The Problem of Back Pain
By Dr. Jeff Phelps
Orthopedic Spine Surgeon
Spine Works Institute
Back pain is one of the most prevalent problems in society today. It is estimated that approximately 40% of the American population at any given time suffers from back pain. In terms of visits to a person’s primary care doctor, it is the second most common reason for a visit, second only to a cold. Back pain is the most common cause of missed work days in the United States and is estimated to cause billions of dollars worth of lost man hours.
One of the most important things that I stress to people is back pain is not a diagnosis but a symptom. In order to treat back pain one must have to understand what causes back pain. You can simplify your spine into two main structures. The first structure is the disc. The disc is the cartilage that is between the bones of our spine that offers cushioning between the bones. The other major component of the spine is the facet joints or knuckles of the spine. These knuckles act as joints between the bones that allow us to bend and twist and rotate. If either one of these structures become degenerated or otherwise injured it can cause pain. Disc’s can degenerate and lose their normal sponginess and cause inflammation. The facet joints or knuckles of the back can also get arthritic and develop pain.
Diagnosis of what is causing the pain can be done in a number of ways. Most of the time the best source of information is simply talking to a patient. Determining what causes the pain to get worse, what causes the pain to get better, what starts the pain and how the pain acts can often lead us to what is causing the pain. Obviously x-rays can also help us determine where the problem exists. MRI’s today have the ability to show us images that are far superior to anything in the past, and they too can also lead us to where a problem exists.
Once we know what is causing the problem then you can start trying to take care of the problem. As in most things in life usually the simplest things are always the best things to try first. The good news about back pain is that within the first to six weeks over 90% of back pain resolves on its own. Simple rest, heat, ice, or anti-inflammatory medication can alleviate most of the symptoms. It is important to know that long periods of bed rest can actually makes the problem worse. Maintaining a good activity level generally lessens the amount of time that someone suffers from back pain.
Anti-inflammatory medicines, such as Advil or Aleve, generally are very helpful in helping to alleviate the pain and inflammation that is associated with a back injury. Oftentimes I get asked which is better, heat or ice, and generally the answer is heat seems to alleviate most of the patients symptoms a little bit better than ice and I think that’s generally related to the fact that it prevents muscle spasms, which also cause pain and discomfort. Physical therapy is an extremely important modality that is often overlooked and really not utilized often enough. Treatments such as ultrasound, heat, gentle massage and CORE exercises can go along way in alleviating discomfort and pain of a back injury.
Sometimes, the pain does not go away as quick as we would like or it persists beyond six weeks and sometimes other treatments are necessary. Again, the easiest treatments are usually always the best. Things such as steroid injections placed into the back can alleviate and sometimes cure the pain. Stronger pain medicines can sometimes be employed as well as specialized techniques to deaden and stop the nerve from causing pain are utilized. Very rarely is any type of surgery necessary but in patients who have intractable back pain who have tried all the easy things first are sometimes candidates for surgery. With the advent of minimally invasive surgeries we are able to treat the patients with much less discomfort and patients require a shorter hospital stay than ever before.
In summary, back pain is certainly a prevalent problem in our country but the good news is it is often always able to be treated with simple medications, physical therapy and gentle exercise. When the problem persists its best to visit a spine specialist who can diagnose the problem and get you quickly back to your life.
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