9 New Ways to Relieve Chronic Back Pain Cutting-Edge Treatments for Back Pain Relief

You’ve tried all the typical back-pain treatments, from anti-inflammatory drugs to physical therapy, with little relief. But don't give up: There's hope with cutting-edge therapies, from new drug regimens to surgeries that target the spine. Lifescript’s Medical Detective uncovers the top new treatments for chronic back pain... Millions of women suffer from chronic back pain, triggered by pregnancy, toting tots, hauling groceries and those heavy purses that hold everything but the kitchen sink. It all takes a toll on the spine, triggering pain that can turn everyday movements into agonizing impossibilities. “Back pain is the major cause of pain and disability in this country,” says anesthesiologist George W. Pasvankas, M.D., medical director of the Pain Management Center at the University of California, San Francisco School of Medicine. “It’s the most frequent [reason patients ask] for medical care.” Most back pain problems are short-lived and can be eased with mild exercise and anti-inflammatory drugs, doctors say. But that's not true for about 26 million Americans with chronic back pain. They live with excruciating aches and spasms that last 6 weeks or longer. They can't get relief with over-the-counter analgesics or gentle yoga poses. Now, some cutting-edge remedies are providing back pain relief where ordinary therapies and medications fail. Lifescript’s Medical Detective unveils the top 9 breakthroughs for the most difficult back pain cases. Back pain relief #1: Gabapentin Anti-convulsants like gabapentin, which were formulated to combat conditions such as epilepsy, now are prescribed to relieve pain caused by nervous system damage from alcoholism, chemotherapy, back problems and spinal surgery. Gabapentin (brand name Fanatrex or Gabarone) changes the way the brain senses back pain by preventing the nerves from firing, says Steven P. Cohen, M.D., associate professor of anesthesiology and critical care medicine at Johns Hopkins School of Medicine and director of medical education for the school’s Pain Management Division. “The drug calms nerves everywhere in the body, including the spine,” adds Magdalena Anitescu, M.D., Ph.D., assistant professor of anesthesia and critical care at the University of Chicago Medical Center. The benefits: “About one-third of patients respond to [gabapentin],” Cohen says. It may help people with sciatica, which can be caused by a herniated disc and often triggers a searing pain that runs down the leg. Watch out: Gabapentin takes 4-6 weeks to work and requires frequent blood tests to monitor kidney function – rarely, patients experience kidney pain, stones and renal failure – and possible side effects. It also requires frequent dosage adjustments, Cohen says. The dose typically is increased every 2-3 days until a patient reaches 1,800 mg per day. Fatigue is a common side effect, but it’s usually not strong enough to stop treatment, he adds. Back pain relief #2: Methadone This medication, best known as a heroin-addiction treatment, is now being used to relieve chronic back pain. The benefits: It’s less expensive than many other narcotic painkillers, according to the Centers for Disease Control and Prevention (CDC). Plus, it's usually covered by insurance, Pasvankas says. Watch out: Not surprisingly, the drug “can be unsafe in inexperienced hands,” he warns. “You must be careful how you use it.” That's because methadone stays in the body long after the pain-reducing effects have worn off, prompting some patients to take another dose too soon. That contributed to a spike in overdoses and deaths from the drug from 1999-2004, according to the CDC. Prescribing methods have improved in recent years, but make sure your doctor knows the safest dosage. Back pain relief #3: Ketamine This powerful injectable anesthetic, widely used as an animal tranquilizer, isn’t commonly prescribed for back pain. It's a last-resort drug, reserved for patients with uncontrollable back pain who can't get relief with opioids, Pasvankas says. “It’s currently used for dire circumstances,” he says. “In the future, however, it may be used more routinely,” when it’s more readily available in pill form. Patients get ketamine injections or infusions (a lower concentration that's administered slowly) in a hospital setting over several days. The benefits: It's sometimes effective because it basically shuts the brain off from pain signals. “Low doses can reduce pain by 60%,” Anitescu says. Watch out: Its chemical structure is similar to the street drug PCP (phencyclidine or "angel dust"), leading some users to experience psychedelic effects. “It has a lot of side effects, such as hallucinations and nausea,” Anitescu says. They can be countered with anti-anxiety medications, she says. Back pain relief #4: Pain pump When oral medications fail, another option is a pain pump – also known as intrathecal (spinal) drug delivery. It sends medication directly to your spinal cord, bypassing the digestive system and providing pain relief faster than pills. The device is sometimes recommended for patients with chronic back pain, sciatica or after failed back and neck surgery. Here's how it works: A neurosurgeon implants the pump, a round metal device the size of a hockey puck, beneath the skin of your abdomen. A reservoir in the pump holds the medication. Medication travels through a small tube called a catheter to the area around your spinal cord. The pump is programmed to release the medication slowly during the day. It can easily be refilled by your doctor. Before undergoing surgery for a permanent pump, your doctor will conduct a trial involving either a single or multiple injections of medication, or a temporary catheter. During the 3- to 4-day hospital stay, the physician monitors the dose necessary for