Read an Excerpt
From Chapter Three: Common Conditions
An allergy is a hypersensitivity to a normally harmless substance. The body's immune system perceives these substances, called allergens, as harmful and reacts accordingly. White blood cells produce antibodies that neutralize the allergen. The reaction between antibody and allergen releases chemicals, most notably histamine, that cause the body to experience a variety of uncomfortable symptoms.
Allergens can be taken into the body by inhalation, through contact with the skin, or by ingestion of food or medications. Among the most common allergens are pollens, including the pollens of trees, grasses, and weeds; molds, which reproduce by means of airborne spores; animal dander, minute bits of sloughed-off skin from animals; dust; certain foods, such as milk, wheat, eggs, peanuts, and shellfish; certain medicines; and venom from stinging insects such as bees.
Symptoms: Allergy symptoms vary depending on the individual, the allergen, and how the allergen entered the body. The most common type of reaction, generally from inhaled allergens, is allergic rhinitis, or hay fever, which is characterized by sneezing; a runny, itchy nose; nasal congestion; and itchy, watery eyes. Hives, or urticaria, are red, raised, swollen, and itchy patches on the skin. Common reactions to food and drugs, they can be isolated or spread over the body. Allergic contact dermatitis is a skin rash that occurs at the site where an allergen (such as poison ivy) has come in contact with the skin. Atopic dermatitis, or eczema, a chronic rash, may also be triggered or exacerbated by allergens. The most serious allergic reaction is anaphylaxis, which is life-threatening and is characterized by respiratory distress and shock.
Diagnosis: Skin and blood tests can determine whether symptoms are caused by an allergy, and to what substance or substances the person is allergic. A food diary, including the date and time of foods eaten, along with any symptoms, their duration, and what action you took, can help with the diagnosis of food allergies, notes Amy Berndt, MSN, MPH, RN, FNP, of the University of Nevada in Reno.
Treatment: Treatment consists of allergen avoidance, prescription or over-the-counter medications to relieve symptoms, and, possibly, immunotherapy, or allergy shots, which are regular injections of the allergen given to desensitize the body to the substance. Medications include antihistamines, which prevent the release of histamine and help reduce swelling, itching, and tearing and help dry up runny nose; decongestants, which constrict blood vessels and shrink swollen mucous membranes to stop nasal congestion; and corticosteroids, hormonelike anti-inflammatory drugs used to treat respiratory and skin allergies.
Self-care: Because allergies are a disorder of the immune system, some experts recommend that you take steps to improve your immunity.
- Increase your dietary intake of essential fatty acids, especially omega-3 fatty acids, suggests Kathy Niemeyer, MSN, RN, CCRN, of Grand Valley State University in Allendale, Michigan. Good sources of these are fish oils and flaxseed oil, she says.
- Increase your intake of vitamin C to at least 1 gram (1,000 milligrams) a day, Kathy Niemeyer suggests. There is some evidence that vitamin C lowers blood levels of histamine.
- Keep windows and doors closed when the pollen or mold count is high.
- Monitor pollen and mold counts and avoid outdoor activity when they are high.
- Use an air conditioner or air purifier, suggests Mary Ann Zakutney, Ph.D., RN, CFNP, of Georgetown University in Washington, D.C.
- Get rid of dust collectors such as carpeting, throw pillows, and heavy drapes, suggests Yvonne Sehy, Ph.D., RN, FNP, GNP-C, of the University of Utah in Salt Lake City.
- Use a dehumidifier to help reduce the growth of dust mites, molds, and fungi during summer humidity.
- Avoid doing yard work, mowing the lawn, and raking leaves.
- Wear a filter or mask to prevent inhalation of allergens.
- Clean your home as often as possible to remove pollen, dust, mold, and animal dander.
- Wash your bedding, synthetic pillows, and mattress pads often in hot water.
- Encase your mattress and pillows in plastic to reduce the amount of dust mite particles in the air.
- Avoid hanging clothes, sheets, and blankets outside to dry.
- When introducing new foods to children, wait 72 hours before giving them another new food so that you can see if they have an allergic reaction, suggests Janyce Cagan Agruss, D.N.Sc., RNC, NP, of Rush University College of Nursing in Chicago.
