Nonoperative Back Pain Treatments
Hot or cold: Hot or cold packs – or sometimes a combination of the two – can be soothing to chronically sore, stiff backs. Heat dilates the blood vessels, improving the supply of oxygen that the blood takes to the back and reducing muscle spasms. Heat also alters the sensation of pain. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area. Although cold may feel painful against the skin, it numbs deep pain. Applying heat or cold may relieve pain, but it does not cure the cause of chronic back pain.
Exercise: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce its risk of returning. The following four types of exercise are important to general physical fitness and may be helpful for certain specific causes of back pain:
Flexion: The purposes of flexion exercises, which are exercises in which you bend forward, are to 1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; 2) stretch muscles of the back and hips; and 3) strengthen abdominal and buttock muscles. Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. One word of caution: If your back pain is caused by a herniated disc, check with your doctor before performing flexion exercises because they may increase pressure within the discs, making the problem worse.
Extension: With extension exercises, you bend backward. They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting while lying prone and raising the trunk while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.
Stretching: The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion.
Aerobic: Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while. For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include brisk walking, jogging, and swimming. For back problems, you should avoid exercise that requires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the discs and actually do more harm than good. In addition, avoid high-impact activities if you have disc disease. If back pain or your fitness level makes it impossible to exercise 30 minutes at a time, try three 10-minute sessions to start with and work up to your goal. But first, speak with your doctor or physical therapist about the safest aerobic exercise for you.
Medications: A wide range of medications are used to treat chronic back pain. Some you can try on your own. Others are available only with a doctor’s prescription. The following are the main types of medications used for back pain.
Analgesics: Analgesic medications are those designed specifically to relieve pain. They include over-the-counter acetaminophen (Tylenol 1) and aspirin, as well as prescription narcotics, such as oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin). Aspirin and acetaminophen are the most commonly used analgesics; narcotics should only be used for a short time for severe pain or pain after surgery.
People with muscular back pain or arthritis pain that is not relieved by medications may find topical analgesics helpful. These creams, ointments, and salves are rubbed directly onto the skin over the site of pain. They use one or more of a variety of ingredients to ease pain. Topical analgesics include such products as Zostrix, Icy Hot, and Ben Gay.
Other Medications: Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable.
Traction: Traction involves using pulleys and weights to stretch the back. The rationale behind traction is to pull the vertebrae apart to allow a bulging disc to slip back into place. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released, the stretch is not sustained and back pain is likely to return. There is no scientific evidence that traction provides any long-term benefits for people with back pain.
Corsets and braces: Corsets and braces include a number of devices, such as elastic bands and stiff supports with metal stays, that are designed to limit the motion of the lumbar spine, provide abdominal support, and correct posture. While these may be appropriate after certain kinds of surgery, there is little, if any, evidence that they help treat chronic low back pain. In fact, by keeping you from using your back muscles, they may actually cause more problems than they solve by causing lower back muscles to weaken from lack of use.
Behavioral modification: Developing a healthy attitude and learning to move your body properly while you do daily activities – particularly those involving heavy lifting, pushing, or pulling – are sometimes part of the treatment plan for people with back pain. Other behavior changes that might help pain include adopting healthy habits, such as exercise, relaxation, and regular sleep, and dropping bad habits, such as smoking and eating poorly.
Injections: When medications and other nonsurgical treatments fail to relieve chronic back pain, doctors may recommend injections for pain relief. Following are some of the most commonly used injections, although some are of questionable value:
Nerve root blocks: If a nerve is inflamed or compressed as it passes from the spinal column between the vertebrae, an injection called a nerve root block may be used to help ease the resulting back and leg pain. The injection contains a steroid medication and/or anesthetic and is administered to the affected part of the nerve. Whether the procedure helps or not depends on finding and injecting precisely the right nerve.
