How is back pain treated?
Most back pain can be successfully treated with conservative (non-surgical) measures. Conservative treatment includes:
- As much activity (standing, walking, working) as can be tolerated
- Acetaminophen (non-aspirin over-the-counter pain reliever) and/or an anti-inflammatory medication
- Cold packs to diminish swelling and pain
Usually, the pain will subside within 4 to 7 days. If there is no improvement after 4 to 7 days, contact your doctor.
When back pain is chronic, persistent and disabling, a complete treatment approach addressing all aspects of the problem, including psychological as well as physical, offers the best hope for rehabilitation and recovery. A multi-disciplinary treatment team — consisting of a medical physician, physical therapist, psychologist or psychiatrist, and pain management specialist — offers the best hope for return to an active, productive life.
The role of medication in the management of back pain is to relieve symptoms and facilitate an active, exercise-oriented rehabilitation program. An array of new medications is now available to assist in achieving this goal.
The newer anti-inflammatory pain relievers, such as celecoxib, are less likely to cause gastrointestinal side effects, such as nausea or diarrhea.
Some older medications also have been found to help in the treatment of back pain. For example, disruption of sleep by chronic back pain is common. Poor sleep may, in fact, magnify pain. Low doses of traditional anti-depressant medicines, such as doxepin, may reduce pain and improve the quality of sleep.
Anti-convulsants, such as gabapentin, often are helpful for nerve irritation symptoms, such as burning or numbness.
In rare instances, careful use of long-acting opioid pain relievers may improve function and quality of life.
Active, exercise-oriented physical therapy is the cornerstone of treatment for people with chronic back pain. Heat, ice, massage, and ultrasound may provide temporary relief, but rarely provide long-term benefits.
Exercise programs should be individualized by a spine-oriented physical therapist. Typically, the exercise program can be performed at home without special equipment. Follow-up visits with the therapist are necessary to "fine tune" the program. Returning to work in any capacity is strongly recommended.
What are the surgical procedures for back pain?
A laminectomy is a surgical procedure that removes a portion of the vertebral bone called the lamina. At its most minimally invasive, the procedure requires only small incisions. The back muscles are pushed aside rather than cut and the parts of the vertebra adjacent to the lamina are left intact.
Discectomy is surgery to remove lumbar (low back) herniated disk material that is pressing on a nerve root or the spinal cord.
It tends to be done as microdiscectomy, which uses a special microscope to view the disk and nerves. This larger view allows the surgeon to use a smaller cut (incision), causes less tissue damage and speeds recovery.
Spinal fusion is a process during which a number of vertebrae are made to grow, or "fuse" together. Mechanical back pain is usually treated with exercise and the strengthening of the support system of the spine (muscle and ligaments). These treatments stabilize the spine in a physiological manner. However, spinal fusion occasionally might be needed in patients who truly have mechanical pain and who have failed an aggressive non-operative program.
Many controversies exist regarding fusion:
- Should the fusion be performed as an entity in and of itself or with instrumentation?
- Should the fusion be anterior or posterior in location?
- Should cages or screws be used to supplement the fusion?
- How long should a fusion be?
- Should it incorporate 1 motion segment (disc), or 2 or 3 motion segments?
All of these questions are appropriate and very difficult to answer.
Remember, "spine surgery begets spine surgery." At least 20% of people who undergo an initial "simple operation" for back pain or leg pain will undergo 1 or more additional operations; these are usually people with chronic back pain.