Spinal manipulation therapy (SMT) that uses compression on the spinal joints may also be a treatment consideration. A 2015 study published in the journal Spine found that this type of therapy works for some, but not all. Typically, SMT is performed by chiropractors and physical therapists. It has been controversial, with some medical experts claiming that it works, while others claim that it doesn't. "The big finding is that both sides have been right all along," said Greg Kawchuk, a professor of rehabilitation medicine at the University of Alberta and co-author of the study.
If surgery is recommended, neurosurgeons have a variety of options available to help relieve pressure on the nerve roots. If there are several nerve roots and discs causing the pain or if there is degeneration and instability in the spinal column, the neurosurgeon may opt to fuse the vertebrae together with bone grafts and stabilize the vertebrae with instrumentation, including metal plates, screws, rods and cages. A successful fusion will prevent the disc from bulging or herniating again. Following a fusion procedure, a patient may gain restored mobility in the back, including the ability to bend over. He or she will most likely experience more mobility after surgery than before. In addition, the patient may require postoperative physical therapy.
For many people, back pain goes away on its own or with nonsurgical treatments. Epidural steroid injections shouldn't typically be used as a first-line therapy for back pain relief, but that doesn't mean they can't play a role in treating pain. But injections won't cure the underlying cause of back pain, and they provide only temporary relief. Unfortunately, in many cases, chronic back pain can't be cured, but must instead be managed, like other chronic conditionsand patients must have realistic expectations of what epidurals can do.