Most spinal conditions do not require surgical treatment. This means that the vast majority of spinal problems can be managed with non-operative care (often called “conservative care”). Each patient and each case must be approached in a very individual manner, and any treatment program should only be recommended by a physician after a thorough evaluation. This section will give you some very general information regarding non-operative approaches to pain and functional recovery from a spine related problem.
TREATMENT OF SPINAL PAIN
Back pain is the third most common reason for patient visits to physicians’ offices, and affects up to 80% of the adult population at some time. The precise cause of low back pain is poorly understood and only 10-20% of all patients have their pain attributed to an accepted, definable diagnosis. In the majority of cases low back pain tends to disappear with time. In about 90% of patients symptoms resolve within 3 months of onset.
True, low back pain is defined as pain located between the lower rib cage and the buttocks. This pain may occasionally extend down to the level of the knee but not beyond. If back pain is associated with numbness, tingling or weakness in the legs then it is possible that irritation of neurologic structures is present (see herniated disc, spinal stenosis). Leg pain with symptoms that extend to the feet is thus usually a separate condition from back pain and may require a different treatment program than for back pain alone.
Conservative treatment (non-operative) for back and leg pain varies greatly depending upon the cause and severity of the pain. There are a number of common treatment approaches available including the following:
Spinal Medications — Pain Management
This is a brief outline of common medications that are prescribed by a physician as part of the treatment in back or leg pain. A thorough evaluation and discussions with a physician are necessary to properly guide treatment. It is important to note that any medication can lead to allergic reactions or side effects; this must be discussed in detail with the prescribing physician and pharmacist.
- Anti-inflammatories – this is a group of medications that specifically aim to decrease inflammation in tissues, they can be quite effective in mild and moderate pain. Side effects (aside from allergic reactions) may include the following: stomach upset, gastritis, ulcer problems, kidney and liver problems.
- Analgesics – this group of medications aims at reducing the sensation of pain without any specific action at the source of the pain. In a sense, this covers, or dampens the pain feeling but does not actually treat the site of the problem.
- Muscle relaxants – these medications aim to loosen the tension and irritability of muscle tissue. By relaxing a very tense muscle, the pain due to spasm and cramping can be reduced. Some patients become very drowsy with these medications.
- Combination drugs – these combine different types of medications to offer, for example, pain relief and anti-inflammatory effects.
- Narcotics – these are pain medications, which are quite strong, and act on the brain and spinal cord to decrease the sensation of pain. Due to addiction potential and risks of overdosage, these medications are restricted in use and require special prescriptions from a physician.
- Antidepressants – in some cases mild doses of antidepressant medication may offer added relief from chronic pain and nerve related pain.
These are treatments designed to decrease pain that involve externally applied methods directly to an affected area (ex. Lower back). They are frequently prescribed by a physician and may be applied by a therapist.
- Heat/cold packs – particularly in injuries, a cold compress (or ice water in a bag) locally applied to the injury area may decrease pain and swelling. After a while, switching to heat (heating pad, warm compress) can help increase circulation to an injured area and with that accelerate healing. In the setting of muscle spasm or tension, heat and cold can also be helpful in controlling pain.
- TENS – Transcutaneous Electrical Nerve Stimulation (TENS) consists of placing electrical pads directly onto the skin in an area of pain. When connected to a special machine, these pads send a low level of electrical current to the tissue, thereby controlling the local pain response to offer relief.
- Massage – this is usually performed by a therapist and involves rubbing and applying pressure to specific areas of tension in muscle tissue. A number of massage techniques exist and therefore experience and proper training by a therapist are important to obtain maximal benefit. Massage is often applied in the setting of muscle spasm and tension.
- Ultrasound – involves a machine that sends vibrating impulses (waves) through tissues and can reach deep to the skin in areas of pain. It is thought that the ultrasound waves release tension and increase blood supply thereby augmenting the action of natural pain relief substances.
- Trigger point injections – some specialists feel that local pain in the back, buttocks or legs is due to specific points of tension called trigger points. In theory, some specialists believe that pain can be relieved through injecting a solution directly into a trigger point. A common setting in which repeated trigger point injections may be attempted is fibromyalgia.
- Acupuncture – in some Asian countries there is a long history of performing needle placement into selected points of the body in order to relieve pain. This has been attempted in the treatment of back pain. Although there is no clearly proven effectiveness for many treatment types, some people feel that acupuncture has given them good relief from back and leg pain.
- Traction – this involves producing tension across an area of the back or neck with an aim at reducing pain. Although many contraptions have been designed to offer traction, there is unfortunately no clear proof that they are effective. Never-the-less, some patients feel that traction offers temporary relief of pain.
There are a wide variety of collars, binders, belts, braces and other devices designed to offer relief from neck and back pain. Their effectiveness in most cases has not been clearly proven, and yet many patients do feel some relief from their pain with some of these applied devices. Long-term wear of back braces may however lead to gradual weakening of the supportive muscles due to an effect of unloading and may therefore not be desirable.
As part of non-operative care, your physician may prescribe a program of physical therapy or exercises. The purpose of such treatments is usually to assist you in restoring muscle tone and muscle strength. The muscular supports of the spine are crucial to maintaining good function and stability of the back. With aging, injury or underlying spinal problem it is very common for the back musculature to become weakened, with diminished tone and easy fatigability. In fact, poor muscle condition can be a significant source of disability and pain itself.
The principle to most physical therapy approaches in spinal conditions is twofold: pain modality treatment (as described above) and structured guided strengthening programs for restoring good muscle function. There are many different types of exercise programs and particular focus on isometric strengthening appears to be quite beneficial for many patients. Isometric exercises involve activities that stimulate contraction of a muscle (working the muscle) while maintaining the length of that muscle (ie. no significant motion across the span of the muscle). Vigorous movements or extremes of motion are often avoided in physical therapy approaches to spinal care.
Most patients that see benefit with a physical therapy program are advised to maintain some form of regular exercise on a long-term basis. Even patients with mild or intermittent back pain and no severe underlying problem can receive benefits with regular exercise. A number of studies have shown that regular aerobic activity reduces the chance of developing repeated back injuries. Clear advantages of one type of sport over another have not been shown and it therefore may be most important to find some activity that is enjoyable and easy to maintain on a regular schedule (ex. swimming, fast walking, running…)