- Be knowledgeable about product labels so that you can avoid things you react to, says Lygia Holcomb, DSN, RNC, FNP, of the University of Central Florida in Orlando.
- When allergies strike, seek relief.
- Use a cool compress to soothe itchy, red, swollen eyes.
- Flush your nose with saline nasal spray or a homemade saline solution (1 teaspoon of salt in 1 quart of lukewarm water), suggests Sharon Johnson, Ph.D., RN, FNP, CS, of San Francisco State University. This soothes irritation, keeps the nasal passages moist, and helps remove some of the offending allergens. You can bend over a sink, says Johnson, and use an enema bucket with a soft tube to spray the solution into your nose.
- To soothe the itch of hives, poison ivy, and other skin allergies, apply calamine lotion or add 1/2 to 1 cup of oatmeal to a tub of warm water and bathe, suggests Madeline Gervase, RN, MSN, CCRN, FNP, of Rutgers, the State University of New Jersey in Newark. Janyce Cagan Agruss of Chicago suggests a paste made from baking soda and water and applied
- to hives to reduce swelling and itching. A paper towel dipped in white distilled vinegar can also provide relief, she says. A cool bath to which you've added several spoonfuls of baking soda can also be soothing, suggests Paula Siciliano, AP, RN, MSN, GNP, of the University of Utah in Salt Lake City.
- If you have a serious allergy that may cause anaphylaxis, wear an alert bracelet and carry an emergency adrenaline kit, says Tracy Call-Schmidt, RN, MSN, FNP-C, of the University of Utah in Salt Lake City. If no kit is available and you have a reaction, Call-Schmidt suggests you pull apart a Benadryl capsule and place it under your tongue to help you breathe until emergency personnel arrive.
- Try herbal therapy. Several herbs may be helpful in treating allergies, says Kathy Niemeyer, who is a member of the American Herbalist Guild. These include stinging nettle, feverfew, ginger, and ginkgo biloba, she says. You may use the herbs in tincture form (by mixing a few drops with water or juice), except for stinging nettle, which is used in tea form only. They are also available in pill form made from standardized extracts. When taken internally, the herbs act like antihistamines.
Brand names of topical antihistamines, which are applied to the skin to relieve itching, include the following: Benadryl Itch Stopping Cream/Spray/Gel and Calagel Clearly Calamine.
Brand names of oral decongestants include the following: Advil Cold & Sinus, Allerest No Drowsiness, Congespirin for Children Aspirin-Free, Dimetapp Decongestant Pediatric, Dristan Cold Maximum Strength No Drowsiness, Sine-Off Maximum Strength No Drowsiness, and Sudafed.
Some topical decongestants, which are applied directly to the nose and generally act faster than oral decongestants, are Afrin 12-Hour, Dristan 12-Hour, Neo-Synephrine 12-Hour, Otrivin Pediatric, and Vicks Sinex 12-Hour.
Combinations of oral antihistamines and decongestants are also available. Examples include Actifed, Benadryl Allergy Decongestant Medication, 12-Hour Allergy Decongestant, Dristan Cold Multi-Symptom, Novahistine, Tavist-D Antihistamine/Nasal Decongestant, and Vicks DayQuil Allergy Relief 12-Hour.
The primary antipruritic, or itch-relieving, medication available over the counter for the treatment of allergies is hydrocortisone, a topical corticosteroid that reduces inflammation. Examples include Bactine Hydrocortisone 1%, Cortaid, Lanacor, and Tegrin-HC.
More than 100 different conditions can be called arthritis, and they all have two things in common -- they affect the joints and cause pain. The two most prevalent forms of arthritis are osteoarthritis and rheumatoid arthritis. Osteo-arthritis, the most common form, involves the breakdown of cartilage and other tissues in a joint and is often called wear-and-tear arthritis. It generally affects older adults. The areas most commonly affected are the hips, knees, feet, and spine. Rheumatoid arthritis involves joint inflammation, but it can also affect other parts of the body, including connective tissues and the tissues that surround organs. It often starts at a young age, and its cause is unknown.
