The good news is that back pain often resolves on its own with rest and non-surgical treatment. However, if your pain doesn’t go away or becomes more severe, it may be time to consult with an orthopedic spine surgeon.
Your doctor will want to review the results of your imaging tests, as well as blood and urine tests. They will likely perform a physical examination and press on your back to pinpoint the source of your pain.
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1. Symptoms Are Persistent or Progressive
In most cases of back pain, conservative measures like over-the-counter pain relievers and physical therapy are all that’s needed. However, if your pain doesn’t improve or worsens over time and starts impacting your everyday activities, it might be time to consider surgery.
If your pain is due to a herniated disc, spinal stenosis or other condition, non-surgical treatment options like medication, at-home exercises and steroid injections may help. Depending on your symptoms and x-ray or MRI findings, you may be referred to a spine surgeon, rheumatologist, physical medicine specialist or other physician.
A lot of patients have back pain due to a degenerative condition, such as osteoarthritis, which causes the bones in the spine to rub together and develop bone spurs. These can cause nerve compression and result in neuropathic pain.
In these cases, spine surgery might be necessary to relieve the pressure on your nerves. A neurosurgeon can perform a procedure called laminectomy, which removes the bony plate (lamina) on the back of the vertebra to open up space for spinal nerves.
2. Medications Aren’t Working
For most back pain, over-the-counter painkillers like ibuprofen or naproxen are the best option. If these aren’t effective, a doctor can order an MRI or CT scan to reveal possible causes of the pain, such as herniated discs.
Muscle relaxants are another common choice for pain, but they don’t work to relieve chronic low-back pain. In fact, they can actually make the pain last longer by prolonging the underlying inflammation.
Your doctor can also inject steroids and anesthetics to reduce inflammation. They can also try radiofrequency ablation, a procedure that uses a needle to send heat into the painful area and damage nerves to stop them from sending pain signals to your brain. This technique is particularly helpful for neuropathic back pain that radiates down your legs (called sciatica).
3. You’re Not Getting Better
If back pain is preventing you from enjoying activities or keeps you from your job, it’s time to consider spine surgery. While most back pain improves with time, if the pain is constant and your quality of life is suffering, it’s likely that your doctor will want to examine you for surgical options.
Your doctor will test your strength and movement, and may order imaging tests, such as x-rays or an MRI scan. It’s important to discuss the benefits and drawbacks of these tests with your doctor, including how the results could influence your treatment plan.
Your doctor will also talk to you about other treatments that could help ease your pain. For example, acupuncture uses small needles to stimulate nerves and block the transmission of pain signals, and some research is currently being conducted on other treatments that can reduce chronic pain.
These techniques can help you avoid the need for a spinal fusion, which is associated with increased risks of complications and death in older patients.
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4. You’re Delaying Treatment
A patient’s doctor should discuss all options, including non-surgical care, to alleviate pain and discomfort. If back pain persists despite a course of conservative treatments, surgery is an option that should not be ignored.
Generally, most doctors prefer to try non-surgical methods first before turning to surgery. However, there are times when this approach is not effective for patients.
One such treatment is spinal fusion, which involves permanently connecting two or more vertebrae together to eliminate movement between them. During this procedure, your surgeon may use bone tissue from another area in your body (autologous), a deceased donor or a synthetic material. He or she will also use hardware, like screws and plates, to strengthen the fusion.
Although back pain is common, it can be a sign of serious medical conditions and should never be taken lightly. If you’re struggling with back pain, contact your local orthopaedic center to schedule an evaluation. Most of the time, pain can be relieved with conservative care.
