What are the common back pain treatment options?
- Treatments for back pain are multiple and varied. At times, counselling and education about the problem to ease a person’s anxiety is enough to make it tolerable until the episode resolves. A few days of rest can often calm down the pain as well. Prolonged bed rest (more than 2 days to 3 days) is no longer generally recommended. Medications such as non- steroidal anti-inflammatory drugs (NSAIDS) or acetaminophen (Tylenol) can be helpful. Occasionally stronger medications such as muscle relaxants and narcotics are used for a short period.
- Although there is minimal scientific evidence of their effectiveness in treating low back pain, back braces are commonly used. Most common is a corset type brace that can be wrapped around the back and abdomen. People who use them sometimes report feeling better supported and more comfortable. Although there is little definite proof that they help, there is also little risk to using them.
- A number of treatments called passive modalities are also used frequently. These are treatments in which the patient isn’t required to actively do anything. Passive modalities include heat, cold, massage, ultrasound, electrical stimulation, traction and acupuncture. All of these measures can help some people with back pain. How long the benefit will be or what the chances are of receiving benefit from any of these treatments isn’t completely known.
- Another form of passive treatment is spinal manipulation. There are many different practitioners of spinal manipulation, each with their own style of manipulation. This has also at times improved symptoms of back pain.
- Injections are sometimes used as well. The most commonly used medications are local anaesthetic and/or steroids. They are usually given either in the area that is felt to possibly be the source of the pain, such as in to a muscle or facet joint, or around the nerves of the spine (an epidural or nerve root injection). Injections are occasionally placed into the disc, but this is done far less frequently.
- The next more invasive type of procedure that is done for low back pain is the procedure aimed at removing or destroying the area that is felt to be causing the pain. Some examples of this are Intra-discal Electrothermal Therapy (IDET) in which a coiled wire is placed in to the disc and then heated, and radiofrequency ablation (RFA). These are more invasive and because they do damage tissue, have higher risk and potential for longer-term side effects than the other treatments. If successful, they can help a person avoid a larger surgery, but there is still controversy over exactly when and to whom these procedures should be offered.
- What is generally felt to be most appropriate and effective for most people with back pain is a good course of exercise and stretching. Restoring motion and strength to a painful lumbar spine can be very helpful at improving pain. Although there is controversy as to what are the best spine exercises, it is generally agreed that exercise should be both aerobic (aimed at improving heart and lung function) as well as specific to the spine. Aerobic exercises include walking, jogging, swimming, bicycling etc.
- Instruction in lifting techniques can be helpful as well. Improperly bending over to lift can cause a large increase in strain on the low back. Proper lifting keeps the back straight while you bend with the knees.
What are the surgical treatment options?
Indications for surgery: A surgery for low back pain should only be performed when a number of conditions have been met. The first is that non-surgical treatment options have been tried and have failed. A surgery should not be done if an exercise program is effective but the person does not want to do it. The second condition is that the surgeon feels there is enough possibility that the individual patient will have a good chance of having a successful result with surgery. An example of this would be a person with severe degeneration at one level of their spine and normal findings at the other levels. Another factor that goes along with this is that low back pain, like many other pain problems, can be worse during times of stress. It may not be a good idea to commit to an operation like this when there are other major stressful events going on in one’s life. Occasionally, the back problem can become more tolerable once the stress is reduced. The final factor is that the patient must decide if they are having enough of a problem to undergo an invasive procedure that is not guaranteed to work.
What are the commonly performed surgical options?
- Historically, the most commonly performed operation for back pain has been spinal fusion. There are a variety of ways this is done but the basic idea is to take the painful segment of the spine and get it to become a solid piece of bone. This will eliminate motion and, in theory at least, if it doesn’t move, it shouldn’t hurt. This can be done through the back (posterior) or through the front (anterior), or sometimes both ways. Spinal fixation of some sort is often combined with some form of bone graft or bone substitute. Bone graft can either be obtained from another part of the skeleton such as the pelvis (autograft) or be donated bone that is processed and used in a spine fusion (allograft). The results of spine fusion for low back pain vary. A good result is a decrease in pain. It is very rare for someone to be completely out of pain after a spine fusion. Full recovery can take more than a year.
- A newer technique that has recently been introduced in to the United States is disc replacement. The procedure involves removing the disc and replacing it with artificial components, similar to what is done in the hip or the knee. Doing this lets the segment of the spine keep some flexibility and hopefully maintain more normal motion. The recovery time may be shorter than with spine fusion because the bone does not have to solidify. Although it has been used in Europe for a number of years, it has only recently been used in the United States. Early results are promising.
Currently disc replacements are done through an anterior approach and are primarily done on the lower two discs of the lumbar spine.
What’s new in the field of Low Back Pain Research?
A great deal of research is being performed to help doctors understand and treat low back pain. Some of the more exciting research includes new forms of disc replacement that someday may be injectable, and research into gene therapy that may someday allow doctors to alter the aging process of the spine.
Everyone’s spine has natural curves. These curves round our shoulders and make our lower back curve slightly inward. But some people have spines that also curve from side to side. Unlike poor posture, these curves can’t be corrected simply by learning to stand up straight.
This condition of side-to-side spinal curves is called scoliosis. On an X-ray, the spine of an individual with scoliosis looks more like an “S” or a “C” than a straight line. Some of the bones in a scoliotic spine also may have rotated slightly, making the person’s waist or shoulders appear uneven.
Who gets scoliosis?
Scoliosis affects a small percentage of the population, approximately 2 percent. However, scoliosis runs in families. If someone in a family has scoliosis, the likelihood of an incidence is much higher – approximately 20 percent. If anyone in your family has curvature of the spine, you should be examined for scoliosis.
Children – The vast majority of scoliosis is “idiopathic,” meaning its cause is unknown. It usually develops in middle or late childhood, before puberty, and is seen more often in girls than boys. Though scoliosis can occur in children with cerebral palsy, muscular dystrophy, spinal bifida and other miscellaneous conditions, most scoliosis is found in otherwise healthy youngsters.
Adults – Scoliosis usually develops during childhood, but it also can occur in adults. Adult scoliosis may represent the progression of a condition that actually began in childhood, and was not diagnosed or treated while the person was still growing. What might have started out as a slight or moderate curve has progressed in the absence of treatment.
In other instances, adult scoliosis can be caused by the degenerative changes of the spine. Other spinal deformities such as kyphosis or round back are associated with the common problem of osteoporosis (bone softening) involving the elderly. As more and more people reach old age in the U.S., the incidence of scoliosis and kyphosis is expected to increase.
If allowed to progress, in severe cases adult scoliosis can lead to chronic severe back pain, deformity, and difficulty in breathing.