Symptoms: The primary symptom of osteoarthritis is pain, which usually begins as an ache or stiffness after unusual exercise or periods of inactivity. Symptoms of rheumatoid arthritis include fatigue, weight loss, fever, and general malaise, in addition to joint stiffness and pain. The symptoms of both kinds of arthritis may come (in what's called a flare-up) and go (in a remission). If left untreated, the affected joints may become deformed.
Diagnosis: Physical examination, X rays, and analysis of joint fluid may help in the diagnosis of both osteoarthritis and rheumatoid arthritis. The diagnosis of rheumatoid arthritis usually also involves a series of blood tests, including a test for rheumatic factor (a protein that signals the presence of inflammation). In difficult cases, techniques such as magnetic resonance imaging (MRI) may be used.
Treatment: There is no cure for arthritis; treatment focuses on relieving symptoms. A hallmark of treatment for both osteoarthritis and rheumatoid arthritis is pain relievers, notably acetaminophen, aspirin, and other non-steroidal anti-inflammatory drugs (NSAIDs). Two recently approved drugs used in the treatment of arthritis are Cox-2 inhibitors and biological modifiers. Ask your practitioner if these might be helpful. The NSAIDs, which are available both by prescription and over the counter, help relieve pain and inflammation. They should be taken with food, says Janyce Cagan Agruss of Chicago. Steroids such as prednisone and cortisone may also be prescribed to reduce the inflammation and relieve the pain of rheumatoid arthritis. Other drugs, known as remittive agents, are thought to slow the progression of rheumatoid arthritis. The drugs most commonly prescribed are gold salts, Plaquenil (a malaria drug), penicillamine, and methotrexate.
Surgery is used as a last resort to treat both types of arthritis. For osteoarthritis, surgery may be used to replace an entire joint or to remove floating bits of cartilage and bone around the joint and resurface or reline the ends of bones so they can move freely against each other. For rheumatoid arthritis, a surgical procedure called synovectomy is used to replace the lining of the joint. Joints may also be altered or replaced depending on the progression of the disease.
Self-care: You can do several things on your own to alleviate arthritis pain.
- Maintain the proper weight. Being overweight puts stress and pressure on joints, which can increase inflammation and pain.
- Exercise. This not only helps reduce weight but is also effective in relieving symptoms of both osteoarthritis and rheumatoid arthritis. Exercise helps you get moving and stay moving; easy weight-bearing exercise helps build muscles and strengthen joints, says Amy Berndt of Reno, Nevada. Easy stretching is also helpful, she says. Water aerobics and swimming are recommended as well: they reduce pressure on the knees and hips, says Paula Siciliano of Salt Lake City.
- Stay away from high-impact exercises such as running. Protect your knees and elbows against injuries when playing sports by wearing protective gear such as knee pads and elbow pads. Braces can provide stability and decrease joint stress, notes Paula Siciliano of Salt Lake City. Lygia Holcomb of Orlando, Florida, advises using a cold pack on joints after exercise to prevent swelling.
- Practice good posture. Standing and sitting up straight can help reduce pressure on the joints, especially those of the spine.
- Learn to perform your job without stressing your joints. Ergonomic office equipment and work tools can help reduce stress on your joints, especially if your job requires repetitive movements.
- Try applying heat or cold. Applying heat to joints increases blood flow and loosens joints; cold treatments can help relieve pain. Yvonne Sehy of Salt Lake City suggests alternating heat and cold for relief. "But don't use an electric heating pad for heat. Instead use a pack that you heat in the microwave, or anything that cools down naturally. For cold, use gel packs that you freeze." Don't put ice directly on your body, warns Lygia Holcomb.
- Soak in a whirlpool or hot tub; it loosens tight joints while providing buoyancy to reduce some of the pressure on affected joints.
- Use an Ace bandage on an affected joint while you are awake, suggests Paula Siciliano of Salt Lake City.
- To relieve pain and redistribute the force on your joints, use orthotic supports such as wedge insoles in your shoes, Paula Siciliano advises.
