Experimental Treatments for Back Pain

Pain expert Dr. Scott Fishman answers questions about back pain:

Q: What are some of the latest experimental treatments for back pain?

A: My book, The War on Pain, describes a number of new developments for back pain. One of the latest tools to come on the market employs a laser that is placed through a small hole in the skin and guided with a tiny video camera into a slipped or herniated disc in order to surgically repair the problem.

Although this treatment is still experimental and not yet widely used, it heralds an important advance in medical technology. This type of laser surgery offers the same presently available surgical treatment in a less invasive and potentially less risky manner.

An interesting but yet unproved technique, epiduralysis, ventures into the epidural space (right next to the delicate spinal cord) where scar tissue may be pressing on nerves. Scarring is a natural part of the healing process after surgery, and I always wonder if scar tissue may be the cause of a lot of post-surgery back pain. Medicine has long been exploring ways to dissolve scar tissue in the back.

Epiduralysis is a serious procedure and requires careful consideration and a sterile operating room. The treatment is new, can generate serious complications, and has not yet been performed widely enough to have a significant track record. But for patients without other options, this treatment approach offers hope.

Another revolutionary surgical technique for low back pain applies the technology of modern plastics. Percutaneous vertebroplasty is a mouthful of a term that refers to injecting medical-quality glue around broken vertebrae. In essence, this glue-like substance fills in cracks in bone or repairs other deficits that make bones ache. This technique provides back stability for people who have compression fractures.

These fractures are typically caused by calcium loss in bone, otherwise known as osteoporosis. The glue is injected into the center of a collapsed spinal vertebra, then quickly hardens. The procedure takes less than an hour and patients can go home the same day. This treatment is not recommended for the majority of back pain patients, but for many, vertebroplasty is a welcome addition to current treatments such as spinal fusion and bone graft.

A device called a spinal cord stimulator is no longer experimental, although its ideal use still is being defined. It has been used with patients following back surgery, as well as for other kinds of pain, and results have been very promising.

A spinal cord stimulator is surgically implanted into the epidural space (the same area where steroids are injected for inflamed nerves) and uses electric signals to distract the brain from feeling pain. The stimulator is thought to generate electrical stimulation that feels like tingling, essentially counteracting the pain signals so that the sensation at the spinal cord is not perceived as pain.

This is the theory, but in truth doctors do not understand fully how spinal stimulation alters the perception of pain. We think it works in the same way as rubbing your elbow after you have jarred the funny bone-it produces an alternate or masking sensation so that the pain signal cannot get through.

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