So you think you need . . . Lumbar surgery:What to do instead

* Warm the affected area using a hot-water bottle or heat pad for instant temporary relief.

* Try spinal manipulation, such as osteopathy, chiropractic or physiotherapy, before opting for surgery.

* Lumbar extension exercise can strengthen back muscles, decrease pain and improve function (Spine, 1993; 18: 232-8). Indeed, exercise is especially good if you have osteoporosis as the stronger your back muscles are, the less likely you are to have a vertebral fracture (Mayo Clin Proc, 1996; 71: 951-6). However, if your chronic back pain is disabling, make sure your fitness programme is supervised (BMJ, 1995; 310: 151-4).

* Rehabilitation massage and exercise therapy can move and strengthen the spine, correct posture and educate you about your back. Consider using several therapists, particularly if ergonomic issues are contributing to your pain. Most patients with a prolapsed disc will respond to such measures. If not, surgery may be necessary. But such manipulations are not recommended if the disc is severely prolapsed and compressing the spinal cord (BMJ, 2004; 328: 1119-21).

* Make sure you pick things up correctly by bending at the knees. This can help prevent future lower-back injury.

* Learn good posture with the Alexander technique or Rolfing, which can also improve muscle tone and stability.

* Learn to relax. A 1995 US National Institutes of Health report found this a useful additional treatment for chronic back pain.

* Make sure your furniture is ergonomic. At work, your chair should have good lumbar support, and you should be able to place your feet flat on the ground, with knees at right angles to your hips. If not, use a footrest. Ensure that your computer is at eye level and that the keyboard has good wrist support. Try not to cross your legs. Uncrossed legs support your back and help you maintain good posture, so avoiding back strain or pressure.

* Treat yourself to regular massage to relieve muscle tension.

* Lose weight, as carrying excess weight can curve the spine (lordosis), pull muscles out of position and create unnecessary pressure on the back.

* Supplement with fish or evening primrose oil. In the long term, this supports bone formation, preventing problems later in life, and improves nerve function (J Nutr, 1999; 129: 207-13).

* Glucosamine can help rebuild damaged cartilage (Orthop Praxis, 1970; 9: 225) but, in excess, can cause liver/kidney damage (Lancet, 1989; i: 1275). Individuals who weigh less than 82 kg (180 lb) should take 1500 mg/day; those weighing more than that should take 2000 mg/day.

* Acupuncture is safe and effective for low-back pain, and can relieve symptoms for up to six months or more, without any adverse effects (Clin J Pain, 2001; 17: 296-305).

* Ultrasound can relax the muscles, providing some relief.

* Transcutaneous electrical nerve stimulation, or TENS, works better than a placebo for pain relief and restoring function in low-back pain. The effects can last more than eight weeks. However, this is only a painkiller, and not all patients may benefit (Cochrane Library, Issue 1. Oxford: Update Software, 1997).

* Try a radiofrequency facet nerve block, or rhizolysis, a minimally invasive neurosurgical technique using a radiowave probe to ‘cut’ (by thermocoagulation) some of the nerves surrounding the spine, thus reducing pain and spasm in certain cases. In one series of studies, the success rate at the three-year follow-up was 67 per cent (Appl Neurophysiol, 1977; 39: 80-6).

* Use opiates (such as morphine or anti-inflammatories) to relieve pain, or muscle relaxants (such as Valium or Baclofen) to reduce spasm, but only in the short term as the potential dangers of these drugs include addiction and organ damage. While taking these drugs, avoid any activities that could exacerbate your condition as any warning pain will be masked by these painkillers.

* As a last resort, you could try spinal steroid injections. In one study, patients injected with steroid into the facet joints of the vertebrae had slightly less pain and better function after six months than those injected with a placebo. However, this approach is short term and offers no sustained improvement (N Engl J Med, 1991; 325: 1002-7).

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Written by What Doctors Don't Tell You

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