pay my bill925-838-8830100 Park Place, Suite 140 | San Ramon, California |

Spine Health

Library

NONOPERATIVE TREATMENTS

 

Medications:
  • Non-steroidal Anti-inflammatory Medications: These include ibuprofen (Motrin, Advil), naproxen (Naprosyn), celecoxib (Celebrex), are among the more common ones.  These need to be taken on a regular basis, around the clock, and not on an “as-needed” basis in order to maximize the anti-inflammatory mechanism of action.  While effective to control pain when taken as-needed, the regular dosing is required to control pain AND reduce inflammation.  Patients need to consult with their physician for proper dosing and precautions.
  • Muscle relaxants: As a TEMPORARY means to reduce pain, these medications may be helpful.  They have numerous side-effects including sedation and risk of dependency.  They should be used conservatively and on a short to intermediate term duration.
  • Narcotics: Medications such as codeine, hydrocodone (Vicoden, Norco), morphine, oxycodone (Percocet, Oxycontin), hydromorphone (Dilaudid), are potent pain medications.  They should be used conservatively and cautiously.  
  • Anti-neuritic or nerve pain medications: Medications such as gabapentin (Neurontin), pregabalin (Lyrica), amitryptiline (Elevil), function under a variety of mechanisms, some of which are poorly understood.  They are helpful in nerve pain in patients who have radiating or shooting pain without losses of strength.  
 
Physical Therapy:

Formal, supervised visits with a physical therapist is critical.  Combination of passive modalities (heat/cold therapy, ultrasound, deep tissue massage/manipulation, etc) and eventual transition to active stretching and strengthening protocols is key to successful treatments.  Not all PT groups have the same level of experience treating spine conditions, so it is important to work with the right group.  The therapists has to understand the condition being treated and have the experience to know when to advance to the next level of exercise intensity.  

 

Chiropractic Treatments:

This is often a  very effective short to intermediate term modality of treatment.  As with any specialty, chiropractors may have varying degrees of experience.  In general, this form of treatment is not recommended in cases with large or extruded disc herniations, which may worsen with forceful manipulation.
Acupuncture: Though not well understood by traditional Western medicine, this treatment may be very effective in managing pain associated with severe nerve pain.

 

 Yoga and Pilates:

After physical therapy establishes a reasonable baseline level of function, the next level of exercise intensity and maintenance of core strengthening includes yoga and Pilates.  These are excellent low-impact ways to optimize flexibility, strength and conditioning to prevent future back and neck problems.  As with any group of exercises, some of the poses, positions, and activities need to be modified to prevent re-injury of an existing back or neck problem.  

 

Epidural Steroid Injections:

These injections should be done under fluoroscopic guidance, usually in an injection suite or surgery center, where a portable “x-ray” machine is used for precise and accurate needle placement and delivery of the medication to the site of the abnormality.   On our prescriptions to the pain management doctors, we are usually very specific as to which vertebral level we recommend for the injection.  The pain management doctor may examine you on the morning of the procedure and modify the intervention, at his or her discretion, but this is usually done after discussing any modifications with our practice.  A follow-up appointment with Dr. Ball should occur two to three weeks after the injection has been completed.

 

Selective Nerve Root Block:

A specifically placed injection of either a lidocaine derivative, steroid, or both placed where the nerve root exits the spinal canal.  This may be done to confirm a diagnosis or plan for a foraminotomy procedure, or for therapeutic purposes to treat an inflamed or irritated nerve root.  A follow-up appointment with Dr. Ball should occur two to three weeks after the injection has been completed.

 

Sacroiliac Joint Injections:

A specifically placed injection of either a lidocaine derivative, steroid, or both placed in the sacroiliac joint.  Like a selective nerve block, this may be done to confirm a diagnosis or plan for a minimally invasive sacroiliac joint fusion procedure, or for therapeutic purposes to treat an inflamed or irritated sacroiliac joint.

 

Facet Blocks and Radiofrequency Ablation: 

Done under fluoroscopic guidance, this procedure is done to relieve pain coming from facet joint(s).  Typically, the pain is worse with the spine or neck in extension (arched back) on physical examination.  If a facet injection is successful, the patient may be a candidate for a radiofrequency ablation procedure to be determined by the pain management specialist.