By Amy Meadows
The commercials make it look so easy. Just take two pills, and back pain will dissipate like magic so you can return to living a carefree life. Of course, if you’re like one of the 31 million people who, according to the American Chiropractic Association, experience low back pain, you know that there’s much more to dealing with the nagging discomfort associated with back issues. While oral anti-inflammatories (and even external pain relief patches) certainly can help, it’s crucial to understand the cause of your back pain so you can weigh the pros and cons of today’s available treatment options.
The Root of the Problem
“Eighty percent of adults will experience lower back pain at some point in their lives,” says Paul R. Jeffords, M.D., a minimally invasive spine surgeon with Resurgens Orthopaedics PC. “It’s the price we pay for walking upright on two feet. It’s part of being human.”
Of course, not all back pain is created equal. In fact, Jeffords notes that there is a range, from a simple pulled or strained muscle to more complicated degenerative conditions that can cause severe or even debilitating pain. Less serious back pain can be the result of overdoing it at the gym, lifting a heavy object incorrectly, sitting for too long at work or leading an overall sedentary lifestyle.
More serious issues can affect either the discs in the back (the cushions or “shock absorbers” along the spine) or the facet joints (where the bones connect to each other). In addition to basic disc degeneration, which derives from general wear and tear as you age, you may also encounter conditions like herniated (bulging) or ruptured discs, pinched nerves, sciatica (compression of the sciatic nerve) or arthritis. A traumatic injury also can wreak havoc on your back, affecting tendons, ligaments and muscles.
Fortunately, according to Shahram Rezaiamiri, M.D., F.A.C.S., a neurosurgeon with AllSpine Laser and Surgery Center, a majority of acute—or short term—back pain cases will resolve spontaneously with time and without the need for major treatment. However, a percentage of those cases will become chronic, lasting 12 weeks or longer and requiring evaluation and possibly medical intervention.
“You don’t have to rush to see a doctor every time you have back pain,” Jeffords says. “But if you have back pain that fails to improve with rest, or if it’s waking you up at night and you can’t find relief with any position, there might be something more serious going on that calls for further investigation.”
A Team Approach to Back Pain
While back pain may be a prevalent problem, it has many possible causes. And that means there are a variety of professionals available to help you navigate the treatment process. But where do you start? Should you see a chiropractor or a physical therapist? If you have severe pain, should you go straight to a spine surgeon?
Chiropractors, physical therapists and surgeons will each bring their own expertise to your case. Jeffords recommends starting with a medical doctor who can look at your medical history, current medications and any other symptoms you may have—such as red flags like a persistent fever, numbness, tingling or weakness—to rule out an emergency situation. Once you have the all clear, you can consider the other professionals in your arsenal and get recommendations for who might be able to help you tackle your specific issue.
According to Zachary Walston, PT, DPT, OCS, CSCS, clinical director of PT Solutions, physical therapy can be very effective for back pain. “Physical therapy involves rehabbing someone through education, exercise and manual therapy when appropriate,” he says. “When back pain is chronic, there may be several issues going on. The body has to be retrained to move pain free and establish proper motor patterns to fully address the issues resulting from chronic pain.” A physical therapist will show you the right exercises and how to do them properly to facilitate the healing process.
A chiropractor is another valuable professional to have on hand. With a focus on the spine and how its alignment and health affects the nervous system, chiropractic care can be extremely valuable not only to your back, but also to your overall health. “We address the subluxations, which can affect the nerves and the nervous system,” explains Samantha March-Howard, D.C., of 100% Chiropractic. “When we start to address the body from that perspective, it can heal properly and achieve the health you’re looking for, whether you have back pain, neck pain or any kind of ailment.”
And while the thought of going to a spine surgeon may sound scary, it doesn’t have to be, as Jeffords notes that surgery is actually a last resort for most back pain cases. However, it doesn’t hurt to be evaluated by someone who specializes in orthopedic care or neurological issues and can identify problems that may not be fixable through noninvasive techniques like physical therapy and chiropractic care alone. When additional treatment is needed, an orthopedic spine surgeon or a neurosurgeon are your next options in your team approach.
With all of these professionals, it is crucial to find someone who is educated and trained in their field. And when it comes to finding a back specialist (particularly a surgeon), Rezaiamiri recommends looking for a professional who has completed a fellowship in spine surgery.
