Ken Cohen, MD, FACP
Chief Medical Officer
Your spine is a column of 25 vertebrae all stacked upon one another. They are each separated by cartilage cushions and supported by groups of muscles that help to stabilize the spine. When the muscles become weak from lack of exercise or injury, or when the cartilage begins to break down, back and neck pain can be the result. Sometimes, working with your physician, you are able to completely correct the pain, but other times only partially. This inability to completely fix neck and back pain has resulted in many different approaches to the problem, only some of which have shown benefit.
Evidence-based medicine is the study of what is proven to work. This allows us to avoid treatments that are ineffective or even potentially harmful. Because neck and back pain are so common, it is particularly important to determine which treatments actually help our patients.
- Physical therapy that progresses to other spine-strengthening exercises shows the greatest long-term benefit. This is because the increase in muscle strength stabilizes and supports the spine. Physical therapy can transition to yoga, Pilates, Tai Chi, and other forms of strength and flexibility training.
- Improving ergonomics is another critical part of a spine program. Ergonomics is the science of studying your day to day activities, job, hobbies, etc., to make certain they are carried out in such a way as to not worsen pain.
It’s important to understand that for some patients, there will always be a level of pain that doesn’t go away. This is very difficult for many patients, and working with a counselor who specializes in pain can provide tools and strategies to manage the pain.
What doesn’t work
Others things have been shown to be ineffective.
- Opioid therapy is at the top of the list. Many drugs that have been used for years have been shown not to help neck and back pain including muscle relaxants, valium-type drugs, and certain drugs affecting nerve transmission such as pregablin (Lyrica) and its cousin, gabapentin. Anti-inflammatories such as ibuprofen, have some benefit and are safe in many, but not all patients.
- Some treatments, such as stem cell injections, have not been studied at all and we have no idea if they are of benefit, although it is unlikely that they will turn out to be.
- ESI (cortisone injections into the spinal canal) is another therapy proven to be largely ineffective. There are only a few situations in which this can be beneficial and then usually only for a few weeks.
- In many patients there is no benefit to spine surgery and some patients may be worse off after than before surgery.
So what is the take-home message? It can be frustrating when modern medicine offers a limited tool kit. On the other hand, this should never be an excuse for trying treatments that don’t work or could be harmful. Sometimes the goal is reduction in pain, but not complete elimination of pain. If injections or surgery are a valid option, your care team will help you make the best decision and help you avoid unnecessary, potentially harmful or expensive care. Working with your primary care physician to develop a good rehabilitation plan and the right team to provide it will almost always be of high value and lead to significant improvements in neck and back pain.