How to treat Back Pain

Majority of the back pain sufferers are managed by their primary care physician who will treat them for a while with medications until the situation becomes chronic and then the patient is sent to the spine surgeon.

However this approach is flawed as the outcome data from large number of patients proves this approach with poor outcomes for a great majority. Instead we know that chronic back pain treatment by a specialist who is trained to manage spinal issues is the appropriate next step.

Scientific data is not very promising when it comes to treating back pain with surgery as the outcomes have been poor with at best 50-50 chances of improvement.  In many cases patients back pain worsens after the surgery and other issues emerge in addition to the underlying pain complaints.  On the contrary if spinal structures are kept intact and the pain is treated by avoiding surgery patients do better, especially if the focus is to improve the function of patients.

Spinal surgery has a unique indication when neural structures are compromised and or instability of the bony structure puts a patient at risk of being neurologically compromised potentially. In these scenarios neurosurgical intervention must be provided. However if the goal of neurosurgery is to improve back pain while the aforementioned indications are not there the outcome is less than satisfactory. These patients instead of being surgically treated should be referred to a multidisciplinary pain management specialist.

Multidisciplinary treatment for chronic back pain is delivered by way of treating the whole person with medications, physical therapy, psychological interventions and minimally invasive procedures

Medications such as neuro-modulators ie cymbalta, gabapentin and lyrica etc.; muscle relaxants ie flexeril or zanaflex etc., anti-inflamatory medications ie Diclofenec etc. are used. In difficult case when needed strong pain killers such as tramadol, codeine, vicodin, oxycodone or buprenorphine can be utilized with caution and appropriate monitoring along with counseling. Nonetheless, these medications carry a whole host of their own side effects and complications most dreaded of all addiction and abuse leading. Poor judgment in prescribing these in the past has lead to an epidemic of these ugly outcomes. Therefore, only the multidisciplinary umbrella of care is the right place where the patient can be monitored on routine bases and swift interventions can be deployed if red-flags are raised.

Physical therapy focuses on preventing further deterioration by strengthening and or balancing muscle strength and also by preventing further injury. This is achieved by improved range of motion an outcome of balancing the strength of opposite muscle groups. This correction/strengthening in some cases can also provide pain relief but that is not the ultimate objective of physical therapy.

Psychological interventions include introducing relaxation techniques, imagery, cognitive behavioral therapy and progressive relaxation techniques along with counseling and other behavioral modifications to improve coping capacity. This can ultimately decrease the frustration and can improve the ability to cope with the chronic pain burden.

If recommended by the treating physician there are a variety of interventions that can be offered based on the disease process. To name a few minimally invasive procedures for chronic pain can range from trigger point injections to minimally invasive spinal decompression by way of MILDS® procedure or Vertiflex® procedure along with neuro-modulation by stimulating the dorsal root ganglion over the dorsal column.  Additionally intra-thecal pump therapy can deliver medication to the spine and a variety of medications and their combinations are available to tackle nearly all kinds of chronic pain issues.  These medications include deep sea snail venom called Prialt®, morphine, baclofen, bupivacaine and many others.

During initial consultation the physician gets to know the patient’s unique health history and features of their complaints and a rough road map of treatment plan is discussed.

Deeper understanding of patients condition comes to surface over time as the response to variety of interventions is reviewed. This further helps the physician optimize patient’s care ultimately developing a treatment plan unique to each patient wit maximum benefit.

Goal is to improve pain while maximizing the function and the ability to perform activities of daily living.