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.
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.