Osteoarthritis of the spine is a degenerative disease. It cannot be reversed, but treatment can slow down its progression, help control pain, and restore some or all of normal function.

There is a wide range of treatment options, from self-care and home remedies to spine surgery. Patients may respond to one or a combination of treatments for a time, then find they need to try something else. Finding the most effective therapy of osteoarthritis symptoms is often a process of trial and error.

Arthritis treatments for the spine are reviewed in this article in three general categories:

  • Medical and alternative treatments
  • Self care, exercise, and rehabilitation
  • Surgery

People with osteoarthritis of the spine may seek treatment from doctors, chiropractors, acupuncturists or massage therapists. These health practitioners may recommend medical and alternative approaches to treating osteoarthritic back pain such as the ones described below.

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Alternative Treatments for Spine Osteoarthritis

    Manipulation. A chiropractor, an osteopathic physician, or a properly trained and licensed physical therapist can perform adjustments on the spine that may help properly align the spine and possibly reduce pain.

    Massage. Therapeutic massage can help reduce osteoarthritis pain, improve circulation, and reduce muscle tension and spasms. It is preferable to find a professional who is specifically trained in treating people with arthritis.

    Transcutaneous Electrical Nerve Stimulation (TENS). This type of non-invasive therapy uses small amounts of electricity to reduce sensitivity of nerves around the spine. Patients typically feel only a gentle vibration or tingling during TENS treatment. Not all patients receive pain relief. TENS therapy may be done in a medical office or the TENS unit may be prescribed to the patient and taken home with instructions regarding its proper use.

    Acupuncture. Acupuncture is a safe medical treatment that involves inserting ultra-fine needles at specific points on the skin. There is evidence that acupuncture can be helpful for some people with osteoarthritis pain, back pain, or headaches.4 Some doctors may recommend acupuncture as an alternative to medical treatments or in combination with other medical treatments or medications.

    Glucosamine and chondroitin sulfate. Glucosamine sulfate and chondroitin sulfate occur naturally in the body’s cartilage. In clinical trials conducted by the American College of Rheumatology, some patients with knee osteoarthritis reported benefits from taking supplements containing glucosamine sulfate or a combination of glucosamine sulfate and chondroitin sulfate.5 However, another study examining patients who had low back pain and who took glucosamine for 6 months found the supplement did not reduce pain.6 Experts agree more studies are needed to fully understand how these alternative supplements affect the symptoms of osteoarthritis.

Medications to Treat Osteoarthritis

Before deciding on a medication, the patient’s lifestyle, severity of pain and medical history should be taken into account. Possible effects and interactions with other drugs and vitamins/supplements should also be considered.

    Analgesics. Pain relievers, such as acetaminophen (the active ingredient in Tylenol), have relatively few side effects and relieve pain but do not reduce swelling.

    Non-steroidal anti-inflammatory drugs, or NSAIDs. Moderate to severe pain may be controlled with anti-inflammatory medications that reduce swelling and inflammation, such as aspirin, ibuprofen (e.g. Advil), naproxen (e.g. Aleve) or cox-2 inhibitors (e.g. Celebrex).

    Topical medications. These creams, sprays, gels and patches are applied directly to the skin over the painful joint.

    • Topical analgesics. The creams contain counterirritants, such as wintergreen and eucalyptus, which stimulate the nerve endings and distract the brain from neck or back pain. These creams are often sold over the counter and are available in most drug stores. Examples of brand names include Bengay, Icy-Hot and Zostrix. Most can be used in combination with oral pain medications.
    • Topical non-steriodal anti-inflammatory drugs, or NSAIDs. Like topical analgesics, topical NSAID creams should be applied directly to the painful neck or back. Topical medications containing the NSAID diclofenac have been found effective in treating isolated pain due to knee and hand osteoarthritis.7 Topical NSAIDs are available only with a prescription and sold under the names Voltaren, Flector, Pennsaid, and Solaraze.
    • Lidocaine patches. Topical lidocaine numbs an area and interrupts pain signals to the brain. Adhesive patches containing 5% lidocaine can be applied directly to the back to reduce or alleviate osteoarthritis pain.8 These patches are available only with a prescription.

    Topical medications may be a good choice for people with spinal osteoarthritis who want to minimize gastrointestinal side effects that oral medications sometimes cause; however, side effects are still possible. Patients should always discuss new medications with their doctor or pharmacist and read drug labels and instructions.

    Mild narcotic painkillers. Narcotic medications are effective in reducing pain but can be addictive and therefore are not prescribed often.

    Muscle relaxants. These drugs may be temporarily prescribed if a spine osteoarthritis patient suffers from muscle spasms.

Injections for Spine Osteoarthritis

Two types of injections are typically used for treatment of severe pain from spine osteoarthritis: steroid injections and hyaluronic acid injections.

  • The goal of steroid injections is to reduce swelling and thereby alleviate back stiffness and pain.
  • The goal of hyaluronic acid injections is to provide lubrication for the facet joint, as hyaluronic acid mimics the viscous synovial fluid that naturally lubricates the facet joint.

The degree of pain relief from injections is variable. When effective, the results from the injections are temporary, typically lasting 6 to 12 months.

Steroidal and/or hyaluronic acid injections are usually used with the goal of providing enough pain relief to enable the patient to get started with a physical therapy program to strengthen muscles and rehabilitate the affected facet joint(s). Injections may also be an option for individuals who are sensitive to medications.

References

  1. Sherman KJ, Coeytaux RR. Acupuncture for Improving Chronic Back Pain, Osteoarthritis and Headache.
  2. Loes M, "Natural Medicine and Pain Relievers: A Review," Natural Medicine Online.
  3. Arthritis Today. Study finds glucosamine supplements are no help for back pain.

Complete Listing of References

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