:

  • Variability in Response: The response to duloxetine can vary among individuals. Factors such as the specific characteristics of the pain (neuropathic vs. non-neuropathic), comorbidities, and individual differences may influence its effectiveness.

7. Adverse Effects and Tolerability:

  • Side Effects: Common side effects of duloxetine include nausea, dry mouth, dizziness, and fatigue. Some patients may experience more severe adverse effects, such as changes in blood pressure or liver function.
  • Tolerability: The tolerability of duloxetine varies among individuals, and clinicians need to weigh the potential benefits against the risks and side effects when prescribing it.

8. Considerations for Clinical Practice:

  • Multidisciplinary Approach: Duloxetine is often used as part of a multidisciplinary approach to pain management, which may include physical therapy, lifestyle modifications, and other interventions.

9. Long-Term Use and Discontinuation:

  • Long-Term Considerations: Long-term use of duloxetine for chronic pain management requires careful consideration of benefits and potential risks. Clinicians should monitor patients regularly and assess the need for continued treatment.

In summary, duloxetine has shown efficacy in the management of chronic pain, including back pain, especially when there is a neuropathic component. However, individual responses and considerations for potential side effects should be taken into account when prescribing duloxetine for back pain. It is crucial for healthcare providers to engage in a thorough evaluation of each patient’s condition and consider a comprehensive approach to pain management. Additionally, ongoing research is needed to further understand the optimal use of duloxetine and its place in the broader spectrum of back pain treatments.

Discuss in-depth the research and science of personalized messages to teach lifestyle skills for pain management related to back pain

Personalized messages for teaching lifestyle skills in pain management, particularly for back pain, involve tailoring communication to individual preferences, needs, and circumstances. The use of personalized messages is rooted in the broader field of health communication and behavior change. Here’s an in-depth discussion of the research and science related to personalized messages for teaching lifestyle skills in the context of back pain management:

1. Tailoring and Personalization:

  • Behavior Change Models: Tailoring messages for individuals with back pain often draws upon behavior change models, such as the Health Belief Model or the Transtheoretical Model. These models consider an individual’s readiness to change, perceived barriers, and self-efficacy in adopting new behaviors.

2. Effective Communication Strategies:

  • Individual Preferences: Personalized messages take into account individual preferences for communication channels (e.g., text messages, emails, in-person sessions) and content (e.g., visuals, text-based information).
  • Cultural Sensitivity: Tailoring messages to the cultural background and beliefs of individuals can enhance their relevance and effectiveness.

3. Content and Lifestyle Skills:

  • Educational Content: Personalized messages often include educational content about lifestyle skills relevant to back pain management, such as proper body mechanics, exercises, and stress reduction techniques.
  • Skill-Building: Messages may focus on building specific skills, like incorporating physical activity, practicing mindfulness, or improving sleep hygiene, tailored to the individual’s needs and abilities.

4. Mobile Health (mHealth) and Technology:

  • Mobile Applications: Research in mHealth has explored the effectiveness of mobile applications in delivering personalized messages for pain management. These apps can provide real-time feedback, reminders, and educational content.
  • Wearable Devices: Integration with wearable devices allows for the monitoring of physical activity levels, sleep patterns, and other relevant health metrics.

5. Evidence-Based Approaches:

  • Integration with Clinical Guidelines: Personalized messages are often designed based on evidence-based guidelines for managing back pain, incorporating recommendations from healthcare professionals and expert consensus.
  • Behavioral Therapy Components: Some personalized interventions draw on principles of cognitive-behavioral therapy to address maladaptive thoughts and behaviors related to pain.

6. Patient Empowerment and Self-Efficacy:

  • Empowerment Model: Personalized messages aim to empower individuals with back pain by fostering a sense of control over their health. This empowerment can enhance self-efficacy, the belief in one’s ability to successfully perform behaviors to achieve desired outcomes.
  • Goal Setting: Messages may include personalized goal-setting strategies, encouraging individuals to set realistic and achievable lifestyle goals for pain management.

