Understanding Back Pain -- Diagnosis and Treatment
What Are the Treatments for Back Pain? continued...
When back pain is chronic, pain modifying medications, such as the antidepressant Cymbalta (duloxetine), may be helpful. Cymbalta, a serotonin-norepinephrine reuptake inhibitor, or SNRI, is FDA approved for the treatment of chronic pain related to the muscles and skeleton, including pain from arthritis and chronic lower back.
If your primary doctor isn't able to help you control back pain, he or she may refer you to a back specialist or a pain specialist. Sometimes, these doctors will use injections of steroids or anesthetics directly into the back to help control the pain. In cases where there is a herniated disc or pinching of the nerve from the spinal cord, surgery may be indicated.
A medium-firm mattress has been shown to be helpful in the treatment of chronic back pain.
For those patients with long-standing back pain and nerve damage, some newer treatments have been developed recently to help with the treatment of pain. One of these is radiofrequency ablation, a process of delivering electrical stimulation to specific nerves to make them less sensitive to pain, or by delivering enough electricity to actually destroy the nerve to prevent further pain. More research is needed to see if this approach is effective.
Some physicians advocate using a transcutaneous electrical nerve stimulator (TENS), although whether TENS is clearly helpful for back pain has not been resolved. Electrodes taped to the body carry a mild electric current that helps relieve pain.TENS is not painful and may be effective therapy to mask pain such as diabetic neuropathy. However, TENS for chronic low back pain is not recommended, according to the American Academy of Neurology (AAN), because its effectiveness has not been proven.
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.
Chiropractors have a role in the treatment of back pain. 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 chiropractic adjustments 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.
Osteopathic treatment is likely to combine drug therapy with spinal manipulation or traction that may be followed by physical therapy and exercise.
Research has shown that acupuncture may bring relief for many chronic back pain sufferers. There doesn’t seem to be any difference, however, between the relief brought on by acupuncture as opposed to simulated acupuncture. More research is needed to find out why both techniques are effective. Acupuncture can be used alone or as part of a comprehensive treatment plan that includes medications and other therapies.