Back Pain Interventions

The Tried-And-True And Brand New

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Almost every adult in the United States will experience low back pain at some point in their life (65-87% of adults). Back pain is the most cited reason for missing work, which adds insult to injury if you are working less and hurting more. 

If you’ve experienced back pain, you know how difficult it can be to manage the pain and return to activity. Muscle strains, stenosis, sciatica, fractures, disc damage, joint issues, and many other sources of back pain can be debilitating and frustrating. 

A high-quality initial evaluation by a provider can help to set you on course to a repair and a reduction of pain. There is no one treatment that will work for everyone, because the underlying reason for the pain can be vastly different. As medical knowledge is progressing there are new treatment options that are consistently emerging. 

I have a unique perspective as a clinical exercise physiologist who runs a Lifestyle Medicine clinic, and just a regular person who has experienced chronic and acute low back pain for over 15 years. I believe in the power of lifestyle as an intervention, and I also believe in pharmaceuticals and skilled clinicians and surgeons. As a patient, I’ve seen physical therapists, massage therapists, orthopedic surgeons, sport medicine physicians, chiropractors, athletic trainers, biomechanists, and pain specialists. 

Relentless pain is one of the most frustrating things to experience for someone who loves to be active. I want to share with you some of the current treatment options and new treatment options that are gaining traction and research to support their use. 

Historically for many soft-tissue injuries, rest, ice, elevation, and compression (RICE) was thought to be an ideal strategy to handle many forms of back pain. Using evidence based medicine, rest was found to be counter-productive for many forms of back pain, ice can help to reduce inflammation, elevation is simply not practical, and compression may not be helpful. Gentle exercise and activity can promote healing in many cases due to increased blood flow, increased lymph circulation, and increased immune system function. 

When you go in to see your health care professional, they will often discuss the options to diagnose the root cause of the pain, and provide a plan for treatment once the root cause is determined. 

TAKE A LOOK INSIDE: DIAGNOSTIC TOOLS 

• X-ray 

You may be very familiar with this imaging technique that allows the radiologist to see through your soft tissues, into your bones. This test will not tell you information about soft tissues (e.g. muscles, cartilage, tendons, ligaments, etc.). 

• CT Scan 

Similar to an X-ray, the CT (often known as a CAT scan) is an excellent test to identify bony tissues. It can help to diagnose osteoarthritis and fractures, by creating a cross sectional image of the area. 

• MRI 

Unlike an X-ray or CT scan that uses radiation to create an image, a Magnetic Resonance Imaging (MRI) scan uses a large magnet, radio waves, and a computer to create a detailed, cross- sectional image of your internal tissues. It is great way to identify disc damage, nerve issues, fractures, and issues with cartilage. 

– Most MRIs require you to lie in a large magnetic tube, and last from 20-60 minutes. 

Once the diagnosis is determined and 

your treatment plan is created, you may be prescribed a variety of common treatment options discussed below. 

CURRENT COMMON TREATMENTS • Reducing high force/intensity 

physical activity. For those who do heavy manual work as a career or exercise behavior, they will often need to reduce and modify their activity greatly. 

• Anti-inflammatories can often reduce some of the inflammation contributing to your discomfort. Often corticosteroids (oral or injected) are prescribed to reduce the inflammation in tissues. 

• Muscle Relaxers are often prescribed to relax muscles that are tight or spastic. Sciatic nerve pain can often cause muscle cramping that can be improved with the use of a muscle relaxer to depress the activity from the central nervous system. 

• Pain Relievers (there are many forms: NAIDS & Narcotics are common) While these pain relievers do very little to treat the root cause of the problem, they may make it manageable to simply handle the 

pain in the meantime. 

• Ice is often used to reduce the inflammation of irritated tissues. 

• Physical Therapy in my opinion is underutilized for back pain treatment. You often do not need a referral from a physician and they offer a wide array of services like focused and prescribed exercise, heat, ice, ultrasound, Graston techniques, and TENS units. 

• Massage Therapy may help increase circulation, aid relaxation, and provide pain relief from sore muscles. Cupping is also becoming a more popular adjunct treatment with massage therapy. 

• Chiropractic Care can be helpful when a vertebrate or joint is dislocated (misaligned.) A licensed chiropractor can help to realign the joints, and often provide relief from pain. 

• Trigger Point Injections are injections provided directly at the site of muscle pain. These injections can help to provide relaxation often through a combination of a local anesthetic and corticosteroid. 

• Acupuncture uses very fine needles (sterilized and disposable) in precise points on the body. It is approved by the U.S. Food and Drug Administration (FDA) as a treatment for back pain, and the National Institutes of Health has recognized acupuncture as effective in relieving back pain. 

COMMON SURGICAL INTERVENTIONS 

• Spinal Fusion (picture on left below) for added stability, hardware is inserted to fuse a portion of the spine that is painful or causing damage. The vertebrae are fused together so that there is no mobility in that portion of the spine. 

• Disc repair known as a discectomy, a surgeon removes a part of the disc that is causing discomfort. Removing the part of the disc that is damaged can cause relief from pain and return to healthy activity. 

• Laminectomy is a surgical procedure used to create an opening and add more space to the spinal cord or compressed nerves. 

• Vertebroplasty and kyphoplasty are both minimally invasive surgical interventions aimed to treat a spinal compression fracture by inflating and injecting a cement-like compound into the weakened bone. 

New surgical and non-surgical options are consistently emerging and rising in popularity. 

WHAT NEW OPTIONS ARE AVAILABLE? 

Wireless percussion massagers are gaining popularity. Traditionally, percussion massagers have been wired, clunky, and difficult to use by yourself. While these devices are unlikely to treat your back pain (and are harmful for fractures), these devices may help to manage the pain, and relax muscles that are tight or inflamed. The two most popular options are the HyperVolt (made by the company HyperIce, sold for $349) and the Theragun (made by the company Theragun, sold for $599). I prefer the HyperVolt due to the quieter machine, and multiple setting options. 

Guided Pulsed Radiofrequency 

A new treatment option for low back pain is image-guided pulsed radiofrequency. The treatment uses CT imaging to help guide a needle into the patient’s herniated disc, followed by a probe that is inserted into the needle. The probe inserted into the disc delivers pulses of electrical energy to the affected area for approximately 10 minutes. 

Lead investigator Dr. Alessandro Napoli said, “The probe delivers a gentle electrical energy, so there is (no thermal damage. The results have been extraordinary. Patients have been relieved of pain and resumed their normal activities within a day.” 

Out of the 80 participants studied over a three-year time period, Dr. Napoli explained that 81% were pain free after one year. No patients experienced any side effects. Six patients (0.75%) required a second treatment. 90% were able to avoid surgical treatment. 

Spinal Stimulators and Pumps for Pain Relief
A neurosurgeon can implant a device commonly known as a “pain pump,” under the skin of the abdomen to provide intrathecal drug delivery. This device provides medication directly to your spinal cord. Because the non- opioid medication is delivered directly to the spinal cord, symptoms can be controlled with a much smaller dose than is needed with oral medication, and is non-addictive. Spinal stimulators work in a similar manner using stimulation instead of medication. 

Disc Replacement Surgery 

Hip and knee replacements have been around for a long time. A lumbar disc replacement is a fairly new treatment option for a small number of patients who have an isolated issue with a disc and healthy surrounding facet joints. (Image on the left below) This procedure involves removing the disk and replacing it with artificial parts. The goal of disc replacement is to allow the spinal segment to keep some flexibility and maintain the expected range of motion by a healthy joint. 

If you are living with significant back pain, don’t give up hope! Clinical trials are constantly providing us with new treatment options. As we progress in research and our understanding of effective treatment and pain management, more of us are living healthy and active lives. 

The body is our ally, fighting for us. It protects us, adapts for us, enables us, and wants to heal from pain and discomfort. 

If you are living without back pain, celebrate your body exactly as it is today and be thankful for the gift your body has given you. 

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