Spinal Osteoarthritis Treatment

Osteoarthritis of the spine is a degenerative disease, and treatment can slow down its progression, help control pain and restore some or all of normal function.

Finding the most effective therapy for osteoarthritis in the back or neck is often a process of trial and error. Patients may find they respond well to one or a combination of treatments for a time, then need to try something else.

Physical therapy

Nearly every treatment plan will involve some amount of physical activity. Strengthening and stretching through controlled, progressive exercise helps the muscles support the spine and ease pressure on the vertebral discs and facet joints.

The goals of physical therapy are usually some combination of building strength and endurance, increasing range of motion, and improving everyday functioning.

Medications

Medications that may be recommended for spinal osteoarthritis pain and inflammation include:

• Acetaminophen relieves pain by interrupting transmission of pain signals to the brain.  It does not reduce inflammation and swelling.
• Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain primarily by reducing inflammation. Types of NSAIDs include aspirin, ibuprofen, naproxen, and cox-2 inhibitors.
• Topical medications come in the form of creams, sprays, gels, and patches that are applied directly to the skin over the painful joint. One common topical medication for arthritis is Voltaren gel. Topical medications may be preferred to minimize gastrointestinal potential risks and side effects caused by oral medications.
• Muscle relaxants may be temporarily prescribed if osteoarthritis triggers painful back muscle spasms.
• Medical marijuana may be prescribed to relieve chronic back pain (where legal).

Opioid medications are rarely prescribed because they carry an increased risk of misuse, abuse, and addiction, and several other potential risks such as cognitive, gastrointestinal, and other organ-related side effects.

All medications, including over-the-counter medications and supplements, carry potential risks and side effects, and these tend to increase with prolonged use and/or high dosages. All should be taken under the guidance of an appropriately trained physician or other health professional.

Massage

Therapeutic massage can help reduce osteoarthritis pain,¹Nelson NL, Churilla JR. Massage Therapy for Pain and Function in Patients With Arthritis: A Systematic Review of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Sep;96(9):665-672. doi: 10.1097/PHM.0000000000000712. Review. PubMed PMID: 28177937. improve circulation, and reduce muscle tension and spasms.

It is a good idea to find a physical therapist or massage therapist who is trained in treating spinal arthritis joint pain.

Manipulation

Manual manipulation on the spine may be done with the goal of helping correct malalignments and kneading out tissue adhesions to reduce pain.  This type of treatment is typically done by a chiropractor.

Transcutaneous electrical nerve stimulation (TENS)

This therapy uses small amounts of electricity to reduce the sensitivity of nerves around the spine. Patients typically feel only a gentle vibration or tingling during TENS treatment. 
TENS therapy may be done in a medical office, or the TENS unit may be prescribed to the patient and taken home with instructions regarding its proper use.

Acupuncture

Research suggests acupuncture can help treat osteoarthritis pain, back pain, and headaches.²Sherman KJ, Coeytaux RR. Acupuncture for Improving Chronic Back Pain, Osteoarthritis and Headache. J Clin Outcomes Manag. Author manuscript; available in PMC 2010 May 4. Published in final edited form as: J Clin Outcomes Manag. 2009 May 1; 16(5): 224–230. PMCID: PMC2863344

During a treatment session, ultra-fine needles are inserted at specific points on the skin in with the goal of correcting and/or maintaining a healthy energy flow. This treatment is considered generally safe.

Supplements

Many supplements are available that focus on reducing inflammation, which in turn tends to reduce pain.  Commonly recommended supplements include:

• Turmeric
• Ginger
• Omega-3 fatty acids (such as fish oil)
• Glucosamine and chondroitin sulfate
• Vitamin D (also available through exposure to sunshine)

Most supplements are considered generally safe, but side-effects, adverse health events, and drug interactions are possible, so it is always recommended to first check with your health provider.

Facet joint injections

A facet joint injection may be recommended to alleviate pain from a specific facet joint.  
The injection is typically delivered through the capsule that surrounds the two facets, into the joint itself. Examples of facet joint injections include:

• Cortisone injections reduce inflammation, and thereby alleviate joint swelling, stiffness, and pain. Steroid injections are usually used to provide enough pain relief to enable the patient to get started on a physical therapy program. Cortisone injections may also be used diagnostically.
• Regenerative medicine injections, such as platelet-rich plasma (PRP) and stem cell injections. The goal of these procedures is not only to help reduce pain, but to stimulate the body’s own reparative processes of cell and tissue healing for longer term recovery.

PRP and stem cell injections are still a newer form of treatment, and more research is needed to fully understand the indications and effectiveness of these treatments for pain due to facet joint degeneration.³Sanapati J, Manchikanti L, Atluri S, et al. Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Metaanalysis. Pain Physician. 2018;21(6):515-540. PMID: 30508983

Medial branch blocks

The medial branch nerves are small nerves that innervate the facet joints in the spine.

The nerves can carry pain signals from the osteoarthritic facet joints to the brain. A medial branch nerve block is a procedure in which an anesthetic is injected near the medial nerves connected to a specific facet joint so that they don’t transmit the pain signals to the brain.

Medial branch blocks may be used diagnostically, as part of treatment, or both.

Radiofrequency ablation (RFA)

The goal of a radiofrequency ablation (also called neurotomy) is to interrupt the pain signal to the brain, while preserving other functions, such as normal sensation and muscle strength.

This procedure produces a heat lesion (using radiofrequency energy) on the pain-transmitting nerve near the arthritic facet joint. The lesion prevents the nerve from sending pain signals to the brain.

When RFA is used, it is typically done after two successful diagnostic nerve blocks (two successful blocks are required prior to RFA, performed on different days, in order to reduce the chance of a false positive/placebo response to the first block). A nerve block can be used on two or more adjacent lateral or medial branch nerves to identify the target nerve(s). The nerve(s) that respond to the diagnostic block is/are treated with RFA.

Self-Care and Activity Modifications

Most doctors recommend self-care to ease arthritis symptoms, such as periodic rest, activity modifications, and diet and exercise.