Back Pain: Conservative Care vs Invasive Care
Most people (80%) will experience a back problem in their lives. It is estimated that 31 million Americans alone experience low-back pain at any given time. There is a spectrum of care related to the treatment of spinal pain. It stands to reason that someone suffering from back pain start with the least invasive treatment, such as chiropractic, massage or rehab.
If a short trial of this care doesn’t meet stated treatment goal parameters, then more invasive options such as injections may come be considered. It is not until all of these options have been exhausted that surgery should be considered.
Purpose of Conservative Care
The American College of Physicians (ACP), the largest medical-specialty society in the world, recently updated its low-back pain treatment guidelines in 2017. The new guidelines support a more conservative approach to care.
Published in the Annals of Internal Medicine and based on a review of randomized controlled trials and observational studies, the ACP guidelines cite heat therapy, massage, acupuncture and spinal manipulation (a centerpiece of chiropractic care) as possible options for non-invasive, non-drug therapies for low-back pain. The guidelines state that only when such treatments provide little or no relief should patients move on to medicines such as ibuprofen or muscle relaxants, which research indicates have limited pain-relief effects. According to ACP, prescription opioids should be a last resort for those suffering from low back pain, as the risk of addiction and overdose may outweigh the benefits.
Setting Goals for Your Care
Although people seek care for many reasons, providers of spine care are typically looking to address certain measurable parameters. This allows the provider to administer a clear treatment plan so both the patient and the provider can assess if care is progressing. For example, at Northern Nevada Chiropractic, goals may include:
- Improve range of motion of affected joint
- Decrease muscle spasm or pain
- Reduction in functional impairment rating questionnaires
- Have the ability to return to pre-injury activity without limitation
In the vast majority of spinal complaint cases, a short trial of care along with proper rest and recommended rehab will provide relief. Pre-existing co-factors such as degenerative disc disease, obesity or congenital anomalies can negatively affect the prognosis. If within 4 to 6 weeks, improvement is not made, co-management or referral should be recommended. There are a few occasions when this algorithm of care is bypassed. If a patient has deteriorating neurological deficits or loss of bowel/bladder control (cauda Equina Syndrome), immediate referral for surgical consult should be made. Although these are scary and potentially life altering possibilities, all physicians are trained to look for and diagnose these symptoms.
When to Discuss Surgery
Surgery is warranted when conservative measures have proven ineffective. Spinal surgery is by no means a guarantee of pain relief. Surgery is viewed as successful if one of the two functions are achieved:
- Decompression of a nerve root (gave a nerve more room to exit the spine)
- Stabilization of a painful hypermobile motion segment
Unfortunately, it is not uncommon for patients with unrelenting lower back pain and descending leg pain to have surgery and find that the leg pain was reduced, but the lower back has only partial or no diminution of pain. Typically, if a follow-up surgical procedure is needed, the likelihood of complications of nerve damage and scar tissue formation continue to rise, limiting therapeutic potential. Patient’s should approach a course of care with all of their options presented thoroughly, and with realistic potential benefits and risks clearly stated by their doctor.
Regardless of the treatment, it is very important to follow the correct course of care. We live in a society that thrives on immediate satisfaction. The body heals at a different timeline than the mind would like. Recent news reports are littered with stories of people turning to pain medication, destroying their lives. These drugs absolutely have a value, but are too commonly prescribed following routine surgical procedures, leading to negative long-term detriment. Hopefully a return to a more conservative-minded treatment protocol can prevent these risks from reaching our patients.