Low Back Pain? You’re Not Alone
Was man ever really intended to walk upright? Sometimes I wonder when I see so much back pain in my office. I often wish there were something new and miraculous to report about it, because I see so much of it every day. In 2019, low back pain is one of the most frequent reasons people visit the doctor. About 80% of adults experience it at some time in their lives and it can range from a constant dull ache to a sudden sharp sensation that makes it impossible to straighten up or move.
However it comes on, back and neck pain can significantly limit day-to-day function and quality of life. Most of it, however is acute, or short term, and lasts from a few days to a few weeks. Don’t try telling a person who has it that it’s temporary, however. To the person who has it, back pain often feels more serious than it is, especially if it comes on quickly after lifting something heavy or engaging in unaccustomed exercise. And nobody wants to be in pain if they can avoid it.
A medical history and physical exam can usually tell me all I need to know to find the root of a patient’s pain. I ask people about the onset, severity and the duration of the pain, how it interferes with movement, whether they have ever had it before, and any health conditions that might be contributors. In a few instances I resort to imaging studies to rule things out, and in rare cases electrodiagnostics to check for lumbar radiculopathy or pinched nerves.
Luckily, most back pain resolves itself with self-care and isn’t permanent. However, without a medical diagnosis, it’s impossible to tell what’s temporary from what’s going to be chronic.
Because low back pain has so many causes, there are many different ways to treat it. That’s the reason to be evaluated by a board certified pain management specialist who can tell you what the true underlying cause is, and give you some recommendations of how to proceed.
That being said, the way to treat most back pain is through core strengthening exercises. Many people are sorry to hear this, because it means they actually have to DO something, especially when they are already in pain. It’s a good idea to get a cortisone injection to relieve the pain temporarily so you can push yourself further in either a home exercise program or physical therapy. Yoga and Pilates, done correctly, are good choices for core strengthening that also help prevent further deterioration.
But core strengthening doesn’t take place overnight, and a comprehensive plan could also include chiropractic care and decompression. The problem with these two modalities is that their effects don’t last for very long, although the relief can often be immediate.
While you are still in pain and working on your core strengthening as much as you can, various other interventions can be tried, such as epidural steroid injections, medial branch blocks, and radio frequency ablations. Back braces are also helpful when someone is healing from an acute attack.
Back surgery, although heavily marketed as painless and immediate, should only be used as a last resort, because of its cost and potential for complications. First try all other non-surgical options, because I can tell you as an anesthesiologist that anesthesia carries its own set of risks.