Fighting the pain is the highest value (priority) in the treatment of spine disorders. It is often a mistake to prescribe pain medication that acts too weak or a lesser amount (dosage) of effective painkillers.
The doctor must clarify the patient that the pain relief is the primary goal to prevent an independence of symptoms (i.e. formation of a pain memory). For this reason, a pain therapist prescribes opioid substances nowadays for a ‘from severe to most severe’ pain.
The use of inadequate, thus ineffective pain therapy out of anxiety of (possible) side effects of pain medication is unfounded, even if the patient has enquired about the possibilities of using modern painkillers and a reliable pain therapy.
For the first appearance of a lumbago or sciatica- if no paralysis is present - a conservative therapy is performed at first. Only when this treatment does not lead to the desired results (within a time window of 6-12 weeks) or the symptoms worsen, a surgical treatment for a herniated disc, with supporting evidence, will be considered.
Basis of conservative therapy is the physical protection, though strict bed rest is not necessarily required. A firm mattress and certain positions, designed to relieve the spine (level bed), can already contribute substantially to a reduction of the complaints. Also an expanded treatment, dosed with reliable extension devices can relieve your back.
The Step diagram of painkillers
The freedom from pain, or at least a significant pain relief is the primary goal of drug therapy. After the step diagram of the World Health Organisation (WHO), three groups (levels) of pain relievers (analgesics) are distinguished:
- Not opioid (step 1)
- Weak opioid (step 2) and
- Strong opioid analgesics (step 3)
This group comprises the non-steroidal anti-inflammatory drugs or antiphlogistics (e.g. diclophenac; the new stomach-protecting drugs from the group of coxibs or ibuprofen), but also the purely analgesic agents (e.g. the "classical" paracetamol or novalgin). The causes of pain is at first mostly due to overwrought free nerve endings and inflammation around the nerves, with a swelling of the nerve.
If, within a few days there is no significant pain relief, then weak opoid-containing analgesics must additionally be selected (e.g. tramadol or codeine, naloxone). These drugs can affect the driving ability in the familiarization phase. It is therefore recommended in the first 1-2 weeks not to drive.
If this pain treatment stays without crucial success, the short-term transition to strong opioids (e.g. oxycodone) without the use of step 2 drugs, is recommended.
Local therapeutic injection
Like the "wheal" treatment (skin, muscles, muscle-tendon rudimentary) with locally-acting, pain-blocking solutions (local anesthetics), the injection treatment with anti-inflammatory drugs, where pain-relieving (analgesic) or pain-inhibiting additives have been added, also has the goal to interrupt the pain conduction of the irritated nerves and nerve roots or to reduce the swelling of the nerves. The start of a good mode of action, at the beginning of the treatment, is explained in relation to the severity of the pain condition. The injection is carried out at the diagnosed pain origin . The most common injections (infiltrations) are:
- in the back muscles (paravertebral)
- between the spinous processes (interspinous)
- in the sacroiliac joints (articulatio iliosacralis)
- in the spinal joints (facets).
In this context, the widely practiced Reischauer blockade i.e. an injection in the proximity of the spinal nerves, has to be mentioned which lowers the pain threshold and reduces the nerves' swelling and should therefore create favorable conditions for subsequent treatments.
Further, even for the elimination of postoperative pain, proven treatment methods can be applied, but require a particular experience and exercise: injections around the hard cord skin, hinder or dorsal epidural infiltration (long-lasting, carried out with the help of a reclining catheter), caudal epidural injection (sacral anesthesia), under the hard cord skin (intrathecal instillation) or as a form of paraspinal injection treatment into the facet blocks, whereas the pain-fibers of the abundant nerve plexus in the capsule of the facet joints are being stunned temporarily in a special way.
To counter the pain, acupuncture, transcutaneous electrical nerve stimulation (TENS) and other techniques are being applied. The aim of this therapy is the treatment of the symptom of pain, not the elimination of a possible herniated disc. This has to be done by the body itself.