Published by PMR of NY & CT
When back, neck or joint pain drags on, it's natural to wonder whether surgery is the only real fix. For most common problems, it isn't. Non surgical pain management, meaning care that treats pain without an operation, is usually the recommended first step, and for many people it's all they need.
That doesn't mean surgery is never the answer. Knowing what conservative treatment includes, what it offers and when to talk with a surgeon helps you make a confident decision with your care team.
What non surgical pain management includes
The right mix depends on the source of your pain, and many plans combine several approaches:
- Physical therapy and exercise to restore strength, flexibility and control of movement
- Chiropractic care, using spinal manipulation and mobilization to improve how joints move
- Medical massage to ease tight, painful muscles
- Acupuncture, which uses very thin needles and may ease some types of chronic pain
- Medicines, from over-the-counter pain relievers to prescriptions, guided by a physician
- Injections given by a physician, such as a steroid injection near an irritated nerve or into a joint, which may ease pain for a while, enough for some people to make progress in rehab
- Treatments for specific problems, such as shockwave therapy, which may help some stubborn tendon conditions
For low back pain, for example, a 2017 American College of Physicians guideline recommended trying nondrug treatments first, such as heat, massage, acupuncture, spinal manipulation or exercise, depending on how long the pain has lasted.
An accurate diagnosis comes first
Good care starts with understanding why you hurt. Your clinician will ask how the pain started and what makes it better or worse, watch how you move, and check your strength, reflexes and sensation.
Tests are most useful when the results will change your care. X-rays can show bone alignment and arthritis. When numbness, tingling or weakness points to a nerve problem, electromyography (EMG) and nerve conduction testing can show which nerve is involved and how much it is affected. An MRI scan is usually saved for red flags or for when surgery or an injection is being considered.
Advantages of non surgical pain management
Choosing alternatives to surgery when they are reasonable has real benefits:
- Lower risk. With no incision, there is no surgical wound to heal or become infected, and no general anesthesia.
- Little or no downtime. Most treatments happen during an office visit, and you can usually go home or back to work the same day.
- Skills you keep. Conservative treatment teaches exercises and habits you can use to manage flare-ups and help prevent the next one.
- Options stay open. For most common back, neck and joint problems, trying conservative care first doesn’t rule out surgery later if you need it.
There are trade-offs too. Conservative treatment usually takes consistent effort over several weeks, and how much it helps differs from one person to the next.
When surgery may be the right choice
Surgery has an important place in pain care. A surgeon's opinion is worth getting when:
- A pinched nerve is causing weakness that keeps getting worse
- Imaging shows an unstable fracture or pressure on the spinal cord
- A complete tendon or ligament tear limits you in ways rehab can't overcome, depending on your age and activity goals
- Advanced arthritis keeps limiting daily life after a fair trial of other treatments
- Pain stays severe despite several months of well-rounded conservative care
If you do need an operation, rehabilitation still matters. Post-surgical rehab helps you regain strength and movement afterward, and we can coordinate with your surgeon.
Red flags that need emergency care
Call 911 or go to an emergency room for:
- New trouble controlling your bladder or bowels, or numbness around the groin, buttocks or inner thighs
- Weakness in an arm or leg that comes on suddenly or gets worse quickly
- Severe pain after a fall, car crash or other major injury
- Chest pain, or pain that spreads into the arm, jaw or back
See a doctor the same day for back pain with fever or chills, or pain that comes with unexplained weight loss or a history of cancer.
Frequently asked questions
What does a physiatrist do?
Physiatrists are medical doctors trained in the specialty of physical medicine and rehabilitation. They diagnose and treat problems of the muscles, bones, joints and nerves without surgery. They may perform tests such as EMG, prescribe medicines, give some types of injections and lead a rehab plan that brings together therapists and other specialists. Their main focus is helping you function better at work, at home and in the activities you enjoy.
Can a herniated disc heal without surgery?
Often, yes. Many people with a herniated disc feel much better within several weeks to a few months with conservative treatment such as activity changes, physical therapy and medicines, sometimes with an injection. Over time, the body can shrink or reabsorb part of the disc material. Surgery is usually considered for worsening weakness or severe leg pain that doesn’t improve, and urgently for new bladder or bowel changes.
What is the difference between noninvasive and minimally invasive treatment?
Noninvasive treatment doesn't break the skin. Exercise, manual therapy, massage, heat and shockwave therapy are examples. Minimally invasive treatments use a needle or small instruments, as with an injection. Minimally invasive surgery is still surgery: it uses small incisions and specialized tools, usually requires anesthesia and involves recovery time, though often less than traditional open surgery.
Explore your options with PMR
At Physical Medicine & Rehabilitation of NY & CT (PMR), our physiatry and pain management team can evaluate your pain and walk you through nonsurgical options, from physical therapy and chiropractic care to acupuncture. Request an appointment and our team will contact you to schedule your visit.
More from the PMR Blog
Continue exploring articles in this topic category.