back pain, Lower back pain and spinal arthritis

TWO COMMONLY USED TREATMENTS FOR TREATING LOW BACK PAIN AND SCIATICA ARE NON-INVASIVE TREATMENT AND INVASIVE TREATMENTS.

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.

Epidural Steroid Injections

EPIDURAL STEROID INJECTIONS

Some people who suffer from back pain are given epidural steroid injections to try help relieve their back pain. A person receiving these injections is only given few a year, usually 2 and in most cases not more than 3 injections a year. Do you know the reason why they are given few injection?

… its because there’s a chance that these drugs might weaken your spinal bones and nearby muscles. This is not caused by the needle, its a possible side effect of steroids.

Epidural steroid injections contain drugs that mimic the effect of the hormones cortisone and hydrocortisone. When injected near irritated nerves in your spine, these drugs may temporarily reduce inflammation and help relive pain.

Steroid injections also disrupt your body’s natural hormone balance. Delaying repeat injections allows your body to return to its normal balance. This is the reason why these injections are not give too frequently.