NON-SURGICAL TREATMENT OF THE SPINE

Over the counter paracetamol is often all that’s required. It’s very safe and can be taken regularly for long periods of time and often in conjunction with an ant-inflammatory and rest. Patients with known gastrointestinal or cardiac conditions should use caution and consult their general practitioner before taking a course of anti-inflammatory medication. A prescription for stronger analgesia or specific medication may also be necessary for the treatment of nerve derived pain symptoms which will be prescribed by either your general practitioner or spinal consultant.

The use of ice and heat can offer comfort with symptoms of muscle spasm and inflammation. It is advised that both ice and heat packs be used in moderation and with caution to avoid any skin damage.

Maintaining an active daily lifestyle and healthy control of weight are key to increasing the longevity of your spine. The main aim of all physical therapies is to add more muscular control and support to the spinal region that is unstable and causing pain. The abdominal and lower back muscles help control the lumbar vertebrae when the degenerating discs cause back ache, hence the obvious benefit of having a good core strength. Chiropractic, acupuncture and osteopathic treatment are also physical treatment options trialled by patients before seeking the advice of a spinal surgeon. These can often provide good relief of symptoms.

TENS stands for Transcutaneous Electrical Nerve Stimulator. A TENS machine emits electrical stimulation to areas affected by pain. Pain producing signals sent from the brain are blocked by the stimulation created and this therapy can often be useful in the long term treatment of pain.

A soft lumbar corset can offer good symptomatic relief of lower back pain in patients requiring mechanical support when performing physically demanding tasks at work and/or home. Time should also be spent out of the corset for as long as possible so the normal lower back and abdominal muscles can maintain their strength.

Facet joints in the lumbar spine are a common source of lower back pain and referred leg pain. Facet joint injections are performed by a specialist radiologist using CT scan guidance to allow exact delivery of a small dose of steroid (cortisone) and local anaesthetic into the degenerate facet joints in either the lower back or neck. The effect is often immediate. The local anaesthetic wears off after about 6 hours whilst the steroid works after a few days to reduce degenerate inflammation around the facet joints. During this pain free period, patients are encouraged to seek physical therapy to maintain an active range of motion. These injections can be diagnostic in confirming the source of pain whilst also providing therapeutic relief of symptoms.

This technique is also performed by a specialist radiologist under CT scan guidance, however the steroid and local anaesthetic is this time injected onto the specific nerve root that is inflamed. This often occurs when a disc has herniated after rupturing and there is a degree of referred pain radiating down the arm or leg. The local anaesthetic wears off after about 6 hours and the steroid works after a few days to reduce inflammation around the nerve root. These injections can also assist in confirming the source of pain if they have been effective in the treatment of symptoms.

Epidural injections can also be effective in the management of symptoms of the lower lumbar spine. A local anaesthetic and cortisone injection can be performed into the epidural space without the need for imaging guidance from a radiologist.

These are available to patients who have either complex pain syndromes in the acute phase or more chronic pain conditions after all the above mentioned treatment methods have failed. These programs and clinics aim at providing tailored individual psychological support, education and the refinement and simplification of pain medication regimes.