What components are included in a nonoperative spine treatment program

The initial goal of a nonoperative treatment program is pain control. Bedrest for longer than 2 days is not recommended. Once pain control is achieved, the patient should advance to an exercise program. The ultimate goal of an exercise program is development of adequate dynamic control of the spine to eliminate repetitive injury to pain-sensitive structures (i.e. discs, facet joints). Socioeconomic, psychological, and vocational issues are considered during treatment. It is critical to realize that treatment of acute back pain requires a different approach from the treatment of chronic back pain. Components of a nonoperative treatment program for spinal disorders may include:

• Education (optimize biomechanics involved in the activities of daily living)

• Local modalities: electrotherapeutic modalities (transcutaneous electrical nerve stimulation [TENS], electrical muscle stimulation [EMS], interferential current [IFC]), physical agents (superficial heat [hot packs], cryotherapy [cold packs], ultrasound [US])

• Medication (analgesics, nonsteroidal antiinflammatory drugs [NSAIDs], steroids, anticonvulsants, antidepressants, muscle relaxants, and antispasticity medications)

• Injections (trigger point injections, sacroiliac joint injections, facet joint injections, epidural steroid injections)

• Exercise (reeducation of range of motion and posture, general strengthening and aerobic exercise, specific spinal exercise [flexion, extension, spinal stabilization], pool therapy)

• Orthoses and assistive devices (braces, canes, walkers, wheelchairs, mobility devices)

• Manual therapy (manipulation, mobilization, therapeutic massage)

• Complementary and alternative therapies (acupuncture, yoga)

• Home environment modification (ramps, raised toilet seat, grab bar system for bathroom)

• Ergonomic modifications (chair modification, workstation modification)

• Lifestyle modification (smoking cessation, nutritional counseling, weight reduction)

• Neuroablative procedures (lumbar medial branch neurotomy for facet [zygapophyseal] joint pain)

• Implantable devices (spinal cord stimulator, intrathecal pump)

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