Osteoarthritis of the spine is a degenerative disease. If it is left untreated, back and neck pain may get worse over time. Osteoarthritis cannot be reversed, but treatment can slow down its progression, help control pain, and restore some or all of normal function.

A wide range of treatment options are available:

  • Integrative medical treatments
  • Spinal injections
  • Self-care and exercise
  • Spine surgery

Finding the most effective therapy for spinal osteoarthritis symptoms is often a process of trial and error. Patients may respond to one or a combination of treatments for a time, then find they need to try something else.

Integrative Medical Treatments for Spinal Osteoarthritis

Treatment plans for spinal arthritis often involve integrative medicine, which combines conventional Western medicine and alternative medicine. Physicians, chiropractors, acupuncturists, and/or massage therapists may each play a role in treatment. Finding the right health care providers and mix of treatments may require trial and error.

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Physical therapy

Nearly every treatment plan will involve some amount of physical activity. Strengthening and stretching the neck and back is crucial to treating spinal osteoarthritis. Strong, flexible back and neck muscles support the spine and ease pressure on the vertebral discs and facet joints, helping to limit the worsening of symptoms.

A doctor or physical therapist can create a patient-specific exercise program to help build strength and endurance, increase range of motion, and improve overall health. Where the source of pain is located in the spine may determine the exercises that are recommended.

People who have participated in physical therapy are encouraged to do their prescribed exercises at home, even after physical therapy has ended.

Read more about Physical Therapy Benefits for Back Pain on Spine-health.com

Manipulation

A chiropractor, a doctor of osteopathy, or a properly trained and licensed physical therapist can perform manipulation on the spine that may help correct malalignments and knead out tissue adhesions, reducing pain.

Manipulation may not be appropriate if certain other conditions are present, such as spinal instability, osteoporosis, and ankylosing spondylitis.

Read more about Chiropractic Treatments on Spine-health.com

Medications

A physician will consider a patient’s lifestyle, severity of pain, and medical history when recommending a medication. To avoid potential side-effects and interactions, patients should always tell their health care provider about any drugs and vitamins/supplements they take.

Medications typically recommended for spinal osteoarthritis pain are described below.

  • Acetaminophen relieves pain and has relatively few side effects. It does not reduce inflammation and swelling.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) reduce pain, inflammation, and swelling. Types of NSAIDs include aspirin, ibuprofen, naproxen, and cox-2 inhibitors.
  • Topical medications come in the form of creams, sprays, gels, and patches that are applied directly to the skin over the painful joint. Topical medications may be a good choice for people who want to minimize gastrointestinal side effects sometimes caused by oral medications (however, side effects are still possible).
  • Muscle relaxants may be temporarily prescribed if a spine osteoarthritis patient suffers from muscle spasms.
  • Medical marijuana may be prescribed to relieve chronic back pain in some states. (While the FDA has approved a small number of cannabis-related products, none are currently approved for treating back pain.1)

Opioid medications are rarely prescribed because they carry an increased risk of misuse, abuse, and addiction. They are typically reserved for carefully selected patients whose back pain is acute or has not responded to other treatments. Other potential risks include cognitive, gastrointestinal, and other organ-related side effects.

See Pain Medications for Arthritis Pain Relief

Massage

Therapeutic massage can help reduce osteoarthritis pain,2 improve circulation, and reduce muscle tension and spasms. It is preferable to find a physical therapist or massage therapist who is trained in treating spinal arthritis joint pain.

Transcutaneous electrical nerve stimulation (TENS)

This type of non-invasive therapy uses small amounts of electricity to reduce the sensitivity of nerves around the spine. Patients typically feel only a gentle vibration or tingling during TENS treatment. Not all patients using TENS experience pain relief.3-5 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.

Read more about Transcutaneous Electrical Nerve Stimulation (TENS) on Spine-health.com

Acupuncture

Limited evidence suggests acupuncture can help treat osteoarthritis pain, back pain, and headaches.6-8

Dating back thousands of years, acupuncture is based on the notion that the body contains patterns of energy flow, and that proper energy flow is necessary to good health. During a treatment session, ultra-fine needles are inserted at specific points on the skin in an attempt to correct and/or maintain a normal energy flow. This treatment is considered generally safe and may even be covered by insurance.

See Acupuncture and Reiki Healing for Arthritis

Supplements

Commonly recommended supplements include turmeric, ginger, omega-3 fatty acids (such as fish oil), glucosamine, chondroitin sulfate, and vitamin D. Whether these supplements effectively reduce osteoarthritis symptoms is a matter of ongoing research,9-11 and experts agree more studies are needed.

Supplements are considered generally safe, but side-effects, adverse health events, and drug interactions are possible, so people are encouraged to talk to their doctor or pharmacists before taking one.

See Dietary Supplements for Treating Arthritis

Injection Therapy

A physician may recommend injection therapy if other nonsurgical medical treatments fail to reduce osteoarthritis pain in the back or neck pain. Injection therapy may also be an option for individuals who are sensitive to oral pain medications.

Facet joint injections

These injections treat pain stemming from a specific facet joint. The injection is typically delivered through the capsule that surrounds the two facets, into the joint itself. Examples of facet joint injections include:

  • Cortisone injections to reduce inflammation, and thereby alleviate joint swelling, stiffness, and pain. Steroid injections are usually used to provide enough pain relief to enable the patient to get started on a physical therapy program. Cortisone injections may also be used diagnostically.

