In the third part of this series, we discussed the different types of lower-back pain treatment options. Let’s now review benefits and risks of these treatments.
Lower-Back Pain Treatment
More conservative and less invasive procedures lower the risks of significant lower-back pain treatment complications. Of course, there are always exceptions, and a minimum level of risk exposure is assumed in any activity, much less a pain treatment. Part of the risk inconsistency emerges as not all providers train exactly the same or share the same treatment philosophies. Some are aggressive with treatment and testing. Others trend more conservative. Look for a provider who takes the time to listen to your concerns and fits best with both your risk and pain tolerance.
Here’s a brief overview of the most common treatment courses, starting with the least invasive, least risky and typically least expensive protocols.
Ice/Heat
Benefit: Both these modalities have pain relieving properties, and are obviously easily accessible to all patients. However, many don’t realize how the two work in tandem and, at times, against each other. Ice reduces blood flow and is better for acute pain or flare ups. Heat increases blood flow, so it’s more commonly used for chronic pain, stiff and achy joints. When you use the two in rotation, the aim is reducing inflammation while loosening surrounding muscles.
Risk: Prolonged exposure to ice or heat can freeze or burn the skin and deeper tissues. The longer the exposure and the hotter or colder the application, the greater the risk. While beneficial for short-term or minor issues, sustained treatment does not solve underlying issues.
Self-massage/massage therapy
Benefit: Massage reduces swelling, decreases pain sensation, and breaks up adhesions.
Risk: Massages directed too deep with too much pressure can damage tissue and bruise. Some areas are hard to reach by yourself, especially in the back, which may require arching. Relief can be temporary if the problem is not primarily muscular.
Over-the-counter pain medication
Benefit: This commonly serves as an inexpensive access to pain relief. The patient is able to self-dose as needed.
Risk: Even over-the-counter (OTC) medications can spur some dependency for pain relief. You may also develop undesirable drug reactions within the body, even if the medication does not fully address the cause of the back pain.
Stretches/Yoga/Pilates
Benefit: These activities reduce mental stress, increase tissue and joint flexibility, strengthen muscles, increase balance and can relieve pain.
Risk: Stretches without a specific functional goal in mind can create hypermobility or damage discs in the spine. Remember flexibility and stability are opposing traits. If you have a disc issue (herniation/bulge/degeneration) then creating spinal flexibility is contraindicated.
Acupuncture
Benefit: Lower-back pain relief is a listed benefit for acupuncture, along with a long list of other conditions. Patients sometimes describe an immediate, if not sustained, relief.
Risk: Few medically significant research findings support meaningful results for pain relief. Since some patients benefit from lying on their stomach, that alone relieves their back pain during acupuncture sessions. However, for others, that position flares back pain.
Chiropractic Adjustments/Treatments
Benefit: Chiropractic examination often determines which tissues cause pain. In addition, it teaches patients which movements to avoid, which exercises will help pain and demonstrates proper spinal mechanics. Adjustments increase spinal range of motion. In addition, chiropractic care often provides a gateway to referral system for advanced medical imaging (MRI, X-ray, CT) and specialists like orthopedic surgeons.
Risk: Chiropractic can create hypermobility in unstable joints and may focus on the symptoms not cause of pain. Some providers have long and frequent treatment protocols. If these become cumbersome for patients it may cause them to abandon treatment before resolving pain issues.
Physical therapy
Benefits: Physical therapy primarily focuses lower-back pain treatment on exercises and stretches for the lower back. This encourages increased strength, flexibility and balance.
Risk: Be aware of a one-size-fits-all exercise programs. Exercises must be tailored to the patient’s condition, abilities and pain source. Exercising too early in pain recovery can flare an unstable back.
Prescription Pain Management
Benefit: Primary care physician/nurse practitioners/physiatrist-provided access to prescription strength medication may include a protocol of muscle relaxers, pain medication, anti-inflammatory medication and opioids. These visits can also provide a gateway to referral system for advanced medical imaging (MRI, X-ray, CT) and specialists like orthopedic surgeons. These providers can typically rule out/in spinal pathology and clear access to lab testing for organic diseases.
Risk: Medication is a short-term solution for back pain, addressing the results, not the cause of lower-back pain. Drug dependency can develop, especially with opioid treatments.
Orthopedic/Neurological Surgeon
Benefit: These specialists provide access to surgical intervention for removal of herniated disc material or fusing an unstable spine.
Risk: Complications and the potential need for additional procedures accompany any surgical treatment. As well, prolonged recovery times limit some patients’ ability to address pain timely.
Which lower-back pain treatment or combination is right for your tolerance and lifestyle? First, find a provider or doctor that looks for tailored plans addressing your specific pain source and relief. This includes pin-pointing what tissues, movements and loads cause your back pain. Finally, effective treatment must include telling you which movements to avoid, how to move correctly in a spine-sparing way, and an exercise regimen that benefits you without causing additional pain. Stop guessing about your pain and blindly engaging treatments that may prolong your pain. For more information and an exam to identify your specific pain source, schedule your consultation here.
