Breaking the back pain cycle

Providence orthopedic spine surgeon J. Rafe Sales, M.D, P.C., presented a community forum on treating back pain at Providence St. Vincent Medical Center in November 2011. If you missed it, here is an overview of some of the key points of Dr. Sales’ talk.

Of all the reasons why people go to the doctor, back pain is second only to the common cold. Genetics, stressful jobs and lifestyles, poor posture and body mechanics, weak muscles, and extra pounds set most of us up for back problems sooner or later.

Pain in the neck or low back can launch a self-perpetuating cycle: the back problem is painful when we move, so we stop moving, which leads to stiffness and muscle weakness, which makes the problem worse, which increases the pain, which restricts our movement even further, and so on. Although about 80 percent of back problems eventually improve on their own, getting stuck in this cycle can slow healing significantly. The goal of most treatments is to break the pain cycle so healing can begin.

Starting conservatively

Whether back problems are caused by injuries to disks (the pads between the vertebrae) or by arthritis (the normal wear and tear on the spine that happens to just about everybody with age), physicians today have some great tools for relieving pain without surgery.

Medications can relieve pain in a variety of ways:

  • Anti-inflammatory medications reduce inflammation, which can improve pain significantly
  • Anti-depressants have been found to work very well for relieving back pain for some patients
  • Anti-seizure drugs can provide relief from pain in the arms and legs caused by nerve compression or nerve irritation
  • Oral or epidural (injected) steroids are another very effective approach to settling down inflammation and relieving pain caused by nerve compression or nerve irritation

If these approaches aren’t successful, a visit to a pain specialist may be recommended – new medicines are being introduced all the time that approach pain in different ways.

Once pain is under better control, physical therapy, chiropractic care or a combination of the two can help many people get moving again safely. Walking, stretching and strengthening exercises are often prescribed to build strength and flexibility in the core muscles that support the spine. Improved strength and flexibility can relieve many back problems and prevent future recurrences.

Surgical solutions

Most back problems respond well to conservative treatment. But for pain that is severe, unrelenting, and accompanied by weakness, numbness or tingling in the arms or legs, or serious complications such as bladder or bowel issues, surgery may be necessary.

Spine surgery is used for two main purposes:

  • Decompression, which takes the pressure off of a nerve by removing the disk or bone that is pressing on it
  • Fusion, which joins two or more vertebrae with screws or rods to stabilize an unstable part of the spine

The traditional methods of performing these surgeries have improved over the years, yielding better results with shorter hospital stays. Providence surgeons also are using newer, less-invasive techniques, such as minimally invasive spine surgeries, with great results. These procedures require smaller incisions, which often results in patients experiencing less pain and quicker recoveries.

In most cases, once the physical problem has been corrected, the worst of the pain resolves and the spine can get on with the business of healing. In some cases, though, pain continues. The term “failed back surgery syndrome” has been used to describe such cases, but that’s not meant to imply that no further treatment will help. The cause of the ongoing pain can often be diagnosed leading to successful treatment. Watch for more on this subject in a future issue of To Your Health.

A new option for unrelenting pain: spinal cord stimulators

In cases of long-term intractable pain that can’t be relieved through conservative or standard surgical treatments, implantation of a spinal cord stimulator is an option that offers wonderful relief for many people. This is a very exciting breakthrough for people living with debilitating pain from severe nerve injuries, failed back surgery syndrome, arterial insufficiency and other complex issues.

In a trial phase, the stimulators – paddles that conduct electrical impulses – are placed along the spinal cord near the nerves that are causing the pain. Patients control the intensity of the impulses to find the right comfort level. If pain is reduced by at least 50 percent after wearing the stimulators for a few days, a surgical procedure can be done to permanently implant the device.

While spinal cord stimulation does not eliminate the underlying problem, it can effectively mask pain for many people who thought they were out of options, making life much more livable. About 47 percent of people who try spinal cord stimulation – including Hulk Hogan – report pain relief of 50 percent or greater. For 30 to 40 percent, pain relief is so great that they can return to work, which can be pretty amazing after living in pain for years.

The last word: don’t give up

If you are stuck in the back pain cycle, talk to your primary care doctor. If you have tried one or two things, ask if there is something else you can try. If you have had back surgery and are still experiencing pain, ask for a new, thorough workup to determine the cause. As you’ve just read, there are a lot of options out there, and new therapies and surgical techniques are being developed every day. For the vast majority of people, the cycle of pain can be broken so healing can begin.

Read more about back pain.

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J. Rafe Sales, M.D, P.C., is an orthopedic spine surgeon with Providence Spine Services and is the director of The Summit Spine Institute.