Ninety percent of Americans will suffer from back pain at some point, and all but ten percent will resolve their back pain uneventfully. Out of the remaining five to ten percent whose pain becomes chronic, a significant amount have degeneration of one or multiple intervertebral discs.
First it must be understood that degenerative disk disease represents a quality of life issue. It is not a true disease in the sense of something like liver disease or cancer that may need life-saving surgery. Degenerative Disc Disease is a condition that is confined to a focal area and a person can live with it and skip surgery, although it may be debilitating.
Treatment options include:
1)Activity Modification and Weight Loss
8)Spinal Decompression Treatment
10)Interventional Pain Injections
11)Surgery - Fusion or Artificial Disc Replacement
Activity Modification is not a very exciting option. It simply means not performing painful activities. If jogging hurts the back, switch to swimming or a cross training activity that does not hurt. Weight loss may decrease the amount of pressure on the ruptured or degenerated disk, and could alleviate pain.
Aerobic exercise has been shown in studies to be very beneficial for the health of the lumbar disc.Whether it’s cycling or swimming the disc receives benefits from the activity.
Back bracing can be very helpful for pain relief. Studies have been equivocal on the benefits of bracing, however, it represents an inexpensive method of pain relief which anecdotally has been shown to provide excellent pain management relief for patients.
TENS units are a safe non-invasive drug free method of pain management that can help decrease the need for pain medication and also supplement treatment being received for pain control. A TENS unit is a device that transmits small square electrical pulses to the electrodes, which transmit this electrical pulse to the underlying soft tissues of the lumbar region.
Pain Medications include Tylenol (acetaminophen), NSAIDS, and narcotic pain medication in addition to muscle relaxers. There is a significant potential for narcotic abuse in the age group associated typically with DDD so caution should be exercised.
Physical Therapy including core stabilization and lumbar strengthening can help with pain relief for degenerative disc disease. Strengthening the paraspinal muscles around the problem disc(s) can help unload the disk and decrease pain.
Chiropractic Treatment has been shown in numerous studies to assist with back pain that is acute in nature. In conjunction with spinal decompression, the results can be quite impressive. Spinal Decompression Treatment is a revolutionary therapy which unloads the disc space and allows increased oxygen and nutrients to flow into the intervertebral disk. This can help repair an injured disc, thereby stopping back pain.
IDET stands for intervertebral discal electrothermal treatment. It was very popular for a few years then the results were shown to be less favorable than originally thought. A significant amount of insurance companies decided to stop reimbursing for it based on the questionable results so it has since fallen out of favor.
Interventional pain management injections by pain doctors can be extremely beneficial. If there is a radicular component to the DDD, epidural injections may help. If there is associated facet arthritis, facet injections can help. There is no intra-discal injection yet that has shown to assist with pain relief for DDD.
If all non-operative methods fail, as a quality of life decision surgery can electively be done. Options for surgery include spinal fusion or an artificial disc replacement. The results are between 50-70% good to excellent.Success does not necessarily mean the pain goes to zero. Usually it’s relieved by one half or so with the definition of success.