Chiropractors that specialize in the treatment of low back pain attempt to improve the function of the joints and the nervous system by adjusting vertebral subluxations. Manual spinal adjustments are the key to chiropractic treatment, and in fact, the word "chiropractor" is derived from the two Greek words "cheiros" and "praktikos", which together mean, "done by hand". Chiropractic adjustments are very popular in the United States, with as many as 40 million Americans receiving regular treatment. Because there are major philosophical and theoretical differences between the ways in which chiropractors and medical doctors treat back pain, there has always been a rift between these two groups. Recently, the chasm between chiropractors and medical doctors has started to narrow as they have begun to share information and provide each other with more insight into their respective methodologies, practices, and treatments.
Chiropractors today are more likely to refer a patient to a medical doctor when they suspect that an underlying condition may be responsible for back pain, and some chiropractors insist that their patients have a primary care physician that they can communicate with in order to ensure that the patient is receiving the best quality care. In this sense, Chiropractors are becoming part of the broader spectrum of providers that treat back pain. Chiropractors frequently have different methods of adjustment, but the theory behind the success of chiropractic treatment is that realigning the spine relieves pressure on the spinal nerves, which can help to restore natural nerve function throughout the body. As such, they believe that a "well-aligned" body is more likely to be in a state of natural balance and the patient will experience less pain and disability. Many chiropractors today have incorporated electrical stimulation, diathermy, ultrasound and a variety of other therapies, but the mainstay remains manual spinal manipulation or adjustment.
Exercise
Regular exercise is an essential part of having a healthy back.
In the treatment of back pain, almost every healthcare provider agrees that exercise plays an important role in recovery.
Every day we make demands on our bodies that can stress our backs. It's a well known fact that the more fit you are, and the stronger your back is, the more easily your body can deal with the stress and strain of every day activity.
The goal when prescribing medication to chronic pain patients should be to derive maximum benefits or reduction of pain and discomfort, encourage compliance and minimize the risk of overuse or abuse of the medications.
Non-Steroidal Anti-Inflammatory Medications (NSAIDs)
This group of drugs includes common over-the-counter drugs such as aspirin, ibuprofen, and ketoprofen among others.
These drugs have potent analgesic effects that can be sustained for long periods of time without concerns of toxicity or dependence. These drugs have almost specific effects in reducing pain and inflammation of inflammatory spondyloarthropathies.
By the anti-inflammatory and analgesic activity of these medications, they can promote the initiation and maintenance of rehabilitation efforts that might otherwise be impossible.
Physical therapy is an important treatment option for most back pain sufferers. A physical therapist is trained to carry out your doctor's orders to stretch, strengthen, and exercise your back in a safe and effective way. It is important that physical therapy is coupled with education, so that patients can be empowered to take charge of their own recovery.
Epidural Injections
Most spinal injections for chronic back pain management contain two different types of medication, typically an anesthetic like the dentist uses to numb your teeth, and a steroid preparation that is designed to decrease inflammation in the area where it is injected. With the exception of people who are diabetic, local injections do not have a significant effect on other parts of your body. For example, steroid injections around the spine will not cause osteoporosis, hair loss, a deep voice, or huge muscles. However, many diabetics will notice that their blood sugars run high after an injection, and dark-skinned patients may develop an area of de-pigmentation where the injection was given.
In general, injections have two purposes: they are either diagnostic or therapeutic. When an injection is diagnostic, it helps to identify which part of the spine is causing the pain, because injecting medication in a particular anatomic area relieves the pain. An injection can also be therapeutic, because it may be able to relieve your pain for a significant period of time. Sometimes this pain relief may break the cycle of inflammation and resolve your problem. At other times, it may only provide temporary relief, such that you are able to make a better decision about proceeding with surgery if surgery has the ability to permanently relieve your pain in the same way as the medication.
When an injection resolves someone's pain for a short period of time, they are often interested in another injection. Most doctors have a limit on the number of steroid injections that they will give to a patient within a certain period of time. For example, it is very common for doctors to limit a patient to three steroid injections in a year. There is nothing magical about these limits, but they exist because most spine surgeons do not believe that repeated and frequent injections are a good way to manage a spine problem in the long term. Instead, if an injection helps to relieve the pain, at least temporarily, it may indicate that surgery will be successful in helping to obtain a permanent solution for the pain.
