back pain, Lower back pain and spinal arthritis


Non-invasive treatments for low back pain and sciatica

The non-invasive treatments have two types, (a) non-pharmacological intervention and (b) pharmacological intervention.

(a) Non-pharmacological intervention includes:

(1) Self-management – self-management is advice and information tailored to individual needs and capabilities to help themselves self-manage their low back pain.

(2) Exercises – group exercise programme (aerobic, mind-body or a combination of approaches) for people with specific needs or flare-up of low back pain with or without sciatica.

(3) Manual therapies – manual therapy include spinal manipulation, mobilisation or soft tissue techniques such as massage for managing low back pain with or without sciatica, but only as part of a treatment package including exercise.

(b) Pharmacological intervention
Pharmacological intervention includes oral non-steroidal anti-inflammatory drugs (NSAIDs) for managing low back pain, taking into account potential differences in gastrointestinal, liver and cardio-renal toxicity, and the person’s risk factors, including age.

If NSAID is contraindicated or not tolerated or has been ineffective, weak opioids (with or without paracetamol) is usually considered for managing acute low back pain.

Invasive treatments for low back pain and sciatica

Invasive treatments have two types, (a) non-surgical interventions and (b) surgical interventions.

(a) Non-surgical interventions includes:

(1) Radiofrequency denervation

Referral for assessment for radiofrequency denervation for people with chronic low back pain has to be considered when non-surgical treatment has not worked for them and the main source of pain is thought to come from structures supplied by the medial branch nerve and they have moderate or severe levels of localised back pain (rated as 5 or more on a visual analogue scale, or equivalent) at the time of referral.

(2) Epidurals

Epidural injections of local anaesthetic and steroid are usually used in people with acute and severe sciatica and tend not to be used in people who have central spinal canal stenosis.

(b) Surgical Interventions

Most performed surgical interventions are spinal decompression, spinal fusion and disc replacement.

Spinal decompression is usually considered for people with sciatica when non-surgical treatment has not improved pain or function and their radiological findings are consistent with sciatic symptoms.

Spinal fusion is not usually offered to people with low back pain unless as part of a randomised controlled trial.

back pain, Lower back pain and spinal arthritis


Lower back is the most common site of the back where arthritis usually starts. Spinal arthritis is inflammation of the facet joints in the spine or sacroiliac joint between the spine and pelvis. Pain and stiffness are the most common symptoms of spinal arthritis.

Exact causes of spinal arthritis are unknown however, normal wear and tear can be construed as a trigger for spinal arthritis. Genetic components have also been identified in connection with some forms of spinal arthritis. Other risk factors for spinal arthritis include:

  • excess weight
  • age
  • presence of certain conditions such as diabetic, gout, tuberculosis, irritable bowel syndrome and Lyme disease.


All arthritis leads to inflammation. Arthritis is categorized as inflammatory and non inflammatory (degenerative) based on its origin. Example of inflammatory arthritis include infectious arthritis, rheumatoid arthritis and gout. An example of noninflammatory arthritis is osteoarthritis, this is the most common type of arthritis.


  • medical history and physical examination
  • blood test for genetic markers and/or RA antibodies
  • x rays of the spine to locate the arthritic joint
  • MRI, CT Scan, myelography, bone scan and or ultrasound to focus on the damage, detect nerve and spinal cord involvement or rule out other causes
  •  joint aspiration testing of the synovial fluid inside joint


In most cases treatment of spinal arthritis is geared towards relieving the symptoms of pain and increasing a person’s ability to function.

Initial treatment may include losing weight if needed and then maintaining a healthy weight. Initial treatment may in addition, include exercises. In addition with helping with weight management, exercises also help to improve blood flow, make it easier to do daily tasks, strengthen the heart, improve attitude and mood, increase flexibility.

Exercises may be divided into three groups: strengthening exercises, aerobic exercises and range-of-motion exercises.

Non-drug treatments available for arthritis include cold or heat compression, nutritional supplements, acupuncture, massage.

Over-the-counter medication include: nonsteroidal anti-inflammatory drugs (NSAIDs) like, naproxen and/or ibuprofen. It is important to remember that NSAIDs may have serious side effects like stomach irritation, bleeding and less frequent side effect is kidney damage.

Topical ointments and creams are also available to treat pain. They are applied to the skin in the area that hurts, but generally, these are not that effective.

A doctor may also recommend prescription drugs to treat symptoms as there are no medication that reverse the process of spinal arthritis. These include prescription pain killers, mild narcotics or injections of corticosteroids around the spinal column (epidural steroid injections).

Most cases of spinal arthritis can be treated without surgery, but surgery is sometimes performed. In cases where bladder and bowel function is impaired, where the nervous system is damaged, or when walking become very difficult, surgery will likely be recommended. Spinal surgery may be further considered if patient’s symptoms are severe and other treatments have failed to provide relief. For spinal arthritis, the only effective treatment is spine fusion surgery. Artificial disc surgery is only indicated for those individuals with degenerative disc disease without facet joint pathology.