Treatment for Vertebrogenic Back Pain

The goals of treatment for vertebrogenic back pain are typically to provide pain relief and restore lower back function.

Most treatments are non-surgical, and currently there is one approved interventional pain management procedure.

Surgery is rare and usually only done when there is both significant damage to the endplate and the surrounding structures, resulting in instability.

Watch  Vertebrogenic Low Back Pain Animation

Medication

Pain-relieving medications are used to reduce pain, inflammation and low back muscle spasms.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (e.g. Advil), may be used for a short period to manage daily pain or symptoms of a flare-up. NSAIDs are available over the counter or by prescription. NSAIDs may not be suitable for all patients due to the potential risks, and the risks increase with prolonged use. Be sure to consult a doctor before taking these medications to avoid these risks.

Topical creams and gels, such as over-the-counter Aspercreme, Voltaren, and lidocaine gels, contain medication to reduce inflammation and/or temporarily numb the area. These may be useful to reduce localized pain after activities or in case of a flare-up.

Topical pain relievers have fewer side effects compared to oral medication and provide similar levels of pain relief, making them preferable for some people.

Muscle relaxants, such as cyclobenzaprine, relax tight, tense muscles and reduce spasms associated with acute symptoms or severe flare-ups of vertebrogenic pain. Muscle relaxants are prescribed by a physician.

Muscle relaxants have high potential side effects, including the risk of abuse, addiction, and are used for a short period under a physician’s guidance.

See Side Effects and Risks of Muscle Relaxers

Physical Therapy (PT)

The primary goals of therapeutic exercise and rehabilitation are to:

• Reduce acute pain and inflammation in the lower back
• Improve range of motion and reduce stiffness through stretching exercises
• Strengthen the muscles and discs surrounding the damaged endplate through core, pelvic, and leg-strengthening exercises
• Provide guidance for correct lifting techniques, posture, and ergonomics

Physical therapy is initially performed under a qualified and trained therapist’s guidance and supervision, followed by a home exercise program for long-term pain relief.

See Physical Therapy for Low Back Pain Relief

Self-care and Lifestyle Modifications

Specific lifestyle changes help decrease excessive loads on the endplates and reduce the risk of developing or worsening vertebrogenic pain, such as:

• Maintaining a healthy weight: Excess weight puts extra strain on the vertebral endplates. Maintaining a healthy weight through diet and exercise helps reduce this pressure and protect the endplates from damage.
• Maintaining a supported posture: Keeping the spine in a neutral position while sitting, standing, walking, driving, and sleeping reduces focal areas of stress on the endplates, discs, and muscles, reducing the risk of endplate damage or degeneration.
• Quitting nicotine use: Smoking, vaping, and any form of nicotine intake accelerate the degeneration of the vertebral endplates and discs.
• Avoiding trigger activities: Avoiding movements that aggravate vertebrogenic pain, such as repeated forward bending or sports that put excessive strain on the lower back.
• Use an ergonomic workstation: Special types of work desks, chairs, and workstation setups are designed to support the natural spinal curvature. These ergonomic designs prevent the endplates and discs from prolonged periods of stress, reducing pain and preventing further injury. It is also a good idea to take frequent breaks and get up and walk around.

Lower back pain from vertebral endplate damage can occur along with other degenerative changes in the spine, so many patients find it most helpful to pursue treatments for their co-occurring diagnoses.

Basivertebral Nerve Ablation (BVN)

There is currently only one treatment for chronic vertebrogenic pain that lasts longer than 6 months and does not get better with the above nonsurgical treatments.

This interventional pain management technique is called basivertebral nerve ablation.

• Ablation refers to the process of using a heated probe to destroy a body tissue
• The basivertebral nerve is the name of the nerve that is targeted and ablated

The treatment applies heat directly to the basivertebral nerve, which destroys a small portion of the nerve so that it cannot transmit pain signals from the damaged endplate to the brain.

During the procedure, a thin needle-like probe is inserted into the lower spine the vertebra, targeting the basivertebral nerve in the bone before it reaches the endplate.

See Basivertebral Nerve Ablation Explained Step-by-Step

Basivertebral nerve ablation is indicated for patients who have a diagnosis of chronic vertebrogenic pain with Modic Type 1 or Modic Type 2 changes seen on an MRI scan.¹Conger A, Schuster NM, Cheng DS, et al. The Effectiveness of Intraosseous Basivertebral Nerve Radiofrequency Neurotomy for the Treatment of Chronic Low Back Pain in Patients with Modic Changes: A Systematic Review. Pain Med. 2021;22(5):1039-1054. doi:10.1093/pm/pnab040

Basivertebral nerve ablation is performed by physiatrists, anesthesiologists, interventional radiologists, orthopedic surgeons, and neurosurgeons with advanced training in interventional pain management.

This ablation procedure is designed to stop the pain but does not heal the damaged endplate and/or other issues in the lower back.

Watch Basivertebral Nerve Ablation Animation

Therefore, it is usually advisable to follow up the ablation procedure with physical therapy and other targeted rehabilitation to help ensure a better healing environment and long-term pain relief.

Surgery for vertebrogenic pain

Spine surgery is not done specifically for vertebrogenic pain caused by endplate damage.

However, surgery may be recommended when there is both significant endplate damage along with other causes of low back pain, such as degeneration of the spinal disc, spondylolisthesis, spinal stenosis, and/or facet joint osteoarthritis.

The surgery to treat these types of conditions is usually lumbar spine fusion surgery.

For endplate damage that occurs along with a compression fracture in the vertebra, a surgery called vertebroplasty or kyphoplasty may be recommended.

Read more about Surgery for Lower Back Pain