PROCEDURAL SOLUTIONS FOR LOWER BACK DISCOMFORT
If you have lower back pain, you are definitely not alone. About 80 percent of adults experience low back pain at some point in their lifetimes. It is the most common cause of job-related disability and a leading contributor to missed work days. Both men and women are equally affected by low back pain, which can range in intensity from a dull, constant ache to a sudden, sharp sensation that can leave you incapacitated. Pain can begin abruptly as a result of an accident, by lifting something heavy or it can develop over time due to age-related changes of the spine. Sedentary lifestyles also can set the stage for low back pain, especially when a weekday routine of getting too little exercise is punctuated by a strenuous weekend workout.
Most low back pain is acute or short-term and lasts a few days to a few weeks. It often resolves on its own with self-care and there is no residual loss of function. Chronic back pain is defined as pain that persists for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated.
Treatment for low back pain generally depends on whether the pain is acute or chronic. In general, surgery is recommended only if there is evidence of worsening nerve damage and when diagnostic tests indicate structural changes for which corrective surgical procedures have been developed. Your physician may prescribe or suggest oral medications. Sometimes those will work without the need for further intervention. In cases where the pain does not resolve through oral medications alone, your doctor may recommend a variety of procedures to alleviate and ultimately resolve your condition.
Here are some common procedural solutions for lower back discomfort:
- Spinal manipulation and spinal mobilization are approaches in which professionally licensed specialists (doctors of chiropractic care) use their hands to mobilize, adjust, massage or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques have been shown to provide small to moderate short-term benefits in people with chronic low back pain.
- Traction involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released, the back pain can return.
- Acupuncture is moderately effective for chronic low back pain. It involves the insertion of thin needles into precise points throughout the body. Some practitioners believe this process helps clear away blockages in the body’s life force known as Qi (pronounced chee). Others who may not believe in the concept of Qi theorize that when the needles are inserted and then stimulated (by twisting or passing a low-voltage electrical current through them) naturally occurring pain killing chemicals, such as endorphins serotonin and acetylcholine, are released.
- Biofeedback is used to treat many acute pain problems, most notably back pain and headache. The therapy involves the attachment of electrodes to the skin and the use of an electromyography machine that allows people to become aware of and self-regulate their breathing, muscle tension, heart rate, and skin temperature. People regulate their response to pain by using relaxation techniques. Biofeedback is often used in combination with other treatment methods, generally without side effects.
- Nerve block therapies aim to relieve chronic pain by blocking nerve conduction from specific areas of the body. Nerve block approaches range from injections of local anesthetics, botulinum toxin, or steroids into affected soft tissues or joints to more complex nerve root blocks and spinal cord stimulation. When extreme pain is involved, low doses of drugs may be administered by catheter directly into the spinal cord. The success of a nerve block approach depends on the ability of a practitioner to locate and inject precisely the correct nerve.
- Transcutaneous electrical nerve stimulation (TENS) involves wearing a battery-powered device consisting of electrodes placed on the skin over the painful area that generate electrical impulses designed to block incoming pain signals from the peripheral nerves. TENS usage elevates the levels of endorphins, the body’s natural pain-numbing chemicals.
- Vertebroplasty and kyphoplasty are minimally invasive treatments to repair compression fractures of the vertebrae caused by osteoporosis. Vertebroplasty uses threedimensional imaging to assist in guiding a fine needle through the skin into the vertebral body, the largest part of the vertebrae. A glue-like bone cement is then injected into the vertebral body space, which quickly hardens to stabilize and strengthen the bone and provide pain relief. In kyphoplasty, prior to injecting the bone cement, a special balloon is inserted and gently inflated to restore height to the vertebral structure and reduce spinal deformity.
- Spinal decompression is performed when spinal stenosis causes a narrowing of the spinal canal that causes pain, numbness, or weakness. During the procedure the lamina, or bony walls of the vertebrae, along any bone spurs are removed. The aim of the procedure is to open up the spinal column to remove pressure on the nerves.
- Discectomy may be recommended to remove a disc, in cases where it has herniated and presses on a nerve root or the spinal cord, which may cause intense and enduring pain. Microdiscectomy is similar to a conventional discectomy; however, this procedure involves removing the herniated disc through a much smaller incision in the back and a more rapid recovery.
- Foraminotomy is an operation that “cleans out” or enlarges the bony hold (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 pressure on the nerve.
- Intradiscal electrothermal therapy is a treatment for discs that are cracked or bulging as a result of degenerative disc disease. The procedure involves inserting a catheter through a small incision at the site of the disc in the back. A special wire is passed through the catheter and an electrical current is applied to heat the disc, strengthening the collagen fibers of the disc wall and reducing the bulging and related irritation of the spinal nerve.
Discuss your symptoms with your health care professional to determine your best option for relieving your lower back discomfort.
