Treatment without surgery
Most disc, back and neck pain is managed by staying active, medicine, physiotherapy and sometimes an injection. This page describes the usual options and when to go back to the surgeon.
What does treatment without surgery mean?
It means controlling pain and improving movement without an operation. For most patients with a slipped disc, nerve pain in the neck or back, or spinal stenosis, this is the first step, and many get better here. For discs, surgery is usually not needed, and treatment usually begins this way. The type of treatment is chosen after an examination and imaging.
Who is this page for?
- people with back or neck pain, or pain and numbness in a leg or arm, who have none of the warning signs (the list is at the end of this page)
- people who have just been told they have a disc problem or spinal stenosis
- people who are not suitable for surgery, for any reason, or do not want it
- people who want guidance for the rehabilitation period after an operation
Usual options
The basics of non-surgical treatment:
- Staying active. Long bed rest is not recommended. Walking, swimming, yoga or Pilates may help. Limit heavy activity for the first few days and then go on as far as you can manage without pain.
- Medicine. Anti-inflammatories such as ibuprofen help many people, but they do not suit everyone. Paracetamol alone is not recommended for back pain and appears to help little in sciatica. Only a doctor or pharmacist should choose the type and dose. Do not take anti-inflammatory medicine for a long time without a doctor’s advice.
- Hot and cold packs. An ice pack wrapped in cloth for pain and swelling, and a hot-water bottle for muscle spasm.
- Physiotherapy and exercise. After an assessment, a physiotherapist writes exercises for strength and flexibility. It is among the main treatments. Some physiotherapy may include massage or hands-on treatment.
- Epidural injection. An injection of medicine (usually a steroid) near the nerve, guided by imaging, to reduce inflammation. Its effect is sometimes temporary and may last a few months. If the pain is severe and other treatments have not helped, a specialist may suggest an injection.
- Specialist pain treatments. For example, disabling a few small nerves that carry the pain message (radiofrequency). This is used for severe, long-lasting pain that other methods have not eased.
- Lifestyle. Keeping a healthy weight, stopping smoking (nicotine weakens disc tissue), moving regularly and lifting objects the right way. For spinal stenosis, weight control and stopping nicotine also matter.
- Psychological therapy for pain. If pain has not improved after several weeks, cognitive behavioural therapy to help cope with pain is one option.
Slow-growing tumours: follow-up without surgery
For some brain tumours, especially slow-growing benign tumours with no symptoms, treatment may not be needed for now and only regular check-ups and scans are done. Only the surgeon and the treatment team make this decision. Details are on the “Brain tumours” page.
The follow-up period
These treatments often take weeks to months, not overnight. If the pain has not improved after several weeks of home treatment, see a doctor. If symptoms continue for more than four weeks, referral to a spine specialist such as a neurosurgeon is recommended. Without warning signs, an MRI is usually not recommended before six weeks. When an MRI is needed for you is for your doctor to decide.
Risks and limits
- Too much or wrong exercise or activity may make the pain worse. If an exercise makes the pain sharper, stop and talk to your physiotherapist or doctor.
- Medicine has its own side effects and does not suit everyone.
- Injections have a temporary effect, may have medicine side effects and do not suit everyone. The doctor explains the risks before an injection.
- Delayed diagnosis. Staying too long on non-surgical treatment when there is a warning sign (worsening weakness, bladder problems) is dangerous. See the next section.
- Treatment without surgery may not remove the root of the problem (for example a narrow canal). The aim is to control symptoms and keep you active.
When to call
Call 115 now or go to an emergency department (115 is Iran’s emergency number) if back or leg pain comes with:
- numbness around the anus or genitals
- trouble passing urine, or leaking urine or stool
- weakness, tingling or numbness in both legs
These two are not signs of pressure on the nerves at the bottom of the spine, but they are emergencies too, and you should call 115 at once:
- pain or weakness that began after a car crash or a heavy blow
- chest pain
Contact a doctor the same day if:
- the pain is sudden and severe, or gets worse very quickly
- it comes with a fever, chills or feeling unwell
- weakness or numbness in a leg or arm is getting worse
See a doctor as soon as you can if:
- the pain is worse at night or does not ease with rest
- you have lost weight without a reason
- you see a lump or change of shape in your back
- the pain gets worse with coughing, sneezing or opening your bowels
- you have had treatment for several weeks and are not better
Every patient’s treatment plan is different; ask your doctor about your own situation.
Frequently asked questions
For back pain, is strict rest better or staying active?
Long bed rest is not advised. Cut down activity for the first few days and then walk as far as you can manage. Stay active and carry on with daily activity.
Does an epidural injection take the pain away for good?
Not necessarily. The injection reduces inflammation, but its effect is often temporary and sometimes lasts a few months. It does not suit everyone. Your doctor will advise.
How will I know that treatment without surgery is not enough?
If you have had treatment for several weeks and the pain has not improved, if the pain limits daily life, or if weakness or numbness in a leg or arm is getting worse. Talk to the surgeon about these. If you have trouble controlling your bladder or bowel, it is an emergency.
Are massage and hands-on treatment helpful?
Manual therapy (massage and moving the muscles and joints by a trained therapist) is an option for back pain that has not improved after several weeks of home treatment. For a disc or nerve problem, it is better for a doctor to examine you first.
What does stopping smoking have to do with discs?
Nicotine weakens disc tissue. For spinal stenosis, stopping nicotine is also part of the advice that goes alongside treatment.