OH! Magazine - Australian Version October 2018 | Page 8

( HEALTH )
FIVE WAYS TO MANAGE
CHRONIC BACK PAIN
Dr Michael Wong shares his tips for managing chronic back pain.
ne in five Australians live with
chronic pain, including adolescents
and children, according to Pain Australia.
So here are five ways to manage chronic
back pain.
O
1. Physiotherapy
Active physical therapy is necessary to
rehabilitate the spine and relieve chronic
back pain. It should include remedial
massage, manual therapy – the hands-on
mobilisation of joints in the back,
hamstring stretching exercises on a daily
basis, 15 to 20 minutes of core muscle
strengthening exercises and low impact
aerobics, which are important for long
term pain reduction. There are a number
of options available, such as cycling,
swimming
or
hydrotherapy.
Physiotherapists skilled in this area can
relieve stiffness and improve movement of
joints and muscles of the spine.
3. Interventional procedures
There are two main spinal interventional
procedures which can help manage
chronic back pain: epidural injection and
nerve root block. The difference in these
treatments lies in the fact they use
techniques to directly address the source
of pain, so they can sometimes help rule
out certain causes if treatment doesn’t
work. A nerve root block is an injection of
local anaesthetic and a small amount of
steroid injected into a specific nerve near
the spinal cord. The injection enables the
doctor to determine exactly which nerve
root or roots are affected. In contrast, an
epidural injection is the delivery of anti-
inflammatory medicine directly into the
space outside of the sac of fluid around
your spinal cord. Its purpose is to decrease
swelling and pressure on larger nerves and
the spine, and to help relieve pain.
4. Medication
2. Cognitive behavioural therapy
Cognitive behavioural therapy (CBT) is a
form of psychological therapy. ‘Focusing
on your thoughts’ makes up the cognitive
part of CBT and ‘putting attention on your
actions’ is the behavioural part. A therapist
or doctor will teach you how to recognise
negative feelings and thoughts that occur
when you have chronic back pain; how to
stop them; and how to practise positive
thinking. Healthy thinking involves
calming your mind and body by using
techniques such as yoga, massage or
visualisation techniques. Changing the
way you think about pain can change how
your body responds to pain. Ensure that
you have realistic treatment goals which
can be done in gradual steps.
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OH! MAGAZINE ( OCTOBER 2018 )
Medication can be a vital part of managing
and treating chronic back pain and can
help you stay pain-free and active.
However, patients have to ensure they are
using the correct ones and in the right
way, particularly as some medications
may have serious side effects. Non-
steroidal
anti-inflammatory
drugs
(NSAIDS) are often the go-to medications
for back pain relief as they help reduce
pain, swelling and inflammation in
muscles and around damaged spinal
discs. Prescription muscle relaxants, like
baclofen, are another option as they act on
the central nervous system to reduce
acute
pain.
Antidepressants,
like
nortriptyline, are another method and they
can be prescribed, even if the person is
not depressed. It may increase
neurotransmitters in the spinal cord that
reduce pain signals. Medication to help
reduce neuropathic pain, like pregabalin
and gabapentin, can also help but need to
be monitored closely for side effects.
5. Surgery
The most important thing about treating
chronic back pain is to identify the reason
and cause. Whilst surgery as a treatment
has improved dramatically, you do not
want to undergo unnecessary surgery. In
most cases, the answer is not surgery but
more conservative treatment including
physiotherapy and pain management by a
specialist physician. However, going
straight to physiotherapy without proper
diagnosis is also not advised. The first
step should be to ask your doctor to find
out the specific cause of your pain, which
can show up via MRI or other tests.
Before choosing to proceed with surgery,
it is important that you are fully informed
by your doctor of all the options available
to you. Don’t be afraid to get a second
opinion from another specialists and ask
as many detailed questions that you need
to, in order to feel comfortable with any
course of action. You should also ask your
doctor about the likelihood of success
from doing the surgery. Keep in mind,
everyone’s body reacts differently to
surgery and recovery time varies for each
individual.
Dr Michael Wong
Dr Michael Wong is one of Victoria’s
leading
and
most
experienced
neurosurgeons and spinal surgeons. He
specialises in minimally invasive and
complex spinal surgery. For more
information visit www.drmwong.com