1. Acupuncture: an ancient Eastern medicine treatment for many ailments; needles are inserted at points in the skin along tracks of Yin and Yang to restore their natural balance for health.  Western medicine-style randomized controlled studies have been unable so far to establish its value. However, it helps relieve pain at times and is completely without risk
  2. Chiropractic: spinal manipulation is as effective as physical therapy and with minimal risk in the lower back.
  3. Epidural Steroid Injections (ESIs): anti-inflammatory drugs are injected into the spinal canal.  RCT double-blind trials have failed to show results any better than just injection sterile salt-solution.  These injections are risky and expensive. See glossary
  4. Nerve blocks: a spinal nerve root can be injected with a local anesthetic to relieve pain.  Some spine specialists do it as a test to find where the pain originates. It it also done as therapy, but pain usually recurs when the anesthetic wears off.  In some clinics, a steroid (betamethasone) is mixed with the anesthetic drug to prolong the effect.
  5. Facet Rhizotomy:  a very small nerve comes off each spinal nerve as it exits the spine and supplies sensation to the facet joint.  It was thought that cutting or blocking that nerve would reduce back pain possibly caused by facet arthritis. This has never been shown to have any value.
  6. Facet injections: injecting local anesthetic with or without steroid drugs into the facet joint is another attempt to treat puzzling cases of back pain.  It’s a difficult maneuver, requiring X-ray guidance and Improvement, if any, is usually temporary.