Back Pain

Dealing with back pain

There are many things you can do to improve your low back pain. Please watch the following video to understand the basics of pain and how to manage them.

What are the treatments available?

In general, treatment for low back pain fall into one of three categories:

  • Self-management with exercises and pain killers
  • Manual therapy and manipulation by trained clinicians
  • Sometimes it may require treatment in hospital such as injections into the spine. Very rarely surgery might be considered.

 

 

 

 

 

 

Nonsurgical Treatment

Medications

Several medications may be used to help relieve your pain. Often this is the first source a patient seeks. However it is important to remember that keeping active and exercising regularly are an important part of treatment.

  • Paracetamol can relieve pain with few side effects.
  • Non-steroidal anti-inflammatory medicines like ibuprofen and naproxen reduce pain and swelling.
  • Opiates such as codeine or morphine, may help.
  • Steroids, injected into your spine, deliver a high dose of anti-inflammatory medicine.

Therapy

  • This includes modalities such as heat, ice, massage, ultrasound, and electrical stimulation.
  • Active therapy consists of stretching, strengthening and cardiovascular exercises.
  • Exercising to restore movement and strength to your lower back are important in recovery and relieving pain.
  • Exercises based on specific approaches such as McKenzie has shown to be beneficial to some groups of patients.
  • Manual therapy is provided in many different forms of manipulation of the joints and soft tissue. Some patients have relief from low back pain with these treatments.
  • Pilates and yoga may be helpful for low back pain as is general exercise such as swimming.

Spinal Injections

Epidural Injections

  • Epidural injections are sometimes used to treat pain that starts in the spine and radiates down the leg. Leg pain often occurs when a nerve is inflamed or compressed ("pinched nerve").
  • Epidural injections involve injecting an anesthetic and an anti-inflammatory medication, such as a steroid (cortisone), near the affected nerve. This reduces the inflammation and lessens or resolves the pain.

Acute LBP 6

Facet Joint Injections

  • Facet joint injections can also be done for both diagnostic and therapeutic reasons.
  • These types of injections are often used when pain is caused by a degenerative/arthritic condition or injury.
  • They are used to treat neck, middle back, or low back pain. The pain does not have to be exclusively limited to the midline spine, as these problems can cause pain to radiate into the shoulders, buttocks, or upper legs.
  • For diagnostic purposes, facet joints can be injected in two ways: injecting anesthetic directly into the joint or anesthetizing the nerves carrying the pain signals away from the joint (medial branches of the nerve). If the majority of pain is relieved with anesthetic into the joint, then a therapeutic injection of a steroid may provide lasting neck or low back pain relief.
  • If anesthetic injections indicate that the nerve is the source of pain, the next step is to block the pain signals more permanently. This is done with radiofrequency ablation, or damaging the nerves that supply the joint with a "burning" technique.

Acute LBP 7

Sacroiliac Joint Injections

  • Sacroiliac (SI) joint is the joint between the spine and the pelvis. Sacroiliac joint injections are similar to facet joint injections in many ways.
  • Problems in the SI joints have been shown to cause pain in the low back, buttock, and leg. Typically, one joint is painful and causes pain on one side of the lower body. It is less common for both SI joints to be painful at the same time.
  • This joint can also be injected for both diagnostic and therapeutic purposes. Anesthetizing the SI joint by injection under X-ray guidance is considered the gold standard for diagnosing SI joint pain. A diagnostic injection of the sacroiliac joint with anesthetic should markedly diminish the amount of pain in a specific location of the low back, buttock, or upper leg.
  • A therapeutic injection will typically include a steroid medication, with the goal of providing longer pain relief.

Acute LBP 8

Surgical Treatment

Surgery for low back pain is rarely considered. Many patients are not candidates for surgery, even though they have significant pain and other treatments have not worked. Some types of chronic low back pain simply cannot be treated with surgery.

Microdiscectomy

  • In a microdiscectomy or micro decompression spine surgery, a small portion of the bone over the nerve root and/or disc material from under the nerve root is removed to relieve neural impingement and provide more room for the nerve to heal.
  • A microdiscectomy is typically performed for a herniated lumbar disc and is actually more effective for treating leg pain (also known as radiculopathy) than lower back pain.
  • This video will explain the step by step procedure of a microdiscectomy.

Open Discectomy

  • Open discectomy uses surgery to remove part of the damaged disc and relieve the pressure on the nerve and alleviate the pain.
  • The surgery involves a small incision in the skin over the spine, removal of some ligament and bone material to access the disc and the removal of some of the disc material.

Laminectomy

  • A laminectomy is typically performed to alleviate pain caused by nerve impingement that can result from spinal stenosis.
  • The surgery involves removing a small portion of the bone and/or disc material around the nerve root to allow more space for better healing.
  • This video provides a step-by-step overview of a laminectomy for cervical stenosis or lumbar stenosis.

Spinal Fusion

  • Spinal fusion is essentially a "welding" process. The basic idea is to fuse together the painful vertebrae so that they heal into a single, solid bone.
  • Spinal fusion eliminates movement between vertebral segments. It is an option when movement is the source of pain. For example, your doctor may recommend spinal fusion if you have spinal instability, a curvature (scoliosis), or severe degeneration of one or more of your discs. The theory is that if the painful spine segments do not move, they should not hurt.
  • Fusion of the vertebrae in the lower back has been performed for decades. A variety of surgical techniques have evolved. In most cases, a bone graft is used to fuse the vertebrae. Screws, rods, or a "cage" are used to keep your spine stable while the bone graft heals.
  • The surgery can be done through your abdomen, your side, your back, or a combination of these. There is even a procedure that is done through a small opening next to your tailbone. No one procedure has been proven better than another.
  • The results of spinal fusion for low back pain vary. It can be very effective at eliminating pain, not work at all, and everything in between. Full recovery can take more than a year.

Disc Replacement

  • This procedure involves removing the disc and replacing it with artificial parts, similar to replacements of the hip or knee.
  • The goal of disc replacement is to allow the spinal segment to keep some flexibility and maintain more normal motion.
  • The surgery is done through your abdomen, usually on the lower two discs of the spine.
  • Although no longer considered a new technology, the results of artificial disc replacement compared to fusion are controversial.
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