Non-surgical Treatments for Chronic Pain

As a pain management physician specializing in back pain, I'd like to provide insights into common causes of chronic back pain and non-surgical treatment that actually work.



Common Causes of Chronic Back Pain:

Chronic back pain often arises from factors such as aging or previous injuries. Some prevalent causes include:

1. Disc problems like herniated or bulging discs.

2. Arthritis of the spine, which involves the gradual wearing down of the cartilage inside the spine in the discs and the small joints.

2. Spinal stenosis, characterized by the narrowing of the spinal canal that pinches nerves.

3. Facet joint syndrome, which involves the small joints in the back of the spine

4. Myofascial pain syndrome, which causes recurrent muscle pain, tenderness and sometimes fatigue.

5. Sacroiliac joint syndrome, which involves the large joints between the sacrum and the hips.

These conditions can mimic each other and all can cause either pure low back pain and/or associated sciatic/leg pain. These conditions often are present at the same time. In those instances, identifying the exact cause of chronic back pain can be challenging. Multiple treatments may be required to optimally treat your pain and set you up for a healthy back as you age.

If you have exhausted options like medications and physical therapy, it's necessary to seek a second opinion from a back pain specialist. It is important to determine if further diagnostic tests or procedures are necessary to narrow down the likely cause(s) of your ongoing pain symptoms.  It is not advisable to rush into spine surgery without understanding the root cause of the problem, since that can result in pain isn’t improved or may end up being worse.

Non-surgical and minimally invasive treatments, which are reversible and do not cause any permanent change to your anatomy, are always the next step before surgery in the absence of emergency symptoms (listed below).

Non-Surgical Treatments for Chronic Back Pain (that actually work):

1. Physical Therapy: Under the guidance of your physician and a spine physical therapist, exercise becomes the foundation of chronic back pain treatment. Tailoring exercises to your specific symptoms and condition is essential, and maintaining a consistent exercise routine at home is crucial.

2.  Activity Modifications and Adaptations: Accepting your limitations and adapting to them is crucial when dealing with chronic pain. Listening to your body and pacing yourself, as well as avoiding activities that worsen your pain, can lead to better outcomes. Giving up smoking is another essential lifestyle change as nicotine can exacerbate pain and hinder healing.

3.  Injection-Based Treatments: Certain injection procedures, such as nerve blocks and epidural steroid injections, can help when the source of your pain is known. These injections can sometimes rule out specific causes if they prove ineffective. However, they are not intended as long-term solutions and should not be used in isolation.

4. Diet: Dietary choices play a huge role on your well being, including pain control. Please see our blog on The Link Between Nutrition and Pain. Maintaining a healthy weight can also reduce pressure on your spine.

5. Vitamins and Supplements: Medical grade vitamins and supplements can support healthy bones, health joints, a healthy nervous system, a healthy musculoskeletal systems and improve your immune system.

6. Mindfulness and Meditation: Chronic back pain takes a toll both physically and emotionally. To address the emotional aspects, a rehabilitation psychologist may recommend practices like meditation, yoga, or tai chi to redirect your focus away from the pain.

7. Self-care: Foam rolling and other forms of self massage, like using a Theracane and other massage tools can provide significant benefit for pain reduction and flexibility.

8. Alternative Therapies: Consider alternative options like acupuncture, chiropractic treatment, massage, and TENS unit. These treatments typically carry minimal to no risk and can be performed in most people. (There are some contraindications to TENS unit like pregnancy and some cancers)

7. Medications: Pharmacologic treatments like analgesics, anti-inflammatory drugs, and muscle relaxants can be used to control chronic back pain.

However, they often come with unwanted side effects and are not meant for long term or daily use. Opioid medications should only be considered after a comprehensive examination and treatment by a back pain specialist. Dependence on opioids to manage daily life is a signal that it's time to seek a second opinion.

Surgery for Back Pain:

Surgery may be a necessary for back pain in specific cases, particularly when certain red flag (emergency) symptoms are present and are related to your spinal condition. These red flags include:

- New or worsening bowel or bladder problems.

- Progressive weakness in your limbs.

- Gait and balance problems, including falls.

- Evidence of increased reflexes.

Surgery should only be considered if there is a confirmed cause supported by imaging, and other treatments have been unsuccessful. Seeking opinions from multiple surgeons is advisable, as pain can sometimes return after surgery. Your pain management physician can help you determine when surgery is recommended.