Facet joint injections: The facet joints are those where the vertebrae connect to one another, keeping the spine aligned. Although arthritis in the facet joints themselves is rarely the source of back pain, the injection of anesthetics or steroid medications into facet joints is sometimes tried as a way to relieve pain. The effectiveness of these injections is questionable. One study suggests that this treatment is overused and ineffective.
Trigger point injections: In this procedure, an anesthetic is injected into specific areas in the back that are painful when the doctor applies pressure to them. Some doctors add a steroid medication to the injection. Although the injections are commonly used, researchers have found that injecting anesthetics and/or steroids into trigger points provides no more relief than “dry needling,” or inserting a needle and not injecting a medication.
Prolotherapy: One of most talked-about procedures for back pain, prolotherapy is a treatment in which a practitioner injects a sugar solution or other irritating substance into trigger points along the periosteum (the tough, fibrous tissue covering the bones) to trigger an inflammatory response that promotes the growth of dense, fibrous tissue. The theory behind prolotherapy is that such tissue growth strengthens the attachment of tendons and ligaments whose loosening has contributed to back pain. As yet, studies have not verified the effectiveness of prolotherapy. The procedure is used primarily by chiropractors and osteopathic physicians.
Complementary and alternative treatments: When back pain becomes chronic or when medications and other conventional therapies do not relieve it, many people try complementary and alternative treatments. While such therapies won’t cure diseases or repair the injuries that cause pain, some people find them useful for managing or relieving pain. Following are some of the most commonly used complementary therapies.
Manipulation: Spinal manipulation refers to procedures in which professionals use their hands to mobilize, adjust, massage, or stimulate the spine or surrounding tissues. This type of therapy is often performed by osteopathic doctors and chiropractors. It tends to be most effective in people with uncomplicated pain and when used with other therapies. Spinal manipulation is not appropriate if you have a medical problem such as osteoporosis, spinal cord compression, or inflammatory arthritis (such as rheumatoid arthritis) or if you are taking blood-thinning medications such as warfarin (Coumadin) or heparin (Calciparine, Liquaemin).
Transcutaneous Electrical Nerve Stimulation (TENS): TENS involves wearing a small box over the painful area that directs mild electrical impulses to nerves there. The theory is that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested it could elevate the levels of endorphins, the body’s natural pain-numbing chemicals, in the spinal fluid. But subsequent studies of its effectiveness against pain have produced mixed results.
Acupuncture: This ancient Chinese practice has been gaining increasing acceptance and popularity in the United States. It is based on the theory that a life force called Qi (pronounced chee) flows through the body along certain channels, which if blocked can cause illness. According to the theory, the insertion of thin needles at precise locations along these channels by practitioners can 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 that inserting and then stimulating needles (by twisting or passing a low-voltage electrical current through them) may foster the production of the body’s natural pain-numbing chemicals, such as endorphins, serotonin, and acetylcholine.
A consensus panel convened by the National Institutes of Health (NIH) in 1997 concluded that there is clear evidence this treatment is effective for some pain conditions, including postoperative dental pain. Although there is less convincing evidence to support using acupuncture for back pain and some other pain conditions, the panel concluded that acupuncture may be effective when used as part of a comprehensive treatment plan for low back pain, fibromyalgia, and several other conditions.
Acupressure: As with acupuncture, the theory behind acupressure is that it unblocks the flow of Qi. The difference between acupuncture and acupressure is that no needles are used in acupressure. Instead, a therapist applies pressure to points along the channels with his or her hands, elbows, or even feet. (In some cases, patients are taught to do their own acupressure.) Acupressure has not been well studied for back pain.
Rolfing: A type of massage, rolfing involves using strong pressure on deep tissues in the back to relieve tightness of the fascia, a sheath of tissue that covers the muscles, that can cause or contribute to back pain. The theory behind rolfing is that releasing muscles and tissues from the fascia enables the back to properly align itself. So far, the usefulness of rolfing for back pain has not been scientifically proven.
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