Epidural Steroid Injections for Back Pain and Leg Pain Video
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, such as:
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 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 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 PEMF may also be combined with TENS for a routine course of treatment that may help reduce pain.4
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
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 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
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 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 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.
- 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.
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 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.
See Acupuncture: An Ancient Treatment for a Current Problem
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
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
References
- 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
- 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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
