INJECTIONS FOR BACK PAIN
Pain management doctors, physical medicine doctors, and spine surgeons rely on injections and nerve ablations (destruction) as the first line of treatment for chronic neck and back pain, when rest, time, and manual therapies haven't helped.
The most common injection treatments are epidural steroid injections (ESI), which target nerve compressions due to bulging or herniated discs and spinal stenosis by injecting anti-inflammatory medication into the space just outside the covering of the spinal cord.
These injections are not without risk. They can cause steroid-induced bone loss, a lowering of the immune system, and, rarely, damage to the spinal cord if misplaced.
We know that these procedures definitely work to reduce pain in some people. But do they work better than placebo injections?
SPINE SURGERY: WHEN ALL ELSE FAILS
There are some people who definitely need back surgery.
If there is an abscess pressing on the spinal cord, or a tumor that cannot be treated with radiation, or a complex fracture, surgery is often necessary.
Some people have a large herniated disc that is clearly pressing on a nerve root, as evidenced by muscle weakness, such as a so-called foot drop. Most of these people will actually get better without surgery, but if the nerve compression gets worse, surgery can be indicated.
Most back surgeries are done to alleviate chronic back pain.
They are done for people with long-standing, chronic pain that hasn't responded to all other measures.
Most of these people have MRI findings of spinal stenosis, degenerative disc disease, and bulging or herniated discs. And, as with injection therapies, surgery can help some people with chronic back pain.