How to treat osteoarthritis of the spine?

A physician will consider a patient’s lifestyle, severity of pain, and medical history when recommending a medication. To avoid potential side-effects and interactions, patients should always tell their health care provider about any drugs and vitamins/supplements they take.

Medications typically recommended for spinal osteoarthritis pain are described below.

Opioid medications are rarely prescribed because they carry an increased risk of misuse, abuse, and addiction. They are typically reserved for carefully selected patients whose back pain is acute or has not responded to other treatments. Other potential risks include cognitive, gastrointestinal, and other organ-related side effects.

See Pain Medications for Arthritis Pain Relief

Therapeutic massage can help reduce osteoarthritis pain, 2 Nelson NL, Churilla JR. Massage Therapy for Pain and Function in Patients With Arthritis: A Systematic Review of Randomized Controlled Trials. Am J Phys Med Rehabil. 2017 Sep;96(9):665-672. doi: 10.1097/PHM.0000000000000712. Review. PubMed PMID: 28177937. improve circulation, and reduce muscle tension and spasms. It is preferable to find a physical therapist or massage therapist who is trained in treating spinal arthritis joint pain.

This type of non-invasive therapy uses small amounts of electricity to reduce the sensitivity of nerves around the spine. Patients typically feel only a gentle vibration or tingling during TENS treatment. Not all patients using TENS experience pain relief. 3 Escortell-mayor E, Riesgo-fuertes R, Garrido-elustondo S, et al. Primary care randomized clinical trial: manual therapy effectiveness in comparison with TENS in patients with neck pain. Man Ther. 2011;16(1):66-73. doi: 10.1016/j.math.2010.07.003 , 4 Johnson M, Martinson M. Efficacy of electrical nerve stimulation for chronic musculoskeletal pain: a meta-analysis of randomized controlled trials. Pain. 2007;130:157-165. , 5 Kroeling P, Gross A, Graham N, et al. Electrotherapy for neck pain. Cochrane Database Syst Rev. 2013;(8):CD004251. TENS therapy may be done in a medical office or the TENS unit may be prescribed to the patient and taken home with instructions regarding its proper use.

Read more about Transcutaneous Electrical Nerve Stimulation (TENS) on Spine-health.com

Limited evidence suggests acupuncture can help treat osteoarthritis pain, back pain, and headaches. 6 Sherman KJ, Coeytaux RR. Acupuncture for Improving Chronic Back Pain, Osteoarthritis and Headache. J Clin Outcomes Manag. Author manuscript; available in PMC 2010 May 4. Published in final edited form as: J Clin Outcomes Manag. 2009 May 1; 16(5): 224–230. PMCID: PMC2863344 , 7 Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain. 2018;19(5):455‐474. doi:10.1016/j.jpain.2017.11.005 , 8 Chou R, Deyo R, Friedly J, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017;166(7):493-505. doi: 10.7326/M16-2459

Dating back thousands of years, acupuncture is based on the notion that the body contains patterns of energy flow, and that proper energy flow is necessary to good health. During a treatment session, ultra-fine needles are inserted at specific points on the skin in an attempt to correct and/or maintain a normal energy flow. This treatment is considered generally safe and may even be covered by insurance.

See Acupuncture and Reiki Healing for Arthritis

Commonly recommended supplements include turmeric, ginger, omega-3 fatty acids (such as fish oil), glucosamine, chondroitin sulfate, and vitamin D. Whether these supplements effectively reduce osteoarthritis symptoms is a matter of ongoing research, 9 Sodha R, Sivanadarajah N, Alam M. The use of glucosamine for chronic low back pain: a systematic review of randomised control trials. BMJ Open. 2013;3(6):e001167. Published 2013 Jun 20. doi: 10.1136/bmjopen-2012-001167 , 10 Vaishya R, Vijay V, Lama P, Agarwal A. Does vitamin D deficiency influence the incidence and progression of knee osteoarthritis? - A literature review. J Clin Orthop Trauma. 2019;10(1):9–15. doi:10.1097/RHU.0b013e3181b08f20 , 11 Bragazzi NL, Watad A, Neumann SG, Simon M, Brown SB, Abu Much A, Harari A, Tiosano S, Amital H, Shoenfeld Y. Vitamin D and rheumatoid arthritis: an ongoing mystery. Curr Opin Rheumatol. 2017 Jul;29(4):378-388. doi: 10.1097/BOR.0000000000000397 and experts agree more studies are needed.

