Back Pain
Consumer
How to
UNDERSTAND
BACK PAIN
Most Americans will experience
significant back pain at some point
during their lives.
Back pain is the second most com-
mon reason for people to seek med-
ical attention. It is the second most
common neurological ailment, sec-
ondary only to headache. Back pain
hurts America.
There are many causes of back
pain. Most are not serious; however,
some forms can herald sinister possi-
bilities.
SERIOUS CONCERNS:
• Tumors can result in back pain either
by compressing nerves or destroying
bone and surrounding tissue. Tumors
can be benign or malignant.
• Infections involving the spine cause
serious pain. They can occur in asso-
ciation with diabetes and obesity.
Such infections generally require, at
minimum, weeks of careful expertly
guided antibiotic therapy. Some
cases will require surgery.
• Fractures can either occur as a result
of trauma or even spontaneously in
the elderly and osteoporotic.
• Cauda equina syndrome refers to a
condition wherein the lower lumbar
and sacral nerves are severely com-
pressed. This can result in severe
pain, weakness, and trouble control-
ling bowels and urine.
• Nerve pain, often referred to as "sci-
atica", is a condition wherein some
type of structural change causes pres-
sure upon one or more of the nerve
roots that supplies the muscles and
sensation to the legs. A variety of
degenerative conditions may result in
this type of pain including degenerat-
ed discs, cysts or other "wear and
tear" conditions.
Muscle and ligaments are common
causes of back pain. Often referred to
as back strain or back sprain, this
accounts for the most common cause
of minor back pain in America.
Bones are a more unusual cause of
back pain. Usually in the context of
14 HOW TO GUIDE
fractures, but also associated with the
muscular and ligamentous strain of
abnormal curvatures (scoliosis,
kyphosis, lordosis, etc.), bone-related
problems can cause pain. Severe
injuries can result in fractures as can
minor injuries later in life, particular-
ly in the elderly and osteoporotic.
TREATMENT OPTIONS:
Every American should develop
their own back brace – made of strong
muscle and ligament. Decondition-
ing is a common theme in the orches-
tration of recurring back pain, often
harmonized with overweight, smok-
ing and general lack of exercise.
Creating a sound muscular back
brace does not require signing up for
boot camp or joining a local exercise
group. Simple lifestyle changes such
as taking short, frequent walks
throughout the day and losing weight
will almost always make significant
differences.
The old adage of bedrest, especial-
ly for more than a couple days, may
actually be far more harmful than ben-
eficial. Many other fads in the treat-
ment of back pain have come and
gone over the past decades. Gentle
strengthening, weight loss and stop-
ping smoking are the absolute
requirements of treating almost any
back pain.
Physical Therapy and Chiropractic
can also play important roles in treat-
ing back pain.
Oral medications are also common-
ly used to help patients get through
acute, and sometimes chronic, back
pain. Over-the-counter pain relievers
are often used. More powerful med-
ications, requiring a prescription, can
be used — however, care should be
exercised to avoid prolonged use, if
possible.
These medications include both
pain modulating medications as well
as steroids that can reduce the inflam-
mation and/or irritation of affected
nerves.
Strong medications can also be
delivered directly to compressed
nerves or to nerves responsible for
long-term pain. This can be done
with single injection or can even be
accomplished continuously with
externally located or surgically
implanted pumps. Single injection is
often useful if pain is severe and there
is a reasonable hope that the pain may
resolve with time. These injections
can also be useful diagnostically.
Continuous pumps are generally used
to treat severe pain associated with
cancer. A significant advantage of
delivering medications directly to the
nerves is that side effects are marked-
ly lessened. Medications that can be
delivered include pain medication
and steroids that reduce the inflamma-
tion and irritation on individual
nerves.
Surgery should be reserved for sit-
uations wherein there is not a reason-
able chance that the pain will resolve
with more conservative measures.
Generally, a trial of conservative ther-
apy should be attempted.
Neurosurgeons, trained in the eval-
uation and treatment of severe pain
caused by compromised nerves, can
assist with the evaluation and
treatment
of
severe
pain.
Neurosurgeons can also recommend
additional non-surgical measures or
counsel regarding what options
should be contemplated if surgery is
considered.
If you have back pain and/or pain,
numbness, tingling or weakness that
seems to radiate down your arms or
legs, you should seek an evaluation by
a medical professional trained in diag-
nosing and treating pain associated
with the spine and nerves.
For more information under-
standing back pain, contact
Neurospine of Aberdeen, Dr.
Charles Miller and Dr. Jay J.
Schindler (605) 225-1133.