Are You Considering Surgery for Spine Pain?
In continuation of our last blog post on medical imaging regarding spine pain, we continue with a look at using medication and surgery for controlling symptoms.
So, what about medication to help with spine pain?
Because low back pain can be excruciating, many doctors prescribe opioids for pain relief. These are narcotics and include common brand names such as OxyContin and Vicodin. In the U.S., narcotics are currently the most commonly prescribed drug, and more than half of these prescriptions are for the treatment of low back pain.
Before deciding to use these prescription drugs, it is important to understand that they alter the chemistry within the brain and have the potential to become highly addictive. Opioid addiction is responsible for more than 14,000 death per year. In as little as two weeks, the body may develop tolerance requiring increased doses and leading to withdrawal symptoms once the medication is removed. Research does show that using opioids for a short time can provide modest pain relief (up to 30%).
However, opioids provide minimal to no improvement in function. In other words, these drugs have not been shown to expedite return to work or improve functional outcomes. Moreover, long-term use has been associated with worsening disability and increased sensitivity to pain (hyperalgesia). This is because long-term use causes a reduction in the ability to tolerate pain naturally, which may mean the pain is experienced long after the original cause has healed. Other side effects include constipation, nausea, sedation, increased fall risk, fractures, depression, and sexual dysfunction. Therefore, if you decide to use these medications, current recommendations include using the lowest possible dose for the shortest amount of time.
One viable alternative to opioids includes anti-inflammatory drugs (NSAIDS), as several high-quality studies have shown they are just as effective if not superior to opioids in reducing pain and improving function with much less risk or potential harm.
Here’s why you should explore all options and consider physical therapy before making your decision:
Surgery is almost always a last resort. The preoccupation and misconceptions associated with disc herniation found on imaging have led to many unnecessary surgeries, sometimes resulting in even worse outcomes, particularly when the herniation is not the true source of pain. Surgery carries inherent risks of complications, including infection, bleeding, and the possibility of permanent nerve damage. Significant complications occur in approximately 20% of patients. Depending on the type of procedure, the surgeon may have to cut through bone, muscle, fascia, or ligaments. Even with successful procedures, these structures take time to heal and can potentially cause scar tissue leading to pain and restricting motion. Muscles may shut down temporarily and motion may be limited for a period, which may lead to additional pain and stiffness since healthy discs require the motion for proper nutrition. The stiffness and muscle guarding may also cause other compensations in motor patterns in an effort to protect the spine. This can cause undue stress to other tissues, ultimately leading to further pain and dysfunction. Likely, physical therapy will be prescribed post-surgery and it will generally take some time to regain full function.
What can conservative care offer me?
For all these reasons, surgery is generally recommended as a last option after all other conservative treatments have failed. Research has shown that long-term outcomes after an appropriate bout of physical therapy are generally equivalent to, if not superior to outcomes after surgery. In most cases, low back pain can be addressed and relieved via physical therapy, as research shows that that therapy leads to greater pain relief and decreased drug consumption. In fact, many insurance companies require a course of physical therapy and other more conservative measures before authorizing funds for surgery. This is because the evidence shows that addressing the issue with physical therapy is successful most the time, saving both patients and their insurance companies money and eliminating potentially expensive and debilitating complications. In addition, trying therapy first is never a waste because in cases where surgery is ultimately required patients who have completed “prehab” (therapy prior to surgery) ultimately have better outcomes and faster recoveries.
We hope this small series of imaging, medication, and surgery has cleared up some preconceived myths about low back pain.
At Fox Physical Therapy, our board-certified Doctors of Physical Therapy specialize in mechanical diagnosis and treatment of spine symptoms. Contact us today to find out how we can help you feel better.