7. Long-Term Engagement and Sustainment:

  • Maintenance Strategies: Research explores strategies for maintaining engagement with personalized messages over the long term. Regular check-ins, feedback loops, and adapting content to changing needs contribute to sustained engagement.
  • Behavioral Maintenance: The focus extends beyond initial behavior change to the maintenance of lifestyle skills, recognizing that sustained changes are crucial for long-term pain management.

8. Psychosocial Factors:

  • Addressing Psychosocial Factors: Personalized messages may address psychosocial factors, such as stress, anxiety, and social support. Understanding and tailoring interventions to these factors can impact the overall effectiveness of pain management strategies.

9. Challenges and Considerations:

  • Individual Variability: Individuals vary in their response to personalized messages. Tailoring approaches need to consider the diversity in preferences, learning styles, and health literacy levels.
  • Technological Barriers: Access to technology and digital literacy can pose barriers to the effectiveness of personalized messages. Efforts to bridge these gaps are essential.

In conclusion, the research and science of personalized messages for teaching lifestyle skills in pain management for back pain highlight the importance of tailoring interventions to individual needs, preferences, and circumstances. By leveraging behavior change models, incorporating evidence-based approaches, and utilizing technology, personalized messages can enhance patient engagement, empowerment, and the adoption of lifestyle skills for effective back pain management. Continued research and refinement of these personalized approaches are critical for optimizing their impact and integration into comprehensive pain management strategies.

Discuss in-depth the research and science of exercise therapy with stretches, strength training, and hands-on treatment by a physical therapist or chiropractor relating to back pain


Exercise therapy, including stretches, strength training, and hands-on treatments by physical therapists or chiropractors, is a common and evidence-based approach to managing back pain. The integration of these components aims to improve flexibility, strengthen supportive muscles, and address biomechanical issues that contribute to back pain. Here’s an in-depth discussion of the research and science related to exercise therapy for back pain:

1. Stretches for Back Pain:
Flexibility and Range of Motion: Stretching exercises are designed to improve flexibility and the range of motion in the spine and surrounding muscles.
Research Evidence: Studies have shown that stretching exercises can help alleviate back pain by reducing muscle stiffness and improving overall mobility.
Types of Stretches: Dynamic stretching, static stretching, and specific stretches targeting muscle groups like the hamstrings and hip flexors may be included in a comprehensive exercise program.

2. Strength Training for Back Pain:
Muscle Support and Stability: Strength training focuses on building the strength of the muscles that support the spine, including the core, back extensors, and abdominal muscles.
Research Evidence: Research supports the effectiveness of strength training in reducing back pain and improving function. Increased muscle strength contributes to better spinal stability and decreased stress on the spine.

Core Strengthening: Core exercises, such as planks and bridges, are commonly incorporated to enhance stability and support for the lower back.
3. Hands-On Treatment by Physical Therapists:
Manual Therapy Techniques: Physical therapists often use hands-on techniques, such as joint mobilization, massage, and manipulation, to address musculoskeletal issues contributing to back pain.
Research Evidence: Studies suggest that manual therapy, when combined with exercise, can be more effective than exercise alone in reducing pain and improving function.
Individualized Approach: Physical therapists tailor manual therapy interventions based on the specific needs and conditions of each patient.

4. Chiropractic Care for Back Pain:
Spinal Manipulation: Chiropractors often employ spinal manipulation techniques to address misalignments or joint dysfunctions in the spine.
Research Evidence: Systematic reviews and meta-analyses support the use of chiropractic care, particularly spinal manipulation, for acute and chronic back pain. It is considered a safe and effective option in many cases.
Multimodal Approaches: Chiropractors may also incorporate exercise and lifestyle recommendations into their treatment plans.

5. Multidisciplinary Approaches:
Comprehensive Care: Combining stretches, strength training, and hands-on treatment in a multidisciplinary approach is often more effective than individual interventions alone.
Collaboration: Physical therapists, chiropractors, and other healthcare professionals may collaborate to develop integrated treatment plans for individuals with back pain.

