Care guidelines: Philosophical approaches to managing spinal pain
All clinical strategies for managing acute and/or chronic spinal complaints can
be grouped into three basic philosophical approaches:
1. Surgical Management – laminectomy and fusion
- It is best to use specific indicators when using surgery for spinal pain:
- surgery normally not considered other than for emergent conditions
- for classic radicular arm or leg pain history and exam, patient should fail aggressive conservative care before a laminectomy is considered (American Academy of Orthopedic Surgeons recommendation)
- aggressive conservative care has different meanings for different providers.
- There are additional considerations for using surgery for chronic spinal pain:
- Fusion surgery is sometimes considered for underlying chronic pain.
- It is difficult to identify appropriate fusion candidates.
- Long-term outcomes of fusion surgery are still less than optimal.
2. Passive Management – the patient receives treatment
- Treatments include heat, ultrasound, massage, manipulation/adjustments,
pills/injections, acupressure, acupuncture, TENS units, muscle stimulation, traction,
whirlpool sessions, copper bracelets, magnets.
- Passive treatment may be appropriate for acute spinal pain:
- patient to understand treatments will help with symptoms only
- currently, no controlled studies showing passive care to impact the pathophysiology of acute spinal pain in the long term.
- There are drawbacks for using passive care for chronic spinal pain:
- Patients sometimes become dependent on passive care and their provider for pain relief.
- Passive care has not shown to be helpful.
3. Active Management – the patient is active, not immobile: the
best practice approach for AMC patients
- This approach is supported in scientific literature and federal publications,
some of which are found on:
- Physicians Neck and Back Clinic, www.pnbconline.com
- Institute for Clinical Systems Improvement, www.icsi.org
- Agency for Healthcare Research and Quality (AHRQ), formerly Agency for Healthcare Policy and Research (AHCPR)
- The degree of aggressive active care is determined by the patient’s provider,
based on the patient’s history, physical exam and progress with prior treatment
plans.
- It will minimize chronicity and the need for costly diagnostic tests and
therapies, such as MRI/CT scans and multiple injections.
- To be the most effective, an active management approach must start at the
first clinical visit for spinal pain.
- This approach hold true for other conditions:
- Patients with other conditions (heart problems, joint replacements) exercise as soon as possible, usually the first or second day after surgery.
- Immobilized body parts lose mobility and function rapidly.
Source: Allina Hospitals & Clinics
First published: 03/05/2002
Last updated: 06/01/2002
Reviewed by: Paul Kleeberg, MD