- Try glucosamine and chondroitin, suggests Mary Ann Zakutney of Washington, D.C. Zakutney says these supplements help the cartilage absorb more water and relieve friction in the joints. Siciliano recommends up to 1,500 milligrams of glucosamine and 100 milligrams of chondroitin a day.
- Watch what you eat. Though there is no definitive evidence, some experts believe that certain foods are linked to arthritis symptoms. In some studies, milk and cheese have been found to cause symptoms. Other research shows that foods in the nightshade family (potatoes, bell peppers, tomatoes, eggplant, and chili peppers) trigger arthritis flare-ups. Some studies have indicated that fish oil helps alleviate some symptoms of rheumatoid arthritis. Pineapple may also help, says Kathy Niemeyer of Allendale, Michigan, noting that the fruit contains an anti-inflammatory substance. If the pineapple causes soreness in your mouth, dip it in honey before eating it, she says.
- Try acupuncture, which involves the insertion of small, thin needles under the skin and may help relieve arthritis symptoms temporarily in some individuals.
- Consider herbal therapy, too, which has met with some success. Herbs that may be helpful include arnica, meadowsweet, cayenne pepper, devil's claw, and feverfew. Arnica is typically used in cream form, says Kathy Niemeyer of Allendale, Michigan. The other herbs may be used in tea, tincture, or pill form. You may also find combinations of these herbs as teas, tinctures, or pills.
Over-the-counter treatment: NSAIDs help relieve pain and inflammation and are commonly used to treat arthritis. They work by blocking the production of prostaglandins (chemicals believed to be responsible for producing pain and inflammation) at the site of an injury. The most well known NSAID is aspirin, which is available in both generic and brand-name forms. Brand-name aspirins include Anacin, Ascriptin Regular/Maximum Strength, and Bayer Aspirin. Other NSAIDs available over the counter include Advil, Nuprin, Orudis, and Aleve.
Another over-the-counter product, acetaminophen, relieves pain but does not reduce inflammation.
Allerest Headache Strength
Allerest Sinus Pain Formula
Anacin Aspirin Free Maximum Strength
Anacin P.M. Aspirin Free
Bayer Select Maximum Strength Headache Pain Relief Formula
Excedrin Aspirin Free
Midol Menstrual Multisymptom Formula
Panadol Maximum Strength
St. Joseph Aspirin-Free Tablets for Children
Tylenol Extra Strength
Tylenol Regular Strength
Unisom with Pain Relief
In addition to analgesics, some people find relief through counterirritants, topical medications that induce sensations such as heat and cold to distract sufferers from muscle and joint pain. Counterirritants include capsaicin (the substance that makes hot peppers hot) and menthol. Products containing capsaicin include the following:
Arthricare Odor Free Pain Relieving Rub
Products containing menthol include the following:
Ben-Gay Arthritis Extra Strength Rub
Mentholatum Deep Heating Arthritis Formula Rub
Asthma is a disease in which the air passages in the lungs periodically become narrowed, obstructed, or even blocked. The airways usually narrow in reaction to certain stimuli, typically something inhaled. These stimuli are commonly called triggers. When a person with asthma comes into contact with a trigger, the muscles that encircle the bronchial air passages squeeze the passages, reducing airflow. These contractions are known as bronchospasms. In addition, the linings of the bronchial tubes become inflamed and swollen, which narrows the air passages; the linings also produce a large amount of thick, gummy mucus, which can further narrow and clog the air passages.
Asthma triggered by allergies is known as extrinsic asthma. It is also called allergic, or atopic asthma. In this form of the disease, an asthma attack is clearly linked to the body's response to something inhaled or, occasionally, ingested. The most common allergens are tree and grass pollen, mold, animal dander (pieces of sloughed-off skin, much like dandruff), and dust mites. Asthma that develops in people over the age of 30 is usually intrinsic, or nonallergic, asthma. This form of asthma may be triggered by respiratory infections, exercise, stress, inhalation of chemical irritants (such as cleaning fluids or paints), and air pollution.
Symptoms: Asthma attacks are characterized by wheezing, coughing, chest tightness, and shortness of breath.
