Having back pain doesn’t automatically mean you will need surgery.
If you’re having serious back pain week after week (or day after day), you might worry that surgery is in your future. This may even make you nervous about telling your doctor about your persistent back pain, keeping you from getting any relief or guidance at all.
But the truth is, you’ve got a variety of methods to treat back pain, and many of them are effective at reducing pain and improving patients’ quality of lives, long before surgery is even considered.
“When it comes to treating back pain, we have a lot of different options,” says Kaliq Chang, MD, pain specialist in New Jersey. “The goal is to reduce the inflammation that’s causing the pain.”
Here are the different options doctors recommend, from least to most invasive.
1. Lifestyle changes.
The first thing doctors will recommend for back pain is simple lifestyle changes. Certain lifestyle choices can lower the amount of inflammation in the body, so eating an anti-inflammatory diet, finding and maintaining a healthy weight, exercising regularly, and quitting smoking may be helpful. Learn more about lifestyle changes to treat back pain at home.
2. OTC medication
You might be able to successfully relieve episodes of acute back pain using simple OTC medications like ibuprofen. Ibuprofen blocks the body’s production of a substance in the body that causes pain, swelling, and inflammation.
3. Physical therapy
“Physical therapy is recommended for all patients that are experiencing back pain,” says Dr. Chang. “When the pain is too severe … for undergoing therapy, [that’s] when you should see a pain management doctor.”
4. Muscle relaxers
“If you’re experiencing a lot of muscle spasms and muscle tenderness accompanying your back pain, it may be useful to try a prescription muscle-relaxing medication,” says Dr. Chang.
Muscle relaxers are an anti-inflammatory medication that works well for short-term pain relief. These are typically not prescribed for chronic pain management.
5. Nerve pain medication
Most pain relievers address the muscles and joints, but these medications actually blunt the pain signals at the nerve level. The nerves are usually just the “messenger” of pain, so dampening the signal results in reduced pain sensations.
6. Opioid medications
Opioid medications are only used as a last resort to relieve pain, according to Dr. Chang. This is, of course, to the addictive nature of these medications.
When opioid medications are used to treat back pain, they are specifically a short-term solution. “They’re only effective in the acute pain setting,” says Dr. Chang. “Within a matter of weeks, the patient’s body develops a tolerance to these medications, and they’re no longer effective.”
7. Nerve blocks
Also called nerve ablations, this unique treatment blocks or burns sensory nerves in the pain area by injecting an anesthetic solution to relieve chronic pain.
8. Epidural steroid injections
First of all, these are *not* the same as the epidural anesthetics used to relieve pain during childbirth. Instead, these steroid injections are a short-term treatment option that helps inhibit inflammation to reduce pain.
“Epidural steroid injections are a procedure that takes only a few minutes, and is done very safely with the guidance of continuous X-rays throughout the procedure,” says Dr. Chang.
9. Regenerative medicines
A newer type of treatment for back pain is regenerative medicine. As the name suggests, it attempts to regenerate damaged tissue in the discs. Types of regenerative medicine include stem cell injections and platelet-rich plasma injections.
10. Spinal cord stimulators
A spinal cord stimulator is “a device that modulates the patient’s perception of the pain,” says Dr. Chang. The small device is surgically inserted at the neck and sends low-voltage electric pulses to the nerves of the spinal cord to block the pain sensation, according to the American Association of Neurological Surgeons.
Finally, doctors may recommend surgery if other options have not resulted in relief. Surgery is considered only if there is a single known cause for the pain that can be fixed or removed. Most commonly, surgery is used for herniated discs, spinal stenosis (the narrowing of the spine), or spondylolisthesis (when a fracture weakens the spine and causes the vertebrae to slip out of place).
Here are examples of surgeries to treat back pain, according to the Arthritis Foundation:
Discectomy, which removes part of the herniated disc.
Laminectomy, which removes the lamia (the back of the spinal canal) and enlarges the spinal column.
Spinal fusion, which fuses two or more vertebrae together to form a immobile spine in order to stop the progression of deformities or injuries.
Vertebroplasty and kyphoplasty, which fixes fractured bone in the vertebrae using a cement-like material.
“When you start to experience back pain, it’s appropriate to see your primary care physician, who can guide you in the initial treatments, including medications and conservative therapy,” says Dr. Chang. “However, when the pain issue persists beyond those points, you should seek a pain management consultation.”
Dr. Chang is a highly specialized interventional pain management specialist in private practice in New Jersey.
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When it comes to treating back pain
we have a lot of different options.
00:00:05,553 --> 00:00:09,575
The goal is to reduce the inflammation
that's causing the pain.
00:00:09,575 --> 00:00:15,929
00:00:15,929 --> 00:00:19,926
Making changes to your lifestyle can
significantly improve the condition.
00:00:19,926 --> 00:00:24,066
This includes losing weight,
having regular exercise,
00:00:24,066 --> 00:00:26,858
stopping smoking, eating properly.
00:00:26,858 --> 00:00:31,581
The most common medications used to
treat back pain are over the counter
00:00:31,581 --> 00:00:36,817
anti-inflammatories such as ibuprofen or
naproxen, as well as acetaminophen.
00:00:36,817 --> 00:00:41,183
Physical therapy is recommended for all
patients that are experiencing back pain.
