Conservative Management of Pain in the Back at KBNI

Physical Medicine Alternatives

Following the development of the case history, review of previous treatment data, and imaging studies Dr. Kraus may recommend a conservative, non-surgical treatment options. These treatment options fall into the realm of physical medicine and pain management. Physical medicine alternatives include braces, exercise, electrical stimulation, epidural steroid injection therapy, application of moist heat and cold compresses, massage, traction and ultrasound.

• Braces - to limit movement around the nerve and give support to the affected region
• Electrical stimulation - to enhance healing, decrease swelling and decrease pain. Surface patches are placed on the skin over the affected area of pain. The electrical current affects both nerve and muscle cells
• Epidural steroid injection therapy
• Exercise and stretching – a patient-specific exercise program can help relieve pain in the back and strengthen back muscles, ligaments and tendons to prevent pain in the back from re-occurring
• Heat and cold - moist heat to relieve muscle spasm and inflammation caused by strain. Generally cold packs are applied to the painful area within the first 48 hours after an injury. Heat is applied after 48 hours
• Massage – to reduce pain and muscles spasms in the low back. A form of localized massage is used to loosen tight tissue and scar tissue
• Traction - decreases the pressure in the disc space and helps to open up the neural foramen through which the nerve roots leave the spine. There are a variety of techniques which can be used to achieve this traction
• Ultrasound - to deliver heat to the deep tissues that hot packs are unable to reach.

Pain Medications

Conservative pain management to relieve pain in the back also includes medical pain management and various forms of injection therapy including:

• Antidepressants - may relieve certain types of neuropathic pain
• Analgesics (oral medications) – some causes of pain in the back respond to non-prescription medications such as aspirin, ibuprofen, naproxen, acetaminophen and muscle relaxants. If you have severe pain, a narcotic analgesic may be prescribed for a short time
• Corticosteroid medications (orally or by injection) - prescribed for severe back and leg pain because of their powerful anti-inflammatory effect
• Epidural Injections or "nerve blocks" - injections of corticosteroid into the epidural space (the area around the spinal nerves) for severe leg pain
• Facet Joint Injections - corticosteroids and local anesthetics injected directly into the painful facet joints of the low back
• Non-steroidal anti-inflammatory medications (NSAIDs) - used to reduce swelling and inflammation. These include aspirin, ibuprofen, naproxen, and a variety of prescription drugs
• Sacroiliac joint injections (SI) - a fluoroscope is used to precisely place the needle into the sacroiliac joint to inject a numbing agent and a steroid. The injection is followed by physical therapy to provide mobilization and range of motion exercises
• Selective nerve root block - injected around the nerve root. This is used for leg pain and for determining which nerve root is responsible for your pain
• Trigger point Injections - local anesthetics (often combined with corticosteroids) are directly injected into painful soft tissue or muscles along the spine or over the back of the pelvis