Monday, May 9, 2011

WELCOME TO THE BACK PAIN INDUSTRIAL COMPLEX



Back pain is a billion dollar problem. Treatment of back pain is a billion dollar industry. Patients have a myriad of choices. There are countless medications, devices, therapies and doctors or therapists of all stripes willing to take your money in an effort to make you better-- or at least make your wallet lighter. Patients often don't know where to begin. It’s very difficult to find answers because there is not a "standard" for treating back pain. Treatment depends on what the problem is, who is giving the advice and who is paying for treatment. What do I mean?  Well, the back is made up of muscles, ligaments, tendons, bones, joints, nerves and discs. Any of these can cause pain. The type of pain and location of this pain are often the same for different pain generators. This explains why so many MRI's are ordered in the U.S. We are always trying to find the source of the problem. Unfortunately, that is not always easy to find when everything looks arthritic or degenerated. The treating provider is important, because everyone has an interest in treating back pain the way they were trained to treat it. Chiropractors think manipulation works best. Physical therapists think therapy works best. Interventionalists think injections/minimally invasive surgeries work best. Surgeons think fusions/decompressions work best. Everyone has studies and evidence to back up their claims. Everyone has a car/house payment to meet.

Where does that leave the average Joe/Jo Ann with new or chronic back pain? Confused.  Let’s see if I can clarify things with some rules to live by.

1. New back pain should be treated very carefully so it doesn't become chronic. Don't ignore the pain. If lifting makes it worse, STOP! You have an injury and need to treat it accordingly.  If you have to lift more than 20 lbs. as part of your job, understand that you are probably making your problem worse by ignoring it and continuing to work. Eventually it will force you to stop working and the problem will be more difficult to treat.

2. First work on the problems you can fix. This means lose weight if you are overweight. Use good posture at work or at the computer. Strengthen your core muscles, but don't do sit ups/crunches. Stop smoking. Don't stay in bed, get out and try to walk if you can.


3. If the pain is still there after a couple of weeks see your doctor or spine pain specialist. Who is a spine pain specialist? They come in various makes and models. Chiropractors, Interventionalists (like me), Surgeons and some Therapists.  Chiropractors or Therapists are often a good place to start because back pain will usually go away on its own and these providers can help it to resolve faster. When to seek additional care?  When the problem is not going away after several weeks/months or the pain is so severe you can't participate in therapy. If this is the case, see a Spine Interventionalist who uses the least invasive methods possible, but is still adept at knowing when to send something on to a surgeon if required. Surgery is needed for the most severe problems that are not responding to more conservative treatment. The good news is that less invasive treatments than traditional spine surgery are coming out all the time and fewer surgeries need to be done.