July 2020

New Treatment Options for Chronic Neck and Back Pain

Author: John P. Batson, MD, FACSM

Arthritis of the spine is very common and typically affects patients after the age of 50 years. Patients often complain of pain or stiffness in the morning or after periods of sitting for some time. The pain is concentrated on either side of the neck or low back but can be referred into the shoulders/shoulder blades and buttocks/upper legs respectively. To an extent, when you move around, the pain will typically feel better, as with any arthritic joint. Some patients notice more pain or stiffness with the weather changing, especially with colder weather.

The joints in the neck and low back which are affected with arthritis are called facet joints. You have two facet joints per level in the spine (one on either side). The facet joints can be seen on x-rays or studies like an MRI.

Arthritis of the spine is treated with medications, physical therapy and home exercises. Staying fit and maintaining a healthy weight limits stress to the joints. Nutrition plans high in plant-based foods and low in processed foods may help with pain and inflammation. Some patients report relief with nutritional supplements such as turmeric, tart cherry extract and CBD oil. It is important to discuss these supplements with your medical doctor as some supplements do have side effects or interact with certain medications.

When the pain does not respond to conservative measures, injections may be suggested to help reduce the pain from these joints. We use an X-ray machine to guide needles to the correct location to ensure the procedure is safe and accurate. The medication used is typically a small amount of a steroid preparation and a long-acting numbing medication. Patients are encouraged to keep a pain diary so they can keep track of how their neck or low back feels after the procedure.

Some patients note near complete or total improvement from the facet joint injection. For patients who obtained short term, but not lasting relief, we have a relatively new procedure to offer which is a more permanent treatment for the arthritis of the spine. It is called radiofrequency ablation (RFA). In this procedure an insulated radiofrequency probe is placed on the nerves that transmit the arthritis pain signal. The radiofrequency probe generates high frequency radio waves, which heat the tip of the probe. The nerve conduction from the joint is disrupted. The joint still has the arthritis, but the pain signal is not transmitted as much or as often. The procedure takes about 15-30 minutes to perform and can provide 6-18 months of relief. It is a procedure (not a surgery) performed in the office without sedation. RFA is covered by most insurance plans. There is little down time after facet joint injections or the radiofrequency ablation procedure.

Some new treatment options for arthritis in the spine include prolotherapy and PRP injections. Prolotherapy involves injecting Dextrose (sugar solution) in and around the joints. This triggers a mild inflammatory response, and the body reacts by sending healing cells to the area to help with pain. PRP is a step up from this. We take some of your blood and use a centrifuge to isolate the platelet cells, which are known to have a lot of healing properties. When injected into the joint, platelets have helped some patients with pain and function in recent studies.

Managing arthritis in the body takes a commitment every day, just like managing diabetes or cholesterol. There are rarely any silver bullets in the treatment plan. Often we implement multiple strategies to figure out what will work with the patient’s individual condition and needs. Flare ups from time to time may happen, but hopefully we have strategies to help with this. Staying healthy and avoiding injuries to the spine are the best prevention strategies we have for patients.

John P. Batson, MD, FACSM is the owner and provider at Lowcountry Spine & Sport. For more information, visit spineandsportmd.com.

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