Diagnosis: Generally, diagnosis involves a medical history, physical examination, and an evaluation of your pulmonary function (how well your lungs operate). Your practitioner is looking for two critical signposts: 1) that airway obstruction or narrowing is episodic, and 2) that airway obstruction improves with medication or self-care. Once these are established, diagnostic tests or procedures may be ordered to determine what is causing the airway obstruction or to rule out other conditions.
Treatment: Medications prescribed for the treatment of asthma reverse symptoms during an acute attack and prevent the onset of attacks. Asthma drugs are generally placed in two categories -- quick relief medications used to treat acute attacks (bronchodilators), and long-term-control medications (anti-inflammatory drugs and leukotriene modifiers). Anti-inflammatory medications, including steroids, prevent inflammation of the airways or, if inflammation is already present, stop it from getting worse. Leukotriene modifiers, a relatively new class of drugs, attack substances that contract the airways, increase mucus secretion, and activate inflammation.
"Understand your treatment plan," says Janyce Cagan Agruss of Chicago. "If you use inhalers (steroids and bronchodilators), use the bronchodilator first, then wait three to five minutes and use the steroid inhaler. After using the steroid inhaler, always rinse your mouth with water because the steroid can cause infections in the mouth."
Self-care: Self-care is the cornerstone to managing asthma. "Asthma is a disease that takes a lot of responsibility and self-care," says Lygia Holcomb of Orlando, Florida.
- "Know what your breathing capacity is and carefully monitor it so you don't get into trouble," says Holcomb. You can do this by taking your peak flow measurement. You take a deep breath while holding a peak flow meter in front of your mouth, exhale hard, fast, and quick, then read the marker
- on the meter's scale. This measures airway obstruction and can give you
- advance notice of progressive airway narrowing so that you can take
- preventive medications. "This is the best way of making an objective deter-
- mination of how well you're breathing and how well your lungs are functioning," says Barbara Sarter, Ph.D., RN, FNP-C, of the University of Southern California-Los Angeles.
- Learn to recognize your triggers, says Janyce Cagan Agruss of Chicago. That way you can eliminate your exposure to them or prepare for your exposure, says Lygia Holcomb. If your asthma is triggered by allergies, follow the avoidance tips in the "Allergies" section. If irritants are your problem, do what you can to avoid them.
- Don't smoke, and restrict smoking inside your house, suggests Paula Siciliano of Salt Lake City.
- Don't use chemicals inside; if you must, wear a dust mask or, better yet, have someone else use them for you.
- If certain foods or food additives trigger a reaction, avoid those foods.
- If stress is your problem, take steps to reduce its causes and try a relaxation technique (see "Stress").
- If exercise is a trigger, discuss with your practitioner how to avoid setting off an asthma attack while exercising.
- Exercise. This is an important part of asthma management. It improves muscle tone and builds lung strength and endurance. Aerobic exercise makes the body's muscles more efficient at taking oxygen from the blood, which means the lungs don't have to work as hard to bring in extra air. Exercise can reduce the severity of exercise-induced asthma and make the lungs less sensitive to other triggers. People who experience exercise-induced asthma, however, may need to take preventive medications before they become active. Check with your practitioner, though, before you start any new exercise regimen.
- Drink plenty of water to keep your body hydrated and to thin mucous secretions.
- Get adequate amounts of vitamins and minerals, particularly antioxidants such as vitamins C and E, beta carotene, and selenium. Several studies indicate that these nutrients seem to protect sensitive lungs.
- Try pursed-lip breathing, suggests Paula Siciliano of Salt Lake City.
Brand names of epinephrine include:
Brand names of ephedrine include:
Athlete's Foot and Jock Itch
You don't need to be an athlete to pick up a case of athlete's foot or jock itch. The conditions can happen to anyone. Athlete's foot, or tinea pedis, is a common fungal infection of the feet. Jock itch, or tinea cruris, is a fungal infection of the groin. Because fungi thrive in warm, moist environments such as those created by perspiration, jock itch is common among male athletes, especially those who wear equipment to protect the groin area. It can also be spread by a person, an animal, soil, or even a shower stall. The fungus that causes athlete's foot thrives in warm, moist environments as well. For this reason, locker-room floors, shower stalls, and the like are a primary breeding ground for athlete's foot; however, any surface that your feet come into contact with could potentially transmit the fungus.
