Low Back Pain Shouldn't Sideline You
Explore the common but under treated and misunderstood issues that accompany chronic back pain in our Back Pain Series. Part 1 explains the latest treatments that could relieve that aching back.
Medication Milieu continued...
Spinal cord stimulators can be implanted in the spine to help both back and leg pain, but they are better for leg pain, Guyer says. These medical devices work by sending low levels of electric stimulation to the spine to block the sensation of pain.
Also promising, but not yet FDA-approved for low back pain, is the lidocaine patch, says Charles E. Argoff, MD, director of the Cohn Pain Management Program of North Shore University Hospital in Manhasset, N.Y., and an assistant professor of neurology at New York University in New York City.
The lidocaine patch is worn on the skin like a bandage.
"It is a very simple, safe, topical analgesic and you can't hurt anyone with it," Argoff says, "In preliminary, non-randomized studies, it has shown great promise in treating both postsurgical low back pain and nonsurgical back pain."
The Opioid Dilemma
Opioid analgesics are one type of pain reliever and they do not work for everybody, says Argoff.
Opioids often get a bad rap from media reports of addiction such as recent reports of talk show host Rush Limbaugh's abuse. Buts some experts in pain management argue that fear of addiction to these medications has lead to undertreatment of patients with chronic pain.
The first question that needs to be answered is do they work for this patient, Argoff says.
If we get past that and show there is benefit, doctors need to determine whether this patient is at-risk of becoming addicted, he explains.
"There is no shred of evidence that suggests the acquisition of drug addiction, but not every patient walks into doctor office and says, 'by the way, before you prescribe, I am a drug addict' or 'I have an addictive personality,' and we can't as health-care providers already know who has that risk," he says.
"Very few people not known to be abusers become abusers, but frequent follow-up, medication contracts, and multidiscipline therapies can help prevent addiction and/or abuse," he says.
Botox, the same toxin that doctors routinely use to eradicate fine lines and wrinkles, can also treat back pain, says Gary Starkman, MD, a clinical attending neurologist at Beth Israel Deaconess Medical Center and the medical director of New York Neurology Associates, both in New York City.