Finding relief for your sometimes endless aches
If your back is aching today, you are not alone. According to the National Centers for Health Statistics, back pain is the leading cause of disability in Americans under 45 years old, and more than 26 million Americans between the ages of 20 and 64 experience frequent back pain.
Chronic pain affects approximately 100 million American adults—more than the total affected by heart disease, cancer and diabetes combined—and costs the nation up to $635 billion each year in medical treatment and lost productivity, according to a recent report by the Institute of Medicine, the health arm of the National Academy of Sciences, which has highlighted chronic pain as a significant public health problem.
Despite these staggering numbers, you don’t have to accept back pain as a “normal” part of life. Today, there are numerous interventions available to ease your back pain and alleviate future problems. But first, you need to determine what’s causing your pain and whether it may be an indication of a more serious problem.
Is it more than a simple ache?
“Lower back pain can be either slowly progressive or of a sudden onset after an injury, such as one from lifting, bending, a slip-and-fall or a car accident. These can result in a muscle sprain, strain or spasm, a ruptured or bulging disc or an irritated nerve,” says Dr. Michael Greene, a physician at Woodbury Spine in Woodbury who is board certified in physical medicine and rehabilitation and pain medicine. “In many instances, pain complaints can be addressed without surgery and can be treated with conservative treatment, including physical therapy and medication. Other instances require a more extensive evaluation, which may include X-rays, MRIs or spinal injections. Patients with pain resistance to these treatments may then be sent for surgical evaluation.”
Acute, or short-term back pain, generally only lasts a few days to a few weeks. Chronic back pain, lasting more than six weeks with little relief of symptoms, could be an indication of a more serious problem.
“It’s important to look at the duration of pain in order to differentiate the run-of-the mill, everyday back pain from more worrisome, chronic pain,” says Dr. Michael Sabia, division head of Pain Management and Pain Medicine Fellowship director at Cooper University Hospital in Camden. “Pain that radiates down the arm or leg or associated with weakness or numbness, fever or infection, loss of bowel or bladder control or history of trauma associated with back pain may be red flags that something more serious is going on, such as a pinched nerve or another chronic condition. If you’re experiencing any of these problems, it’s important to seek a consultation from your primary care physician or a pain medicine specialist, who can take a full history and perform a physical exam to identify what may be causing your pain.”
Conditions that may cause chronic back pain and require treatment by a physician or specialist include bulging or herniated discs, sciatica, spinal degeneration, spinal stenosis, osteoporosis, scoliosis or osteomyelitis—an infection in the bones of the spine.
“Lifestyle choices also have a significant effect on back health,” says Dr. Robert Greenleaf, an orthopedic surgeon at Reconstructive Orthopedics, with eight offices throughout South Jersey. “Smoking, obesity, poor posture, lack of sleep and stress can all contribute to back pain. We know that smoking causes damage to the small blood vessels in the heart and lungs. Similarly, smoking also damages the vessels supplying the discs on your spine, preventing the disc from receiving vital oxygen and nutrients needed for health and repair. This leads to degenerative disc disease and subsequently, low back pain.
“Obesity or being overweight can place more stress on the spine and may lead to back pain or degeneration of the spine,” he adds.
Something as simple as incorrect exercise or sleep patterns can also lead to aching problems.
“The most common complaints I hear concern musculoskeletal back pain from over exercising or exercising incorrectly, sleeping in the wrong position, bending, twisting or lifting the wrong way,” says Dr. Kieran Slevin, an interventional pain medicine specialist at Virtua Pain and Spine Specialists, with offices in Voorhees and Moorestown. “I typically prescribe four to six weeks of conservative treatment, including rest, non-steroidal anti-inflammatories such as ibuprofen or Aleve, and physical therapy to strengthen the patient’s core and increase range of motion. For back pain that doesn’t resolve after six weeks, an MRI or CT scan can help identify the need for more advanced interventions.”
Dr. David Clements, director of Orthopedic Spine Surgery at Cooper Bone & Joint Institute in Camden, adds, “The best treatment for chronic back pain relief is regular exercise with a cardio component for core strengthening. Swimming, walking, using the elliptical or stationary bike are all great exercises to promote good low back health. In addition, good nutrition and losing excess weight, along with quitting smoking, can help give you more energy to stay active and maintain your overall health. Many of our patients are also looking into alternative therapies such as acupuncture, chiropractic care, biofeedback, yoga and other non-medical approaches to back pain relief.”
When the pain calls for more attention
For chronic back pain that does not resolve over time, there are numerous minimally invasive techniques available to help individuals manage their pain.
“In addition to non-narcotic oral medications, I may look at bracing techniques, which help to physically support the back; TENS (transcutaneous electrical nerve stimulation), which sends mild electric pulses to the nerves to block pain signals to the brain; transdermal creams, which provide targeted delivery to painful areas; or epidural injections to treat more chronic pain and accelerate the healing process,” says Slevin.
In fact, injection treatments vary and are quite common. “There are a host of different injections and non-narcotic treatments available today, depending on what the problem is,” says Sabia. “Pain management techniques may include epidural steroid injections, facet joint injections, spinal nerve blocks, radiofrequency ablation—which uses heat energy to target nerves that carry pain impulses—or spinal cord stimulator implants. Different modalities used together, such as a regular exercise regimen along with use of anti-inflammatories or spinal injections, often produce the best outcomes.”
However, for individuals with more severe, unresolved pain, surgery may be an option.
“The main focus of spine surgery is typically decompression and stabilization,” says Dr. Evan O’Brien, an orthopedic surgeon at Woodbury Spine. “There are a number of minimally invasive surgical procedures available today to help relieve chronic back pain, including endoscopic disc surgery, minimally invasive lumbar decompression, spinal fusions, and bone cement procedures to address vertebral compression fractures in osteoporotic patients.
“For patients with more serious, life-altering pain,” adds O’Brien, “major spinal surgeries such as artificial disc replacement, open laminectomies and disectomies to relieve nerve compression, and anterior cervical and lumbar surgeries to remove disc herniations that cause radiating pain are treatment options. We also perform decompressive extensive laminectomies to treat cervical and lumbar stenosis, as well as combined anterior/posterior approaches to treat back pain and restore spinal alignment with fusion techniques using appropriate instrumentation, including structural implants, pedicle screws and various anterior and posterior plates. All of these advanced techniques are designed to relieve back pain and minimize recovery times,” he says.
Of course, like in other aspects of health care, the best advice physicians can give revolves around prevention.
“While back pain is often unavoidable, you can prevent major back problems by taking control of the health of your spine,” says Greenleaf. “Good core strength and stability can be accomplished through regular exercise, a healthy diet, maintaining your weight within an acceptable range and quitting smoking. If you do wind up with a pain in your back, consult with a reputable pain medicine practitioner or spine surgeon and make sure you understand the host of options available to alleviate your pain.”
Cooper University Hospital & the Cooper Bone & Joint Institute
Serving South Jersey
1 (800) 8-COOPER
Serving South Jersey
Virtua Pain and Spine Specialists
200 Bowman Drive, Suite E 355
1225 N. Broad St., Suite 3
Published (and copyrighted) in the Art of Living Well pull-out section of Suburban Family Magazine, Volume 4, Issue 1 (March, 2013).
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