MEDICATION AND SURGERY FOR BACK PAIN
If the back pain is not relieved using other forms of treatment, the doctor may prescribe medication. The choice of medication depends on the back pain. For example, medications called analgesics can relieve pain. Other medications called muscle relaxants can help relax tight muscles. If the back pain is caused by arthritis, the doctor can prescribe medication that reduces inflammation and relieve the back pain. The most common medications prescribed are called Nonsteroidal anti-inflammatory drugs (NSAIDs). Aspirin and ibuprofen are NSAIDs. Some other NSAID medicines are also prescribed when needed.
Some medications are highly addictive. Pain medication used for prolonged periods has the potential to lead to addiction. No medication will cure back pain of degenerative origin. Medications control pain, inflammation, muscle spasm, and sleep disturbance. Many physicians feel narcotic medications should not be used continuously to treat chronic low back pain. There are certain circumstances where pain management specialists find that chronic narcotics will benefit specific groups of patients with chronic low back pain. Still, the majority of low back pain will not require this approach.
An Epidural Steroid Injection (ESI) may be suggested if simple measures fail to control the back pain. The epidural steroid injection involves placing a small amount of cortisone into the bony spinal canal. Cortisone is a potent anti-inflammatory drug that may control the inflammation surrounding the nerves and ease the pain. The epidural steroid injection is not always successful. These injections are reserved for cases where all other conservative measures have failed or as a last attempt to postpone surgery.
A patient should be well informed about his medication and clarify all doubts regarding the medicines from the doctor.
ABOUT MEDICATION
• What will the medication do?
• How long will it take to show results?
• What is the name of the medication?
• Is there a generic brand?
• Are there any side effects?
• How should the medication be taken? (i.e. before or after meals, with or without food, etc.)
• How often is the medication to be taken?
• What will be done if the dose is not taken at the specified time?
The doctor should be told about the other medication taken, as sometimes certain medications cannot be taken together.
SURGERY
People with sciatica or spinal stenosis often benefit from surgery. A few people with tumours within the spinal canal require it. Other than that, few people with back pain need surgery. Most people can be treated successfully with rest, exercise, and medication. Surgery does not always work for many common kinds of back pain, and it is difficult to know who will be helped and who will not. An orthopedist or neurosurgeon can help decide whether a back operation is necessary. It is always recommended to seek a second opinion.
If surgery is suggested for a problem, the best operation for that specific problem will be suggested. Although back surgery is not so joint in India, so many people have back problems at some time in their lives that many back operations are done. However, most people with back problems never have back surgery and function quite well with minimal effect on their daily lives. Below is an overview of the general types of back surgery that are sometimes necessary.
One of the most common surgical procedures is a diskectomy, removing a herniated disc to relieve pressure on a nerve root. The first step is to remove a portion of the lamina of the vertebra. The lamina is the portion of the vertebra that forms the roof over the spinal nerves. Removing a portion of the lamina creates a window into the spine. The nerves are then pulled to the side to see the herniated disc. Tiny instruments are then used to remove the herniated disc material. Most of the nucleus pulposus is removed to prevent the disc from herniating again. Once the disc material is removed, the nerves are free of pressure and irritation: the lamina and the disc area that is removed fill with scar tissue very rapidly.
When the primary problem appears to be spinal stenosis, the spinal canal needs to be made more prominent. This is done by performing a complete laminectomy. The lamina is the back portion of the spine and forms the roof of the spinal canal. The term laminectomy means to remove the lamina. Removal of lamina allows more room for the nerves and enables the surgeon to remove bone spurs around the nerves. This allows more room for the spine’s nerves and reduces the irritation and inflammation of the spinal nerves. The bone does not grow back. Instead, scar tissue replaces the lamina and protects the spinal nerves.
A spinal fusion may be suggested if the back problem results from segmental instability. A spinal fusion involves placing a bone graft between two or more vertebrae, causing the vertebrae to grow together or fuse. The bone graft is usually taken from the bones of the pelvis at the time of surgery. There are two general types of spinal fusion:
• Posterior fusion
• Interbody fusion
In the posterior fusion, the bone graft is placed on the back side of the vertebrae. During the healing process, the vertebrae then fuse or grow together. This creates a solid block of bone between the vertebrae and the fused vertebra act like one bone. Interbody fusion differs by placing the bone graft between the vertebrae where the disc has been removed. Once again, the healing process causes the vertebrae to fuse, creating a solid block of bone between the fused vertebrae. Both fusions accomplish the same thing. The vertebrae grow together or fuse into one bone. The goal of a spinal fusion is to stop the motion between two vertebrae that comes from segmental instability. Fusing the vertebrae reduces the mechanical back pain and impingement on the nerve root resulting from too much motion between the vertebrae.