There are three broad areas of non-surgical treatment for acute or chronic spinal or nerve pain: Medical management (e.g pain medicine and anti-depressants), Steroid injection treatment, Non-injection non-medication treatments (e.g Physiotherapy, Acupuncture, Exercise).
Patients with persistent or complex spinal pain may benefit from referral to a Pain Clinic to be assessed and treated by Consultants in Pain Management. These specialists, who are usually trained Anaesthetists or Physicians, have expert knowledge in the use of a variety of pain medications and are also skilled at various techniques of steroid injections into the spine and related soft tissues such as muscles and ligaments.
Physiotherapy can be a very effective treatment option for acute and chronic spinal conditions. The treatment uses a combination of postural, stretching and strengthening exercises to improve muscle tone and core muscle strength of the spinal column and abdomen. Several other modalities of treatment such as massage therapy, posture correction, joint mobilising, hydrotherapy, acupuncture and heat and cold treatments may also be employed depending on the type of spinal condition being managed.
An exercise programme tailored to the individual's spinal condition and supervised by specialist spinal physiotherapists is essential for a smooth and trouble-free recovery.
There are several categories of pain medication which can help improve spinal or nerve pain:
- Anti-Seizure Neuroleptic Medications such as Gabapentin (Neurontin) or Pregabalin (Lyrica) can help relieve nerve pain due to nerve damage (neuropathic pain), nerve degeneration or in patients who continue to experience nerve pain after surgery. It is not clear how these anti-epileptic drugs reduce nerve pain and although side effects can occur, many patients are able to tolerate the drugs safely.
- Non-Steroidal Anti-inflammatory Drugs (NSAIDS) can be very effective in improving inflammatory back or limb pain. However, some patients may develop side effects such as gastritis and nausea and therefore long-term usage may not be possible. Commonly used NSAIDs are Brufen (Ibuprofen) and Voltarol (Diclofenac).
- Muscle Relaxants such as Diazepam (Valium) in small doses can help relieve acute episodes of back pain due to muscle spasm. However, diazepam is addictive and should therefore only be used as a short course lasting no more than a week or two.
- Opioid or Narcotic Medication is very effective in relieving pain but is associated with addiction and other side-effects such as lethargy and constipation. Examples of opiate medication include Morphine, Codeine Phosphate and Tramadol. The latter is a poplular choice in spinal pain as it has a very low incidence of addiction and may be used for longer periods without patients developing drug tolerance.
Steroid I injections
Inflammation is a common cause of many painful spinal conditions. Since steroids are powerful anti-inflammatory agents, a precision X-Ray guided steroid injection into the area of inflammation has the potential to reduce spinal or nerve pain.
- Epidural Steroids: The epidural space contains fat and small blood vessels and surrounds the dural sac containing the spinal nerve roots and cerebrospinal fluid (CSF). Injection of steroids into this space may effective in several spinal conditions including low back pain (lumbago), leg pain (sciatica), and lumbar spinal stenosis.
- Nerve Root Block: A selective nerve root block is a precise steroid injection around a spinal nerve at the point it exits the spinal canal. The procedure is either performed to relieve limb pain due to an inflamed or compressed (therapeutic nerve block) or used as a diagnostic test when the exact nerve responsible for the pain is not known (diagnostic nerve block). A nerve block can relieve pain in up to 25 % of patients but the benefits may not last very long.
- Facet Joint Block: Facet joints are small spinal joints that link the vertebrae together. Facet joint inflammation can cause neck or back pain and this may improve with facet joint steroid injections combined with physiotherapy and pain medication.