Supplements are considered generally safe, but side-effects, adverse health events, and drug interactions are possible, so people are encouraged to talk to their doctor or pharmacists before taking one.

See Dietary Supplements for Treating Arthritis

A physician may recommend injection therapy if other nonsurgical medical treatments fail to reduce osteoarthritis pain in the back or neck pain. Injection therapy may also be an option for individuals who are sensitive to oral pain medications.

These injections treat pain stemming from a specific facet joint. The injection is typically delivered through the capsule that surrounds the two facets, into the joint itself. Examples of facet joint injections include:

Spinal arthritis is inflammation of the facet joints in the spine or sacroiliac joints between the spine and the pelvis. It may be related to wear and tear, autoimmune disorders, infection and other conditions. Sometimes, the inflammation may also affect the sites where ligaments and tendons attach to the bones of the spine. Regardless of the exact location, arthritis in the back or neck can be painful and often becomes chronic.

The causes of arthritis in the back or neck vary depending on the type of arthritis you have. Besides normal wear and tear and autoimmune triggers, in many cases the exact cause remains unknown. Genetic components have been identified in connection with some forms of spinal arthritis, meaning that it may be hereditary.

Other spinal arthritis risk factors include:

There are more than 100 different types of arthritis, and most of them may affect the back or neck. Although all arthritis leads to inflammation, arthritis is categorized as inflammatory and noninflammatory (degenerative) based on its origin.

Osteoarthritis (noninflammatory or degenerative arthritis) is the most common form of spinal arthritis. It usually affects the lower back and develops through wear and tear. As the cartilage between the joints slowly breaks down, it leads to inflammation and pain. Because the pain is from mechanical damage, it is typically more noticeable when you bend or twist your back. Past back injuries may also contribute to the development of degenerative arthritis of the spine.

Osteoarthritis of the spine usually affects the facet joints between the vertebrae. It is also known as facet joint arthritis, facet joint syndrome and facet disease. In some cases, degeneration of the spinal discs (degenerative disc disease) may contribute to facet joint arthritis. As discs between the vertebrae become thinner, more pressure is transferred to the facet joints. This leads to more friction and more damage to the cartilage.

When these degenerative changes occur in the neck, this condition is called cervical spondylosis. Arthritis in the neck doesn’t always cause pain, and many people have no noticeable symptoms.

Rheumatoid arthritis (RA) is an autoimmune disorder, meaning that the immune system turns on itself. It attacks synovium — the lining of the joints. Although rheumatoid arthritis is more common in other joints, it can also affect the spine, specifically the cervical region (neck). Rheumatoid arthritis of the spine is not caused by wear and tear, so it’s considered an inflammatory arthritis. It may cause back pain (and pain in other joints) even when these joints are not in use. It tends to affect women more than men.

Spondyloarthritis is a group of inflammatory diseases that affect both the joints and the locations where the ligaments and tendons attach to the bones (entheses). Spondyloarthritis, although inflammatory by origin, is not the same as rheumatoid arthritis.

There are several forms of spondyloarthritis — some are more common in the spine than others:

According to a different classification, if a particular type of arthritis involves the spine and/or sacroiliac joints, it is called axial spondyloarthritis. If other joints and tendons are involved, this is called peripheral spondyloarthritis. Many people experience both types at different points in the progress of their spondyloarthritis.

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Symptoms of spinal arthritis may differ from person to person. In general, they may include:

Although back pain is a common symptom, not all people have it, even those with advanced spinal arthritis. On the other hand, some may experience pain even before arthritis can be seen on an X-ray.

In certain types of spondyloarthritis, eye inflammation (iritis or uveitis) may occur, causing pain, watery eyes and blurred vision.

Spinal arthritis may cause bone spurs — overgrowths on the edges of the bones. In the spine, bone spurs particularly affect facet joints, making them grow larger. This condition is called facet joint hypertrophy. Although bone spurs on their own are not harmful, they may narrow the passages for the spinal cord and the nerves exiting the spine. This may lead to two painful conditions:

Ankylosing spondylitis (the slow calcification of the ligaments between the vertebrae) may also cause additional problems such as:

Your doctor may use some or all of the following diagnostic methods to confirm spinal arthritis:

To pinpoint the painful joint, your doctor may numb it with an injection and check whether the pain goes away.

The treatment for spinal arthritis depends on many factors. They may include your age, level of pain, type and severity of arthritis and personal health goals. Because the joint damage caused by arthritis is irreversible, the treatment usually focuses on managing pain and preventing further damage.

Nonsurgical treatments for spinal arthritis may include: