Back pain treatment begins with conservative therapy
As a total spine care provider, Inspired Spine will always recommend the least invasive approach that’s appropriate to treat your condition. Before you think about surgery, we recommend several stages of conservative care first. Treatment options are considered “conservative” when they are non-invasive (such as physical therapy) or markedly less invasive than surgery (such as injections). Inspired Spine has developed a multi-tiered Conservative Therapy Policy, which is meant to employ the least invasive treatments available to reduce your pain and strengthen your back. Some of these treatments are described below.
Conservative Treatment Path
|wdt_ID||3-6 months||As needed||3-6 months||1-year|
|1||Physical Therapy (PT), OTC Pain Medicines, Chiropractic Care, Yoga and other alternatives||Advanced Diagnostic Procedures to pinpoint the exact cause of pain, such as an upright MRI or Discogram||Pain Management Services ranging from Epidural Steroid Injections to more advanced therapies||Opioids
Minimally Invasive Surgery
The goal of our Conservative Treatment Policy is to ensure that conservative treatment options are explored with each patient prior to surgery. During your initial consultation at Inspired Spine, you should expect to discuss your medical history, current symptoms, and any previous treatments you have had for your back problems. We will also review any recent diagnostic images you may have.
If you have a current MRI or CT scan that is less than a year old, you can
When there are no signs of neurological symptoms, Physical Therapy (PT) and over-the-counter (OTC) pain medications are the most commonly recommended therapies for back pain lasting between 2 to 6 weeks. A typical PT program for back pain will combine active and passive components designed to decrease pain and improve function.
Passive Physical Therapy
Passive therapies are those that are performed on you. The goal of passive PT is to reduce your pain and make it more manageable, until you are able to become more active. Examples of passive PT are heat/ice packs, ultrasound, and TENS Therapy.
- Ultrasound Therapy uses sound waves to provide deep heating to muscles and soft tissue to reduce pain.
- TENS stands for Transcutaneous Electrical Nerve Stimulation. It aims to manage pain by delivering low voltage stimulation to painful muscles in the back.
Active Physical Therapy
Active physical therapy involves active exercises to stretch and strengthen the spine and back muscles. The goal of active PT is not only to improve immediate function, but also to provide a maintenance program to prevent future recurrences of back pain.
Complementary and Alternative Medicine (CAM)
Complementary and Alternative Medicine (CAM) is a popular term generally applied to healthcare approaches developed outside of mainstream Western, or conventional, medicine. (Please see our FAQ on Complementary and Alternative Medicine) CAM therapies such as chiropractic care or yoga, are often used in combination with traditional back pain treatments.
The upside of CAM treatments it they are relatively inexpensive and painless. The downside is they are not covered by all health insurance plans.
Chiropractic or osteopathic manipulation of the spine is the most popular alternative therapy for back and neck pain, with about 75% of CAM users choosing this route.1 Spinal manipulation focuses on restoring proper alignment of the vertebrae, so bulging discs or bone spurs don’t irritate or pinch spinal nerves.
According to the CMS, Medicare Part B currently covers 80% of the cost for manipulation of the spine if medically necessary to correct a subluxation (a misalignment of the vertebrae). There is no Medicare cap on the number of medically necessary visits to a chiropractor. However, many other insurers do not cover chiropractic care and those that do generally limit covered visits to 10-30 per year.2
Yoga provides similar benefits to physical therapy by stretching and strengthening the spine and surrounding muscles. Aficionados swear by it, lots of health and fitness articles promote it and even traditional medical journals recommend yoga for back pain relief.3
If you’ve never practiced yoga before, it may be a stretch (pun intended) to grab a YouTube video or magazine article and try to treat yourself, unless you are familiar with yoga practice. Many fitness centers offer yoga classes with a qualified instructor. If yoga works for you, you will have learned a lifetime skill for increased flexibility and function. Just don’t expect your health insurance to cover the cost.
