Pain Management Techniques for Degenerative Disc Disease

Low back pain caused by degenerative disc disease is often complicated to treat. Patients usually find that they must try more than one treatment, or several combinations of treatments, through a process of trial and error before finding sufficient pain relief.

The field of pain management uses a wide variety of techniques to address pain and painful disorders. In addition to pain medications and physical therapy, physicians may also recommend a variety of treatments.

Epidural steroid injections

An injection that delivers steroids and/or anesthetic into the epidural space in the spine may help provide temporary relief of low back pain. Reduced pain may provide enough comfort to initiate an exercise and rehabilitation treatment program.

See How Epidural Steroid Injections Work

Effectiveness may vary based on the technique and approach taken by the healthcare professional, as well as other factors. Spinal steroid injections may prove most useful in advanced stages of degenerative disc disease, when diagnostic imaging reveals inflammation and changes to the end-plates near the disc. ¹ Buttermann GR. The effect of spinal steroid injections for degenerative disc disease. Spine J. 2004;4(5):495-505. doi:10.1016/j.spinee.2004.03.024 Generally, steroid injections are limited to 3 per year.

See Epidural Steroid Injection Pain Relief Success Rates

Electrical stimulation

The use of electrical stimulation may help relieve back pain caused by degenerative disc disease and improve daily function with less reliance on pain medication, although there is limited hard evidence in the literature to support efficacy of this treatment option.

An example of electrical stimulation is Transcutaneous Electrical Nerve Stimulation units, or TENS units. Pads are applied to the skin overlying the most painful areas and a low current electrical charge is transmitted to the skin. The theory is that the electrical signals help override the pain signals, and research indicates that spinal function and movement may also improve. ² Pop T, Austrup H, Preuss R, et al. Effect of TENS on pain relief in patients with degenerative disc disease in lumbosacral spine. Ortop Traumatol Rehabil. 2010;12(4):289-300. Less conventional examples of this type of pain management approach include Pulsed Electromagnetic Fields (PEMF) and Pulsed Electrical Stimulation (PES), which may help treat disc degeneration. ³ Miller SL, Coughlin DG, Waldorff EI, Ryaby JT, Lotz JC. Pulsed electromagnetic field (PEMF) treatment reduces expression of genes associated with disc degeneration in human intervertebral disc cells. Spine J. 2016;16(6):770-776. doi:10.1016/j.spinee.2016.01.003 PEMF may also be combined with TENS for a routine course of treatment that may help reduce pain. ⁴ Hattapoğlu E, Batmaz İ, Dilek B, Karakoç M, Em S, Çevik R. Efficiency of pulsed electromagnetic fields on pain, disability, anxiety, depression, and quality of life in patients with cervical disc herniation: a randomized controlled study. Turk J Med Sci. 2019;49(4):1095-1101. Published 2019 Aug 8. doi:10.3906/sag-1901-65

See Transcutaneous Electrical Nerve Stimulators (TENS)

Manual manipulation

Manual manipulation, a spinal adjustment by a chiropractor or other qualified health professional, may help relieve low back pain via the following potential mechanisms:

• Taking pressure off sensitive neurological tissue
• Increasing range of motion
• Restoring blood flow
• Reducing muscle tension

Methods of adjusting the spinal segments may include rotational manipulation or oscillatory manual therapy, which may be more suitable than rotational manipulation in the early stages of disc degeneration. ⁵ Swanson BT, Creighton D. The degenerative lumbar disc: not a disease, but still an important consideration for OMPT practice: a review of the history and science of discogenic instability. J Man Manip Ther. 2020;28(4):191-200. doi:10.1080/10669817.2020.1758520

See Understanding Spinal Manipulation

Psychological therapy

Pain management treatments may be enhanced with the use of various psychological tools.

• Cognitive behavioral therapy trains the mind to change how pain-related thoughts are perceived and how pain-related behaviors are performed.
• Applied relaxation techniques teach the muscles to relax under stress or after certain cues.
• Coping techniques may involve visualization of the self in a peaceful, pain-free setting.
• Biofeedback therapy uses electrodes to gradually alter neuromuscular signals and help monitor and modify low back pain.

