Back in Action
Don’t suffer in silence—get relief from chronic pain
Maybe it started with yard work. Or a bad move during a softball or basketball game. You don’t have to suffer with debilitating back pain. The goal of pain management is to correctly diagnose your pain and then treat it with the most conservative means possible, says Dr. Raj Sureja, interventional pain management specialist at the Orthopaedic and Spine Center in Newport News.
“One goal of pain management is to diagnose and treat the pain generator to improve the use of potentially harmful pain medications,” Sureja says. “Then we want to not only reduce pain, but improve function. We want patients to be able to go back to work so they can support their families and return to a normal activity level with improvement in their quality of life.”
The first step will be to ensure the back pain is not neurological, Sureja says. If neurological issues are suspected, your doctor may obtain X-rays. Symptoms of nerve-related pain include bladder or bowel dysfunction (so don’t be too embarrassed to mention it) as well as sensory loss and/or weakness in the arms or legs. Once that possibility has been eliminated, your doctor will begin with the most conservative treatment, stepping up as needed if conservative treatment doesn’t bring you relief.
While your pain may make it tempting to stay in bed or on the couch, your physician will want you to continue with everyday activities. Years ago, the first treatment for back pain often was bed rest, Sureja says. But bed rest has been found not only to result in no improvement in function, but also to lead to weakening of muscles, he says.
But proceeding directly to invasive treatment such as surgery is not a good idea either. “We explain to patients the natural progression of back injuries and explain that the more conservative treatment efforts provide more long-lasting gain than jumping to more aggressive treatment right away,” he says. “In general, most acute back pain does get better within two to six weeks.”
Your physician might first prescribe muscle relaxers to lessen back spasms and prescribe anti-inflammatory medication to help reduce inflammation and pain, Sureja says. When your back is hurting, you’ll avoid certain movements—movements that might be essential in physical therapy. The goal is to get your pain sufficiently under control so you can tolerate physical therapy, which will further aid your recovery, he says.
“What you’re doing with physical therapy is not only restoring the range of motion, but also strengthening the muscles that support the spine,” he says. “More support takes the pressure off the soft tissues of the spine that could be contributing to the pain.”
In addition to physical therapy, your doctor may prescribe electric nerve stimulation and heat therapy, Sureja says.
“From this point, either the patient will get better or the pain will continue to get worse and may require a consultation either with a neurologic surgeon or an orthopedic spine specialist,” he says.
If the pain doesn’t get better, your doctor may prescribe stronger pain medications such as narcotic pain medicine or topical anti-inflammatories as well as topical treatments to reduce pain. Sureja may refer patients to a chiropractor for additional treatment. He also may suggest a back brace to be worn several hours a day for a few weeks to a few months to support painful muscles and joints in the spine. Sureja may encourage patients to seek out alternative treatments such as biofeedback or acupuncture.
If after a few months these treatments bring no relief, your doctor may order a CT scan or MRI to evaluate for a pinched nerve, herniated disc, degenerative disc disease, or narrowing of the spinal canal (spinal stenosis), Sureja says.
The next step in treatment might be trigger point injections to break up muscle spasms, he says. If the joints between the vertebrae (called facet joints) are arthritic and inflamed, a doctor might order facet joint injections to relieve that pain.
If injections don’t provide long-term relief, your doctor might perform what’s called a diagnostic medial branch nerve block, blocking the pain for different facet joints to determine which one is causing your back pain, Sureja says. Once the problem joint has been identified, the doctor could perform a procedure called a radio frequency ablation to cauterize the nerve sending the pain signals and bring you relief.
For herniated/degenerate dics or pinched nerves, lumbar epidurals also can provide significant pain relief lasting from three months to up to three years, Sureja says.
Don’t suffer in silence. Get help for your back pain.