Thursday, September 14, 2017

Chronic Back Pain: Surgery Or Conservative Treatment?

By http://en.wikipedia.org/wiki/user:Vsion - Originally Vsion's work, CC0, https://commons.wikimedia.org/w/index.php?curid=16090144

Should you have surgery or nonsurgical treatment for chronic lower back pain? This paper suggests nonsurgical treatment can be “effective, feasible, and safe” although more studies, properly conducted, are required to give more definitive results (a caveat one often reads with respect to such studies and reviews). Conclusions from the abstract:
CONCLUSIONS: For chronic low back pain, nonsurgical treatment was shown to be effective, feasible, and safe during the follow-up period. More randomized controlled trials are needed to compare surgical and nonsurgical treatment of chronic low back pain.

Here is a paper on lumbar spinal stenosis treatment, conclusions of the abstract:
AUTHORS' CONCLUSIONS: We have very little confidence to conclude whether surgical treatment or a conservative approach is better for lumbar spinal stenosis, and we can provide no new recommendations to guide clinical practice. However, it should be noted that the rate of side effects ranged from 10% to 24% in surgical cases, and no side effects were reported for any conservative treatment. No clear benefits were observed with surgery versus non-surgical treatment. These findings suggest that clinicians should be very careful in informing patients about possible treatment options, especially given that conservative treatment options have resulted in no reported side effects. High-quality research is needed to compare surgical versus conservative care for individuals with lumbar spinal stenosis.

Essentially, these authors state that there is no clear evidence of whether surgery or more conservative treatment is best for lumbar spinal stenosis; however, given that there is a significant risk of side effects for surgery and no side effects reported for conservative treatments, clinicians need to take care in how they inform patients of treatment options. Everyone must make their own decisions on these matters with the consultation of their physician. Speaking strictly for myself (as someone who has had some moderate flare-ups of lower back pain), I would always first choose the conservative treatments and have surgery as a “last resort’ back-up plan. But, that’s me. Others may be in a condition where conservative treatment does not help and then they and their physician need to review more aggressive treatment options.

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