Non-Operative Treatment for Back Pain

Nearly 90% of the adult population will experience back pain in their lifetime. Most patients respond to non-surgical treatments. This non-surgical approach is often referred to as "conservative " care. Only 1-2% of those with back pain actually will actually come to surgery.

Medications
Since the majority of pain comes from an inflammatory reaction in bone, nerves, and other soft tissues, the first line of defense is the use of anti-inflammatory medication. Steroids (cortisone) are the most potent anti-inflammatory drug, but long term use has side effects. Therefore, we usually turn to non-steroidal anti-inflammatory drugs (NSAIDs) as our first line of defense in treating the inflammation. In this instance NSAIDs are not taken as pain killers, but as a therapy to reduce inflammation. You must, therefore, take them on a regular daily schedule for a few weeks to experience their effect. I often prescribe a short (6 day) course of steroid pills before starting the NSAID to augment the effect. Several different brands may be prescribed. Examples of NSAIDs include ibuprophen, Motrin®, Aleve®, Celebrex®, Vioxx®, Relafen®, Naprosyn®, Bextra, and Voltaren®.

Do not take these medications if you have had a stomach or intestinal ulcer.

Analgesics-
Pain medications are prescribed for severe persistent pain. It is important that the patient be responsible in taking medications as directed by your neurosurgeon. Abuse of these drugs will only complicate your problems. Take your medication only as they have been prescribed. If you increase your use without calling our office, they will not be renewed. They are very addicting; therefore I will not prescribe inordinate amounts of narcotics. You are responsible for your medications.

Muscle relaxants-
Back spasms are nature’s way of reacting to the inflammation. Spasms try to keep the back still, by stopping the movement. To combat spasms, the neurosurgeon may treat you with muscle relaxants. The medication is not always effective. (Be aware that if unpleasant nighttime dreams arise, it could be a side effect of the muscle relaxant drugs.) They often cause drowsiness.

Corticosteroid (cortisone/steroids)medications-
Steroidal medications are the gold standard in treating inflammation of the spinal nerves. The medication is prescribed either orally or by injections. Injections are often referred to as epidural steroid injections, trigger point injections, or nerve blocks. The medication is delivered directly into the epidural space, around the nerves, by injection. Steroid medications are helpful for 6 out of 10 patients, although the length of effectiveness varies greatly. Injections may be prescribed for two reasons-to relieve the pain, or to help determine the exact location of the pain origin. Oral steroids work nearly as well, but may not last as long.

Back Braces
A brace may be prescribed to test the patient’s response to spine stabilization. A brace restricts mobility, and therefore may be successful in relieving the pain. If the cause of the discomfort is a herniated disk, a brace will not correct the problem. I am hesitant to prescribe braces because they can contribute to weakening the back muscles.

Physical Therapy (PT)
Rehabilitation in the form of PT is an important treatment for many suffering from back pain. Physical therapy helps restore flexibility and strengthens the back and abdominal muscles. This in turn, improves the posture and possibly decreases the pinching of the nerves. Physical therapists provide back education on body mechanics and lifetime fitness programs that help prevent recurrences.

Walking and aquatic exercise is very beneficial to the back pain patient. Walking against water resistance in about 3 feet of water is a good cardiovascular workout and strengthens the back, leg, and abdominal muscles. The pool is also very safe from twisting, falling, etc. Do not swim; just walk and do some stretches.

Land walking is also good activity for the back patient. Wear comfortable shoes, in good weather conditions, on a flat surface, and walk as much as is comfortable. This is not a "pain for gain" scenario.

Summary

Of all the things listed above, it is time that seems to make the most difference. Some 85% of disc problems will resolve if given sufficient time. The trouble is, the patient may not be able to wait. That is, the pain may be intolerable or there may be nerve damage making surgery a better alternative.

The mere presence of a disc herniation or bone spur is not a reason for a patient to have surgery. After the age of forty, disc degeneration and arthritic changes begin in all of our spines. Some people have very little, while others have a great deal. Twenty percent of people randomly studied with CT or MRI will be found to have some degree of disc herniation, even though they are without symptoms.

Many factors are considered when evaluating a patient for surgery. The patient’s ability to withstand a general anesthetic, the overall medical condition of the patient, or whether they have had prior surgery in the problem area. Basically, however, there are two reasons to operate on a disc herniation or stenosis patient. One is if there is nerve damage present. In this case we are trying to reverse or holt the progression of the nerve damage. The other reason is pain. Since the patient is the one with the pain, this decision rests solely with them. If the pain is tolerable and they choose to continue non-operative measures to see if it will go away in time, they should be allowed to do so. If, on the other hand, the pain is disrupting their life and is intolerable, they should consider surgery.

Link:
Acute Low Back Pain
Chronic Low Back Pain