Monday, January 10, 2011

Illustration by Stephen Sauer.

More Info

Pain Solutions, Nashua: www.painsolutionsusa.com, (603) 577-3003
Interventional Spine Medicine, Barrington: www.nhpain.com, (603) 664-0100
Foundation Neurosurgery, Southern New Hampshire Medical Center: www.snhmc.org/medical/surgicalservices.htm

Unfortunately, a quick and easy fix for back pain remains elusive, and the recurrence rate of back pain is "very high," but the good news is most instances of back pain resolve with conservative treatment, says P. K. Suchdev, M.D., A.B.I.P.P., a board-certified pain medicine physician and president of Pain Solutions. For patients whose back pain is more stubborn, a broad array of choices exists, ranging from minor treatments and procedures to surgery.

Out with the old

Not so long ago, back pain patients were prescribed bed rest. Now, although some acute cases of back pain might still require a couple of days of back babying, doctors say that movement can help speed backache recovery. "The most important thing is to get people back to activity as soon as possible," Suchdev says.

Initially, some of a back pain patient's movement might come through what is called passive physical therapy, which can include ultrasound, heat and a therapist helping the patient to stretch, Suchdev says. Then, when the patient's condition allows, the emphasis shifts to an active form of physical therapy, in which the patient initiates the activity.

An assortment of choices

Back pain treatment options also include complementary therapies such as chiropractic manipulation to align the back and acupuncture, but Suchdev says results of these treatments are mixed - they appear to bring pain relief to some patients but not to others.

Patients whose pain persists after conservative therapies might want to consider other treatments typically offered by pain management providers, such as medications to alleviate pain symptoms or various interventional procedures, including injections guided by x-ray images that help pinpoint the source of pain and enable greater injection precision.

Sometimes pain management techniques can spare patients from surgery, says Manuel Sanchez, M.D., a board-certified pain medicine physician who practices at Interventional Spine Medicine.

Chronic back pain patients, especially, might find that nutrition and psychological support aid their recovery. Nutrition plays "a huge role" in the overall back pain picture, Suchdev says, with obesity and inactivity taking their toll on many backs. Obesity also contributes to conditions such as diabetes and high blood pressure, which can worsen pain issues, Suchdev says. "Just that alone - with proper nutrition and exercise and weight loss, most patients will see a lot of the back pain issues get substantially better. Back pain, knee pain, all the different pain issues get substantially better," he says.

Offering patients psychological help goes hand in hand with changing the patient's outlook and habits. "It is incredibly important," Suchdev says, because patients who have been in chronic pain often dwell on their pain and the effect it is having on their marriage, their friends and their work. Many chronic pain patients have significant amounts of depression and substance abuse, he says, so solid psychological support is essential.

What about surgery?

Most back pain patients do not require surgery, but back pain patients who fail to respond to less invasive options can take heart in knowing that back surgery has greatly improved in recent years as surgeons today correlate test and MRI results to better identify patient trouble spots than in the past, says Gary Fleischer, M.D., orthopedic spine surgeon at Foundation Neurosurgery and Southern New Hampshire Medical Center in Nashua.

Still, the back "is a very complex system," Fleischer says, with more than 20 joints, plus discs and exiting nerves in the lower back alone, he says. "There's a lot there. To try and sort through all of that and find the actual pain generator and then determine if it's something that could actually be helped with surgery is very, very complicated." A steady stream of technological advances and new surgical techniques continue to stuff the back surgeon's tool box, he says, with some turning out to be helpful, others not so much.

The foundation of successful back surgery is an accurate diagnosis, Fleischer says, but overall results also naturally depend on the individual situation. And, since back pain can indicate a degenerative problem, pain relief that results from surgery might not last forever; even if surgery addresses the current pain it cannot necessarily prevent further breakdown. Especially because cumulative wear and tear can continue to occur over time, surgery should aim to provide the most benefit with as little disruption and risk to the patient as possible, he says.

Back surgeons should give patients realistic expectations, Fleischer says. "I almost never tell a patient they're going to be 100-percent pain-free because there's no way to guarantee that," he says, but he might at least be able to promise an 80-percent chance of being 80-percent pain free, or a 90-percent probability of being 60-percent pain-free, depending on the patient's underlying condition. And that might sound pretty good to someone who's experienced 100 percent pain for a long time. NH

Couch potatoes, listen up!

The incidence of back and neck pain appears to be on the rise, although reasons why are tough to determine, says Manuel Sanchez, M.D., a board-certified pain medicine physician who practices at Interventional Spine Medicine. One thing's for sure, though: being a couch potato will not help your odds of avoiding the back discomfort that is affecting people at a younger and younger age, Sanchez says. The electronic games that so many young people today choose over sports or other exercise "cause de-conditioning of the spine, so when those people do engage in some activity they are more likely to develop injuries," he says.

And yes, "micro-trauma" to the back can result from jogging and certain sports, Sanchez says, but that doesn't mean that we all should hang up our exercise shoes, only that we be sensible about it, especially if our family history indicates a predisposition to back trouble. "If you have a good family history and you warm up before jogging [for example], and you stretch and you do it with the proper shoes, then chances are, nothing is going to happen to you. But a lot of these injuries happen because people are not properly conditioned, they don't warm up, they have bad genes" and then they choose to engage in an activity that places them at a high risk of injury.