Noninvasive Pain Management Techniques
Clinical research is continually being conducted to help determine which pain management therapies are the most effective in treating back pain and neck pain. Patients are advised to consult with their physician regarding any questions about a specific program.
In general, pain management techniques can be grouped in terms of their invasiveness.
- Some, such as physical therapy, are not invasive at all and do not inherently involve the use of medications
- Some pain management techniques, such as pain medications, are purely pharmacologic in nature
- Other techniques involve invasive techniques, such as injections
There is an immense variety of noninvasive non-drug pain management techniques available for treating back pain and neck pain. A few of the most widely accepted in comprehensive pain management programs are the following:
- Exercise – physical exertion with the aim of increasing strength, increasing flexibility, and restoring normal motion. Includes the McKenzie method, water therapy, stretching exercises, aerobic routines and many others. May involve active, passive and resistive elements. Exercise is necessary for proper cardiovascular health, disc nutrition and musculoskeletal health. See also Exercise and Back Pain
- Manual techniques – manipulation of affected areas by applying force to the joints, muscles, and ligaments. Some evidence for the effectiveness of certain techniques is available.
- Behavioral modification – use of behavioral methods to optimize patient responses to back pain and painful stimuli. Cognitive therapy involves teaching the patient to alleviate back pain by means of relaxation techniques, coping techniques and other methods. Biofeedback involves learning to control muscle tension, blood pressure, and heart rate for symptomatic improvement. See alsoChronic Pain Coping Techniques – Pain Management
- Superficial heating or cooling of skin – These pain management methods include cold packs and hot packs, ultrasound, and diathermy and should be used in conjunction with exercise.
- Electrotherapy – the most commonly known form of electrotherapy is transcutaneous electrical nerve stimulation (TENS). TENS therapy attempts to reduce back pain by means of a low-voltage electric stimulation that interacts with the sensory nervous system. Randomized controlled trials have yielded either positive or neutral results regarding the efficacy of TENS as a treatment for back pain. See also Electrotherapy
Noninvasive Pharmacologic Pain Management
Pain relievers and related drugs are used at every stage of the medical treatment of back pain, from the initial onset of acute pain to facilitation of rehabilitation, treatment of chronic back pain and alleviation of pain in cases of failed back surgery. The most common noninvasive pharmacologic treatments for chronic back pain are:
- Analgesics – or pain medications, including acetaminophen. Long-term use may involve risk of kidney or liver damage.
- Nonsteroidal anti-inflammatory agents (NSAIDs) – includes aspirin, ibuprofen, naproxen and COX-2 inhibitors. Long-term use may cause gastrointestinal ulcers, and may slightly raise the risk of heart attack.
- Muscle relaxants – used to treat muscle spasms due to pain and protective mechanisms.
- Narcotic medications – most appropriate for acute or post-operative pain. Since use of narcotics entails risk of habituation or addiction if not properly supervised, they are not often used for chronic conditions.
- Antidepressants and anticonvulsants – used to treat neuropathic (“nerve”) pain.
- Neuromodulating medications – used to treat neuropathic and muscular pain.
Invasive techniques in pain management involve injections and/or placement of devices into the body. A multitude of invasive pain management therapies have been used to treat neck and back pain.
Some of the most popular interventional pain management techniques include:
Injections (also known as blocks)
Injections provide direct delivery of steroids or anesthetic into joints, ligaments, muscles, or around nerves. These injections may provide relief of pain (often temporary) and can be used to confirm if the injected structure is the source of the pain, clarifying the diagnosis. Epidural injections can provide temporary relief for upper extremity or lower extremity pain due to a pinched nerve in the spine.
This technique involves injection of an irritant solution to stimulate blood circulation and ligament repair at affected site. The effectiveness of this technique is not known.
This procedure involves deadening of painful nerves via heat administered through a small needle. In carefully selected patients, this helps in approximately 60% of patients and lasts for months to years.
Surgically implanted electrotherapy devices
These are implantable spinal cord stimulators (SCS) and implantable peripheral nerve stimulators. Clinical data offers inconclusive findings on the effectiveness of SCS, but in general they are more effective for arm and leg pain than they are for localized spine pain. Spinal cord stimulators are expensive.
Implantable opioid infusion pumps
These are surgically implanted pumps that deliver opioid agents directly to the spinal cord. These pumps are expensive. The appropriateness and effectiveness of these devices for treating chronic back pain is controversial.