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.
If it’s an emergency, call 911 or go to an emergency room right away. Tell the medical staff that your injury or illness is work-related. If you can safely do so, contact your employer for further instructions.
If you don’t need emergency treatment, make sure you get first aid and see a doctor if necessary.
Once you file a claim, your employer is required to provide you with medical care. Be sure to include all injured body parts, as this initial reporting document will be used to determine eligibility for treatment until the case is closed.
According to the Department of Industrial Relations in the State of California, doctors in California’s workers’ compensation system are required to provide evidence-based medical treatment. That means they must choose treatments scientifically proven to cure or relieve workplace injuries and illnesses. Those treatments are laid out in a set of guidelines that provide details on which treatments are effective for certain injuries, as well as how often the treatment should be given (frequency), the extent of the treatment (intensity), and for how long (duration), among other things.
To comply with the evidence-based medical treatment requirement, the state of California has adopted a medical treatment utilization schedule (MTUS). The MTUS includes specific body region guidelines adopted from the American College of Occupational and Environmental Medicine’s (ACOEM) Practice Guidelines, plus guidelines for acupuncture, chronic pain, and therapy after surgery. The DWC has a committee that continuously evaluates new medical evidence about treatments and incorporates that evidence into its guidelines.
To learn more about your rights for workers’ compensation in the state of California, click here.
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.