Majority of spine problems are self-limiting. Some amount of activity restriction, pain-killers and other medicines, brace (neck/ back belt) give sufficient relief to most of the patients in few days. A complete bed rest is not recommended now a days as it creates a “sick role” in the mind of the patient and also creates muscle weakness. Also, research has found out that patients who carry on with their day to day activities within the confines of their pain recover faster compared to the patients who take long duration of bed rest.
Physiotherapy is usually prescribed along with medical treatment. It helps strengthen the muscles which in turn support the spine better. Also, physiotherapy relieves muscle spasm. Muscle spasm is developed in response to primary spinal pathology to create a functional brace in the body to prevent spinal movements as excessive spine movement can cause pain in acute phase. Many times, the pain of the primary pathology gets better, but this muscle tightness persists and becomes a source of chronic pain. Physiotherapy also helps in relieving this muscle spasm. There are various other modalities for pain relief like IFT (Interferential Therapy), SWD (Short Wave Diathermy) and TENS (Transcutaneous Electrical Nerve Stimulation) which helps in relieving local back/ neck pain and nerve related pain in legs/ arms. Patients should be careful though, if physiotherapy increases the pain, they should stop it and take doctor’s advice to continue physiotherapy or not.
Various spinal injections and pain management procedures are available. These injections usually deliver the medicine directly at the site from where pain is originating. Pain relief is maximum and a very small dose of pain medicine is required. Also, there are minimal side effect as medicine is given at the site of pathology and it does not affect the entire body. On the same line, various other techniques, e.g. Radiofrequency Ablation (RF), directly destroys those painful tissues. One of the major utility of spinal injection is a stepwise treatment to treat patient’s symptoms. Also, it buys time for patient and doctor if for any reason a surgery cannot be done (pathology not severe enough to require surgery/ patient wants to postpone surgery due to personal issues). Also in doubtful cases, relief after spinal injection to a particular site confirms the source of pain, so it has diagnostic value as well. In patients where pathology is multilevel and a surgery cannot be done due to extensive nature of the problem or patients general medical condition, injection procedures are very useful. There are certain conditions where injections cannot be given. In a patient with very high uncontrolled sugar, injections may increase blood sugar and can cause infection at the local site. Also, in patients who are on anti-coagulants (blood thinners) therapy due to heart or other disease conditions, injections are usually contra-indicated as they can cause internal bleeding by the needle which in turn can cause compression on the spinal cord and lead to paralysis.
One should remember that none of these procedures reverses the primary underlying pathology. They are usually given to take care of the pain in the acute phase. If the inflammation of the primary pathology subsides by natural healing mechanist of the body, patient can get a long term relief also even after these medical treatments are discontinued after the acute phase of the problem is over. Patients should remember that these medical treatment primarily gives symptomatic relief. A degenerated disc (wear and tear) is usually irreversibly damaged. It may not be causing symptoms, especially after the acute phase is over, but degeneration of the disc persists. Patients still have to be careful and should avoid getting involved in very heavy activities to avoid recurrence of the symptoms due to excessive wear and tear of the disc material.
Dr. Amit Sharma, Minimally Invasive Spine Surgery, Mumbai, India