Nonsurgical Spine Treatments
At CalSpine MD, Dr. Ball treats a wide range of spine conditions and offers several nonsurgical spine treatments as a conservative approach to managing your condition. They include:
Though not well understood by traditional Western medicine, acupuncture may be very effective in managing pain associated with severe nerve pain. Acupuncture is the stimulation of specific points on or near the surface of the body by the insertion of needles to prevent or modify the perception of pain or to normalize psychological functions, including pain control.
Chiropractic treatment 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.
Epidural Steroid Injections
Epidural steroid 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 2 to 3 weeks after injection.
Facet Block and Radiofrequency Ablation
Facet block and radiofrequency ablation are done under fluoroscopic guidance. This procedure is done to relieve pain coming from the 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 or Dr. Ball.
Anti-neuritic or Nerve Pain Medications. Medications such as gabapentin (Neurontin), pregabalin (Lyrica), amitryptiline (Elavil), function under a variety of mechanisms, some of which are poorly understood. They are helpful in treating nerve pain in patients who have radiating or shooting pain without loss of strength.
Muscle relaxants. As a TEMPORARY means to reduce pain, muscle relaxants 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 basis.
Narcotics. Narcotic medications such as codeine, hydrocodone (Vicoden, Norco), morphine, oxycodone (Percocet, Oxycontin), hydromorphone (Dilaudid), are potent pain medications. They should be used conservatively and cautiously.
Non-steroidal Anti-inflammatory Drugs (NSAIDs). NSAIDs include ibuprofen (Motrin, Advil), naproxen (Naprosyn), and celecoxib (Celebrex). These are among the most common ones. They 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, regular dosing is required to control pain AND reduce inflammation. Patients need to consult with their physician for proper dosing and precautions. Chronic use may increase ulcer risk and kidney problems.
Formal, supervised visits with a physical therapist are critical. A 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 physical therapy groups have the same level of experience treating spine conditions, so it is important to work with the right group. The physical therapist has to understand the condition being treated and has to have the experience to know when to advance to the next level of exercise intensity.
Sacroiliac Joint Injection
A sacroiliac joint injection is 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.
Selective Nerve Root Block
A selective nerve root block is 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 2 to 3 weeks after the injection has been completed.
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.