Back pain is one of the most common problems affecting 31 million of American men and women on any given day. When ancient man\woman stood erect on two feet, there was increased pressure on the spine and the nerves that go to the back. As a doctor with specialty training in pain management I see every type of pain. The vast majority of patients have back pain. Listed below are the 5 most common questions that my patients ask me and which I would to share with others who suffer from this common medical problem.
Is the back pain I feel a sign of something more serious?
First of all, we experience a lot of back pain in the United States. Back pain is the most common reason men and women visit doctors, second only to headaches.
The most common type of back pain is mechanical or due to age and with wear and tear on the discs, muscle and joints that support the structure of our spine. It is a sharp and aching pain. This back pain is often caused by movement or activity such as bending over to tie your shoes. While mechanical back pain can be painful, it is also often short lived and not necessarily harmful.
Mechanical back pain is felt mainly in the back without involvement of the legs or other areas of the body. Maybe we feel some pain in the hips and maybe some in the buttock, but the biggest focus is the back itself. The pain is usually not constant but rather comes and goes, especially with movement.
What can I do on my own to make the pain better?
It wasn’t but a few years ago that doctors recommended bed rest and inactivity. Bed rest was to last for days, sometimes even for weeks. Doctors do not recommend bed rest any longer.
Don’t stop walking. It is helpful to move with back pain. I recommend that you keep bending, keep twisting, and, most of all, keep going.
Reduce back pain instead by managing stress, getting good sleep, and also by keeping active. Many studies confirm that being physically active significantly improves low back pain. Keep active and it is has been shown that you experience less pain and avoid worsening of back pain with immobility.
Exercises that strengthen the back and the stomach or core muscles can be effective in speeding recovery. They are also good in helping the back pain from recurring again. Walking, swimming or biking for 30 minutes a day are excellent ways to increase and maintain strength and flexibility of your back.
I have back pain that shoots down my leg. What is that about?
When the focus of our pain is first, the legs and only second, the back – think sciatica. It may be in the leg, but it is due to a problem with a disc between the bones of the spine. The spinal discs are out of place and put pressure on the nerves that run from the spine down to the legs and send a signal of pain. This pain is often sharp or electric.
The management of sciatica is different from the management of mechanical back pain. Sciatica pain with pressure on the spinal nerves needs more medical care than time and exercise alone. Interventional pain management doctors can perform epidural steroid injections that help with back and leg pain from disc and can help us avoid surgery.
Leg pain can also be due to a narrowing of the tunnel that house the nerves of the spine, otherwise known as “spinal canal stenosis”. Often seen in people over the age of 60, spinal stenosis causes a “heavy” or “burning” pain in the legs made worse with walking. Sometimes walking a distance as short as the front door to the driveway to pick up the morning paper causes crippling pain.
Pain from spinal stenosis, like that from disc herniation, can also be helped by epidural steroid injections.
Should I take medicines, and if so which medicines would be best?
The answer to this question is both yes and no.
Yes, take medicines if it helps you keep active. Identify two to three things that you cannot do comfortably because of the back pain. Take the medicines if they help you do these activities more easily. Many of my patients’ goals revolve around walking, working or being more engaged with friends and family.
On the other hand, I do not recommend that you take pain medicines if they don’t actually help with these goals. Taking pain medicines is surprisingly less for pain control itself and more to reduce pain to increase function such as movement like walking, swimming, or even driving. Taking pain medicines 4 times a day without increasing activity neither helps with recovery nor with pain control.
Common types of medicines for back pain include acetaminophen (Tylenol), anti-inflammatories (Aleve, Motrin), muscle relaxants, nerve medicines and opioids or narcotics. Important to know that opioids are not a long term solution for the treatment of back pain caused by sciatica. Click here to learn more about the treatment of sciatica
What are some of the serious types of back pain that you mentioned before? What should I look out for?
Back pain can be painful but is often not necessarily harmful. This is especially true if it is short lived. However, there are times when back pain can be a signal of something more serious. These signs are often called “Red Flags” and prompt immediate attention.
- Sudden changes in bowel or bladder control or numbness in the groin or rectal area are indications of an urgency or emergency and require an appointment with a pain management doctor. This may be a sign of pressure on a spinal nerve that may become irreversible if not treated quickly.
- Back pain that begins with a big fall or car accident or if you have brittle bones with age which is called osteoporosis, may be due to a bone fracture in the spine, otherwise called “vertebral body compression fracture.” This can be helped with a simple surgical procedure. Click here for more about information about this procedure called vertebroplasty or kyphoplasty.
- Back pain with sustained fever, history of IV drug use or immune compromise. This may be a sign of infection in the spine and needs immediate treatment by a pain management doctor.
- Cancer of the spine is a rare condition. Seek medical care with a pain management specialist if you have new back pain with a prior history of cancer, especially of the prostate, breast or lung as these diseases can spread to the bones or the spine. Other subtle symptoms of generalized cancer include unexplained weight loss, fatigue and a constant, unyielding back pain that is worst at night and not helped with laying flat.
Bottom Line: Back pain is one of the most common maladies affecting men and women. Most patients with back pain can be easily treated by a pain management specialist with conservative or non-surgical treatment. Help is available. Please give me a call if you have any additional questions or if you would like to make an appointment.