Standard Medical Care

Standard Medical Care of Back Pain

What is Standard Medical Care for Back Pain?

Doctors have many types of possible treatments for the medical care of back pain. Here are just a few of them:

1. Prescription Medications

2. Physical therapy to strengthen the back muscles and improve pain

3. Surgical Procedures that Fix the Problem

4. Surgical Procedures that Stop the Pain

Prescription Medications

In the medical care of back pain, one of the primary concerns is to get you out of pain. Non-steroidal anti-inflammatory (NSAID) drug are often prescribed along with a muscle relaxant for the medical treatment of back pain.

The purpose of the NSAIDs is to decrease the inflammation.

Doctors claim that sometimes the fact that when some patients receive any type of pill, the pain will lessen. This is called the placebo effect.

However, NSAIDs have a distinct physiological effect that causes their pain-reducing qualities. They interfere with the action of an enzyme called cyclooxygenase (COX) in the body. This enzyme converts one of the fats you get in your diet, arachidonic acid, to chemicals called prostaglandins. The prostaglandins cause inflammation in the body; thus, by inhibiting them, pain relief is felt.

Some examples of NSAIDs include:

• aspirin                        • ibuprofen                        • ketoprofen

• naproxen                   • sulindac                          • etodolac

• piroxicam                 • meloxicam

Muscle relaxants are another type of treatment in the medical care of back pain. These medications allow muscles to relax, which can remove pressure on nerves from tight muscles. Studies do show that these are effective for acute cases of low back pain. Some examples of muscle relaxants include the following:

• methocarbamol (Robaxin)          • cyclobenzaprine (Flexeril)

• metaxalone (Skelaxin)                   • carisoprodol  (Soma)

• diazepam (Valium)                          • tizanidine (for headaches) (Zanaflex)

• clonidine                                             • baclofen

• dantrolene (Dantrium)                  • gabapentin (Neurontin)

There are many different types of muscle relaxants, and some fit into other categories such as anti-epileptics, which can reduce spasming in the back as a side effect of working on decreasing epileptic seizures. The problem with using muscle relaxants is that they can be moderately addictive and really won’t address what is wrong.

Pain is occurring in the body for a reason. It’s a signal to take care of something that is not right. When back pain hits you, you must find the underlying reason why you have the back pain. Is it structural, and a disc, facet or spinal nerve is crying out? Is it physiological and the result of something else such as a kidney stone or a trigger point referring pain to the back? Is it emotional and does it flare up when you’re under stress?

The medical care of back pain is often challenged by alternative practitioners for this reason – of not addressing the problem head on. If the reason is not addressed, the problem will worsen, or the person can become easily entrapped in a cycle of taking more and more NSAIDs and muscle relaxants, or even opioids for pain. Most doctors recognize that the medications being used are not fixing the problem, but rather treating the pain while the body heals itself. The body has a tremendous ability of self repair and often the only treatment necessary is time to allow it to heal.

However, some patients will need a referral to a neurologist or physical medicine and rehabilitation specialist is indicated if the pain is persistent or particularly severe.

Side Effects of NSAIDs and Muscle Relaxants

One thing to remember about NSAIDs and muscle relaxants is that they are not meant for long-term usage. Both types of medication have side effects associated with them.

Here’s a list of what to watch for:

• Perforation of the stomach lining, causing internal bleeding

• Permanent kidney damage

• Permanent liver damage (Dantrolene)

• Nausea and vomiting

• Heartburn

• Swelling of the feet/ankles

• Muscle pain / weakness

• Bruising / bleeding

• Abdominal pain

• Dizziness

• Drowsiness

• Diarrhea / constipation

• Allergic reaction

• Heart failure or strokes

• Paralysis

• Confusion

• Dry mouth

• Blurred Vision or halos seen around objects

• Fatigue

• Hallucinations

• Difficulty urinating

• Lack of appetite

• Seizures

• Loss of coordination

• And more!

Non-narcotic Painkillers

This category includes Tylenol, Tramadol, and Darvocet. Neurontin and Pregabalin have also been used with moderate success in chronic low back pain. Medications like tramadol and darvocet may have distinct addictive properties.

Opoids for Back Pain

These medications are used for severe pain and work directly on the central nervous system. Because of this type of action, they can be very addictive. Percocet, a combination of acetaminophen and oxycodone, as well as Oxycontin, are two examples of opioids. While these medicaitons are good at relieving pain in the short term, there is a high potential for addiction. In addition, most people will soon develop a tolerance to the opiod medicaitons and thus will require more and more of the medication to achieve the same effect. These medications should not be used for chronic pain in most cases, but only for a short time for acute pain.