you. A permanent pump may be implanted if you get relief with no side effects, such as dizziness, headaches, respiratory depression, or constipation. The benefits: This treatment gives patients more control over the timing and amount of medication they get, allowing them to use a smaller dose with better results. “The pump delivers more medication at night, for example, when the pain is worse,” Pasvankas says. “They get more when they need it.” Watch out: Pain pump side effects may include constipation, nausea and vomiting, memory impairment and depression from the medication. Some people become dependent on the medications, and may get seizures and headaches during the course of treatment. Back pain relief #5: Sympathetic nerve blocks Sympathetic nerves, which travel along the front of the spinal column, help control automatic bodily functions such as digestion and blood pressure. They usually don’t send pain messages to the brain, but when they do, it can lead to a chronic pain condition called complex regional pain syndrome (CRPS). It can affect any area of the body, often an arm or leg, according to the UCSF Pain Management Center. A nerve block is used to reduce or eliminate pain by obstructing pain signals with a local anesthetic. Here's how it works: The doctor inserts a needle into your neck or back using an X-ray or computed tomography (CT) scan for guidance, and then injects a local anesthetic into the affected area. If it’s effective, your doctor may recommend a series of treatments, often 1-2 weeks apart, or suggest treating other nerves, even in your legs and feet, to treat pain there. Watch out: Side effects may include itching, rash, bleeding, elevated blood sugar and weight gain. Back pain relief #6: Radiofrequency ablation (RFA) This new pain-control technique can bring long-term relief to patients with chronic lower-back and neck pain, or degenerated arthritic joints. During the procedure: The doctor injects local anesthesia to locate the nerves that carry pain impulses, noting the areas that provide relief. A needle directs radio waves that heat the area around nerves, effectively burning them. That decreases “the firing of small pain fibers,” interrupting pain signals to the brain, Cohen says. The benefits: Pain may be reduced or eliminated for several months to a year. “It’s pretty effective,” especially for sacroiliac pain, which occurs in the area near the bottom of your back where bones come together, Cohen says. Watch out: The procedure may cause an infection, although the risk is small. Some patients experience swelling and bruising where the needle is inserted, but they disappear in a few days. Back pain relief #7: Spinal cord stimulation Spinal cord stimulation is used “after patients have had four to five [failed] back surgeries and still feel pain,” Anitescu explains. For example, patients with diabetic neuropathy (painful nerve damage from diabetes) and CRPS may be candidates. Spinal cord stimulation uses a device that delivers mild electrical pulses to replace areas of intense pain with a tingling sensation. By stimulating nerves different from the ones that cause pain, “it blocks out signals coming from the pain fibers,” Cohen says. Here's how the out-patient procedure works: Patients first undergo a trial treatment, using a temporary stimulator inserted with a needle. If it’s successful, a permanent stimulator is surgically implanted, Pasvankas says. A local anesthetic is used to numb the area where the stimulator is implanted, according to UCSF’s Pain Management Center. One or more insulated wires, called leads, are inserted into the epidural space (the outer part of the spinal canal). Afterward, you use a remote control-like device to deliver the electrical impulses when needed. The benefits: “The relief lasts a long time, and the device can last forever,” Cohen says. Watch out: Side effects may include infection, hardware breakage and allergic reactions, Anitescu says. Back pain relief #8: Kyphoplasty This minimally invasive procedure “reshapes the vertebra’s form and alleviates the pain,” Anitescu says. Here's how: A balloon helps place the vertebrae in its natural position. Next, cement – similar to the kind used in a knee replacement – is injected into the patient’s vertebrae, she says. The balloon then is deflated and removed. The benefits: Patients suffering intense pain from spine fractures – often due to osteoporosis – may undergo this procedure, in which the broken vertebra (spinal column) is repositioned. Watch out: An infection may develop on the skin where the needle is inserted or around the vertebrae after surgery. Also, nerve damage may result from bone cement that leaks into the muscles surrounding the spinal cord, causing nerve damage. The spinal cord and surrounding nerves also may be damaged during the procedure and may cause tingling or numbness in certain body parts, depending on where the kyphoplasty took place and which nerves were damaged. Back pain relief #9: Lumbar decompression Calcified ligaments – hardened and less flexible due to arthritis or joint injuries – can “pinch” the nerves, causing pain. When small portions are removed during lumbar decompression surgery, it gives the nerve root – the part closest to the spine – enough space to heal. The benefits: A doctor may recommend this operation to patients with severe back pain, often due to arthritis. Watch out: For some patients, the pain remains, or may even get worse, immediately following the procedure, until the nerve begins healing. For more information, visit our Pain Management Health Center. How Bad Is Your Back Pain? So your back hurts? Take our back pain quiz to see how severe it really is. You may need to see a doctor but have just been avoiding it, thinking it will get better. On the other hand, your back pain may be more normal than you suspect.