Pain in the spine and joints is something everyone faces, whether it’s minor or intense. Back and neck pain, as well as pain between the shoulder blades, are common experiences for many. The causes of spine and joint pain are diverse, and as time passes, the likelihood of experiencing this type of pain increases, especially with certain lifestyle factors. Prolonged and improper sitting, increased body weight, physical exertion during work, and injuries throughout life can contribute to these pains. In the modern sedentary lifestyle, where more jobs are done sitting down, almost everyone is at risk of experiencing these pains more frequently.
Characteristics of Back and Joint Pain
Global statistics indicate that over 80% of the population experiences some form of lower back pain at some point in their lives. Patients often try self-medication before seeking medical advice. It is common for several months to pass from the onset of pain symptoms to a doctor’s visit, leading to the development of chronic pain.
“The patient should first undergo an examination in primary healthcare, where they will receive initial therapy from their chosen general practitioner. If symptoms improve with nonsteroidal anti-inflammatory drugs (NSAIDs), are not associated with significant findings on magnetic resonance imaging, and do not cause serious functional impairment, treatment continues with the selected doctor. This approach can resolve more than 70% of all acute pains. Otherwise, if the pain persists or there is serious functional impairment, the patient is referred to an examination with a spinal surgeon,” explains Dr. Marko Aleksić, a specialist in orthopedics and traumatology.
“Chronic pain is a serious physical and psychological problem, and there is a direct connection between chronic pain and depressive disorders. In such situations, we always advise involving a neuropsychiatrist or psychiatrist in the treatment, because despite all our efforts, pain can persist for a long time and, of course, affect the patient’s quality of life and mental state,” says Dr. Marko Aleksić about the impact of chronic pain on the quality of life.
Treatment of Back and Joint Pain
The first line of defense includes nonsteroidal anti-inflammatory drugs (NSAIDs), which must be used for an extended period, not just a few days. These drugs provide immediate relief within a few days, and with prolonged use, they can have a curative effect. This addresses not only the symptom but also the cause—inflammation affecting nerves, spinal joints, cartilage, and bones.
“I recommend aceclofenac, specifically Aflamil, because it combines the best aspects of previously known drugs. In terms of anti-inflammatory response strength, it matches diclofenac but is similar to ibuprofen in terms of safety, which has been known as the drug with the least side effects. Aflamil is a unique drug that provides an adequate response not only to pain but also to inflammation, with the lowest incidence of side effects. These properties, especially its safety, allow us to use it for extended periods,” emphasizes Dr. Aleksić.
Long-term Use of Analgesics for Back and Joint Pain
In severe pain conditions, corticosteroid therapy may be introduced, but its use should be minimized due to its positive effect on inflammation and the seven negative side effects it carries. Balancing positive and negative effects is crucial. NSAIDs, which can be used for years with short breaks and stomach protection, play a significant role here. Detailed medical history, especially regarding the patient’s cardiovascular problems and previous stomach damage, should be considered when starting this therapy. Proper patient selection allows for long-term use of NSAIDs. This therapy has positive health effects even in patients with indications for surgical treatment or those who have already undergone surgery. After surgical intervention, pain may return, mainly due to spinal ossification. Despite surgery addressing acute pain and providing mobility, stability, and spine correction, some degree of pain may persist. In such cases, periodic use of NSAIDs is recommended when pain occurs but not within just a day or two, but at least every 2-3 weeks with proper stomach protection.
Lifestyle and Physical Activity
Physical activity can improve or worsen the condition, as mentioned by Dr. Marko Aleksić:
“I recommend a few days of rest with active use of NSAIDs, primarily Aflamil with proton pump inhibitor, or other stomach protection. Early initiation of physical activity is ideal, even in acute lumbar syndrome when severe pain suddenly occurs. Ideally, the patient should be upright and walking after two days, as the spinal column is most stressed when sitting with the entire body weight on the buttocks. During active walking, the weight is distributed distally down the legs, so there is no prolonged pressure on a single point. Only after completing physical therapy with the use of NSAIDs, providing not only pain relief but also inflammation reduction, can we recommend more intense physical activity. This falls into the phase of maintaining improvement and preventing the recurrence of painful symptoms.”
“To help the spine bear the weight of the body, the first thing to pay attention to is whether the body mass index (BMI), indicating the ratio of body weight to height, is appropriate. Although this index is not an absolutely reliable parameter because not every weight is the same – the weight of an obese person is different from that of a muscular person – unfortunately, regardless of the constitution, the spine bears almost the same pressure. Therefore, it is crucial to consider body weight. Additionally, at this stage, exercise is recommended, including regular walking, swimming, and other activities to strengthen the muscles of the spinal column. Care should be taken in choosing and performing anaerobic activities because, despite their potential benefits, they can also be harmful if not selected or executed correctly. However, this is more in the hands of physiatrists than surgeons.”
In general, physical activity should be performed up to the pain threshold. It is also advised to avoid prolonged sitting, take 5-minute breaks every half hour, and use chairs with lumbar support.
What to Do When Back and Joint Pain Occurs
“If lower back pain occurs without significant trauma, lifting heavy weights, a traffic accident, or a similar injury, try NSAIDs first. I always recommend Aflamil in combination with Controloc or another proton pump inhibitor for stomach protection. If the pain does not subside within seven days, consult your chosen general practitioner. If the chosen doctor determines that the pain persists or is possibly associated with a more serious condition, they should refer the patient to someone who is highly specialized in that field. Regarding lifestyle, an active lifestyle is advised despite most of us sitting or standing at work. If sitting is inevitable, take breaks and stretch every half hour. Also, ensure that the chair provides adequate back support. The same applies to lying down and sleeping; choose a relatively firm surface. Pay attention to nutrition to prevent excessive weight gain, which is a definite risk for the onset of pain. Sports activities should be age and patient-condition appropriate. Aerobic activity, swimming, biking, walking are sufficient,” summarized Dr. Aleksić.
Ass. Dr. Sci. Med. Marko Aleksić, specialist in orthopedics with traumatology, spinal surgeon, works at the Orthopedics and Traumatology Center of the Atlas General Hospital. In his clinical practice, he deals with almost all diseases of the spinal column, including trauma, deformities, and oncological pathologies in the spine, both in adults and children.