Symptoms: Symptoms of athlete's foot include itching, burning, and redness on or between the toes. Most of the time, athlete's foot will not disappear by itself but will instead cause the skin to blister or crack, leaving it susceptible to bacterial infection. The symptoms of jock itch include burning, itching, and red, scaly lesions or rings on the genitals and the inner thighs. Usually jock itch can be identified by its appearance. However, if confirmation of the diagnosis is necessary, the fungus can be cultured in a laboratory to identify its type.
Treatment: Antifungal creams and powders are available by prescription or over the counter. They should be applied for the entire length of time directed, even if the symptoms subside. If jock itch spreads to other parts of the body and becomes "systemic," you should see a health care provider, who will most likely prescribe an oral antifungal to combat it. However, if you're pregnant, you should not take oral antifungal medication, says Janyce Cagan Agruss of Chicago.
Self-care: In addition to using an antifungal product, you can try the following self-care tips:
- Take acidophilus capsules two or three times a day, suggests Mary Ann Zakutney of Washington, D.C. These bacteria are good for any fungal infection, she says.
- Apply tea tree oil, suggests Janyce Cagan Agruss. The oil helps relieve burning and itching when it's applied to the infected area; it can be found in most health food stores, she says.
- Take a foot bath in chlorine bleach, salt water, or vinegar.
- Try garlic. Agruss suggests taking it orally. Kathy Niemeyer of Allendale, Michigan, suggests combining garlic with olive oil in a blender to make a compress that can be applied to the affected area.
- Wear clean white cotton socks, and clean and air out your shoes, says Yvonne Sehy of Salt Lake City. Sandals may be your best option, she says, because they let the air get to the fungus.
Over-the-counter treatment: Antifungal medications come as creams, powders, sprays, and liquids. Liquids and sprays are more appropriate for athlete's foot than for jock itch. These products must be used consistently, notes Yvonne Sehy. Some brand names of antifungal medications are Lotrimin AF, Mycelex, and Absorbine Jr.
Prevention: To prevent athlete's foot, heed the following guidelines:
- Wash your feet at least once a day.
- Keep your feet thoroughly dry. After showering, dry your toes before you put your foot in your shoe, suggests Lygia Holcomb of Orlando, Florida. Some experts suggest applying cornstarch or powder to the toes to absorb moisture.
- Avoid tight shoes, especially in warm weather. Also avoid plastic footwear, suggests Paula Siciliano of Salt Lake City. Leather shoes and sandals are preferable.
- Wear cotton socks rather than those made of synthetic materials. White socks are better than colored socks, which can add to heat buildup inside shoes. Change socks every day.
- Expose your feet to light and air as much as possible. Go barefoot at home if possible. However, if you are prone to athlete's foot, don't go barefoot in locker rooms or around swimming pools, where you could come into contact with the fungus.
- Sprinkle antifungal powder into your shoes during warm months.
Prevention techniques for jock itch are similar.
- Keep your groin area dry and clean to make it inhospitable to the fungus.
- Avoid polyester shorts or clothing, suggests Sharon Johnson of San Francisco. Instead wear absorbent cotton underwear and change clothes as soon as you finish exercising.
- Wear loose-fitting clothes that allow the evaporation of moisture.
- If necessary, use drying powders and products that reduce sweating.
- Always bring a clean towel from home if you plan to shower at the gym -- a breeding ground for fungi and other germs.
- To prevent spreading athlete's foot to the genital area, wash your genital area first, and then your feet, says Sharon Johnson. Also, put socks on your feet before putting them through the legs of your trousers, suggests Barbara Sarter of Los Angeles.
