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. 8 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