Back Pain Treatment
What Are the Treatments for Back Pain? continued...
Opioids can be addictive and their use on a long term basis should be avoided unless a definite cause of back pain related to an injury or a disease can be established. Even then, they must be cautiously used and under the close supervision of a physician. Opioids reduce pain by working within the nervous system.
If your primary doctor isn't able to help you control the pain, he/she may refer you to a back specialist or a pain specialist. Sometimes these doctors will use injections of steroids or anesthetics to help control the pain or for diagnosis.
The use of injections and procedures in and around the spine is limited as such treatments often provide only temporary relief. However, they can be important in helping diagnose structural causes in pain and assisting the physical rehabilitation when other methods have failed. The various injection procedures are costly and have potential side effects, which should be discussed in detail before proceeding. Often, a pain specialist or back specialist will also employ rehabilitation and counseling by non-physician personnel such as therapists, counselors, and patient educators.
TENS: Some physicians advocate using a transcutaneous electrical nerve stimulator (TENS). Electrodes taped to the body carry a mild electric current that helps relieve pain. After appropriate training, patients can use a TENS on their own to help reduce pain while they recover from strained or moderately injured backs.
Surgery for nonspecific back pain is a last resort as spinal problems are unlikely to be the cause of chronic non-specific back pain in the absence of loss of movement and sensation or other findings such as loss of muscle bulk and reflexes. In cases where the pain spreads into the extremities and imaging studies reveal compression or damage to nerve tissue in the spine, surgery remains a consideration if loss of function as well as pain continues after a trial of conservative treatment with medications and activity modification including a home exercise program and physical therapy.
Rhizotomy: In cases of persistent pain from extreme nerve damage, rhizotomy - surgically severing a nerve - may be necessary to stop transmission of pain to the brain. Rhizotomy can correct the symptoms caused by friction between the surfaces in a spinal joint, but it doesn't address other problems, such as herniated discs.
Spinal manipulation: The U.S. Agency for Healthcare Research and Quality recognizes spinal manipulation by chiropractors and osteopaths as effective for acute low-back pain. Its effectiveness for treating chronic back pain is less well established. Some researchers suggest that early manipulative treatment for acute back pain may prevent chronic problems from developing. Other doctors warn against some chiropractic manipulations, particularly those that involve rapid twisting of the neck. Spinal manipulation can be considered a form of conservative care for the treatment of acute and chronic back pain as it is not invasive and does not employ prescription medications.