Back pain, triggered when you strain the muscles near your spine, is a very common condition, affecting some 80 percent of adults at some time in their lives. Back pain can occur anywhere in the spine, as well as in the neck, but it more commonly occurs in the lumbar spine, or lower back. Back pain is generally attributed to one of three factors or a combination of the three: strained or sprained muscles, or a problem with a facet joint (such as arthritis), bone disease (such as osteoporosis), or a problem with a spinal disk (such as a herniated, or "slipped," disk). A slipped disk occurs when the protective cushion surrounding the disk bulges out of its normal placement in the spine and presses on the spinal nerves. Back pain may be acute (severe and short-term) or chronic (long-term).
You're more at risk for back pain if you are overweight, sedentary, emotionally stressed, or have a job that requires a lot of lifting and forceful movements. Some people find that emotional stress directly affects their back -- for example, problems at work intensify their back pain.
Symptoms: These depend on the type of back pain. Back pain caused by strains and sprains is dull and achy. Back pain caused by spasms is severe and piercing upon movement. Back pain caused by a slipped disk is pressing and may lessen when you stand up and worsen when you lean forward. If a disk ruptures, the pain is excruciating, and you may feel pain in your legs and feet. Back pain related to the facet joints feels like a constant muscle ache. If the facet joints break down, pain may shoot down your buttocks and legs (called sciatica). The pain worsens when you stand up and lessens when you lean forward.
If your pain is accompanied by fever or difficulty with urination or defecation, see your health care provider, says Connie Kartoz, MS, RN, FNP-C, of Rutgers, The State University of New Jersey in Newark. "These can signal bone infection or neurological problems."
Diagnosis: Back problems are diagnosed and treated by your primary care physician or by a practitioner who specializes in back pain, such as an orthopedist, a neurologist, an osteopath, or a chiropractor. A physical exam can determine how mobile you are, whether the pain comes from your disks, muscles, nerves, or other sources (such as infection or osteoporosis), and what part of your back is affected. If pain lasts for more than a month, diagnostic tools such as blood tests and imaging tests (X rays, magnetic resonance imaging, and CAT scans) may be used. An electromyogram, which measures the electrical impulses in your muscles, may be done if your health care provider suspects nerve damage.
Treatment: A variety of self-care measures (listed on page 69) can help ease back pain. Seek professional help if self-care provides no relief after two or three days. Your health care provider may prescribe corticosteroids, drugs that reduce pain and inflammation. They are used for a short period of time only because of such potential side effects as increased body hair, insomnia, muscle wasting, weight gain, and nervousness. If a muscle spasm is present, muscle relaxants may be needed, says Teri Kaul, MSN, ANP-CS, of Concordia University Wisconsin in Mequon. Christine B. Berding, RN, MSN, CCRN, of the Medical College of Georgia in Athens, notes that these medications may cause drowsiness. If you take them, she advises you to be careful when driving or performing manual activities. They are generally used for no longer than a week, says Paula Siciliano of Salt Lake City.
Treatments other than medication include physical therapy and ultrasound. In the case of a ruptured, or herniated, disk, a procedure called chemonucleolysis might be used: a practitioner injects an enzyme into the disk to shrink it, relieving pressure on the adjacent nerves. This is successful 75 percent of the time, but it may entail a painful recovery.
Sometimes surgery is necessary if back pain is caused by nerve damage, fractures, or dislocations. Two types of surgery are decompression and fusion. Decompression relieves pressure on a nerve or other spinal structure by removing all or a part of the offending disk. Fusion binds together a spinal structure to prevent painful or damaging movement. However, make sure that back surgery is the answer for you because many experts contend that the majority of surgeries performed are unnecessary. Discuss all the risks and benefits of the procedure and get a second opinion before you make a decision.
Self-care: Although several days of bed rest was once standard, recent research suggests that you shouldn't immobilize yourself unless you have to. "The worst thing you can do for back pain is stay in bed," says Sharon Johnson of San Francisco. Moderate activity is recommended.
- Resume regular activity as tolerated. Research indicates that this results in better recovery, improved function, and fewer missed days from work than a program of two days of bed rest and back conditioning exercises, says Judith C.D. Longworth, Ph.D., RN, CS, FNP, cochair of the family nurse-practitioner program at the University of Texas Health Science Center-San Antonio. "Try to maintain as regular a schedule as you can," agrees Amy Berndt of Reno.
