Nonsurgical pain relief
For damaged structures to heal, good blood supply is essential for repair and to remove waste products. The bones, ligaments and muscles in the back have a good blood supply, so the back can heal reasonably well. The problem is that they usually heal with a special type of tissue called scar tissue, which is strong but not as flexible as normal muscles, ligaments, etc. However, discs have a poor blood supply and this often results in slower healing. Discs, therefore may be more easily damaged if care is not taken to prevent this. The most common type of injury to the back is to the soft tissue – the muscles, tendons and ligaments. Most of these soft tissue injuries heal well, and this is why most people with back injuries recover.
Back pain is often an unseen injury to others. As such, it is sometimes difficult to understand the problems that a person with back injury has to live with daily. To help yourself, it is important to keep as mobile as possible and learn how to move your body to prevent strain on your back.
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.
X-rays show bones and the space betweenbones. 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.
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.
Pain-relieving injections can relieve back pain and provide important information about your problem.
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.
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.
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
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.
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.
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.
Physical therapy and injection therapy are the two most common tools used by a spine center to help patients recover from back or neck pain — without surgery. A physician who fails to use these nonsurgical options may only be increasing the need for surgery. Spine surgery should be the last option to explore. While physical therapy is the safest treatment option, sometimes intense pain prevents a patient from entering physical therapy. Injections can often relieve pain long enough to begin therapy. There are many different injections that can be used including epidural steroid injections, facet injections and trigger point injections which can stimulate healing of weak or damaged connective tissues. Injections can also act as a diagnostic tool by providing a spine specialist with key information and insight into the possible causes of your back or neck pain symptoms.
It is important to remember that injection therapy serves as a means to an end. While passive things like massage or pills may feel good, they don’t change anything with the structure of your back. Physical therapy and customized exercises make the back and neck muscles stronger, more flexible and resistant to future strain and pain.
By inserting pain-relieving medication into the injury site or pain generator, joint pain and/or inflammation surrounding a nerve root can be relieved long enough for a patient to begin working with a physical therapist. Injections essentially act as a bridge on the path of your return to activity.
How do injections work?
When physicians choose to use injection therapy, their ultimate goal is to relieve pain long enough to enable the patient to begin physical therapy.
Relief from such injections can last anywhere from a few weeks to a few months and sometimes longer, especially if therapy is used simultaneously to strengthen muscles in the back. In other cases, an injection may bring patients minimal or no pain relief.
The injection procedure
During an injection procedure you may lay on your stomach to enable the X-ray to visualize your spine. Local anesthetic may be injected into the skin and underlying tissues to reduce discomfort.
Once the anesthetic sets in, the epidural needle is inserted into the epidural space, with the vertebrae serving as “landmarks.” The physician will use a special X-ray image from a C-arm fluoroscopic device to make sure the needle is positioned correctly.
The corticosteroid injection may include a saline solution and/or a local anesthetic. Its dosage, volume and components will vary according to the doctor’s assessment of each individual patient.
Once the needle enters the epidural space, a syringe containing corticosteroid solution is connected to it. After ensuring the needle is in the correct place, the solution is slowly injected. During this time, you will be able to communicate with the doctor, and the most common sensation reported is one which resembles the feeling of “pins and needles.”
What are the risks involved?
There are risks involved in any operation or injection procedure. In the case of epidural steroid injections, these risks are minimal. There are a variety of possible side effects and complications, most of which relate to the way in which the injection is administered rather than the actual steroid itself.
The most common side effect of epidural steroid injections is a temporary surge in pain, but this only occurs about one percent of the time and most likely relates to the volume of the injected substance. Headaches are another potential complication, with an incidence of just one percent. These headaches may be linked to the unintended puncture of the innermost membrane that surrounds the spinal cord. In most cases, the headache will subside within a few hours and rarely lasts more than a day.
How many injections will I need?
You are unlikely to benefit from repeated epidural steroid injections if the first or second do not provide relief. You should not receive more than three injections if none of them have helped. Additional epidural injections usually are not indicated if your pain symptoms are increased after an injection. Even if the injections do provide relief, only in exceptional cases will more than three be recommended over a three-month period. Other injection techniques may prove helpful even if the initial approach is not clearly beneficial.
Common types of injections for back pain relief include:
Selective nerve root block (SNRB)
Facet joint block
For more information on the common types of injections for back and pain relief click here.
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.
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
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.
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.