Research shows that bed rest does not help simple back pain – it’s much better to return to normal physical activity as soon as possible. Staying active may hurt more at first, but it helps the back to heal quickly, and reduces the risk of the problem occurring again.
If the pain is so bad that taking to bed really seems the only option, keep bed rest as short as possible before getting up and about again.
Specific exercises are also important to take the load away from the spine. They are not a quick fix solution, although some exercises can provide quick relief.
Medications of various forms may be appropriate over the short term and may help to keep you active, which is very important.
Local injection therapies can be very helpful for some specific complaints, but these need to be carefully discussed with your doctor.
Manipulation and Exercise
Osteopathy and chiropractic are treatments involving manipulation of the spine. They may provide short-term relief for simple back pain within the first six weeks. The Alexander Technique may help improve posture. Some people find that acupuncture helps with the pain, although there is no definite scientific proof of its effectiveness. Also, because back pain can sometimes be related to emotional problems, counselling may also be helpful.
Other methods of treatment
Denervation procedures for spinal pain
Surgery is necessary only in the tiny minority of cases, for specific situations. Treatment of back pain arising from the facet joints may include radio frequency denervation of the nerves supplying the affected joints. As the nerves supply more than one joint, it is necessary to treat more levels than those directly affected. This is usually very effective and may last nine to twelve months. The treatment can be repeated if required. The denervation is performed by a pain specialist and involves applying electric current to the nerve to cauterise it.
It is not unusual for this painful condition to affect different areas of the spine e.g. neck and the lower back. Also severe low back pain may arise from the sacroiliac joints below the spine. This may be felt in the buttock/s and the legs and be mistaken for sciatica. Radio frequency denervation is also used to treat this type of pain.
Radio frequency denervation is done in an operating theatre under sedation or light anaesthetic. X-ray or fluoroscopy is used to identify correct electrode placement and local anaesthetic with a steroid drug is injected to assist in post-operative recovery.
Normally you can expect to be discharged several hours following the procedure but in some situations a night in hospital is needed. Moderate pain can be expected and agents such as Panadeine or similar should be available. Pain may take up to two weeks to settle fully.
Like every medical treatment, there is no guarantee of success.
A Cochrane Review, considered to be a ‘gold standard’ in reviewing medical evidence, concluded that: radiofrequency denervation can provide short-term pain relief for a small proportion of people with specific joint problems in the neck. There is conflicting evidence about effects for low-back joint pain, and some evidence that it does not relieve pain from low-back disc problems. It is not clear what ‘short-term’ means!
It is more likely that you will have a positive outcome if you have responded to corticosteroid injections to the facet joints.
Although the duration of benefit from denervation is longer than with steroid injection, there is a chance the denervation may need to be repeated.