The Phases of Back Pain Treatment
“It’s frustrating when you’re looking for a cure. If you have an infection, you can take antibiotics in order to cure the infection. But in cases of spinal arthritis or disc degeneration, the underlying condition causing back pain can’t be cured,” Jeffords explains. “If the back pain is due to degenerative conditions, the goal of treatment is not to cure. We actually have two goals—to relieve the pain and to improve the patient’s function so they can return to an active lifestyle. And we do that by breaking it down into phases of treatment.”
The first phase of back pain treatment involves noninvasive options like medications, ice and heat, physical therapy and home exercises. Chiropractic care may be an appropriate adjunct to treatment in certain conditions. “Ninety percent of patients experience improvement with time and the treatments in phase one,” Jeffords says.
The next category or phase, Rezaiamiri reveals, includes the use of either steroid or nonsteroid injections. Dr. Tara Frix, case manager of Total HealthCare Medical Centers has seen great success with the use of the nonsteroid Ortho-Biological Injection treatment. “Anti-inflammatory bio-injections decrease pain and help retrain the soft tissues of the body to do what they are supposed to be doing instead of being held in a state of spasm causing joint and muscular pain,” says Frix. Epidural steroid injections, facet joint blocks, selective nerve root blocks and other injections can be used sparingly to try and alleviate the pain associated with disc or facet joint issues. “There is a 30 to 70 percent success rate with these injections,” Rezaiamiri continues. Jeffords adds, “The goal is not to cure the underlying condition. It’s not to shrink the disc. It’s to reduce the pain and inflammation to a manageable level. But there is a limit to what it can do.” In fact, patients should receive no more than three to four injections over a 12-month period.
Surgery comprises the final phase. While most patients do not require surgical options, there are several, from a lumbar microdiscectomy to remove the herniated part of a disc to a laminectomy to relieve symptoms of lumbar spinal stenosis (a narrowing of the spinal canal). An initial comprehensive evaluation, including an MRI, allows a spine surgeon to identify the area of concern and plan the best surgical strategy. Fortunately, technological and medical advancements have created minimally invasive alternatives to major back surgery. “We use smaller incisions and try to limit the amount of trauma to the body while doing surgery,” Jeffords notes. “It allows for less blood loss and faster recovery.”
In recent years, some patients have turned to percutaneous laser disc compression (PLDD), a noninvasive procedure in which a laser probe is used to vaporize the center of a disc, thereby shrinking its size, reducing the pressure and relieving pain. Rezaiamiri, who was trained by Daniel Choy, the founder of the Laser Spine Center, reveals that between 50 and 60 percent of patients find the procedure effective. “It’s not a large operation. There is no incision,” he says, adding that some people find relief immediately while others may experience relief slowly as the disc shrinks over the course of a month. However, while he specializes in PLDD, Rezaiamiri warns that some practices throughout the country purport to offer this specialized laser procedure but actually do not. Therefore, it’s important to research any facility thoroughly before agreeing to a procedure.
The Lowdown on Low Back Pain Treatment
As with any kind of medical care or therapy, there are positives and negatives to each phase of back pain treatment. In the earliest phases, physical therapy and chiropractic care can take time. Injections may not last or work at all, depending on the severity of your issue. And surgery always has its drawbacks, from the development of scar tissue and muscle atrophy to the acceleration of degeneration in some instances. Yet, treatment can be very effective when the right plan is implemented. And March-Howard suggests dealing with the issues as soon as possible. “If you feel pain, or if you feel your posture shifting, get corrective work and start to address that,” she advises.
And as your team helps you work through the issues you are experiencing, you can rest easy knowing that research is being done to try and find even better ways to treat back pain. “For the future, the focus is on regenerative treatments, such as gene therapy and stem cell therapy,” Jeffords says.
In the meantime, there are many options available to you if you are one of the millions of back pain sufferers. It’s just important to keep one thing in mind as you set out on your journey. “Don’t give up. Don’t lose hope. It takes time and effort,” Walston concludes. “But it will make you so much healthier in the long run.” Remember to thoroughly research your treatment options and do not do anything you are not comfortable with.
100% Chiropractic, 100percentchiropractic.com
AllSpine Laser and Surgery Center, allspinesurgerycenter.com
American Chiropractic Association, acatoday.org
PT Solutions, ptsolutions.com
Resurgens Orthopaedics PC, resurgens.com
Total HealthCare Medical Centers, totalhealthmed.com