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 chronic spinal pain may benefit from referral to Consultants in Pain Management, who are usually trained Anaesthetists with expert knowledge in the use of a variety of pain medications. They are also skilled at various techniques of steroid injections into the spine and related soft tissues such as muscles and ligaments.
Physiotherapy can be very effective 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:
- Neuroleptic Medications such as Gabapentin (Neurontin) or Pregabalin (Lyrica) can help relieve nerve pain due to nerve damage (neuropathic pain), or in patients who continue to experience nerve pain after surgery.
- Non-Steroidal Anti-inflammatory Drugs (NSAIDS) can be very effective in improving inflammatory back or limb pain. 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.
- 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.
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 surrounds the dural sac containing the spinal nerve roots and cerebrospinal fluid (CSF). Injection of steroids into this space may effective in reducing low back pain (lumbago) and leg pain (sciatica).
- Nerve Root Block: A nerve root block is a precise steroid injection around a spinal nerve. The procedure is either performed to relieve limb pain due to an inflamed or compressed (therapeutic nerve block) or used as a diagnostic test to find the nerve responsible for the pain (diagnostic nerve block). A nerve block can relieve pain in up to 30 % 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.