Treatment Options

Treatments for chronic back pain can vary greatly depending on the type and source of the pain. The goals of the treatment are to reduce pain, improve quality of life and increase function.

There are several different general categories of treatment that are usually recommended for chronic back pain. The treating physician will tailor a program involving a combination of these options to address the patient’s needs. Involvement of a physician with special training in chronic pain management is advisable.

• Physical therapy includes patient education, and patient training in a variety of stretching and strengthening exercises, manual therapies and modalities (ice, heat, transcutaneous electrical nerve stimulation [TENS], ultrasound, etc.). Active therapies which the patient can continue on his or her own (such as exercise and strengthening) usually have the most permanent and long lasting effects. A home exercise program (HEP) is usually in place before the patient is discharged from therapy

• Medications used for treatment of pain are multiple and varied. They fall into several different categories. Both non-narcotic and, rarely, narcotic pain medications may be used in the treatment of chronic back pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) are helpful with pain control and may help reduce inflammation. Muscle relaxants can also help with chronic pain and may enhance the effects of other pain medications. Nerve stabilizing drugs (antidepressants and antiseizure medications) are used to treat nerve-mediated pain. All these medications have different side effect profiles and interactions, and should be carefully monitored by a physician.

• Coping skills are extremely important in the management of chronic back pain. Chronic pain directly affects all areas of a patient’s life. Pain affects mood, and a patient’s mood affects his or her ability to cope with pain. Pain also affects how patients interact with other people. For this reason, teaching patients appropriate coping skills for dealing with anxiety, depression, irritability and frustration can be invaluable. Involvement of a trained pain specialist, psychologist or psychiatrist greatly enhances the treatment of chronic back pain.

• Procedures ranging from minimally invasive injections to surgery may be used to manage chronic pain. Sometimes, implantable devices, such as a spinal cord stimulator, are beneficial in managing chronic pain. The patient, with the help of his or her physician, should discuss the potential risks and benefits of any procedures considered. A second opinion may provide additional information or alternative approaches to managing your condition.

• Complementary medicine also offers a variety of treatments, often helpful in the treatment of chronic pain. These treatments include acupuncture, dry needling, nutritional therapy, use of magnets and many others. It is important for a patient to discuss these treatments with his or her treating physician, to ensure that there are no harmful effects and that they do not interfere with other treatments being prescribed.