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 Nonsurgical pain relief
Return to activity | Diagnostics | Pain
relief | Time | Limiting
rest | Physical therapy | Exercise | Injection
therapy | Types of medication | Massage | Biofeedback | Acupuncture
Non-surgical treatment options for back pain and neck pain
Paradoxically, when a back spasm strikes the natural reaction is to stop what you are doing. This is good advice in general for the first 48 hours after a back strain.
But beyond that, the key is movement. Multiple research studies in the mid-1980s and 1990s conclusively proved that too much rest actually hurts your back. For example, a landmark study in the New England Journal of Medicine in 1986 found that people did worse with extended bed rest beyond two days. Another 1995 study in Finland found that persons with back pain who continued their activities without bed rest recovered faster than those who rested in bed for a week. Other studies linked bed rest to other problems like depression and weakened muscles. Some researchers went as far as saying that bed rest may be the most harmful treatment for simple acute back strain.
Another comforting fact: About 80% of back and neck pain symptoms can go away on their own with special exercises. That’s the good news.
The bad news is that if you are in the other 20%, you need to get informed about how to manage your care. That’s because in spine it’s very common for various spine care providers to be biased to the treatment they were trained in. While surgeons may be biased toward using surgery as a quick way of repairing a damaged disc, non-surgeons can also be excessively biased to waiting and delaying surgical intervention for six months or more. The patient then becomes frustrated that nothing has been done and they continue to suffer with pain symptoms.
Generally speaking, non-surgical treatment options like exercise, therapy, spinal injections can relieve many cases of back pain and neck pain all without the need for surgery. But with that said, it’s important to recognize when non-surgical treatment options have not worked, and to seek out a spine surgeon to correct the problem that can’t heal on its own with nonsurgical treatment options.
A rule of thumb: If your back or neck pain hasn’t improved with three months of nonsurgical treatment, it’s probably time to consult a spine surgeon. Also, symptoms like loss of control of bowel or bladder, or weakness and numbness into an arm or leg, are all emergency symptoms to see a spine surgeon with a few days at most. Otherwise these symptoms can cause permanent paralysis of the nerves in those areas, causing the symptoms to become permanent, even if you have surgery.
Dealing with herniated discs
There are three main options for dealing with a diagnosis of a herniated disc.
1. Therapy: A herniated disc can cause painful pressure on the nearby nerves that branch off from the spinal cord. Many herniations occur in the back of the disc wall. Special extension exercises where the back arches backward can compress the back side of the disc, which in turn creates a vacuum toward the front of the disc. It’s believed that this vacuum can suck the herniation back inward, which then relieves pressure on the adjacent nerve root. While the disc herniation has not been fixed, the pain generated by the herniated disc may be lessened.
2. Injections: Inflammation can act like a ring on a swollen finger. By reducing inflammation, the symptom disappears. “The purpose of a spinal injection is to reduce inflammation around the nerve root,” explains Dr. Monte Haber, a Physical Medicine physician fellowship-trained in spinal injections. “By placing medication directly around that nerve root, we can reduce pain symptoms long enough to get the patient moving and into therapy. In many cases, that’s all the patient may need to resolve their symptoms, and they are back to activity without the need for surgery. If you haven’t tried spinal injections, you may be moving resorting to surgery too quickly. It’s your last nonsurgical option.”
3. Surgery: When surgery is performed, the disc wall is not repaired, rather the herniated part of the disc is removed, which then reduces the pressure on the nerve root.
Exploring your surgical options
Is it possible to wait too long to have surgery? Perhaps. Pain that radiates into a leg or arm, can be addressed with watchful waiting, to the point that the patient can’t endure the discomfort any longer.
However, watchful waiting should NOT be used when the symptom involves numbness, tingling or weakness in a leg or arm. While the difference may seem subtle to the patient, it is extremely different. Weakness, numbness and tingling is a neurological sign that the disc herniation may be causing permanent damage to the nerve root. If the patient doesn’t address this quickly, that numbness or tingling in the foot or hand could become permanent.
