Treatment Options for Lower Back Pain

December 18, 2023

Lower back pain is an extremely common medical problem with eight out of ten people affected by it at some point in their life. For some, the pain is transient, resolving quickly with rest and over-the-counter anti-inflammatory medications. For others, the pain becomes chronic and may limit day-to-day functioning.

So what can be done? Physical medicine & rehabilitation specialist, Antimo Paul Gazzillo, MD, discusses the causes of back pain and the wide variety of treatment options that are available, ranging from at-home remedies, to minimally invasive procedures, to surgery.

Why is Back Pain Such a Common Problem?

“There are many reasons why back pain is so prevalent in our modern society,” says Dr. Gazzillo. “Sedentary lifestyles, with long hours spent sitting at a desk or in the car, are definitely a factor. Conversely, people in jobs that require a lot of heavy lifting, twisting and bending, are also at risk. Both scenarios put a lot of stress on the spine.”

“In addition to lumbar strains and sprains that occur due to injury or overuse, arthritis in the joints of the spine may begin to develop as we age, causing achy pain that is typically worse with activity. As arthritis progresses, there’s an additional risk of developing narrowing of the spinal canal (stenosis), which can cause pain or heaviness in the legs when walking. And, given that people are living a lot longer, we are also seeing more age-related conditions like osteopenia and osteoporosis, which are risk factors for back pain as well,” adds Dr. Gazzillo.

Treating Back Pain at Home

If back pain is not severe and isn’t getting worse over time, it can usually be managed at home with rest, the alternating use of heat and ice and over-the-counter anti-inflammatory medications like ibuprofen.

“Once the acute pain has resolved, you should work to take control of your risk factors,” says Dr. Gazzillo. “Maintaining a healthy weight, staying active, being physically fit and developing strong core muscles all help to take pressure off your spine and reduce the risk of future injury.”

When to See a Doctor

If back pain persists or worsens despite at-home treatments and preventive measures, talking to a primary care physician is a good place to start. They will do a complete evaluation, including a physical exam and medical history, to try and determine the main cause of your pain.

“It can be very difficult to pinpoint the exact cause of back pain,” says Dr. Gazzillo. “It usually has multiple points of origin and often results from a combination of structural, functional and lifestyle factors. A primary care provider may prescribe physical therapy, prescription-strength anti-inflammatories and integrative medicine therapies like massage and acupuncture to try and get your pain under control.”

However, if the pain becomes progressively worse or you're having significant pain shooting down the leg or any kind of neurological changes like numbness, tingling or weakness in the arms or legs, it’s time to be evaluated by a spine specialist.

Taking the Next Step: Specialty Care

A spine specialist will take a close look at what treatments have already been tried, what’s worked and what hasn’t. In addition, they may order specialized imaging exams to look for structural problems in the spine like herniated discs, bone spurs and arthritic changes to further pinpoint the reason for your pain.

“Conservative treatments are usually effective in up to 90 percent of the patients I see,” says Dr. Gazzillo. “Even spine specialists don’t automatically move to interventional care. Instead, we first ensure that the patient has been receiving the appropriate physical therapy and medications and is correctly following recommendations for the application of heat and ice. Only if conservative care has proven to be insufficient or ineffective, do we consider other treatment options, like injections.”

Fluoroscopic-Guided Injections

This minimally invasive procedure uses a specialized instrument called a fluoroscope to provide real-time imaging of the area of the spine being treated. After the skin is sterilized and numbed with local anesthetic, a small needle is precisely guided into the joint. Once in place, the doctor can deliver steroids, anesthetic medication or a mixture of both through the needle and into the painful joint.

“These epidural injections can be very helpful for radicular pain from pinched nerves, achy arthritis pain and sometimes they can also be beneficial for pain related to central canal stenosis,” says Dr. Gazzillo. Although results are extremely variable, most individuals can expect three months or more of symptom relief. Injections may be repeated up to three times a year.

When Surgery Might Be Recommended

If conservative treatments and epidural injections are not working to control the pain it might be time to consider surgical treatment options. “In particular, if a person is experiencing progressive weakness or numbness, significant balance issues or they have bowel or bladder changes or incontinence, those are all red flags,” says Dr. Gazzillo. “In that scenario, we would want to consider surgery sooner rather than later to stop those symptoms from getting any worse.”