- If you must rest, don't overdo it. Lying down for more than two days can make your muscles and bones weak. Periodically walk around during these days of rest even if your back hurts.
- Until your back improves and you are given the okay by your health care provider, avoid heavy lifting, extreme physical activity, and sitting for long periods of time. "Sitting puts a tremendous amount of pressure on your spine," Christine Berding says. "It is much better to stand or lie down."
- During an acute back spasm, sleep on your side in a fetal position or on your back with a pillow under your knees to prevent strain on your lower back, suggests Christine Berding. "The worst position to sleep in is on your stomach. When you get up, roll to your side and slide your legs off the bed first." And make sure your mattress is firm, says Paula Siciliano.
- During the first 24 hours after the pain begins, apply a cold pack for 15 to 20 minutes every two to four hours to numb the area and reduce inflammation, Amy Berndt says. After the initial period has passed, switch to moist heat to increase blood flow to the area for healing. Hot baths and showers are also beneficial at this time. "Adding a quart of Epsom salts to your bathwater will help relieve inflammation," says Berding.
- Exercise. Gentle movement exercises can improve the elasticity and strength of tense, weakened muscles, says Longworth. Exercise also releases endorphins (natural painkillers) in the body and improves the flow of blood and oxygen throughout the body. But if exercise makes back pain worse, don't do it, says Berding.
Berding suggests swimming and gentle stretches such as lying on your back, pulling your knees up to your chest, and holding them for a couple of seconds before lowering them, keeping your knees bent. Longworth says your health care provider can suggest other back and abdominal exercises for maintaining strong back muscles. "Strengthening abdominal muscles also helps support back muscles by building a natural 'girdle' of muscles around the lower back and abdomen," explains Diane E. Witt, RN, MA, CNP, of Minnesota State University-Mankato.
- Add pineapple to your diet, suggests Kathy Niemeyer of Allendale, Michigan. It contains an anti-inflammatory substance.
- Apply a compress of comfrey and cayenne pepper directly to the painful area, Niemeyer suggests, adding that the heat causes the blood vessels to dilate and improves blood flow.
- Consider spinal manipulation (in which manual pressure is applied to the spine to readjust it), which can be done by osteopaths and chiropractors. "Research has shown that seeking chiropractic care for lower back pain may help significantly," Berding says. However, spinal manipulation should be done only by a trained professional.
- Try massage therapy and acupuncture to treat back pain.
Over-the-counter treatment: Pain relievers such as acetamino- phen, aspirin, or other NSAIDs can provide some relief. See "Arthritis" for more information about these medications. Counterirritants may also provide relief. Those used for pain other than arthritis pain include the following:
Absorbine Jr. Extra Strength
Ben-Gay Daytime Pain Relieving Gel/Vanishing Scent Formula
Eucalyptamint Muscle Pain Relief
Pain Gel Plus
Therapeutic Mineral Ice
oil of wintergreen
Ben-Gay Extra Strength
Ben-Gay Greaseless Formula
Ben-Gay Original Formula
Ben-Gay Ultra Strength
Exocaine Medicated Rub, Heet
Mentholatum Deep Heating Rub
Sports Spray Extra Strength
Prevention: "Back pain can become chronic," says Teri Kaul, who recommends that you start a back protection program.
Her suggestions for this program include:
- Exercise daily.
- Warm up before exercising.
- Rearrange your work station if necessary.
- Avoid prolonged sitting.
- Wear good-fitting shoes.
"Proper back mechanics are essential to preventing both initial and re- current problems," says Connie Kartoz of Newark, New Jersey. "Your health care provider or physical therapist can review how to avoid damage to your back."
Diane Witt suggests these preventive body "mechanics":
- When lifting, pivot rather than twist, bend at your knees (not at your waist), and hold objects close to the body, near your center of gravity.
- Size up what you're intending to lift. Know what your limits are. If it is an awkward or heavy object, use equipment to lift it or get someone to help you.
- Don't reach for objects over your head. Use a step stool or a ladder.
- Stretch your muscles before doing any heavy lifting.
Copyright © 2001 by American Association of Colleges of Nursing and People's Medical Society