Steroids for Back Pain

In the medical care of back pain, oral steroids are generally prescribed for these back pain conditions:

• Herniated disc

• Spinal stenosis

• Nerve compression problems, including sciatica and Piriformis Syndrome

Steroids can be taken in other forms as well, including injection. The reason why medical doctors choose steroids are to:

  1. See if surgery can be prevented
  2. Reduce inflammation quickly
  3. Reduce pain so that rehabilitation and exercise can be initiated

Side effects of steroids include the following;

• Insomnia

• Depression or euphoria

• Osteoporosis when used long term

• Decrease collagen content of the skin (can cause loss of elasticity if used for long-term)

Steroids should not be taken by those who have diabetes, are immunocompromised, or who are taking anticoagulants.

Surgical Procedures that Decrease the Pain

Medical doctors can also perform surgeries where painkillers are injected into the spine in the area that is causing the back pain. The painkillers are sometimes in the form of a pellet that releases medication over time. These injections have done wonders for many patients, especially those with intractable pain that results from cancer.

Epidural injections of steroids may be used in severe back pain cases. The advantage of using epidural injections is that they are local and do not have the usual side effects that occur with steroids given orally.

Surgical Procedures that Fix the Problem

Spinal fusion is one of the primary surgical procedures that is performed for back pain, fractures, scoliosis, and spondylolisthesis. The procedure may also be used in cases where an infection has eaten away parts of the vertebrae and the vertebrae is no longer able to support itself.

In spinal fusion surgery, two surgeries may need to be done:

  1. Bone fragments are removed from the pelvis bone
  2. The actual spinal fusion

The bone fragments help the area heal in time by providing cells that build bone. When the bone starts building new bone in between the vertebrae, this will prevent the motions that cause back pain. Both surgeries are quite painful.

And you may have noticed that the goal of this surgery is to prevent the motions that cause back pain. It wasn’t to attack the real cause of the back pain itself.

There’s a difference in the definition of “successful spinal fusion surgery” from the point of view of a surgeon and a patient. A surgeon will say the surgery was successful if the bone grafts “took’ and new bone was formed, limiting movement. A patient will say the surgery was not successful because he still has pain, and now after the surgery has more limited range of motion than he ever had. A patient wants total recovery – and to be back to normal, or better than normal. A doctor wants less for the patient. Make sure you understand what is the meaning of success before you have any surgery! You must listen in between the words!

Spinal Fusion for Herniated Disc

When spinal fusion surgery is performed for a herniated disc, the herniated disc is removed after the surgery to obtain the bone fragment. The fragments will make the two bones grow together to form one bone. Titanium screws, strips or rods may hold the vertebrae together for support during the bone growth period.

This type of surgery depends on a lot of assumptions that things will go right, such as:

• The bone from the hip will grow the bone without complications

• The motion of the rest of the spine will be intact.

• The patient’s pain will be reduced.

However, in a lot of cases, the person has a long rehabilitation period and then has restricted motion. His range of motion is decreased. This happens more often with multiple fusions in the spine.

New Medical Ideas Replacing Spinal Fusion

Luckily, medical science has progressed rapidly in the last decade in the medical treatment of back pain. Although spinal fusion is still performed for disc herniations and some cases of pinched nerves, innovative doctors are trying to perfect better techniques.

For example, using a genetically engineered protein, doctors can create a new disc. Here’s how the procedure is done:

  1. First a sponge made from collagen is soaked with bone proteins and sterile water.
  2. The sponge is then inserted inside a titanium cage that resembles a vertebrae
  3. New bone then grows on the sponge and fills the space of the cage. The process takes about five months.

What a pretty incredible idea! And so far, doctors are liking this new surgical procedure because they see that it can immediately make a patient feel better. It tries to address the cause of the pain. The titanium cage allows separation of the two vertebrae that have collapsed on top of each other, which has created all the back pain symptoms in the first place. The new bone grows and the patient feels like he’s brand new.

Another new surgical technique involves first the suction of the herniated disc through a very small one-inch incision in the back. A needle is guided into the area where the disc needs to be replaced. Then a rubberized silicon material is injected which hardens in about 10 minutes. Now the patient has a new disc. It’s not exactly like the original but it may be a great substitute.