Back in Action
The best ways to put pain in reverse and get back in the game
Maybe it started with a car wreck. Perhaps a hard basketball game (hope your team won). Maybe you fell. Perhaps it’s come on gradually, thanks to spinal arthritis or a degenerating disc. Your back pain has you beat. What to do?
Once you’ve decided you can’t tough it out anymore, a thorough physical exam by your primary care doctor or orthopedist, along with an X-ray or MRI if needed, can help determine if you have a strained muscle, pinched nerve or a neurological problem, says Dr. Raj Sureja, board-certified interventional pain management physician with the Orthopaedic and Spine Center in Newport News.
Likely, your doctor will take a tiered approach to get you better. The first line of defense will be over-the-counter anti-inflammatory drugs and conservative pain management to include physical therapy, heat and possibly medication, Sureja says. (If it’s a neurological problem, more treatment will be called for.)
You’ll also be advised to rest—but that doesn’t mean taking to your bed, he says. Light physical activity is a good idea.
“Bed rest is no longer recommended,” Sureja says. “With bed rest, the muscles that support the spine end up becoming weaker. Once you become better, you have a higher chance of re-injuring yourself. Don’t go building your new porch that weekend, packing up to move, putting in bushes or flowers or any activity you can put off for a little while. But stay active—just do the things around the house that you need to do as long as they’re not too taxing.”
You may need to modify how you do certain activities, he says. For example, you may be advised to bend at your knees rather than at your waist.
If you and your doctor don’t see significant improvement in one to two weeks, the second phase of treatment can include muscle relaxers, stronger pain medication, stronger anti-inflammatory medicine and structured physical therapy, Sureja says.
Although your pain meds may include short-term use of narcotics so you can tolerate physical therapy and your daily activities, the goal is to avoid long-term use of narcotics, Sureja says. Your physical therapy likely will include education on how to prevent injuring your back again.
If you’re not seeing improvement in two to six weeks, you might be a candidate for diagnostic injections, Sureja says. These injections will block the pain in certain parts of your back and are intended to help your physician determine where the pain is coming from, he says.
Based on what the doctor learns with the diagnostic injections, you will likely get therapeutic cortisone injections to help relieve your pain.
If these treatments don’t provide relief, you may be a candidate for surgery including removal of a herniated disc or removal of a part of the vertebrae that is pressing on a nerve.
A surgeon also can implant a spinal cord stimulator adjacent to your spine, he says. This device, which is similar to a pacemaker, blocks pain signals from reaching your brain, he says. You would test a temporary device, with a wire going through your skin to a battery pack you wear, first for about a week to see if it works for you, Sureja says.
Surgeons also can perform surgery to help restore a collapsed vertebrae by inserting a special balloon, inflating it, then filling the area with a cement-like material to restore the vertebrae closer to its normal height, he says. The procedure is minimally invasive and is performed under X-ray, he says.
“It used to be the only thing we could do in pain management was prescribe narcotics,” he says. “There’s a great deal more to the field now—we can diagnose and treat the pain instead of masking it. Our goal now is to diagnose the pain generator, treat it and get people off medication as quickly as possible.”