Low Back Pain and Degenerative Disc Disease Treatments

The cause of low back pain, especially in young adults, is frequently degenerative disc disease. Although this condition can cause symptoms of low back pain over a long period of time, the good news is that the pain is usually manageable with various conservative treatment options (meaning treatments that don’t involve surgery).

Low back pain treatment goals

The vast majority of people with degenerative disc disease experience low back pain symptoms that flare up periodically, but don’t get worse over time. For those people, the main goals for managing low back pain caused by degenerative disc disease are usually:

• Achieving enough pain relief to be able to engage in an exercise and rehabilitation program
• Preventing the application of excess stress on the disc through proper ergonomics and posture
• Trying to manage the low back pain and maintaining an ability to function enough at home and at work

Most types of surgery for ongoing, debilitating pain and loss of function from degenerative disc disease are fairly extensive, so it is usually in the best interest of most patients to manage their low back pain using non-surgical approaches and self-care. Over time, the low back pain and other symptoms of degenerative disc disease will usually subside. This happens because the disc starts to become stiffer with age, and a stiffer disc stabilizes the motion segment and thus reduces pain. However, this is a very slow process that occurs over many years.

Low back pain treatments

Pain from degenerative disc disease is caused by a combination of instability at the motion segment and inflammation from the degenerated discs. Both the instability and the inflammation have to be addressed for the treatment to be effective.

The treatments for degenerative disc disease are either passive (done to the patient) or active (done by the patient). Usually a combination of treatments is used to help control the symptoms. Passive treatments are rarely effective on their own—some active component, such as exercise, is almost always required.

Passive treatments for low back pain from degenerative disc disease may include:

• Pain medication. Typical pain medications used to treat the low back pain include acetaminophen, NSAIDs, oral steroids, narcotic drugs, and muscle relaxants. Each type of medication has strengths, limitations, and risks, and the patient’s particular low back problem and overall health will determine which pain reliever, if any, is indicated.
• Chiropractic manipulation. Manual manipulation by a chiropractor or other qualified health professional is thought to help relieve low back pain by taking pressure off sensitive neurological tissue, increasing range of motion, restoring blood flow, reducing muscle tension, and creating a series of chemical reactions in the body (such as endorphin release) that act as natural painkillers.
• Epidural injections. An epidural injection into the spine delivers steroids that can provide low back pain relief by decreasing inflammation in the painful area.
• TENS units. These devices deliver mild electrical stimulation that overrides the painful signals sent to the lower back.
• Ultrasound. For acute low back pain, ultrasound may be used to warm the area, which in turn brings blood flow and healing nutrients to the area.
• Massage. Therapeutic low back massage is thought to provide low back pain relief by improving blood flow, reducing muscle stiffness, increasing range of motion, and raising endorphin levels in the body.

In addition, heat and/or ice therapy, acupuncture, behavioral therapy, and other therapies often provide enough low back pain relief to allow the patient to progress with his or her exercise and rehabilitation program.

Active treatments for low back pain may include:

• Exercise. For the vast majority of patients, the only way to achieve long-term healing is active exercise, which usually includes a combination of strengthening, stretching, and low-impact aerobic exercise.
• Quitting smoking. For patients who smoke, doctors recommend quitting smoking to improve blood circulation and healing. Chronic tobacco use is closely linked to chronic low back pain.
• Weight loss can reduce low back pain in overweight people by lessening the amount of stress on the low back’s muscles and ligaments.
• Ergonomics. Proper lifting techniques, ergonomic furniture, supportive footwear, and avoiding static posture for prolonged periods of time can help take pressure off the low back.

The following pages provide additional information on the main treatments usually used to treat low back pain from degenerative disc disease, including:

• Exercise and physical therapy [10]
• Pain medications [11]
• Pain management techniques [12]
• Chronic pain and depression [13]

[14]

• Peter F. Ullrich, Jr., MD [15]

May 3, 2006