As with most things in medicine, we start off by treating back pain with the least invasive methods first and only move to more invasive treatments as needed. The most important treatment for back pain in general is physical conditioning. In almost every category of back pain, to include muscle pain, joint pain, disc pain or nerve pain, these conditions can be improved by selectively strengthening the muscles surrounding the spine (known as the core muscles). By strengthening these muscles in the proper way, the muscles can begin to take on some of the forces of the body and thus release some of those forces on the spine. This can in some cases halt progression or even reverse pain coming from spinal structures. This type of specific muscle strengthening is usually done under the supervision of a trained physical therapist.
Unfortunately, many individuals have pain levels that simply make it intolerable to do the kinds of exercises needed to properly strengthen the core. For these individuals we can offer different types of treatment modalities designed to reduce pain, which will allow them to properly rehabilitate the back. These modalities include pain medications, spinal injections and nerve blocks and surgery. There are a multitude of pain medications to choose from based on the etiology of pain and the individual. As all medications include risks and side effects a careful discussion about risks vs. benefits will take place with the prescribing provider.
In certain conditions where there is inflammation of the nerves due to compression from bone spurs or discs, an epidural steroid injection may be helpful. This is where a needle is advanced under X-ray guidance to the area of nerve inflammation and a small amount of steroid is deposited which is a very potent anti-inflammatory. Certain joints of the spine can also be injected with steroid in a similar manner. In some cases the small nerves that supply painful stimulus from the back to the brain can even be selectively destroyed with a small amount of energy using a tiny probe.
Lastly, when all these efforts fail to offer significant pain relief or functional improvement, spinal surgery may be indicated based on the etiology of spinal pain. Our office in Sonora will be offering full consultations and evaluations for the above mentioned conditions as well as many other painful conditions. We will be offering all of the treatment modalities mentioned above for appropriate candidates.