Health Education Library / Relieving Back Pain
Back pain is a common problem. You can strain back muscles by lifting too much weight or just by moving the wrong way. Back strain can be uncomfortable, even painful. And it can take weeks to heal.
Ice helps most during the first day or two after an injury. Ice reduces muscle pain and swelling. It helps most during the first 24 to 48 hours after an injury. Wrap an ice pack or a bag of frozen peas in a dishcloth. (Never place ice directly on your skin.) Place the ice where your back hurts the most. Don't ice for more than 20 minutes at a time. You should use ice several times a day.Medications
Over-the-counter pain relievers include aspirin, acetaminophen, and ibuprofen. They can help ease discomfort. Some also reduce swelling. Tell your doctor about any medications you are already taking. Take medications only as directed.Heat
After the first 48 hours, heat can relax sore muscles and improve blood flow. Try a warm bath or shower. Or use a heating pad set on low. To prevent a burn, keep a cloth between you and the heating pad. Don't use a heating pad for more than 15 minutes at a time. Never sleep on a heating pad.
Medial Branch Neurotomy
Back or neck pain may be due to problems with certain nerves near your spine. If so, a medial branch neurotomy can help relieve your pain. The treatment uses heat, cold, or chemicals to destroy the nerves near a problem joint. This keeps some pain messages from traveling to the brain, and helps relieve your symptoms. Each vertebra in your spine has facets (flat surfaces). They touch where the vertebrae fit together. This forms a facet joint. Each facet joint has at least two medial branch nerves. They are part of the nerve pathway to and from each facet joint. A facet joint in your back or neck can become inflamed (swollen and irritated). Pain messages may then travel along the nerve pathway from the facet joint to your brain. Medial branch nerves in each facet joint send and carry messages about back or neck pain. Destroying a few of these nerves can keep certain pain messages from reaching the brain. This can help bring you relief.
The treatment is done in a hospital or surgery center. You'll be asked to fill out some forms, including a consent form. You may also be examined. You may be given an IV (intravenous) line for fluids and medications.Getting Ready for Your Treatment
Ask your doctor whether you should stop taking any medications before treatment. Tell your doctor if you are pregnant or allergic to any medications. Stop eating or drinking 8 hours before you check in for your treatment.During the Procedure
To help you relax, medication may be given through the IV line. You will lie on an exam table on your stomach, back, or side, depending on where the problem joint is. The skin over the treatment site is cleaned and then numbed with medication. Fluoroscopy (x-ray imaging) is used to help your doctor see the spine and guide the treatment. A contrast "dye" may be injected into the affected region to help get a better image. Heat, cold, or chemicals are used to destroy part of the nerve near the inflamed facet joint. Nearby nerves may also be treated. Relax at home for the rest of the day after your treatment, even if you feel good.After the Procedure
Most often, you can go home in about an hour. Have an adult friend or relative drive you. The treated spot may be swollen and may feel more sore than usual. This is normal and may last for a day or so. It will be a few days before you feel relief from your symptoms. Your doctor may prescribe pain medications for you during that time. Ask him or her when it's okay for you to go back to work. Call your doctor if you have a fever over 101.0°F, chills, or redness or drainage at the treatment site.Risks and complications are rare, but can include:
- Increased pain, numbness, or weakness
- Nerve damage
- Failure to relieve pain
Lumbar Epidural Injection
Your doctor may have suggested you have a lumbar epidural injection. This procedure can help relieve low back and leg pain by reducing inflammation (swelling and irritation). An injection also can help your doctor diagnose the source of your pain by numbing certain areas of your back. Where you are injected depends on the goal of the injection. A lumbar epidural injection won't stop all low back and leg pain. But it can reduce pain and break the pain cycle. This cycle may begin when back pain makes it hard to move. Lack of movement can then slow down healing. By getting you back on your feet, the injection can help speed your recovery. Some people may feel more relief from an injection than others. And some people may need more than one injection to get relief.
An injection can help locate the source of pain. Also called a selective nerve block or a selective epidural, it numbs the roots of specific nerves. The effect lasts only briefly. But if you feel relief, it may indicate the source of the pain. If you feel no relief, it may mean that the pain's source is at another level in your spine. Or it may mean that something other than inflammation is causing the pain. Injection results also may be used to help plan back surgery, if needed.Getting Ready For Your Procedure
A lumbar epidural injection is an outpatient procedure. It's often done in a hospital or an outpatient surgery center. Before your injection, your healthcare provider will discuss how you need to prepare. You may need to prepare by doing the following: Give the doctor a list of all medicines you take, including aspirin and anti-inflammatories. (You may need to stop taking some of them before the injection.) Don't eat 6 hours before check-in, or drink anything 4 hours before. Arrange for an adult friend or family member to drive you home afterward. Bring any requested x-ray, CT, or MRI images on the day of the procedure.During the Procedure
The injection takes just a few minutes. But extra time is needed to get ready. You may be given medicine before the injection to help you relax. Monitoring devices may be attached to your chest or side. These devices measure your heart rate, breathing, and blood pressure. You lie on your stomach or side, depending on where the injection will be given. Your back is cleaned and may be covered with sterile towels. Medicine is given to numb the skin near the injection site. If fluoroscopy (x-ray imaging) is to be used, a contrast "dye" may be injected into your back. This helps get a better image. A local anesthetic (for numbing), steroids (for reducing inflammation), or both are injected into the epidural space.After the Procedure
You'll spend up to an hour in a recovery area. Before going home, you may be asked to fill out another survey about your pain.Risks and complications are rare, but can include:
- Spinal headache
You don't need to stay in bed when you get home. In fact, it's best to walk around if you feel up to it. Just be careful about being too active. Even if you feel better right away, avoid activities that may strain your back. And follow up on all treatment with your doctor. Keep in mind that some patients feel increased pain at first. It usually goes away within a few days. You may also have headaches or trouble sleeping. These should also go away within a few days. In general:
- An injection to reduce inflammation takes a day or two to work. There may even be more pain at first.
- An injection to help locate the source of pain may give only brief pain relief. Later, you'll feel the same as you did before the injection.
- Take walks when you feel up to it.
- Rest if needed, but get up and move around after sitting for half an hour.
- Don't exercise vigorously.
- Don't drive the day of the procedure or until your doctor says it's OK.
- Return to work or other activities when your doctor says you're ready.
- Severe pain or headache
- Loss of bladder or bowel control
- Fever or chills