Your spine is a column of 25 vertebrae all stacked upon one another. They are separated by cartilage cushions and supported by groups of muscles that help to stabilize the spine. When the muscles become weak from lack of exercise or injury, or when the cartilage begins to break down, back and neck pain can be the result. Sometimes, working with your physician, you are able to completely correct the pain, but other times only partially. This inability to completely fix neck and back pain has resulted in many different approaches to the problem, only some of which have shown benefit.
Evidence-based medicine is the study of what is proven to work. This allows us to avoid treatments that are ineffective or even potentially harmful. Because neck and back pain is so common, it is important to find which treatments actually help patients.
- Physical therapy that progresses to other spine-strengthening exercises shows the greatest long-term benefit. This is because of the increase in muscle strength stabilizes and supports the spine. Physical therapy can transition to yoga, Pilates, Tai Chi, and other forms of strength and flexibility training.
- Improving ergonomics is another critical part of a spine program. Ergonomics is the science of studying your day to day activities, job, hobbies, etc., to make certain they do not worsen the pain.
What doesn’t work
- Opioid therapy is at the top of the list. Many drugs including muscle relaxants, valium-type drugs, and certain drugs affecting nerve transmissions do not fully relieve neck and back pain. Anti-inflammatories such as ibuprofen have some benefit and are safe for many, but not all patients.
- ESI, cortisone injections into the spinal canal, is a therapy proven to be largely ineffective. There are only a few situations in which this can be beneficial and then usually only for a few weeks.
- Spine surgery may not be as effective and some patients may be worse off after than before surgery.
So what is the take-home message? It can be frustrating when modern medicine offers a limited tool kit. On the other hand, this should never be an excuse for trying treatments that don’t work or could be harmful. Sometimes the goal is a reduction in pain, but not complete elimination of pain. If injections or surgery are a valid option, your care team will help you make the best decision and help you avoid unnecessary, potentially harmful or expensive care. Working with your primary care physician to develop a good rehabilitation plan and the right team to provide it will almost always be of high value and lead to significant improvements in neck and back pain.
Guest Blog By Ken Cohen, MD, FACP and Chief Medical Officer New West Physicians
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