The Nonsurgical Management of Chronic Low Back Pain

By Eric Francke, MD

It is increasingly difficult for people with chronic low back pain to make sense of the growing list of nonsurgical treatment options. Low back pain is a common problem with one recent study estimating that 85% of people will experience an episode of low back pain in their lifetime and that 20% of people with this problem describe their pain as severe or disabling. The non-operative treatment of chronic low back pain includes a large inventory of approaches: some have been supported by research that demonstrates safety and effectiveness while others have not.

There are a variety of lifestyle therapies that have been shown to help reduce low back pain including physical fitness and smoking cessation. There are a variety of alternate therapies including acupuncture, homeopathic medications, herbal supplements, meditation, etc. There are a multitude of pharmaceutical products which are prescribed for chronic low back pain. These medications include non-steroidal anti-inflammatory medications, muscle relaxants, anticonvulsants, lidocaine patches, etc. There are a variety manual therapies including physical therapy, chiropratic manipulation, massage therapy, and exercise programs with the goal of reducing low back pain. There are a variety of physical modalities including cold, electrical stimulation, heat, traction, ultrasound, etc. There are a variety of injection therapies with the goal of decreasing low back pain including facet blocks, radio frequency denervation, trigger point injections, etc. Thereis also a shorter list of minimally invasive procedures being touted as alternatives to surgery for low back pain. Minimally invasive procedures include intradiscal electrothermal treatment, intradiscal radio frequency ablation, and nuclear decompression through a variety of methods including the use of a laser. Finally, the use of one of these treatments does not necessarily exclude the use of others, which further complicates the decision process.

How does one decide what would be the most beneficial from this long and growing list of nonsurgical treatment options? The best place to start is with one's primary care physician. One's internist or family practitioner is capable of initiating the conservative measures which are often successful in the treatment of low back pain. Primary care physicians frequently treat low back pain and have experience prescribing these interventions and are knowledgable about the research which supports or doesn't support the use of these interventions. Only after a thorough trial of nonsurgical management has failed should further measures be considered by the patient. If and when these conservative measures fail, your primary care provider can make the appropriate referral to a spine surgeon for further evaluation and management necessary to give the patient the information necessary to decide if surgical intervention would be in the patient's best interests. After all, it is the patient who decides the most appropriate treatment and this decision can only be made after the patient has been fully informed of all the options and their potential benefits.