Unfortunately, it is less common that patients get the above, and more common that standard traditional treatment includes opioid pain medications, palliative short-term and risky cortisone injections, and then surgery. Although these options may actually be reasonable for specific situations, it is our belief that these treatments are used way too excessively and carry real risks.
A pain medication, for example, may be helpful for an acute low back injury, but should not be used long term. The opioid epidemic is a real thing – there should be no doubt that chronic opioid use can lead to addiction – but not enough people talk about the fact that opioid pain medications can also cause hypersensitivity to pain called opioid hyperalgesia. This means that patients that are taking opioid pain medications can actually feel more pain!
Cortisone injection may be the correct choice for a young healthy patient in pain. But outside of a small set of patients, these only last for a short period of time and have significant side effects including hormonal changes and even decreased healing! For example, cortisone is known to increase blood sugar levels in diabetes, repeated or high doses of cortisone injections in post-menopausal females can actually cause osteoporosis that leads to osteoporotic fractures, and there are multiple reports of cortisone injections causing tissue damage. That said, cortisone should be used with caution.
And finally, surgery may be absolutely necessary – especially when there are urgent situations such as progressive weakness or emergent situations such as bowel or bladder incontinence. However, any surgery – but especially for the spine – is not a small endeavor! Surgery carries real risks including chronic pain, worsening degeneration, paralysis and even death. While there are risks in every type of treatment, something as irreversible as surgery should be a last resort if possible.