Treatment of Lower Back Pain

Treatment of lower back pain is typically performed without surgery. Non-surgical treatment of lower back pain involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury. Most patients with back pain recover without residual functional loss. Patients should contact a doctor if there is not a noticeable reduction in pain and inflammation after 72 hours of self-care techniques. Lower back pain treatment options can include: 

Ice and Heat

Ice and heat compresses may assist in lower back pain treatment and allow greater mobility for some individuals. As soon as possible followings trauma, patients should apply a cold pack or a cold compress to the tender spot several times a day for up to 20 minutes. After 2 to 3 days of cold treatment, they should then apply heat for brief periods to relax muscles and increase blood flow. Warm baths may also help relax muscles. Patients should always avoid sleeping on a heating pad, which can cause burns and lead to additional tissue damage.

Bed Rest 

Bed rest should be used in the treatment of lower back pain for 1 to 2 days at most.  Although bed rest is good for a short period of time, patients who continue their activities without bed rest following an onset of LBP appear to have better back flexibility than those who rest in bed for a week. Too much bed rest can make back pain worse and lead to secondary complications like decreased muscle tone and blood clots in the legs. Patients should resume activities as soon as physically possible. At night or during rest, patients should lie on one side with a pillow between the knees or resting on the back with the pillow beneath the knees.

Exercise

Exercise may be the most effective way to provide speedy lower back pain treatment and help strength back and abdominal muscles. Doctors and physical therapists can provide a list of gentle exercises that help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking and movement therapy to improve coordination and develop proper posture and muscle balance. Any mild discomfort experienced at the start of these exercises should lessen as muscles become stronger.  However, if the pain is more than mild and lasts more than 15 minutes throughout the exercise, patients should stop exercising and contact their doctor.

Medications

Medications are often used for acute and chronic lower back pain treatment. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Patients should always check with a doctor before taking drugs for pain relief. Over-the-counter analgesics, including non-steroidal anti-inflammatory drugs (NSAIDS), like aspirin or ibuprofen, are taken orally to reduce stiffness, swelling and inflammation and to ease mild to moderate LBP. Opioids, like codeine, oxycodone and hydrocodone, are often prescribed to manage severe acute and chronic back pain. These should be used only for a short period of time and always under the instruction of a doctor.  Side effects can include drowsiness, decreased reaction time, impaired judgment and the potential for addiction.

Interventional Therapy

Interventional therapy can ease chronic pain by blocking nerve conduction between specific areas of the body and the brain. Approaches range from injections of local anesthetics, steroids or narcotics into affected soft tissue, joints or nerve roots to more complex nerve blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. Chronic use of steroid injections may lead to increased functional impairment.

Vertebroplasty and Kyphoplasty

Minimally invasive outpatient procedures to seal fractures of the vertebrae include vertebroplasty and kyphoplasty. Vertebroplasty uses 3-dimensional imaging to help a doctor guide a fine needle into the vertebral body. A glue-like epoxy is injected, which quickly hardens to stabilize and strengthen the bone and provide immediate pain relief.  In kyphoplasty, prior to injecting the epoxy, a special balloon is inserted and gently inflated to restore height to the bone.

In the most serious cases, surgical treatment of lower back pain may be the best option to relieve a patient's symptoms and pain.

Discectomy

Lumbar Discectomy is one of the more common treatments to remove pressure on a nerve root from a bulging or herniated disc. During the procedure, the surgeon takes out a small piece of the lamina on the vertebrae and removes the affected piece of the vertebral disc.

Foraminotomy

A foraminotomy is an operation that enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can cause narrowing of the space through which the spinal nerve exits and can press on the nerve, resulting in pain, numbness and weakness in an arm or leg. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve the pressure on the nerve.

Laminectomy

Laminectomy, also known as spinal decompression, is a surgical lower back pain treatment option which involves the removal of the lamina to increase the size of the spinal canal and relieve pressure on the spinal cord and nerve roots.

Spinal Fusion

Spinal fusion is used to strengthen the spine and prevent painful movements. The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are 'fused' together by bone grafts and/or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine.

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