    See Cortisone Injections (Steroid Injections)

  • Regenerative medicine injections, such as platelet-rich plasma (PRP) and stem cell injections. The goal of these is injections is to provide pain relief and also stimulate cell and tissue healing.

While limited evidence suggests stem cell and PRP injections may help treat pain due to facet joint degeneration,12-14 they are not considered standard practice and are less common than steroid injections.

In general, facet joint injections produce variable results. The back or neck pain may:

  • Not be relieved at all
  • Only provide partial relief
  • Return after a few days, weeks, or months
  • May not recur

It is unclear why the results of facet injections vary and who will respond best.

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Medial branch blocks

Medial branch nerves are small nerves that feed out from the facet joints in the spine. They can carry pain signals from the osteoarthritic facet joints to the brain. A medial branch nerve block is a procedure in which an anesthetic is injected near the medial nerves connected to a specific facet joint.

Medial branch blocks may be used diagnostically, as part of treatment, or both.

Read more about Medial Branch Nerve Blocks on Spine-health.com

Radiofrequency ablation (RFA)

The goal of a radiofrequency neurotomy is to interrupt the pain signal to the brain, while preserving other functions, such as normal sensation and muscle strength. This injection procedure produces a heat lesion on the pain-transmitting nerve near the arthritic facet joint. The lesion prevents the nerve from sending pain signals to the brain.

When RFA is used, it is typically done after a successful diagnostic nerve block. A nerve block can be used on two or more adjacent lateral or medial branch nerves to identify the target nerve. The nerve that responds to the diagnostic block is treated with RFA.

Read more about Radiofrequency Ablation (RFA) on Spine-health.com

Medial branch blocks and radiofrequency ablation do not work for every patient, and both procedures carry the risks. Patients are encouraged about their specific health circumstances and treatments with their health care providers.

References

  • 1.FDA and Cannabis: Research and Drug Approval Process, US Food and Drug Administration, Updated August 3, 2020. Accessed August 17, 2020. https://www.fda.gov/news-events/public-health-focus/fda-and-cannabis-research-and-drug-approval-process
  • 2.Nelson NL, Churilla JR. Massage Therapy for Pain and Function in Patients With Arthritis: A Systematic Review of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Sep;96(9):665-672. doi: 10.1097/PHM.0000000000000712. Review. PubMed PMID: 28177937.
  • 3.Escortell-mayor E, Riesgo-fuertes R, Garrido-elustondo S, et al. Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain. Man Ther. 2011;16(1):66-73. doi: 10.1016/j.math.2010.07.003
  • 4.Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain. 2007;130:157-165.
  • 5.Kroeling P, Gross A, Graham N, et al. Electrotherapy for neck pain. Cochrane Database Syst Rev. 2013;(8):CD004251.
  • 6.Sherman KJ, Coeytaux RR. Acupuncture for Improving Chronic Back Pain, Osteoarthritis and Headache. J Clin Outcomes Manag. Author manuscript; available in PMC 2010 May 4. Published in final edited form as: J Clin Outcomes Manag. 2009 May 1; 16(5): 224–230. PMCID: PMC2863344
  • 7.Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455‐474. doi:10.1016/j.jpain.2017.11.005
  • 8.Chou R, Deyo R, Friedly J, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(7):493-505. doi: 10.7326/M16-2459
  • 9.Sodha R, Sivanadarajah N, Alam M. The use of glucosamine for chronic low back pain: a systematic review of randomised control trials. BMJ Open. 2013;3(6):e001167. Published 2013 Jun 20. doi: 10.1136/bmjopen-2012-001167
  • 10.Vaishya R, Vijay V, Lama P, Agarwal A. Does vitamin D deficiency influence the incidence and progression of knee osteoarthritis? - A literature review. J Clin Orthop Trauma. 2019;10(1):9–15. doi:10.1097/RHU.0b013e3181b08f20
  • 11.Bragazzi NL, Watad A, Neumann SG, Simon M, Brown SB, Abu Much A, Harari A, Tiosano S, Amital H, Shoenfeld Y. Vitamin D and rheumatoid arthritis: an ongoing mystery. Curr Opin Rheumatol. 2017 Jul;29(4):378-388. doi: 10.1097/BOR.0000000000000397
  • 12.Richardson SM, Kalamegam G, Pushparaj PN, et al. Mesenchymal stem cells in regenerative medicine: Focus on articular cartilage and intervertebral disc regeneration. Methods. 2016;99:69-80. doi:10.1016/j.ymeth.2015.09.015
  • 13.Desai MJ, Mansfield JT, Robinson DM, Miller BC, Borg-Stein J. Regenerative Medicine for Axial and Radicular Spine-Related Pain: A Narrative Review. Pain Pract. 2020;20(4):437-453. doi:10.1111/papr.12868
  • 14.Sanapati J, Manchikanti L, Atluri S, et al. Do Regenerative Medicine Therapies Provide Long-Term Relief in Chronic Low Back Pain: A Systematic Review and Metaanalysis. Pain Physician. 2018;21(6):515-540. PMID: 30508983
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