Consequently — if you’ve been diagnosed with a herniated disc, and non-surgical options don’t appear to be working — it’s a good idea to consult a spine surgeon to become educated on your surgical treatment options.
Even with radiating pain, it may be that waiting too long can reduce the likelihood of a positive outcome from spine surgery. Some recent research in the spine community is focusing on the theory that there may be a window of time where the disc responds best to surgical correction.
A nerve root can act like a garden hose. A herniated disc can press on the adjacent nerve root interrupting circulation, like a car parked on top of a garden hose lying in the driveway. The theory is that if you leave the car on that hose for six months, even after you move it, there may be a permanent crimp in that hose.
Consequently, watchful waiting may be okay for radiating pain but NOT for weakness, numbness or tingling. And waiting longer than six months with radiating pain may compromise how well eventual spine surgery will be at relieving symptoms.
Return
to activity
The primary goal of treatment is to get you back to your everyday activities.
During your initial visit, the physician will assess
your medical history and collect more specific information during the
exam. In order to better understand your back or neck problem, the
physician may gently move your joints and limbs. It is important to
answer all the physician’s questions honestly, because your answers
help determine a correct diagnosis.
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Types of
diagnostics you may encounter:
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X-rays show bones and the space between
bones. Although X-rays are of limited value to muscle-related back
pain cases, your physician may conduct X-rays to detect possible
fractured vertebrae or narrowing of disc space.
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MRIs (Magnetic Resonance Imaging)
and CT scans provide images of soft tissues and nerves in the spine,
including discs and joints. This is valuable information to your
physician in determining the cause of your pain. These tests provide
a medical photograph of your body and are painless.
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Pain-relieving injections can relieve
back pain and provide important information about your problem.
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Myelograms can reveal the amount
of damage in the spine. They are used to determine if surgery is
necessary. If it is, myelograms provide a surgeon with key information
to ensure the success of surgery.
Click here for more information on diagnostics.
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Pain
relief
Doctors who focus mainly on pain symptoms often recommend the
exact opposite course of action that is optimal for recovery
from a back problem. For example, years ago, doctors treated
back pain with bed rest and heavy drugs in order to mask the
patient’s discomfort. Patients became sedentary and increasingly
dependent on drugs. It was later discovered that this treatment
was actually damaging to the back, because it weakened muscles
and caused more pain.
Pain is a signal from the body to the brain that something
is wrong. Either a certain motion placed too much strain on the back,
or the back is too weak or inflexible. Your specialist will help determine
the origin of your pain and the best treatment for it. Click here for more information.
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Give
it some time
Time is your most valuable asset. In cases where
pain is focused in the low back or when there are red flag symptoms, take the time to help yourself. Check out the home
remedy section of this Web site for ways to treat your pain.
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Limiting
rest
Studies have reported that rest and inactivity should
be limited to two days at most. After that time, patients should be
encouraged to start moving and exercising to strengthen the back muscles
and increase flexibility. And part of the rehabilitative process can
require a commitment on the part of the patient to work closely with
the therapist during those first few weeks to ensure a successful long-term
recovery.
While drugs and manipulation may relieve initial pain,
neither of these alters the musculature of the back, which is essential
for long-term recovery. Only exercise can strengthen the back muscles
and make them more flexible and resistant to future strain.
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Physical
therapy
Physical therapy increases flexibility and strengthens muscles
that support the spine. Greater strength and flexibility will
help prevent future back strain. A therapist may use ultrasound,
electrical stimulation, heat or ice, mobilization and exercises
to reduce pain and the likelihood of future injury. Click here for more information.
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Exercise
Years ago, the prescription for pain was bed rest. However, we
know today that more than a few days of bed rest after an injury
can be counterproductive to rehabilitation.
Exercise and movement actually help tissues in
the back become stronger, more supportive of the back and resistant
to additional injury. Specific exercises can be used to target
particular types of back pain. Engaging in activity acts as a
lubricant to the back muscles and joints, and it is as necessary
to recovery as oil is to the hinge in a squeaky door.
