Back pain is one of the most common reasons why people go to the doctor or miss work. Pain in the back or neck or even down the leg can be caused by a herniated or bulging disc, arthritis, even a muscle or ligament strain.
There are several methods to try and alleviate back pain besides an operation. Sometimes, fixing the problem with surgery is the only option, particularly if it is a disc problem that is causing the pain. But most experts say it should be the option of last resort. Non-surgical options include getting rest, easing up on activities, taking mild pain medications or muscle relaxants, wearing special shoes, using a specially designed desk, getting a new mattress or receiving physical therapy — or any combination of these things. Some people say they find relief with alternative strategies such as acupuncture or chiropractic.
Non-surgical back pain treatment
But one of the most popular and effective non-surgical back pain treatments involves receiving epidural injections of cortisone, an anti-inflammatory steroid. Often, these are given in conjunction with physical therapy.
“The injections are not usually a permanent fix,” said Adriana Desillier, MD, anesthesiologist and pain physician in the Spine Center at Tufts Medical Center. “But sometimes the pain can go away completely.”
She said that she had a herniated disc in her neck about 15 years ago and received physical therapy and an injection. The pain went away for good. “Now it is history,” she said.
As a result of her personal experience, she believes she can offer patients a unique perspective on the treatment. “I know how to make it a better personal experience for my patients,” she noted.
In most cases, more than one injection may be needed, however. The injections deposit the medication in the epidural space around the spinal cord. The medication can start working in a few days and relief usually lasts for months. The shots are especially effective if the pain is associated with sciatica, pain caused by a pinched nerve in the low back that radiates down the leg.
Spinal injection success
Studies have shown the injections can help in up to 84 percent of cases.
“The first thing we do is look at what caused the pain,” said Dr. Desillier. “It could be muscle spasms, arthritis inside the spine, a collapsed vertebrae, a herniated disc or a ruptured disc that is irritating the nerves.
“We ask the patient if there was something that brought the pain on, such as lifting a heavy object, a car accident or a sports injury or whether it was something that just came on gradually for no particular reason,” she said.
Back pain can range from dull or throbbing aches to shooting, sharp pain. It can come and go, be constant, worsen with exercise or prolonged sitting and may be associated with numbness or tingling. Sometimes, the pain can resolve on its own.
If the pain is so bad that the patient is having trouble walking and it can be seen that there is a disc compressing a nerve, that usually requires immediate surgery, Dr. Desillier said.
However, even in such acute cases, patients may want to try injections first and they may still help, she noted.
“Everybody responds differently,” she said. “A lot depends on how they respond to the first injection. Sometimes we have to repeat the injection in a few months. Chronic pain may require two or three injections a year. “
Surgeons at Tufts Medical Center are very conservative, she noted, and prefer to see patients try other options first.
In many cases, insurers mandate the patient receive several weeks of physical therapy before they will pay for injections, Dr. Desillier said. In some cases, insurers will approve the injections without first trying physical therapy if the doctor makes a special appeal.
Side effects associated with the shots are typically minimal and may include muscle spasms or headaches that may occur if the medication is absorbed throughout the body due to improper needle placement. But that is rare.
While epidural steroid injections are nothing new, efficacy has improved as imaging techniques such as ultrasound have evolved. “We can pinpoint the specific area where we want to go,” she added.
To make an appointment at the Spine Center at Tufts Medical Center, call 617-636-2266 Monday – Friday, 8am – 4:30pm.