Lower back pain: your questions answered

What non-surgical options do I have for my lumbar spinal pain, and how effective are they?

The management for Lumbar Spinal Pain (LSP) is initially to make an accurate diagnosis and to rule out any red flags symptoms which warrant emergency treatment.

A comprehensive treatment plan will then be developed with discussion between the patient and physician based on patient expectations.

Available treatments are:

• Education and explanation of disease process and prognosis.
• Non-invasive methods: simple analgesics, specific nerve pain medications, physiotherapy and exercise (to strengthen the core muscles), and TENS trial.
• Procedures: Injections around the nerve supplying the spinal joints (nerve root injection), epidurals, radiofrequency procedures and spinal column stimulators.

How long does it usually take for pain to improve with medication and physical therapy?

90% of acute LSP resolves without specific therapy and without any interventions in less than 2 weeks.

Chronic low back pain may not fully recover, however, improvement in pain level is achievable using the techniques mentioned above. The aim of managing chronic LSP is to reduce pain and to have more good days then bad days.

What are the risks and benefits of steroid injections for lumbar spinal pain, and how often can they be given?

Steroids use in LSP has both favourable and unfavourable consequences. The anti-inflammatory effects may prolong the pain, relieving effects of injection, but it can theoretically cause bone demineralisation on repeated injections. It also may reduce immunity in vulnerable patients and cause deranged blood sugars in diabetic and prediabetic patients.

Can I modify my activities and posture to reduce lumbar spinal pain and prevent 

Good posture and regular exercises to strengthen the core and back are the essential to early reduction of pain, preventing further deterioration and reducing flare ups.

Pilates, yoga, Alexander technique and aquafit are all recognised and increasingly popular techniques in holistic management of chronic pain.

Creator of pilates, Joseph Pilates stated, ‘because of poor posture, practically 95% of our population suffers from varying degree of spinal curvature ailments. Good posture can be successfully acquired only when entire mechanism of body is under perfect control’.

When is surgery recommended for lumbar spinal pain, and what are the potential outcomes and risks?

Surgery is only indicated in cases of demonstrable nerve compression or similar pathology. In most cases, surgery is only recommended after an appropriate trial of non-surgical treatments. The aim of surgery is to improve the persistent pain and numbness in the legs caused by pressure on the spinal nerves, it does not address the back pain.

Lumbar decompression surgery has around 70% chance of improvement of nerve compression pain. As with all types of surgery, it has a risk of complications such as infections, blood clots in the legs and lungs, damage to spinal nerves causing continuing or worsening symptoms.