Approximately one in six Australians suffer from back pain, according to the Australian Institute of Health and Welfare. Often this leads to poorer quality of life, psychological distress and disability.
As part of National Pain Week, neurosurgeon and spinal surgeon, Dr Michael Wong, shares his five top ways to manage chronic back pain.
Medication
Simple medication such as paracetamol paired with rest should be the first stage of treatment for short term pain says Dr Wong. When pain becomes chronic, long-term use of medication should be closely monitored for side effects.
“Non-steroidal anti-inflammatory drugs are often the go-to drugs for back pain relief,” Dr Wong explains. “It helps reduce pain, swelling and inflammation in muscles and around damaged spinal discs.”
Prescription muscle relaxants are another option for acute pain, as well as antidepressants which can reduce pain signals.
Dr Wong adds that a consultation with your GP before taking any medication is always recommended, and always follow the dosage instructions.
Physiotherapy
Back injuries that derive from muscular pain can be treated with physiotherapy, most often for degenerative wear and tear, according to Dr Wong.
Physiotherapy includes remedial massage that targets the joints in the back, hamstring stretching exercises on a daily basis, core strengthening exercises and low intensity aerobics.
While exercising through the pain may seem confusing, activities such as cycling, swimming or hydrotherapy can relieve pressure on the back by strengthening joints and muscles around the spine.
Interventional procedures
For someone with sporadic instances of back pain, injections can be helpful for a temporary pain control.
“Often patients come in with a history of back pain and if the cause is minor it responds well to spinal injections because it relieves inflammation from the nerve or joint,” says Dr Wong.
Epidural injections and nerve root blocks are the two main types of interventional procedures. These treatments address the pain and can help rule out causes if the treatment fails.
A nerve root block enables the doctor to determine exactly which nerve root or roots are affected. An epidural injection works by decreasing swelling and pressure on larger nerves and the spine.
Cognitive behavioural therapy
After a patient has tried medical injections and physiotherapy but continues to experience chronic pain, Dr Wong recommends seeing a psychologist for cognitive behavioural therapy.
“If they continue to suffer then perception of pain changes. It probably becomes heightened and more sensitive,” says Dr Wong. “There may be a deal of depression so they can help with that part of the equation too.”
Adults experiencing back problems are more than twice as likely to report very high levels of psychological distress than those without the condition.
Not only will the therapy try to restore pain perception, but it could also be used to manage heightened stress.
Surgery
The most invasive and final form of relief comes from surgery.
“Once they have done the appropriate investigation and think the scan shows the source of pain, the next question is ‘can they remove this for me?’” explains Dr Wong.
“Some spinal surgery is done before this is identified and that’s when bad surgery takes place.”
Common treatable back pain includes nerve compression, disc prolapses and fractures to the spine. These make up a large portion of injuries where surgery is the appropriate treatment.
Dr Wong suggests seeking multiple expert opinions when it comes to a delicate procedure as a more experienced surgeon could be the difference.
“Operating on back pain is an elective surgery not a matter of life and death,” adds Dr Wong.
“The primary outcome should be to return them back to the normal quality of life not survival.”