00:00:41,183 --> 00:00:45,397
When the pain is too severe,
however, for undergoing therapy,
00:00:45,397 --> 00:00:50,064
is when you should seek a pain
management doctor more quickly.
00:00:50,064 --> 00:00:54,478
If you're experiencing a lot of muscle
spasms and muscle tenderness accompanying
00:00:54,478 --> 00:00:58,970
your back pain, it may be useful to try
a prescription muscle relaxing medication.
00:00:58,970 --> 00:01:03,597
Muscle relaxer medications are a
first-line treatment for acute back pain.
00:01:03,597 --> 00:01:06,991
However, it's not ideal to
continue them for many months.
00:01:06,991 --> 00:01:10,004
Once a headache or
radiculopathy are involved,
00:01:10,004 --> 00:01:12,509
nerve pain medications may be helpful.
00:01:12,509 --> 00:01:16,357
These are meant to calm down
the nerves that are causing the pain.
00:01:16,357 --> 00:01:19,932
Opioid medication should only be
used as a last resort; however,
00:01:19,932 --> 00:01:22,855
they're only effective in
the acute pain setting.
00:01:22,855 --> 00:01:27,106
Within a matter of weeks,
the patient's body develops a tolerance to
00:01:27,106 --> 00:01:30,429
these medications and
they're no longer effective.
00:01:30,429 --> 00:01:32,368
As pain management physicians,
00:01:32,368 --> 00:01:36,321
we have a responsibility to make
sure they are utilized correctly.
00:01:36,321 --> 00:01:39,265
A nerve block or
a nerve oblation is one of the unique ways
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we can treat arthritis in the joints and
00:01:41,955 --> 00:01:44,093
First we do a test block.
00:01:44,093 --> 00:01:48,218
If that reveals that the pain is coming
from the area, we can go back and actually
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burn those sensory nerves that go to those
joints to help give longer term relief.
00:01:52,485 --> 00:01:56,603
Epidural steroid injections are a
procedure that takes only a few minutes,
00:01:56,603 --> 00:02:00,850
and it's done very safely with the
guidance of continuous x-rays throughout
00:02:00,850 --> 00:02:01,763
00:02:01,763 --> 00:02:04,111
How long the steroid injections last for
00:02:04,111 --> 00:02:06,812
is very variable,
depending on the patient.
00:02:06,812 --> 00:02:10,710
It all depends on how long it takes
to reaggravate the inflammation.
00:02:10,710 --> 00:02:14,468
There are new types of injections
that are becoming more popular.
00:02:14,468 --> 00:02:18,745
These include stem cell injections and
platelet-rich plasma injections,
00:02:18,745 --> 00:02:21,638
which focus on regenerating
the tissue in the disk,
00:02:21,638 --> 00:02:24,218
rather than just reducing
00:02:24,218 --> 00:02:28,291
Another form of treatment that doesn't
involve major surgery is a spinal cord
00:02:28,291 --> 00:02:28,978
00:02:28,978 --> 00:02:33,357
This is a device that modulates
the patient's perception of the pain.
00:02:33,357 --> 00:02:38,357
As opposed to injections, where we are
only trying to reduce the inflammation,
00:02:38,357 --> 00:02:41,827
the goal of a surgery is to
remove the offending matter.
00:02:41,827 --> 00:02:44,740
This is when there's
a single known cause for
00:02:44,740 --> 00:02:47,509
the pain that can be removed with surgery.
00:02:47,509 --> 00:02:49,620
When you start to experience back pain,
00:02:49,620 --> 00:02:53,222
it's appropriate to see your primary
care physician, who can guide
00:02:53,222 --> 00:02:57,525
you in the initial treatments including
medications and conservative therapy.
00:02:57,525 --> 00:03:01,425
However, when the pain issue
persists beyond those points,
00:03:01,425 --> 00:03:04,582
you should seek a pain
00:03:04,582 --> 00:03:10,719
Chou L, Ranger TA, Peiris W, Cicuttini FM, Urguhart DM, Sullivan K, Seneviwickrama KLMD, et al. Patients’ perceived needs of health care providers for low back pain management: a systematic scoping review. Spine J. 2018 Apr;18(4):691-711.
Drugs that relieve nerve pain. Cambridge, MA: Harvard Health Publishing, 2018. (Accessed on December 17, 2018 at https://www.health.harvard.edu/pain/drugs-that-relieve-nerve-pain.)
Spinal cord stimulation. American Association of Neurological Surgeons. (Accessed on December 17, 2018 at https://www.aans.org/Patients/Neurosurgical-Conditions-and-Treatments/Spinal-Cord-Stimulation.)
Surgery for back pain. Arthritis Foundation. (Accessed on December 17, 2018 at https://www.arthritis.org/about-arthritis/where-it-hurts/back-pain/treatment/back-pain-surgery.php.)
Sympathetic nerve blocks for pain. Baltimore, MD: Johns Hopkins Medicine. (Accessed on December 17, 2018 at https://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/sympathetic_nerve_blocks_for_pain_135,54.)
Witenko C, Moorman-Li R, Motycka C, Duane K, Hincapie-Castillo J, Leonard P, Valaer C. Considerations for the appropriate use of skeletal muscle relaxants for the management of acute low back pain. PT. 2014 Jun;39(6):427-35.