It is important to work with a therapist to make sure
exercises are done properly. Never do any exercise that causes pain
to your back. Click
here to learn about specific back pain exercises.
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Injection
therapy
For years, spine physicians have used cortisone injections, epidural
steroid injections, trigger point injections and nerve blocks to relieve
pain in the spine. They are often provided in a series of three or
four injections spanned over a couple weeks.
These injections are
intended as a means to an end. The goal is to provide enough
pain relief to bridge the patient from being inactive to being
able to attend physical therapy, where they can better treat
their back problems with special exercises.
Common types of injections for back pain relief include:
- Epidural
- Selective nerve root block (SNRB)
- Facet joint block
- Sacroiliac joint
- Vertebroplasty
For more information on the common types of injections for back and pain relief click here.
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Medication
Medications can lessen swelling and reduce pain in the back and neck.
The type of medication your physician recommends depends on your
symptoms and your level of pain.
At home, pain can be relieved with Non-Steroidal Anti-Inflammatory
Drugs (NSAID), such as ibuprofen products like Motrin or Advil. Aspirin
may also be recommended to ease pain.
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Massage
Not only is it relaxing, but massage has notable health benefits that
are an important part of back rehabilitation. Massages release toxins
in muscles, increasing circulation, releasing endorphins, reducing
inflammation, alleviating muscle cramps, breaking down scar tissue
and calming the nervous system.
Aside from the physical health benefits, massage has
a psychological impact by teaching the patient to feel relaxed. For
the chronic back pain sufferer, even the simple luxury of drifting
off to sleep may not be a reality. Massage can provide that feeling
of calm.
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Biofeedback
For thousands of years, Eastern medicine has emphasized the importance of the
mind in controlling physical health. In the West, these ideas were touted as
mystical and scientifically unfounded. Recently, however, as more scientific
connections are being made between mind-body healing, Western science is starting
to appreciate and incorporate this type of therapy into pain rehabilitation.
Due to its objective means in tracking progress, biofeedback
is one of the more popular mind-body therapies in pain rehabilitation.
During biofeedback sessions, electrodes are attached to the body to
monitor body temperature, heart rate, muscle tension, skin resistance
and perspiration.
Through biofeedback, the patient is taught to recognize
how stress and relaxation chemically alters the body's functions. The
patient can learn to lower heart rate and muscle tension. The biofeedback
equipment records statistics and gauges progress as the patient learns
to control the body, thus controlling pain.
After recognizing the
body’s signals during
biofeedback sessions, the patient is able to recognize them in
daily life and arrest the onset of muscle spasms or high blood
pressure. This can reduce pain and even eliminate it.
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Acupuncture
Traditional acupuncture is based on the ancient Chinese theory
that there are energy pathways that run throughout the body.
These pathways, called meridians, carry the body's vital energy,
or chi (pronounced "chee"). The principle behind
acupuncture is that disease and pain are a result of an imbalance
in the body's energy flow (chi). Through the insertion of thin
needles at specific points along meridians, the flow of energy
is controlled and rebalanced in the body.
Acupuncture dates back to the first century B.C. in China,
during the era of the Han dynasty (206 B.C. - 220 A.D.). Because Western
physicians in the United States have difficulty understanding the correlation
between acupuncture philosophies and traditional physiology, acupuncture
has not been readily accepted in the United States.
Modern scientists have attempted to explain how acupuncture
can relieve pain. Some observe that the traditional Chinese "meridians" overlap
with pathways of the central nervous system. By using needles, an acupuncturist
can stimulate the nervous system to release endorphins (morphine-like
chemicals) in the muscles, spinal cord and brain. These chemicals either
relieve pain symptoms or trigger other chain reactions that relieve
them.
Acupuncture is nonsurgical, does not involve drugs, and
has no extremely negative side effects or permanent complications.
It may be worth exploring as a nonsurgical option, particularly if
you have exhausted the traditional remedies of Western medicine.
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