For back pain that persists longer than a few months, there are several interventions that are less invasive and less expensive than surgery.
A pain management program
A pain management program can help you manage chronic pain more effectively. These programs are run by certain hospitals and pain clinics. They usually involve a team of doctors, physiotherapists, occupational therapists, psychiatrists, psychologists and dietitians who all work together on your behalf. By attacking your pain from several different angles, a pain management program can help you get on top of pain, so you can get back to your regular activities.
You can locate a pain management program near you at painaustralia.org. You’ll need a referral from your GP.
Neurotomy, which is also called radiofrequency ablation, RFA, neurotomy or rhizotomy is a minimally invasive procedure performed in hospital by a pain specialist or neurosurgeon. It can help relieve pain originating in a facet or sacroiliac joint. To make sure this is where your pain is coming from, your doctor will first inject local anaesthetic next to the nerve. If this blocks the pain, then the neurotomy can proceed.
Neurotomy doesn’t fix the cause of your back pain but it stops the nerves from carrying pain signals. It has little or no harmful effect on the nerves that control your muscles. X-ray imaging is used to guide the procedure.
You’ll be given IV sedation, but you’ll need to be awake to answer the doctor’s questions while the procedure is carried out. You’ll probably feel a little discomfort as the nerves are zapped. You may have mild to moderate discomfort after the procedure for 1 to 2 weeks. Between 30% and 50% of people get significant relief from neurotomy for up to 2 years. Some people get some relief for a shorter time while other people get no relief. After you’ve had the procedure, you’ll need to have someone come and take you home from the hospital.
If neurotomy works for you, you can have it done again if the pain returns in future, so it can be a practical alternative to surgery if your pain comes from your sacroiliac joint or a facet joint.
Botulinum toxin (Botox®, Dysport® and Xeomin®) is a drug that reduces muscle contraction. It’s been widely used as a cosmetic anti-wrinkle treatment, for migraines and certain conditions associated with muscle spasm. Early findings have shown that Botox® can be effective for relief of chronic low back pain. Botox® can be administered by pain specialists and neurologists but it’s not Medicare-reimbursed for back pain treatment.
A spinal cord stimulator
This method of pain relief involves a neurosurgeon or pain specialist implanting a small rechargeable device under your skin, usually in your lower abdomen. After a successful trial with a temporary device, permanent leads are inserted and connected by wires running under your skin. The day procedure is done in hospital using general anaesthetic. After the surgery, the stimulator is programmed by a technician to give you optimum pain control. A hand-held programmer lets you ‘fine-tune’ the stimulation.
Half of the people with chronic back pain experience significant relief from spinal cord stimulation with an average reduction in pain of around 50%.
Although it doesn’t fix the problem that’s causing your pain, the cost, risks and recovery time associated with getting a spinal cord stimulator may be less than having major spinal surgery.
Spinal cord stimulators are often used as the last line of treatment after previous spine operations have failed.
An intrathecal pain pump
An intrathecal pump is an implanted device that administers painkilling drugs directly to the area surrounding your spinal cord. The procedure involves a hospital stay of 1 to 2 weeks. First a temporary pump is implanted by a pain specialist or neurosurgeon and several medications are trialled to see which one best helps relieve your pain. Then, if this is successful, a permanent pump is implanted. After you leave hospital, it can take several months of adjustments before you achieve optimum pain control. Pain pumps have quite a few disadvantages (infection and malfunction to name two). They’re useful for people who need to take opioid drugs for their pain and have intolerable side effects. If you can’t have spinal surgery or if your spinal surgery has failed to fix the problem, an intrathecal pain pump may be a good option. It’s less popular nowadays because the outcomes with spinal cord stimulation are better.
Traction, also known as non-surgical spinal decompression, used to be recommended for problems with intervertebral discs and spinal joints. It’s still provided by some physiotherapists and chiropractors. You lie fully clothed on a traction table with a harness placed around your hips. The lower part of the table slides back and forth to stretch and relax your spine. You may be recommended 15 to 30 treatments. By stretching your spine, it was thought that pressure would be removed from protruding discs and they would move back into place, however, there’s no good evidence of its effectiveness.
Cold laser (also called low level laser) is a therapy that uses specific wavelengths of light to accelerate the body’s own healing processes. Light from the cold laser penetrates your skin and is supposed to reduce pain and inflammation. There’s some evidence for the effectiveness of cold laser but the studies are limited. Cold laser is not painful, and the side effects are minimal. Treatment is available from some physiotherapists, pain specialists, sports medicine specialists, chiropractors and osteopaths.
Prolotherapy treats pain in the ligaments of the lower spine. It involves injections of irritating substances such as glucose and dextrose to trigger your body’s healing response. An average of 4-10 sessions a couple of weeks apart may be needed and the side effects of bruising, stiffness and swelling can last for up to one week. Although it’s been around for over 50 years, evidence for the effectiveness of prolotherapy is conflicting. It varies according to the substance injected and the other treatments (such as spinal manipulation or exercise) given with it. Prolotherapy is usually provided by a sports medicine clinic or pain specialist.
Note: Check your level of health insurance cover before undertaking back pain treatments, as some may not be included in your cover.