4 Treatments for Chronic Back Pain to Discuss With Your Doctor

The Trouble With Treating Chronic Back Pain

There are several types of back pain and even more causes. An injury can have short or long term effects, some conditions develop on their own without a trigger and are treated over time and others need emergency treatment.

When is it time to worry about chronic back pain? If you have pain radiating down one leg, especially if accompanied by numbness, tingling or loss of control of your bowel or bladder, see your doctor immediately. These symptoms may indicate a serious compression of the spinal cord or its nerves and require an immediate diagnosis so treatment can be started to preserve nerve function.

Don’t get frustrated with your doctor if she won’t send you for an MRI or X-ray. There’s no evidence that either test can help diagnose uncomplicated lower back pain. And even if it shows a disk problem, that doesn’t mean you need surgery. Studies find that 64 per cent of 45-year-olds have disk herniation without pain. Instead, your doctor should perform a series of movement tests, such as having you push your legs against her hand, lean over, bend side to side, lift your legs, etc., to try and determine the extent of your problem and whether any nerves are involved.

If you experience severe back pain-and you’ve already tried natural and over-the counter remedies, physical therapies and exercise-here are some treatments you might want to discuss with your doctor.

1. Surgery

The primary surgery for chronic low back pain is fusion surgery, in which bone grafts are inserted between vertebrae so the vertebrae grow together. This limits movement in that part of the spine, however, and there’s little evidence that it’s effective for any kind of back pain beyond that caused by isthmic spondylolisthesis, in which one cracked vertebra slides over another. This condition occurs in only about 5 or 10 per cent of people with back pain.

2. Muscle relaxants

Muscle relaxants include benzodiazepines like Valium, sedatives, certain antihistamines (which can be very sedating) and other medications that act on the central nervous system. They’re often prescribed after an acute injury, but haven’t been studied for chronic back pain. However, their relaxing effects may help, particularly if anxiety or tension makes your pain worse. Don’t take for more than 4 weeks, however, because they can be addictive.

3. Antidepressants

Generally, low doses of tricyclic antidepressants like Elavil (amitriptyline) help with sleep and pain management, probably because the perception of pain occurs in the brain, not at the site of the pain itself, and antidepressants alter levels of neurotransmitters, chemicals in the brain that relay signals between brain cells.

4. Injections

Your doctor can inject medication into the spaces between the vertebrae in the back (epidural injections), certain muscles (trigger point injections) or into the joints between the vertebrae (facet injections). Medications include steroids to reduce inflammation and anaesthetics to deaden pain. Benefits depend on the reason behind the back pain. For instance, epidural steroid injections work very well to alleviate pain from compressed nerves, while facet injections work best if the pain is related to the vertebral joint.

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