If you suffer from back, neck, or foot pain and none of the treatments you’ve tried so far have provided relief, you may want to explore other options available today.
By Lisa Ellis
Living with pain is time-consuming and exhausting. If you've been to countless doctors and specialists and are still in search of relief, here are some approches that may not be familiar to you. While some of these methods may not be covered by insurance (and can be costly), you may decide that easing your pain is worth the expense. The good news is none of these remedies involve medication so there is no danger of developing dependency.
Common Causes of Musculoskeletal Pain
“Chronic back and foot pain are becoming more prevalent as the population ages,” says Pedram Aslmand, DPM, a foot and ankle specialist who serves as residency director of the Podiatric Surgical Program at Long Beach (California) Memorial Medical Center. In fact, he points out that more than 30% of the US population today suffers from some form of musculoskeletal pain on a daily basis.
Using Exercise to Manage Spine Pain
Depending on your doctor’s diagnosis of the cause of your back or neck pain, yoga can be a simple, yet effective, way to provide relief. “A type of yoga called Iyengar yoga has been very effective in this regard,” Dr. Aslmand says.
Iyengar yoga is intended for people of all ages and abilities. Participants work through a sequence of poses that require the body to be in proper alignment. Learning to breath properly is an integral part of the exercise, which builds strength, flexibility, and stamina. A study included in the International Journal of Yoga in 2015 looked at the various research efforts exploring this type of yoga and found this technique was effective in treating spinal (neck and back) pain. Dr. Aslmand adds that Pilates can also be beneficial for some people with chronic pain.
It’s important to point out that for some patients with a back or neck disorder, working out at a gym or taking a yoga or Pilates class could be harmful. Always consult your physician before starting ANY kind of exercise program.
Physical therapy (PT) is often prescribed by a doctor to address the cause of pain by strengthening muscles and improving their function. A comprehensive PT program may also include home exercises.
Insurance typically covers all or part of the cost of PT sessions but usually won’t cover exercise classes. Some gyms offer yoga and Pilates for their members free-of-charge, while a yoga studio might charge $10 to $15 for a single class, or monthly memberships starting at $100 that include unlimited classes. (Prices vary depending on your location.)
Regular exercise can improve your health, help you manage your body weight, and may result in feeling less pain.
Topical NSAID Cream
Try medication applied directly to the painful. It can be an effective way to treat pain without the side effects of oral medication.
To address the actual inflammation that can be related to musculoskeletal pain, Dr. Aslmand says that the topical cream form of anti-inflammatory drugs (such as nonsteroidal anti-inflammatory drugs [NSAIDS] like ibuprofen and naproxen) can be a good option, have fewer side effects than the oral version of the medicine, and have been used with good results.
The formulation is rubbed right into the painful area, which allows it to enter the tissue directly and reduces the amount of anti-inflammatory medication in the blood stream, minimizing side effects that may include stomach upset. A medical review published on Cochrane.org found that topical NSAID formulations can provide pain control results similar to oral versions.
Such prescription treatments are usually covered by insurance. (There are also topical anti-inflammatory medications that are available over-the-counter, but these come with some serious risks including skin burns. Be sure to consult your physician before using them.)
Treating Foot Conditions Can Alleviate Pain
Another cause of spinal pain may be related to an abnormal foot structure.
“When we stand or walk, our feet send signals to our cerebellum [the postural center of the brain]. The cerebellum responds to these signals by automatically adjusting our posture,” says Brian A. Rothbart, DPM, PhD, who is based in Portugal. Dr. Rothbart explains that when you have a normal foot structure, correct signals are sent to your brain. The brain responds by automatically maintaining an upright posture.
But in some cases, people have a condition that causes the foot to hyperpronate, says Dr. Rothbart. Hyperpronation in turn forces the body into postures when standing or walking that inflict pain throughout the body. Dr. Rothbart explains that when foot bones don’t develop completely in utero the feet “send distorted signals to your cerebellum and your brain responds by automatically maintaining distorted (bad) posture. Bad posture results in misaligned joints and strained muscles. Over time, inflammation occurs and chronic pain develops,” the expert says.
To address this problem, Dr. Rothbart developed Rothbart Proprioceptive Therapy, which is available in person and also via long-distance technology (facetime or skype, for example). The treatment takes 12 to 18 months to complete and relies on the results of computerized postural and gait analyses and neurological tests that Rothbart uses to design and fabricate proprioceptive insoles for the patient to correct the distorted signals.
