Back pain treatment
Back pain can refer down the leg into the buttock and sometimes as far as the knee. Most back pain is not sinister and gets better with time. It is rare for back pain to require spinal surgery. There are, however a number of things you can do to help manage a flare up of symptoms in your back. Your GP can prescribe anti-inflammatories, if your medical history allows. If these alone do not work, or are unsuitable there are other pain killers that they may recommend.
Evidence shows that early manual therapy, such as Physiotherapy, combined with exercise can help reduce pain and shorten the episode of lower pack pain. Physiotherapists can also give advice regarding ergonomics and exercises to help in the longer term.
If low back pain symptoms persist, despite time, medication and Physiotherapy then, following assessment by a spinal specialist a diagnostic Injection, called a Lumbar Medial Branch Block can sometimes help to confirm which structures are causing symptoms. Sometimes, a further procedure, called Lumbar Rhizolysis can then give relief of symptoms for long enough for you to engage in an exercise programme to give longer term management of symptoms.
Unfortunately, there is not always a ‘cure’ for long term low back pain. Pain management teams can help people with long term back symptoms live well, despite their ongoing symptoms. A combination of physical exercise, pacing activities and ergonomic advice, along with emotional support and understanding why pain symptoms persist can often help.
The National Institute for Clinical Excellence (NICE) does not recommend use of opioid medication for low back pain (LBP). If the nerves in your low back are affected they can give severe Leg Pain or Sciatica.
At Ramsay Health Care we offer a range of treatments for leg pain including injection therapies and spinal surgery. Your consultant will be able to tell you which treatment is best for you.
Non-Invasive Treatment Options
Medication- Early pain relief is essential as sciatica can be very painful. It is common for function to be limited and for sleep to be restricted. Most pain medications reduce symptoms, but do not eliminate them entirely. If you have some pain relief the evidence suggests you move better, sleep better and therefore recover more quickly. Talk to your GP about a suitable prescription based on your other medical history. The National Institute for Clinical excellence (NICE) recommend anti-inflammatories initially. There are other pain relieving drugs that your GP can prescribe if anti-inflammatories are not suitable or do not give sufficient symptom control for you. A group of medication called anti-neuropathic drugs can also help some people with nerve pain. Talk to your GP to see if you are a suitable candidate for these tablets.
Physiotherapy- Manual therapy has been shown to help people recover from sciatic leg pain. It’s advisable to avoid high velocity manipulation techniques, but gentle manual techniques, ergonomic advice and exercises can be helpful. At New Hall Hospital we have a PHYSIOTHERAPY LINK department and offer rapid access clinics. By knowing the right way to exercise and manage flare ups of pain you are more likely to be able to manage any episodes if they occur. If you are physically fit then you are less likely to suffer with recurrent episodes.
Injections which relieve pain and allow other therapies a better chance of working are an important weapon in the armoury of any consultant looking at back problems. They can also give your consultant important information about where the pain is coming from and how bad it is.
These injections are done as day case procedures while you are under sedation, and you would be able to leave hospital within a few hours.
While they don’t ‘cure’ your bad back, they can help your recovery. For a start, you may not be in so much pain and any inflammation may be reduced, and your quality of life should improve. And you are likely to get more benefit from other therapies, such as physiotherapy, if they are done during the window of opportunity after an injection. Sometimes the pain does come back over time and the injections may need to be repeated.
Two types of injections commonly used are facet joint injections and epidurogram and nerve root blocks.
Facet joint injections
Facet joints are the weight bearing joints in your spine which are created when two vertebrae sit on top of each other. There are many reasons why they may become inflamed and painful, and sometimes injection therapy can be useful in relieving this. You may need to see one of our physiotherapists after this to help address the possible causes of the pain, such as poor posture, weakness or a prolonged period of bed rest affecting the spine.
Epidurogram and nerve root blocks
Persistent back pain can sometimes be due to irritation of the nerves in your spine. This can be caused by tissue adhesions and may be associated with former trauma or surgery to the spine. Injecting the area around the nerve root with a mixture of local anaesthetic and an anti-inflammatory called cortisone can be an effective way of reducing the pain in these cases.
A diagnostic procedure called an epidurogram is used to allow the consultant to build up a picture of your back and see where the injection would spread. Then the mixture is injected into the appropriate areas.
Surgery on your back can sound frightening but it can have good outcomes and does not involve a lengthy stay in hospital. Should surgery be necessary, each consultant will inform you of the risks and potential benefits under their individual care.
Procedures available at Ramsay hospitals include spinal decompression and discectomy, and spinal fusion. These all involve a stay in hospital - the length will depend on the procedure and how quickly you recover from it. Our physiotherapy team may be involved in your rehabilitation, both while you are in hospital and afterwards.
Lumbar discectomy treatment is the removal of the herniated or bulging part of an intervertebral disc in your lower back. It is performed to relieve the pressure the bulging disc is exerting on nearby spinal nerves. Nowadays, lumbar discectomy is often performed using minimally invasive surgery called microdiscectomy. More information can be found here for Lumbar Discectomy.
Lumbar laminectomy for spinal stenosis is a type of decompression surgery that gives squashed spinal nerves in your lower back more space. It removes vertebral bones that are narrowing your spinal column and compressing the spinal nerve roots often due to age-related changes of spinal stenosis. Spinal stenosis is the narrowing of part of your spinal column due to bone or other tissue overgrowth or a herniated disc. More information can be found here for Lumbar Laminectomy.
Lumbar Spinal Decompression
Spinal decompression is a type of surgery used to give your spine nerves more space and relieve their compression. “Decompression” usually means removing tissue that is compressing a spinal nerve. It can be performed anywhere along your spine from your neck (cervical) to your lower back. Lumbar decompression surgery relieves lower back neural impingement. More information can be found here for Lumbar Spinal Decompression.
Osteopathy takes a holistic approach to the diagnosis and treatment of a wide range of medical conditions by looking at the whole body. One of the most common problems an osteopath treats is lower back pain, Osteopathic treatment can be used to address back pain and help prevent it from becoming a chronic, long-term condition. Find out more here.