Non-Surgical Treatment

Most of the times, pain can be resolved without surgery. The conservative treatment involves use of pain medications and other methods to reduce inflammation and restore normal function. Usually, some self-care methods and medications can help to overcome pain, but if pain and inflammation persists over 72 hours, it is necessary to consult your physician.

Self-Care at Home

Ice and Heat: is the use of cold and hot compresses over the affected area. This helps to relieve the pain and swelling and also improves the mobility. A cold pack or compress (crushed ice wrapped in a towel) should be applied to the affected area immediately following trauma and kept there for at least 20 minutes. This can be done several times in a day. Heat treatment should be started after 2-3 days of cold compress. Heat is applied with a hot pad or warm bath for a short period of time. This helps to relax muscles and increase the blood flow.

Rest: is recommended for 1–2 days and you should resume to normal activities as soon as possible.

Exercise: ensures fast recovery and also helps to strengthen the muscles. Your doctor can advise some gentle stretching exercises to relax muscles and relieve pain. If your pain increases and lasts for more than 15 minutes during exercise, you should stop exercising and consult your doctor.

Medications

A combination of over-the-counter pain medications and prescription drugs offer effective pain relief. Certain medicines may be unsafe to be taken during pregnancy or may have interaction with some other medicine you are taking, so it is best to consult your doctor before taking any medications.

  • Over-the-counter analgesics: includes nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, naproxen, and ibuprofen .It reduces stiffness, swelling and relieves moderate back pain.
  • Anticonvulsants: are useful in treating neurologic pain and are prescribed with pain medications.
  • Antidepressants: Tricyclic antidepressants such as amitriptyline and desipramine can relieve pain by masking the pain signals from the brain.
  • Opioids: such as codeine, oxycodone, hydrocodone, and morphine are prescribed if the pain is more severe, but only for a short time. Side effects of these medicines include drowsiness, decreased reaction time, impaired judgment, and addiction.

Non-Invasive Therapies

There are several options of non-invasive techniques which can be considered when the more conservative methods fail to respond .These include:

Acupuncture: Acupuncture is the procedure which involves insertion of fine needles of about the width of your hair into specific points throughout the body in order to relieve pain. This process is said to release some naturally formed painkillers in the body called peptides. It is a method of encouraging the body to promote natural healing and to improve functioning. Acupuncture is performed by a physician or other licensed health care professional.

When acupuncture needle is inserted into acupuncture points, stimulates the nervous system to release chemicals in the muscles, brain and spinal cord. These chemicals provide local inhibition to the incoming pain signal.

In addition to causing effects in the spinal cord, the nerve impulse is also transmitted to the mid –brain, where brain chemicals are released. These chemicals play a role in suppressing the transmission of the pain impulse.

Each acupuncture point area is swabbed with alcohol before tapping the needle into the site. These are stainless steel needles and available in various dimensions. They are very thin, solid, with smooth point and have a finely tapered point. The number of needles used during treatment may vary and they are placed under the skin. After inserting, the needles stay in place for several minutes to an hour. The needles are twirled, energized electrically to intensify the effect of the treatment. Tingling sensation is common when electricity is applied.

Biofeedback: Biofeedback can be used to treat most acute pain including back pain. A special electronic machine is used and the patient is trained to be aware of and to follow and gain control over body functions such as muscle tension, heart rate, and skin temperature (done by controlling local blood flow). The patient is also trained to change his or her response to pain by using relaxation techniques.

Interventional Therapy: Interventional therapy is used to treat chronic pain by blocking the nerve signals between specific areas of the body and the brain. The treatment approach involves injections of local anesthetics, steroids, or narcotics into the affected soft tissues, joints, or nerve roots. It may also involve complex nerve blocks and spinal cord stimulation. When there is extreme pain, low doses of drugs may be injected directly into the spinal cord through a catheter. Chronic use of steroid injections is avoided as they cause functional impairment.

  • Proliferation Injection: Proliferation injection is also known as sclerotherapy and is a non-surgical treatment for musculoskeletal injuries. It involves injecting the dextrose solution (irritant) into the damaged or injured ligaments and tendons. During an injury the tendons and ligaments get worn out, tears up, stretches, and lead to rupture of the connective tissue causing pain, loss of strength, and instability. For an instance, back pain is caused because of the instability of the vertebrae, which result in the weak or damaged ligaments or tendons or muscles. If the ligaments are damaged, the bones in the vertebrae rub against each other causing inflammation and pain. To reduce the inflammation, anti-inflammatory drugs or even pain relievers are prescribed.

Macrophages are the group of cells that recognizes, attack and dispose the foreign particle out of the body. Macrophages consider the irritant as a foreign body and attack the irritant once it is injected. Meanwhile the body brings in ‘fibroblasts’ which heal the damaged ligaments and produce connective tissue that helps in the reconstruction of ligaments at the weak and injured area. This injection helps in the proliferation of new cells and helps in the repair of connective tissue. The injected solution provides joint stability which decreases pain. This therapy works on all joints and therefore is recommended in various injuries including back fractures, disc herniation, and arthritis. An X-ray is performed to know the exact location of the injury. This treatment is not painful and does not lead to major risks. It is done by injecting a local anesthesia and the PRP solution.

  • Neural Prolotherapy: Neural prolotherapy is a non-surgical treatment of injecting an irritant solution into the painful areas where the ligaments and tendons are injured. It is recommended in the treatment of musculoskeletal pain, arthritis, back or neck pain, sports injuries, torn ligaments, cartilage, and tendons.

The irritant solution irritates the local area causing inflammation. The scavenger cells (macrophages) arrive at this site to dispose the irritant solution. This encourages the repair process where the fibroblasts, the connective tissue builder cells, stimulate the production of connective tissue. Release of growth factors at the site of injury may help in strengthening, reducing the pain, inflammation, and weakness.
Prolotherapy injection is given every 2–6 weeks. This procedure is considered safe and does not have any major risks.

Traction: In this therapy, a continuous or intermittent force is applied to the skeletal structure in order to bring it into alignment. Force is applied using some weights. This treatment is not recommended for acute back pain.

Transcutaneous Electrical Nerve Stimulation (TENS): TENS is a technique which uses a device to send electric pulses along the nerve fibers so that the pain signals to the brain are blocked. Small electrodes are placed on the skin at or near the site of pain. Mild nerve impulses are produced which block the pain signals coming from the peripheral nerves. TENS may also stimulate the production of endorphins (chemicals produced in the brain having pain-relieving properties).

Ultrasound: Ultrasound is a noninvasive technique which uses sound waves that can pass through the skin and injured muscles. It can cause the soft tissues to warm up and thus relax the muscles and ease some amount of pain.