“When the signals are correct, the brain in turn corrects the posture. This greatly reduces or completely eliminates chronic muscle and joint pain—permanently,” he says.
The treatment is costly ($15,000 to $20,000 as of January 2017, depending on Euro-dollar exchange rates) and not covered by insurance but many patients have experienced a far better quality of life as a result of the treatment. Take Dr. Rothbart's quiz to help you determine if you may have feet abnormalities that could benefit from being professionally evaluated.
Interventional Pain Therapies
Today's imagining technology has revolutionized how spine pain is treated.
When your back pain is related to the spine itself, interventional pain therapies can be helpful. These are techniques that address the source of the pain and are often used along with other pain management strategies.
“The human spine is a complex flexible structure made up of discs, facet joints, spinal cord, spinal nerves, a spinal canal, and sacroiliac joints that attach to the spine. Any one or several of these elements may be a potential source of pain,” says Andres Betts, MD, DABPM, who is affiliated with Saddleback Memorial Medical Center in Laguna Hills, California, and practices anesthesiology and pain medicine. He says that’s where interventional therapies such as injections can be helpful.
“The application of fluoroscopy [a form of X-ray that shows the body part in motion] and ultrasound imaging [a procedure that uses high-frequency sound waves to show the inside of the body] has been seen by some clinicians as having revolutionized how we treat spine pain, as well as muscle, tendon, and joint pain. These imaging technologies allow physicians to precisely place special needles [spinal injections] directly at the source of pain and inject medications into the painful structures,” Dr. Betts explains.
“Instead of prescribing drugs that affect the entire body, we direct powerful anti-inflammatory steroid medications that are chemically similar to the natural steroid called hydrocortisone to the specific source of pain targeted for each individual patient,” he explains. This makes it possible to apply treatment directly at the level of the spine where the disc is irritating spinal nerves.
“These image-guided procedures are applied not only to the spine, but to other body parts including the shoulder, elbow, knee, or foot, or are directed to joints, tendons, or peripheral nerves that may be causing pain,” Dr. Betts adds.
Such treatments are usually covered by insurance when performed by board-certified pain specialists.
Pain Related to Osteoporosis
Other people with back pain may find that their problem stems from osteoporosis, which is a condition in which bones become more porous and can fracture more easily, according to Dr. Betts. Osteoporosis can be more common with age, and women are at higher risk than men, as are those with a family history of this condition. But younger people who don’t eat a nutritious diet, who smoke, drink heavily, or consume excess caffeine, can also be at increased risk. In addition, some autoimmune conditions, as well as long-term use of medications such as steroids and antacids, can also be risk factors for osteoporosis.
While osteoporosis itself isn’t painful, people with this condition are more vulnerable to vertebrae compression fractures (fractures caused by tension on the vertebrae that cause it to snap or break) which can occur for minor slips or falls and cause severe pain, deformity and loss of height. Compression fractures can also lead to nerve compression.
“Some fractures may cause such severe pain that patients cannot even stand or walk, which may require prolonged bed rest and can cause complications like pneumonia, blood clots, and even death,” Dr. Betts says.
So, pain caused by osteoporosis fractures often requires a different treatment strategy than pain caused by other sources.
“One option for some patients to treat these painful spine fractures is the minimally invasive balloon kyphoplasty procedure. During this procedure, a bone needle is inserted through the skin under fluoroscopic (live x-ray) guidance into the fractured vertebra,” he says. “A balloon is inserted through the needle, which is inflated to restore the height of the squashed vertebra. Then the balloon is removed. Special bone cement is subsequently instilled through the same needle, which hardens in the body and acts like an ‘internal cast’ to glue the bone together, thus relieving pain,” he explains. Some doctors perform a similar procedure called Vertebroplasty instead, which involves injecting cement to repair the fracture without using the balloon.
Both kyphoplasty and vertebroplasty are usually performed in a hospital or surgery center by spine surgeons, interventional radiologists, and interventional pain specialists on an outpatient basis. Medicare and most insurance plans cover kyphoplasty and vertebroplasty, so either one may be an accessible option for people who are good candidates. Just keep in mind that depending on the type of fracture you have and where it’s located, in some cases these types of interventions may not be enough and spine surgery may be required.