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Health Fax Articles
Back Pain Management
Patrick Callahan, M.D.
Back pain! I have experienced it myself and odds are you have too. In fact, three-fourths of the world’s population will experience it sometime during their lives. Back pain, whether it is in the cervical (neck) or lumbar (lower back) area, is a very common clinical problem that affects most everyone but many people will not seek the advice of a physician in its diagnosis and treatment.
Fortunately, a significant amount of back pain is self-limited in nature. If it does not resolve on its own with rest and over-the-counter analgesics in one month’s time, an appropriate medical evaluation should be done by a physician, including a history, physical examination, laboratory tests and radiological imaging if necessary.
Pain of spinal origin can be caused by many things and it is up to the physician to help decipher its cause and to construct a treatment plan, along with the patient, to help alleviate the problem. Early treatment of back pain may include anti-inflammatory and muscle relaxant medications in addition to rest. These modalities are safest and most effective when applied over a six-week period. Some patients benefit from a back brace as well as beginning a program of back exercises. In any case, the cause of the pain should be found, whether it is poor posture, stress on the back in the work place or trauma.
Patients who fail to improve after these conservative measures have been taken are then treated more aggressively. Some may have localized cervical or lumbar pain and require plain x-ray films and/or a magnetic resonance imaging (MRI) scan to help pinpoint the exact nature of the pain. Possible causes include, among others: spondyloarthropathy (abnormalities of the joints in the spine), osteoporosis (lack of bone density), vertebral fracture, bone cancer, metastatic cancer or endocrine (hormonal) dysfunction. Treatment can include anti-inflammatory medication, physical therapy and non-operative pain management including facet joint blocks with local anesthetic and steroids. Facet joints are small joints within the spine. In difficult cases, surgical intervention should be considered.
Another group of patients to be considered are those with back pain which also radiates down the arm or leg. These patients usually experience this symptom due to mechanical back pressure and/or inflammation of the nerve roots. Pain, numbness and tingling may then travel down the extremity along the particular nerve involved. The source of the mechanical pressure can be soft tissue (herniated back disc), bone or a combination of the two. After these patients have had up to six weeks of controlled physical activity and anti-inflammatory medication they should undergo a trial of epidural steroid injections to help alleviate the inflammation of the spinal nerves. This simple procedure can be performed on an outpatient basis with intravenous sedation. If the epidural steroid injections prove not to be totally effective, serious consideration should be given to surgical intervention in order to remove the herniated disc or remove the bone which is irritating the spinal nerve(s) in the case of spinal stenosis.
The good news with pain of spinal origin is that medical treatment is expanding every day as new medications are developed, as are new non-operative and operative techniques. The bottom line is that no one should be in constant pain because of back dysfunction. A visit to your family physician is the first step in managing back pain and getting appropriate pain management consultations if needed.