Injections are a minimally invasive nonsurgical treatment option for low back pain. They are typically used to treat low back pain after a course of medications and/or physical therapy is completed, but before surgery is considered. Injections can be more effective than oral medication, because they deliver medication directly to the area that is generating the pain.4
Injection therapy is typically an outpatient procedure. A solution of long-acting local anesthesia and anti-inflammatory medicine or other pain modifying drug is injected through the skin with a very tiny needle. The procedure is guided by fluoroscopic imaging – a kind of x-ray movie. (To learn more, see our FAQ on Fluoroscopy.)
Injections can also be used as a diagnostic tool. By providing temporary pain relief, they can help your doctor or surgeon identify the specific cause and prescribe the best treatment plan. If the pain relief is more long-lasting, continuing the injections may be the least invasive course of treatment.
Epidural Steroid Injections
Epidural steroid injections can help manage lower back and radicular pain (the kind that radiates down the legs) from a pinched or irritated spinal nerve. A mixture of local anesthetic and long-acting steroid medication is injected into the epidural space outside the affected area. This delivers an anti-inflammatory solution to the cerebrospinal fluid that bathes the nerve roots in the space where they branch out from the spine.
You should start noticing pain relief within 1 to 2 days after an epidural injection and the effects may last several days, weeks, or many months. The procedure may be performed up to three times a year, if needed.5
Selective Nerve Root Blocks or SNRBs are another common injection for diagnostics and pain treatment. An inflamed or irritated nerve that is pinched by a herniated disc or bone spur may not always show up clearly in x-ray or MRI images. But it can cause a shooting or radiating pain along that nerve root from your neck or back to your extremities.
A small needle placed in the “foramen”—the space between vertebrae where the nerve exits the spine – delivers local anesthesia and anti-inflammatory medicine. The anesthesia will wear off in a few hours and it may take a few days for the anti-inflammatory to take full effect.
As pain management therapy, nerve blocks can sometimes have progressively better effects with repeated injections.
Facet Joint Blocks
Similar in concept to Nerve Blocks (described above), Facet Joint Blocks are both a diagnostic and pain management treatment for Facet Joint Syndrome.
The facet (fuh-SETT) joints are small bony projections that connect each vertebra to the one below it. When they become arthritic and inflamed, these little joints can act up like a bad knee or hip – causing pain that often radiates from the back to hips, buttocks and legs or through the neck and upper extremities. It can be tricky to isolate which one is causing your pain from imaging tests alone.
A local anesthetic and long-acting anti-inflammatory steroid is injected with into the facet joint capsule. The anesthetic will wear off in a few hours, but you should feel the full effect of the anti-inflammatory within 1-2 days.
If the pain and other symptoms return after some length of time, you and your doctor may elect to have the injection repeated. It is often considered reasonable for the procedure to be done up to three times per year.
Advanced Pain Therapies
If none of the first line treatments or injection therapies have been effective, there are more advanced pain therapies that are also minimally invasive, outpatient procedures, such as neuroablation.
Neuroablation is a minimally invasive procedure whose aim is to temporarily block or interrupt nerve pathways that send pain signals to the brain, also known as denervation. Neuroablation can generally be performed with local anesthesia and mild sedation, using live x-rays (fluoroscopy) to precisely position the needle on the target nerve and avoid injury.
Radiofrequency Ablation (RFA) is one version of this procedure that uses a special radiofrequency needle. Radio waves produce a small amount of electrical current that heats the tip of the needle. When the heat is applied to a tiny portion of nerve tissue, it creates a heat lesion. This disrupts the nerve’s ability to transmit pain signals.
Thermoablation has the same effect as RFA, but instead of electrical current, the heat is created by a surgical laser. However, a small incision must be created for insertion of the laser.
When is minimally invasive keyhole surgery the best option?
A minimally invasive procedure is an option when:
- Conservative back treatments have failed
- Pain, numbness and spasms have persisted for an extended period of time
- And you are unable to maintain normal everyday functions.
Many of the people who come to Inspired Spine have been living with severe back pain for many years. They’ve tried every possible treatment alternative to avoid the trauma of traditional open surgery. But their pain still restricts their work, leisure, and even normal activities of everyday life. For them, minimally invasive keyhole surgery is the lifeline they’ve been waiting for. See their Inspired Stories.
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