A combination of cognitive behavioral therapy and structured exercise may be more effective than exercise alone. ⁶ Swanson BT, Creighton D. The degenerative lumbar disc: not a disease, but still an important consideration for OMPT practice: a review of the history and science of discogenic instability. J Man Manip Ther. 2020;28(4):191-200. doi:10.1080/10669817.2020.1758520 Management techniques are typically designed by a mental health counselor or psychotherapist over the course of a limited number of therapy sessions.

Prolotherapy

Prolotherapy is designed with the goal of promoting healing by inducing an inflammatory response in the soft tissues of the back. Prolotherapy injections are most effective in combination with another treatment, such as manual manipulation or exercise. ⁷ Dagenais S, Yelland MJ, Del Mar C, Schoene ML. Prolotherapy injections for chronic low-back pain. Cochrane Database Syst Rev. 2007;2007(2):CD004059. Published 2007 Apr 18. doi:10.1002/14651858.CD004059.pub3

See Prolotherapy and Chronic Back Pain

Therapeutic massage

Visiting a massage therapist may be useful, particularly for short-term relief of lower back pain. ⁸ Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M. Massage for low-back pain. Cochrane Database Syst Rev. 2015;(9):CD001929. Published 2015 Sep 1. doi:10.1002/14651858.CD001929.pub3 A physical therapist may include a massage during treatment sessions. While a home massage chair system may not be as effective as physical therapy, ⁹ Kim SK, Min A, Jeon C, et al. Clinical outcomes and cost-effectiveness of massage chair therapy versus basic physiotherapy in lower back pain patients: A randomized controlled trial. Medicine (Baltimore). 2020;99(12):e19514. doi:10.1097/MD.0000000000019514 some people consider it a viable option for pain relief.

See Massage Therapy for Lower Back Pain

Heat therapy and cold therapy

An inexpensive, simple way to manage low back pain is to apply ice or heat, perhaps in combination with a massage.

• Heat therapy may be customized for convenience and for individual needs. For instance, a more severe case of lower back pain may require a low-level heat application for 2 hours, while a low-grade backache may improve with less than 30 minutes of applied heat.

  See Benefits of Heat Therapy for Lower Back Pain

• Cold therapy is generally applied for no more than twenty minutes at a time, with an interval of one to two hours in between applications.

  See Ice Packs for Back Pain Relief

It is important to use insulation with heat or ice treatment to avoid overheating or frostbiting, respectively. For people with decreased sensitivity on their skin, such as people with diabetes, extra caution is warranted when applying heat or cold on the skin.

Acupuncture

One of the numerous benefits of acupuncture may be the effective treatment of chronic back pain. A popular acupuncture treatment for back pain is auricular acupuncture (auriculotherapy). ¹⁰ Moura CC, Chaves ECL, Cardoso ACLR, Nogueira DA, Azevedo C, Chianca TCM. Auricular acupuncture for chronic back pain in adults: a systematic review and metanalysis. Acupuntura auricular para dor crônica nas costas em adultos: revisão sistemática e metanálise. Rev Esc Enferm USP. 2019;53:e03461. Published 2019 Aug 19. doi:10.1590/S1980-220X2018021703461 This approach involves the placement of needles on the outer ear, which is believed to have points that align with other areas of the body, such as the lower back.

Electrical acupuncture may involve the application of electrical charge after the needles are inserted, or may be performed using electrodes rather than needles. Electrical acupuncture may be just as effective as manual acupuncture. ¹¹ Comachio J, Oliveira CC, Silva IFR, Magalhães MO, Marques AP. Effectiveness of Manual and Electrical Acupuncture for Chronic Non-specific Low Back Pain: A Randomized Controlled Trial. J Acupunct Meridian Stud. 2020;13(3):87-93. doi:10.1016/j.jams.2020.03.064

Lifestyle measures

Practical measures may be taken at home and throughout the workday to help cope with degenerating discs. Self-care practices include, but are not limited to, adopting a sleep routine, using a back brace, eating an anti-inflammatory diet, staying well hydrated, avoiding nicotine, and using correct ergonomics and sitting posture.

See Living with Degenerative Disc Disease