According
to
Irvine
Chiropractor
, the management goals when treating back pain are to
achieve maximal reduction in pain intensity as rapidly as
possible; to restore the individual's ability to function in
everyday activities; to help the patient cope with residual
pain; to assess for side-effects of therapy; and to
facilitate the patient's passage through the legal and
socioeconomic impediments to recovery. For many, the goal is
to keep the pain to a manageable level to progress with
rehabilitation, which then can lead to long term pain relief
says
Orange County
Chiropractor
. Also, for some people the goal is to use non-surgical
therapies to manage the pain and avoid major surgery, while
for others surgery may be the quickest way to feel
better.
-
Lumbar
disc herniation or degenerative disc disease
-
Spinal
stenosis from lumbar disc herniation, degenerative joint
disease, or spondylolisthesis
-
Scoliosis
-
Compression
fracture
-
Emerging
Treatments
Vertebroplasty
involves the percutaneous injection of surgical cement into
vertebral bodies that have collapsed due to compression
fractures. This new procedure is far less invasive than
surgery, but may be complicated by the entry of cement into
Batson's plexus with subsequent spread to the lungs or into the
spinal canal. Ideally this procedure can result in rapid pain
relief.
The
use of specific biologic inhibitors of the inflammatory
cytokine tumor necrosis factor-alpha may result in rapid relief
of disc-related back pain.
Treatments
with uncertain or doubtful benefit
Injections,
such as epidural steroid injections and facet joint injections,
may be effective when the cause of the pain is accurately
localized to particular sites. The benefit of prolotherapy has
not been well-documented.
Orange County
Chiropractor
recommends cold compression therapy is advocated for a
strained back or chronic back pain and is postulated to reduce
pain and inflammation, especially after strenuous exercise such
as golf, gardening, or lifting. However, a meta-analysis of
randomized controlled trials by the Cochrane Collaboration
concluded "The evidence for the application of cold treatment
to low-back pain is even more limited, with only three poor
quality studies located. No conclusions can be drawn about the
use of cold for low-back pain" Bed rest is rarely recommended
as it can exacerbate symptoms, and when necessary is usually
limited to one or two days. Prolonged bed rest or inactivity is
actually counterproductive, as the resulting stiffness leads to
more pain.
Electrotherapy,
such as a Transcutaneous Electrical Nerve Stimulator (TENS) has
been proposed. Two randomized controlled trials found
conflicting results. This has led the Cochrane Collaboration to
conclude that there is inconsistent evidence to support use of
TENS. In addition, spinal cord stimulation, where an electrical
device is used to interrupt the pain signals being sent to the
brain and has been studied for various underlying causes of
back pain.
Inversion
therapy is useful for temporary back relief due to the traction
method or spreading of the back vertebres through (in this
case) gravity.
The
patient hangs in an upside down position for a period of time
from ankles or knees until this separation occurs. The effect
can be achieved without a complete vertical hang (90 degree)
and noticeable benefits can be observed at angles as low as 10
to 45 degrees.