While your ATTR-CM treatment is key for your heart health, longevity, and quality of life, it may not have an effect on the back pain you’re experiencing.
“No medications that treat ATTR-CM also help with back pain or discomfort,” says Gabriel A. Smith, MD, the Spine Institute director at University Hospitals Health System in Westlake, Ohio. “Certainly, treating ATTR-CM and stopping the amyloidosis would decrease the accelerated rate of deposits all throughout the body.”
However, Dr. Smith is unaware of solid data confirming that these treatments prevent the development of spinal stenosis specifically. Theoretically, they may decrease the risk compared with someone who has ATTR-CM and isn’t receiving treatment.
That means for back pain relief, you’ll have to turn to additional treatments to soothe the back itself.
Supportive Medications
Smith says that certain medications may help alleviate pain caused by spinal stenosis in ATTR-CM:
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Conversely, doctors tend to stay away from opioids when treating spinal stenosis. “We try to avoid opioids for neuropathic pain,” says Mauricio. “In the long run, these medications don’t help patients and cause more problems down the road.” Complications of opioid use include sedation, cognitive impairment, falls, fractures, and constipation.
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Physical Therapy
Partnering with a physical therapist may also help you address back pain. “Physical therapy can build core strength to help protect your spine and nerves,” says Mauricio. “Stretching, working on balance and mobility, and strengthening core muscles can help people in the long run.”
Ask your primary care physician for a referral to a physical therapist if needed.
Surgery
In some instances, surgery may be warranted to relieve nerve pressure, but it’s not the first treatment your care team will explore.
“We would attempt all measures to alleviate pain and improve quality of life without surgery first,” says Smith.
If you’ve tried physical therapy, anti-inflammatory medications, nerve pain medications, and possibly steroid injections, and none of these options provided long-term relief from your symptoms, you may be evaluated for surgery.
Surgery is a last resort. “Surgery has risks, and with ATTR-CM, we would be taking on cardiac risk in particular,” says Smith. The procedure can be used to improve quality of life for people facing severe pain and weakness, problems sleeping, and interference in activities they love to do. Your healthcare team, including your cardiologist, an anesthesiologist, and a surgeon, will work together to evaluate both the benefits and risks before recommending surgery, he says.
