Back Pain Health Center
Treatment for back pain differs depending on whether the pain is acute or chronic. In acute back pain, the pain usually goes away on its own and without medical treatment (although you may wish to use aspirin or ibuprofen to ease pain). Getting up and continuing your normal activities can reduce pain and ease stiffness.
Chronic back pain treatment falls into two categories: the kind involving an operation or surgical procedure and the kind that does not. Usually, back pain does not require surgery.
Some non-surgical treatments include the following:
- Hot or cold packs. Either a hot or cold pack, or sometimes a combination of the two, can be incredibly soothing to irritating pain and stiffness. Heat dilates blood vessels, both improving the supply of oxygen the blood takes to the back region and reducing muscle spasms. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to a specific area. It also works to numb deep pain.
- Exercise. Proper exercise can ease chronic back pain, although it might not be safe for acute pain. Flexion exercises (exercises which help you bend forward), extension exercises (bending backward), stretching and aerobic exercises, which get your heart pumping faster, can all help. But speak with your doctor before beginning an exercise regimen to be sure that its safe and will work for you.
- Traction. Traction involves using pulleys and weights to stretch out the back. The idea behind traction is to pull the vertebrae apart to allow a bulging disk to slip back into its appropriate place.
- Corsets and braces. Corsets and braces include multiple devices such as elastic bands and stiff supports with metal stays designed to limit the motion of the lumbar spine and provide support to the abdomen. These devices can also assist in the correction of posture.
- Behavioral modification. A healthy attitude can help in treating back pain. It can be beneficial to learn to move your body properly while you do daily activities, particularly those involving heavy lifting, pushing or pulling. Pick up other healthy habits such as regular exercise, relaxation and a steady sleep pattern.
- Medication. There are numerous medications used to treat chronic back pain. Some of these medications are available over-the-counter, while others require a doctor's prescription. The following are common medications used in the treatment of back pain:
- Analgesics. Analgesic medications are those designed specifically to relieve pain. Tylenol and aspirin are analgesics, and so are prescription narcotics like oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin). Topical analgesics are also available in the forms of creams, ointments and salves rubbed directly onto the skin over the site of pain.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are medications that relieve pain and inflammation. These include ibuprofen (Motrin, Advil), ketoprofen and naproxen sodium (Aleve). These medications work by blocking substances called prostaglandins that contribute to inflammation and pain.
- Muscle relaxants and certain antidepressants have also been prescribed for the treatment of back pain.
- Injections. When medications and other nonsurgical treatments fail, doctors may recommend injections for pain relief. The most commonly used injections include the following:
- Nerve root blocks. If a nerve is inflamed or compressed as it passes from the spinal column between the vertebrae, a nerve root block injection may be used to help ease the resulting back and leg pain.
- Facet joint injections. The facet joints are those where the vertebrae connect to one another, keeping the spine straight and aligned. An injection of anesthetics or steroid medications into facet joints is sometimes used to try to relieve pain.
- Trigger point injections. An anesthetic is injected into specific areas in the back that are painful when pressure is applied.
- Manipulation. Spinal manipulation refers to procedures in which health care professionals use their hands to mobilize, massage or stimulate the spine and surrounding tissue.
- Transcutaneous electrical nerve stimulation (TENS). TENS involves wearing a small box over the site of pain. This box directs mild electrical impulses to nerves in that area. Some experts suggest that stimulating the nervous system could modify the patient's perception of pain.
- Acupuncture. Acupuncture is based on the theory that a life force Qi flows through the body along certain channels, which if blocked, can cause illness. Insertion of thin needles at precise locations along these channels can supposedly unblock the flow of Qi, relieving pain and restoring health. Although few Western-trained doctors would agree with the concept of blocked Qi, some believe this insertion of needles may spark production of the body's natural pain-numbing chemicals such as endorphins, serotonin and acetylcholine.
- Rolfing. Rolfing is a type of massage involving strong pressure on deep tissues in the back to relieve tightness.
Besides these nonsurgical treatments, there are surgical remedies for back pain, but such procedures are not always necessary. Depending on the diagnosis, surgery may be the first treatment of choice or might be reserved for chronic back pain for which other treatment avenues have failed. Herniated disks, spinal stenosis, spondylolisthesis, vertebral fractures and degenerative disk disease are some diagnoses that may require surgery.
Surgical procedures that may be used for back pain include the following:
- Laminectomy/discectomy. In this procedure, which is used in the treatment of herniated disks and spinal stenosis, part of the lamina (a portion of the bone on the back of the vertebrae) and a portion of the ligament are removed. Then, the herniated disk is taken out through the incision.
- Microdiscectomy. This procedure is similar to a traditional discectomy and involves the removal of a herniated disk through an incision in the back. In microdiscectomy however, the incision is much smaller than it is in discectomy and the doctor uses a magnifying microscope or lenses to locate the disk through the incision.
- Laser surgery. In laser surgery, which is also used for herniated disks, the surgeon inserts a needle that delivers a few bursts of laser energy to vaporize tissue in the disk. This procedure reduces the size of the disk and relieves pressure on the nerves.
- Spinal fusion. Spinal fusion is used to treat spondylolisthesis — a condition in which a vertebra in the spine slips out of the proper position onto the bone below it. In a spinal fusion, two or more vertebrae are joined together using bone grafts, screws and rods to stop the affected vertebrae from slipping. The grafted bone usually comes from another area of the body, most commonly the hip or pelvis, but can also come from a donor.
- Vertebroplasty. Both trauma and osteoporosis can cause a compression fracture (broken vertebra). If this happens, your doctor may cut a small opening in the skin over the affected part of the spine and inject a cement-like mixture called polymethylacrylate into the fracture. The goal of this procedure is to relieve pain and stabilize the spine.
- Kyphoplasty. The procedure begins with the doctor inserting a balloon device to help restore the height and shape of the spine. The doctor then injects polymethylacrylate (the cement-like mixture) to repair the fracture.
- Intradiscal electrothermal therapy (IDET). In this procedure, a heat wire is inserted through a small incision in the back and into a disk. An electrical current is then sent down the wire to strengthen the collagen fibers that hold the disk together.
- Disk replacement. This procedure is used to treat a herniated disk. Instead of just removing the disk (discectomy), the disk is removed and replaced with a synthetic disk. This artificial disk restores height and mobility between vertebrae.