If you have chronic back or spine pain, you may be hesitant to seek care out of fear that surgery will be the first and only option suggested. It’s a common concern, says Christina Nguyen, D.O., a physical medicine and rehabilitation physician on the medical staff at Texas Health Alliance and at Spine Team Texas, a Texas Health Physicians Group practice. But it’s not the only option — there are many non-surgical and minimally invasive treatment options available to address pain.
“At Spine Team Texas, we pride ourselves on taking a conservative approach to treatment and we reserve surgery as a last resort,” Nguyen explains. “My goal for my patients is to improve their pain and in turn improve their function and quality of life. I use a variety of non-surgical methods such as medication, physical therapy, lifestyle changes, and injections to achieve this goal. Most of our patients experience successful treatment without ever needing surgery.”
Medication is often one of the first items addressed when exploring non-surgical treatment options. In light of the opioid crisis, the use of medicines can be frightening for some patients. While opioids are one form of medication to help treat pain, Nguyen says there are other options.
“We realize there is a lot of sensitivity to the use of opioids right now, and rightly so,” she explains. “There are many non-opioid medications I consider for my patients such as non-steroidal anti-inflammatory drugs (NSAIDs), oral steroids, neuropathic agents and muscle relaxants.”
If opioids are prescribed, Nguyen says there are monitoring processes in place to ensure that you are not at risk for dependency and abuse. Since opioids can also commonly cause constipation, short-term use and low dosage can be used to achieve pain relief.
An injection is another minimally invasive treatment option available to treat pain and reduce inflammation. There are several types of injections, that can include steroids or anesthetics, to treat pain. After reviewing your history, physical exam and imaging, the physician will decide if an injection is an appropriate treatment.
These injections can be guided by fluoroscopy (X-ray,) or ultrasound based on the patient’s source or cause of pain to ensure proper placement of the injection.
A few examples of injections and location sites are:
- Cervical or Lumbar Epidural Steroid Injection – This injection procedure is performed to relieve low back or neck pain which radiates down the leg or arm caused by a “pinched nerve” from conditions such as a herniated disc or spinal stenosis.
- Sacroiliac Joint Steroid Injection – This injection procedure is performed to relieve buttock or pelvic pain in the sacroiliac joint, where the sacrum and hip bone meet.
- Facet Joint Injection – A facet joint injection may help diagnose and treat axial pain and inflammation of the facet joints, which line both sides of the spine from the neck to the low back.
- Trochanteric Bursa Injection – This injection is used to treat lateral hip pain from an inflamed bursa.
“Every patient is different and therefore, their imaging, pain response and pain tolerance varies,” Nguyen says. “Patients can get several months to even years of relief with injections. That being said, all injections come with their own inherent risks. I try to limit steroid-based injections to no more than 3-4 per year.”
Physical therapy and rehabilitation
Physical therapy (PT) can help restore physical function and relieve pain. PT aids in improving posture, movement retraining, spinal stabilization, and conditioning. “Our physical therapists at Spine Team Texas are certified in the McKenzie Method, which is a formal spine-related methodology proven to improve spine-related conditions,” says Nguyen.
Typically, a patient would participate in PT for 4-6 weeks, depending on their schedule and severity of pain. While in-person physical therapy is still available, many places are offering virtual telehealth physical therapy, which allows patients with busy schedules or a high risk of COVID-related complications to eliminate travel time or stay in the safety of their homes.
“I LOVE physical therapy,” Nguyen exclaims. “Everyone can benefit from PT. The most important thing I tell my patients is to get comfortable performing the exercises on their own so they can extend the benefits therapy provides. While we give our patients an individualized home exercise program, we want patients to graduate from their physical therapy treatment with the confidence that they can continue to utilize this training once they leave therapy.”
PT may be recommended in combination with other treatment options such as medication management or injections. Oftentimes, if a patient is in too much pain to take advantage of PT, an injection may be recommended to help bridge a patient into PT. The combined use of PT and injection can improve the results of your treatment plan.
Chiropractic treatment, massage, and acupuncture can help restore flexibility and alleviate mild to moderate pain in many patients.
Chiropractic treatment helps to “realign” the spine by pressing on the joints. Most chiropractors focus on skeletal and muscular problems, especially low-back, neck and shoulder pain.
Acupuncture involves the insertion of extremely fine needles into the skin at specific “acupoints.” This may relieve pain by releasing endorphins, the body’s natural pain-killing chemicals. It also activates the part of the brain that controls the release of serotonin, a brain chemical involved with mood. A typical course of treatment includes six to 12 sessions over a three-month period.
Massage therapy can provide pain relief for many minor back problems, such as those caused by a muscle strain. When the correct muscle is targeted, pain can be controlled at its source. A study published in the Annals of Internal Medicine found that chronic low back pain sufferers receiving weekly massages reported less pain after 10 weeks than those who didn’t. Massage is most effective if your back pain is muscular in origin.
“Many of my patients use massage, acupuncture and chiropractic treatment as adjunct therapies to their treatment with me,” Nguyen adds. “These are often helpful for at least temporary relief, while some patients receive lasting effects. I always recommend you clear these methods with your treating physician first, though. For instance, if a patient has a large herniated disc, then getting ‘adjusted’ may do more harm than good.”
Don’t be afraid to seek care
There are various treatment options to consider that are non-surgical, even beyond what is listed here. But it can be hard to learn more about them on your own. A trusted physician and professional health care team can present all of the options for you and provide you with a treatment plan that works best for you.
“You don’t have to live with back pain,” Nguyen says. “Our goal is to improve your spine pain so that you can return to doing the things you love.”
Is back pain impacting your life? Our 5-minute back health assessment offers real insight into treatment options for your pain and symptoms, with a focus on non-surgical solutions.,