Nearly 90 percent of Americans will suffer from back pain during their lifetime. In fact, only the common cold causes more lost days of work. Thankfully, there are many options for alleviating back pain, and they’re nearly all available under one roof at Floyd Memorial Hospital.
“As the population ages, we are seeing more degeneration of the spine related to arthritis. People are living longer, and they want to be functional into their later years. People in their 70s and 80s are not accepting it as fact that they must hobble around. They are seeking medical treatment for back pain in greater numbers.”
Michael Doyle, MD
Board Certified Neurosurgeon
Back pain can be caused by many underlying conditions, typically involving disease or an injury to the muscles, bones or nerve of the spine. The good news is that back pain usually resolves on its own, improving in a few days and disappearing within a few weeks. If it doesn’t, patients can turn to Floyd Memorial, where they have access to a multidisciplinary team who develop pain treatment plans that fit each patient’s individual needs.
Common Causes of Back Pain
“A variety of conditions are associated with back pain. It can be as simple as a pulled muscle, a herniated disc from a work injury, arthritis or the result of the natural aging process. Plus, there’s not one treatment that fits everyone. Responses are very individual, and so is our approach to treatment.”
Rodney Chou, MD
Board Certified Physical Medicine
and Rehabilitation Specialist
Floyd Memorial Pain Management Center
Some back pain will resolve itself without the patient ever knowing what triggered it. But if you have pain for more than a week, it’s time to seek help. “It’s important to begin with a good evaluation. Many times, an MRI on someone over 20 will show a major disintegration of a disc, but that may not necessarily be the cause of the pain.
An appropriate evaluation leads to the correct treatment,” said Rodney Chou, MD, a board certified physical medicine and rehabilitation specialist. “At Floyd Memorial’s Pain Management Center, you have access to a variety of treatment options and specialists all under one roof, without having to make multiple appointments and travel to various places.” Some common causes of back pain include:
- Lumbar muscle strain, the most common cause of low back pain
- Ruptured disc, also called a herniated disc
- Discogenic back pain, resulting from damage to the intervertebral disc
- Infection of the discs and/or vertebral body
- Tumors, which are primarily the result of metastatic disease
- Spinal stenosis, caused by the constriction of the spinal canal, often due to arthritis and other conditions common with aging
- Lumbar spine arthritis, which afflicts the small joints of the spine
- Spondylolisthesis, often caused by the loss of the normal stabilizing structures of the spinal column
- Osteoporosis, which can lead to compression fractures of the vertebra
An Escalating Scale of Treatment Options
If there has not been a traumatic injury, treating back pain usually begins with resting the spine and avoiding lifting and other physical exertion. Anti-inflammatory medications and heat packs also can be helpful. If self treatment does not alleviate the pain, then it is time to seek help from a specialist and find an accurate diagnosis.
Dr. Chou emphasized that different treatments help different people, even those with the same underlying condition. “People are very individual in what they respond to for pain. The majority of people with spine problems do not need surgery. About 95 percent benefit from conservative treatment. The sooner we can see the patient, the more likely it is that we can prevent a chronic condition from occurring.”
Conservative pain management treatment options may include pain medications, muscle relaxers and physical therapy as well as exercises and therapy modalities including ultrasound and electrical stimulation. Dean Collis, MD, a board certified anesthesiologist and pain management specialist, noted that an epidural steroid injection is often the next component added to the patient’s treatment. “An injection of a lumbar epidural places a powerful antiantiinflammatory medication directly around the spinal nerves.
The doctor uses an X-ray to guide the needle to an area near the spinal nerves. Usually this is a series of two or three injections spaced a week apart. It often controls the inflammation and may provide long-lasting relief. It won’t fix a herniated disc, but it will help alleviate the pain caused by the disc.” Larry L. Zhou, MD, also a board certified anesthesiologist and pain management specialist, added, “Other options include radiofrequency nerve ablation, which generates heat around the nerve and destroys the nerve’s ability to transmit pain. We may also try a nerve block, which is an injection of medication onto or near the nerves that helps control pain and make the nerves less sensitive.”
“As the baby-boomer population ages, we are seeing more and more back problems. One study showed that up to 65 percent of people over age 50 reported back pain in the last 12- month period. This is often the result of natural degeneration of the spine, and continues to progress with age.”
Larry L. Zhou, MD
Board Certified Anesthesiologist and
Pain Management Specialist
Floyd Memorial Pain Management Center
When Surgery is Required
Only about five percent of patients are unsuccessful with more conservative treatment and must progress to back surgery. Orthopedic and Spine Surgeon Mohammed E. Majd, MD, explained, “These patients have tried non-surgical management, but their pain has not improved. They may have a disc herniation or protrusion and have weakness in their lower extremities. Under very unusual circumstances, they may also have pressure on a nerve to the bladder.”
“Spinal surgery is not something to be entered into lightly. It is very important to attempt more conservative treatment modalities first. However, when a patient is unable to achieve lasting relief from those options and surgery is necessary, they can rest assured that the team at Floyd Memorial is highly trained and qualified to provide the most cutting edge, effective procedures available.”
Mohammad E. Majd, MD
Orthopedic and Spine Surgeon
Spine Surgery, PSC
One of the most common reasons that patients seek spine surgery is from pain caused by a disc degeneration with spinal stenosis. These patients are often pain-free while sitting or lying down, but can walk only a short distance before pain in the back and buttock forces them to sit down. If conservative treatments have been unsuccessful, Dr. Majd sometimes uses a NuVasive technology that places a device in the spine to restore disk height, opening up the collapsed section and decompressing the nerve roots.
Another option is interbody fusion, which is a minimally invasive procedure that can help alleviate back pain associated with spinal instability from spinal stenosis or disc degeneration. It involves using bone graft to promote specific vertebrae to grow or fuse together into a solid and stable column. For neck pain, new advances include the placement of artificial discs instead of the traditional practice of fusing the discs together, which preserves neck movement.
Board certified Neurosurgeon Michael Doyle, MD, noted that spinal surgery technology has made great strides in recent years and is steadily becoming less invasive. “One procedure to relieve leg pain associated with severe sciatica is even done on an outpatient basis. The surgeon makes a small incision that splits the muscle and removes the ruptured part of the disc to take the pressure off.
“Spinal pain can be caused by just a small change in the spine. Therefore, it is important to have an accurate diagnosis of the problem in order to ensure that pain management is most effective for the patient.”
Dean Collis, MD
Board Certified Anesthesiologist
and Pain Management Specialist
Floyd Memorial Pain Management Center
It often gives immediate relief and only takes about an hour. We have seen very good results with this technique,” he added. “Patients with major structural abnormalities, severe nerve impingements or neurological issues may require more invasive surgery, but recovery times are becoming shorter and shorter thanks to new techniques.”
Worth a Pound of Cure
How can you prevent back pain from interfering with your life? Take these tips from our experts:
- Maintain a healthy weight. A large midsection shifts a person’s center of gravity and changes the normal alignment of the spine.
- Perform exercises that strengthen the core muscles of the back and abdomen.
- Exercise regularly so you stay physically fit and flexible
- Always use correct lifting techniques, squatting to lift heavy objects rather than bending over.
- Quit smoking. Smokers are more likely to experience disc degeneration. If they require back surgery, they are also slower to heal than non-smokers.
For more information about pain management options available at Floyd Memorial call 812-949-5790.