Mention back pain and suddenly everyone is listening… That is because back pain affects 8 out of 10 people at some point in their lives. It is estimated that direct health care costs due to chronic low-back pain amount to around $96 million a year. These staggering statistics beg for answers about how treatment for back pain is evolving.
To find answers about new approaches to back pain treatment, Well-Being looked to Dr. Graham Calvert, Orthopaedic Surgeon and neck and back specialist at Mississippi Sports Medicine and Orthopaedic Center and Dr. Kevin Vance, Anesthesiologist and pain management specialist at Comprehensive Pain Center of Mississippi. It turns out their professional training, experience and new research give credence to the wisdom of initially following a conservative path when treating back pain.
Physical Therapy and Exercise
“When a patient comes to me with back pain, the first thing we talk about is how long the pain has been going on and whether it is primarily in the back or if it radiates to the extremities,” begins Calvert. “I also want to know what activities or motions make the pain worse, and which make it better. If the pain is off mid-line, along the sides in the paraspinal muscles, then the treatment could be as simple as strengthening the core muscles. We can accomplish this through physical therapy, exercise and the use of over the counter anti-inflammatory medicines. If the person is overweight, shedding the extra pounds has been proven to benefit back pain.”
Dr. Vance also recommends physical therapy and exercises to strengthen the core muscles for pain that is limited to the back.
“Most people who injure their backs have done so because they are lifting, bending and stooping incorrectly,” Vance explains. “The problem is exacerbated by weak core muscles. When we are young and fit our structure is supported 60% by our muscles and 40% by our bones. When we near 30 this trend starts to reverse. Strengthening the core muscles along with maintaining a healthy weight and overall good lifestyle can help prevent back injury in many cases.”
“Beside core strengthening exercises, there are a number of additional options in physical therapy that may prove successful, including traction therapies (like inversion tables), ultrasound, and cold and hot therapy,” adds Vance. “Massage therapy, acupuncture and nutritional supplements such as calcium and vitamin D and NSAIDs (non-steroid anti-inflammatory drugs) may also be included among potential treatment options.”
Other Non-Surgical Solutions
When physical therapy and exercise have not worked successfully to reduce the pain, often the next step is advanced imaging to perhaps identify an organic source of the pain.
“Pain in the midline of the back could be related to the bones and joints of the spine itself, such as a stress fracture or arthritis of the spine,” notes Calvert. “If the arthritis is advanced or has gotten to the point that it impinges on nerves in the back, then we may proceed with a pain injection consisting of a steroid combined with an anesthetic agent. Sometimes the relief provided by these injections can last several months. They also represent a good option for patients with nerve compression, for whom surgery is too high a risk.”
“For degenerative conditions in which pain is coming from the joints of the spine alone, facet blocks or heat ablation may be options to inhibit the ability of specific nerves in the spine to relay the pain signal to the brain,” Calvert continues. “As a last resort, spinal cord stimulators could be an option for chronic back and leg pain in which a source cannot be identified and all other conservative treatments have been exhausted. These stimulators inhibit the ability of the spinal cord itself to transmit pain signals to the brain.”
According to Dr. Vance, the use of epidural steroid injections, facet joint blocks, radiofrequency (heat) ablation, and cooled radiofrequency ablation for degenerative disc disease are options to relieve pain and give physical therapy and exercise a chance to strengthen the core muscles. For radicular pain (caused by irritation of the sensory root of a spinal nerve) a series of epidural steroid injections may be in order – especially when trying to avoid surgery.
Interestingly enough, a recent study conducted at Thomas Jefferson University Hospital in Philadelphia, PA, found that physical therapy and other non-operative treatments were often as effective at reducing pain and disability as surgical spinal fusion for patients suffering from degenerative disc disease.
“While surgery is also a last resort, patients experiencing pain associated with a nerve being pinched in the back are actually good candidates for surgery. There are several procedures to decompress these pinched nerves that offer predictable and reproducible pain relief. Patients that have deformity of the back causing the pain are also good candidates for surgery, as rebalancing the spine can offer significant pain relief,” Calvert concludes.
Hope for Back Pain Sufferers
“There is no doubt about the fact that we are much better at diagnosing the causes of back pain today than we were in the past,” adds Calvert. “Not only are we better at identifying causes of pain, but our treatment options are much wider than they were even 5 – 10 years ago.”
“Given the number and variety of treatments that are available to us today, there is really no reason for people with back pain to put off getting help,” concludes Vance. “The sooner they come for help, the quicker we can get to the root of their pain and prescribe solutions for relief.”
Graham C. Calvert, M.D., Orthopaedic Surgeon and back and neck specialist, received his Doctor of Medicine degree from the University of Mississippi School of Medicine. Dr. Calvert’s professional training includes the completion of his Residency in Orthopaedic Surgery at the University of Alabama-Birmingham, and a one-year Spine Surgery Fellowship at the University of Utah Medical Center, in Salt Lake City, Utah.
L. Kevin Vance, M.D., received his Doctor of Medicine degree from the University of Mississippi School of Medicine. He served his Residency in Anesthesiology at the University of Alabama School of Medicine, Birmingham, AL, and completed a Fellowship in Interventional Pain Medicine at M.D. Anderson Cancer Center in Houston, TX. Dr. Vance is board certified in Anesthesiology and Pain Management.