Hertfordshire Spine Clinic Mr Sajjad Mushtaq

Non-Surgical Care

Medications

Medications play an effective role in the treatment of back or neck pain. Your doctor may prescribe several medications to help reduce pain and associated symptoms that are caused by unhealthy spinal conditions or deformities.

When treating a chronic lower back pain, the healthcare professional will prescribe a medication regimen, taking into consideration the precise needs of the patient including severity, period of pain and medical history of the individual. The main aim of prescribing medications is to reduce the pain and increase the comfort level of the patient and to reduce the danger of misuse or abuse of the medications.

Over-the-counter pain relievers

Over-the-counter pain relievers are medications available without a doctor's prescription. They include acetaminophen, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and topical pain relievers.

  • Acetaminophen (Tylenol) and NSAIDs help to reduce fever and alleviate pain caused by general muscle aches and stiffness. Moreover, NSAIDs can also reduce inflammation. NSAIDs help relieve pain by reducing the level of prostaglandins (hormone-like substances) that cause pain.
  • Topical pain relievers (Aspercreme, Ben-Gay, and Capsaicin) include creams, lotions and sprays that are applied to the skin of painful muscles or joints to ease pain.

Opioid pain medications:

Because of possible toxicity to the body, physical dependence, and the loss of efficacy due to developmental tolerance and psychological dependence or addiction, opioid medical care or narcotic administration is widely rejected in the treatment of chronic back pain.

Opioids are typically prescribed for patients with chronic non-malignant pain, including low back pain who experience high levels of comfort while not developing toxicity to the body or having any indication of psychological dependence or addiction. Opioid therapy should be considered as the last treatment option in cases of unrelieved pain despite alternative medications (such as use of non-opioid drugs). Patients should be informed regarding the side effects of opioids and suggested to follow-up with their doctor regularly. Monthly appointments should be scheduled to assess the dose of the drug until the patient experiences partial or complete relief from pain.

Corticosteroids: Corticosteroids are used to reduce swelling caused due to inflammation. When used to control pain, corticosteroids can be prescribed in the form of pills or injections.

Muscle relaxers: Muscle relaxers are drugs that are commonly used to treat acute muscle problems. Sometimes, they can help treat painful muscle spasms. These medications help in reducing muscle tone and tension in skeletal muscles. Some muscle relaxers have direct effect on the skeletal muscle fibres, while others work at the level of the spinal cord.

Physical Therapy

Physical therapy is one of the foremost necessary treatment modes of recovery for back pain. A referral to physiotherapy sometimes is created by your spine surgeon. A physical therapist is a well-trained, skilled health care professional who facilitates improving movement and manages the pain by safe stretching, conditioning, and strengthening exercise techniques. Patients are guided concerning the fundamental anatomy of the body and their mechanism of action. They are also instructed about the varied exercise regimens to extend the activity level thereby strengthening the muscles. Most patients manage low back pain and associated symptoms with therapy and medications without surgical intervention.

The different modalities of physical therapy include hot or cold packs, ultrasound, transcutaneous electrical nerve stimulation, spinal manipulation, diathermy, massage, and aqua therapy. These treatment options may be indicated depending on the type and severity of pain.

People susceptible to back pain should avoid activities that exert excessive stress on the lower back or twisting movements like in sports activities and weight lifting. The two different forms of physical therapy include:

  • Active physical therapy includes physical exercise or stretching, whereby the patient uses their own force to reduce back pain.
  • Passive physical therapy is where the modalities are done to the patient by the therapist.

A physical therapist tailors an exercise program per the individual necessities and goals.

What are the expectations from physical therapy?

Your first visit will be an initial evaluation. Your therapist will ask history about the present problem followed by a physical examination. You may be asked to walk around or asked to sit or stand to measure the movements (range of motion) and strength. Be prepared to discuss your symptoms and what factors worsen or diminish your pain levels as this helps the therapist to determine the nature of your problem and to determine your special care and focus.

Initial evaluation also includes postural assessment which helps to determine a specific treatment plan for the patient. Make sure to ask questions of your therapist if you are unsure of any of the instructions for your treatment plan.

Spinal Bracing

Spinal braces are external devices that help in the management of spinal disorders. They restrict the movement of the affected region of the spine, as well as support and stabilize it to relieve pain and promote healing following injury or spinal surgery. Braces are also called orthotics and are made from different materials such as nylon, rubber, moulded plastic and elastic cotton. The basic function of the brace is to:

  • Immobilize the spine and aid in healing
  • Stabilize the injured area
  • Prevent the advancement of the deformity
  • Manage pain by limiting movement

Based on the segments of the body supported by the spinal braces, spinal bracing can be categorized as:

  • Sacroiliac orthoses (SIO)
  • Lumbosacral orthoses (LSO)
  • Thoracolumbosacral orthoses (TLSO)
  • Cervicothoracolumbosacral orthoses (CTLSO)
  • Cervical orthoses
  • Cervicothoracic orthoses (CTO)

Based on the material used and the impact on movement, spinal braces can be categorized as flexible braces and rigid braces.

Flexible braces or corsets are made of cotton or nylon. Corsets reduce the pressure on the affected spinal segment by compressing the abdomen and help relieve low back pain associated with different spinal disorders such as degenerative disc disease, trauma, and postural deformities.

Rigid braces are made of fabricated material and provide additional immobilization that minimizes the risk of further injury in conditions such as spinal fractures, unstable spine, post-surgery and other related disorders. The rigid braces provide external stability to the affected spinal area for better healing.

A brace specialist is also referred to as an orthotist and is trained in different fields such as anatomy, biomechanics, material engineering, physical science and other related fields. In some cases, spinal braces are fitted in consultation with an orthotist, as per the requirements of the treatment and condition of the patient. Your doctor may recommend spinal braces for a specified time, which may range from a few weeks to months, depending on the condition and the type of the disorder. Physical therapy may also be recommended along with spinal braces to improve muscle strength.

Patients wearing cervical braces should avoid activities that put undue strain on the affected area such as driving. Follow the instruction of your doctor for bathing and while performing other daily activities. If the patient is instructed to shower with the brace, then the brace should be cleaned appropriately following bathing.

Injections

Spine injection is a nonsurgical treatment modality recommended for treatment of chronic back pain. Injection of certain medicinal agents relieves the pain by blocking the nerve signals between specific areas of the body and the brain. The treatment approach involves injections of local anaesthetics, steroids, or narcotics into the affected soft tissues, joints, or nerve roots. It may also involve complex nerve blocks and spinal cord stimulation.

Epidural Injections

  • Cervical epidural injection
  • Lumbar epidural injection

Nerve root blocks

  • Cervical nerve root block
  • Lumbar nerve root block

Facet Injections

  • Cervical facet injection
  • Lumbar facet injection

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