6. Patient Education:
Empowering Patients: Exercise therapy involves educating patients about the importance of maintaining an active lifestyle and performing prescribed exercises independently.
Self-Management: Teaching self-management strategies empowers individuals to take an active role in their recovery, contributing to long-term success.

7. Adaptation and Progression:
Individualized Plans: Effective exercise therapy recognizes the importance of individualization. Treatment plans should be tailored to the specific needs, abilities, and goals of each patient.
Progressive Loading: Gradual progression in the intensity and complexity of exercises is essential for continued improvement and prevention of future episodes of back pain.

8. Psychosocial Considerations:
Addressing Psychological Factors: Exercise therapy programs may incorporate strategies to address psychosocial factors contributing to back pain, such as stress and anxiety.
Patient-Centered Care: Considering the patient’s psychosocial well-being is integral to providing patient-centered care.

9. Long-Term Management:
Maintenance and Prevention: Exercise therapy is not only a treatment for acute back pain but also a crucial component of long-term management and prevention of recurrent episodes.
Lifestyle Integration: Encouraging the integration of exercise into daily life, including work-related activities and recreational pursuits, contributes to sustained benefits.

In conclusion, the research and science of exercise therapy for back pain, encompassing stretches, strength training, and hands-on treatment by physical therapists or chiropractors, highlight the multifaceted nature of effective interventions. Evidence supports the role of these approaches in reducing pain, improving function, and promoting long-term back health. The individualization of treatment plans, collaboration among healthcare professionals, and consideration of psychosocial factors contribute to the success of exercise therapy in managing and preventing back pain.


Nonsurgical approaches

Studies have shown that nonsurgical approaches can be more effective and less expensive than surgery. A recent University of Pittsburgh study of nearly 30,000 patient records over three years found that patients who first seek out physical therapy or chiropractic care have better outcomes and lower costs. Patients who first sought care through an emergency department, by contrast, were more likely to have high-cost imaging and steroid injections; and more than half of them filled prescriptions for opioids, compared with just 11% among those who sought chiropractic care and physical therapy first.

One of the most puzzling aspects of back pain is that patients who have had physical damage to their lower back may not have any pain, while others who have little visible damage can have a great deal of pain.

“What we see on the X-ray, or the MRI may not tell the whole story, so we have to address all aspects of a person’s condition to better characterize who needs what type of treatment,” says Dr. Gwendolyn Sowa, director of the UPMC Rehabilitation Institute at UPMC, a large healthcare provider affiliated with the University of Pittsburgh.

Part of the Bacpac consortium, UPMC is one of an increasing number of healthcare providers taking a more holistic approach. Experts in its spine health program evaluate sleep habits, nutrition, exercise, social engagement, and lifestyle. Patients may see pain psychologists, physical therapists trained specifically in spine care, surgeons and physiatrists, the specialized physicians who focus on nonsurgical treatments for back pain.

Dr. Christopher Standaert, a UPMC physiatrist who oversees the program, says the center has had success in helping patients identify what works best for their pain, with a low percentage needing surgery or steroid injections and the majority benefiting from physical therapy and other lifestyle and mental health interventions.

“Patients aren’t just afraid of pain; they are afraid of what might come of it—‘Am I going to be able to play with my children or work in my garden?’ ” says Standaert. By overcoming fear and reconnecting patients to movement and activities they enjoy, “they can live well, age well, and successfully adapt.”

Downward spiral

Vinny Rossitto, 67, a former Navy officer and retired businessman, says his back first went out in 1986, and he had recurrent and often severe bouts of pain. He took anti-inflammatory medications and Valium and regularly visited a chiropractor, but things only got worse over time.

By 2017, diagnosed with degenerative disk disease, lumbar spinal stenosis, and scoliosis, he was finding it hard to walk. He cycled through treatments including physical therapy, opioid and other medications, steroid injections, an antidepressant, and an anticonvulsant drug. The stenosis and scoliosis worsened by 2022, but he says he wasn’t considered a good candidate for surgery.

“I was spiraling downward and mentally resigned and depressed. I gave myself a year before I thought I would be in a wheelchair,” he says.

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