Ten Ways to Manage Back Pain

I like this one:
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Ten Ways to Manage Back Pain:

I am a joint replacement surgeon. In the operating room, in a given year I perform over 300 procedures related to joints, arthritis, and injury. In my office, half the patients I see have hip and knee arthritis; the rest have every other joint involved. The most difficult for many physicians to manage is back pain. I know that I am not alone in this.

Back pain has many sources. In general, there are so many experts out there concerning back pain that I am now wholly convinced that no one knows what the heck they are talking about in this entire specialty. One day surgery is good, the next it's bad. The alternative medicine people will extol the virtues of acupuncture to nutrition. Sometimes it works and sometimes it does not. There are more pillows and beds and commercial crap you can buy than there is room in the entire state of Rhode Island.

How can a reasonable person try to help themselves with back pain when the medical specialties are in such disagreement?

Here are a few things that may help you:

1. Be your own best doctor. We often are more discriminating when buying a car than when seeking medical advice. After some period of time, you will know which mix of interventions help more than others. I am often amazed when a patient comes to me and says that they have back pain and have been in physical therapy for 3 years and it does not help. What exactly were they thinking after the first year?


2. Understand the source of your pain. Some people have back pain from a degenerative condition, like arthritis. The joints in the back of the spine can wear and cause pain. Other sources of pain can be from a sudden injury or muscle strain. Sometimes the pain is due to a nerve being irritated by some disc material in the spine. There are even many valid theories that stress causes back pain. If you try to get a handle on the origin of the pain then this is a good place to start.


3. See the right doctor. There are many physicians out there -- family medicine, internal medicine, rheumatologist, orthopaedic surgeon, neurosurgeon, chiropractor, and others -- that have a keen interest in back pain. There are may more from each of these specialties that don’t care as much about back pain. Choose a physician who has back pain high on their list of diseases they want to treat.


4. Do not listen to lawyers. Many patient hurt their back on the job, in a motor vehicle accident, or in a slip and fall. The lawyer you choose may send you to a group of doctors who do every test under the sun and a series of bogus treatments not designed to make you better but to build your legal case. The only time a lawyer refers a case to me is when the first doctor, who was probably in their pocket, messed up the case so much, they actually need a real doctor to bail them out. While it is possible that the doctor your lawyer sends you to is good, ask around; you will probably find otherwise.


5. Understand that there will probably not be one single treatment method that will work on its own. I have generally seen that combinations of drugs, rest, exercise, physical therapy, chiropractic, acupuncture, and more are needed in many situations. While it is important to try a number of these modalities, set a time limit on each of them. If there is no improvement within the first two months from a specific modality, the chances of it helping in the long run are low.


6. Choose your physician or other health professional carefully, then listen to their advice. I can't tell how many patients want their back pain to go away but when I recommend something the patient says that they do not want to do that. For example, I may recommend taking ibuprofen. I will then get the response, "I don't take drugs." Then I may recommend epidural steroids and I hear, "I don't want any injection." Then I send the patient to a chiropractor and I hear, "I don't believe in that." The list goes on. In the end, I am not exactly sure why the patient came to me when EVERY treatment I offered was rejected. This does not mean to accept any treatment blindly and without question. On the contrary, be open to any and all suggestions and try to stay away from biases that carry over from rumors and hearsay. Evaluate each piece of advice with an open mind and then make a decision.


7. Surgery is neither aggressive nor conservative. Surgery has a role in back pain, but not a large role. When properly indicated, surgery will always be a good choice. When not indicated, it is unnecessary and a problem for the patient. Get 2-3 opinions if surgery is recommended.


8. Don't be afraid to take it easy for some time period. You may not be able to return to 10 mile runs for 6-8 weeks. This is not the end of the world. Respect the pain and the injury. If you do not, your back will tell you.


9. Try to return to reasonable activities and work as soon as you are cleared to do this. Too many people stay out of the mainstream of work and this causes a culture of not wanting to get better. If your doctor feels it's safe to return to work in some capacity, then you should do so.


10. Make sure you do all you can to get a real diagnosis. If the doctor was with you for 3 minutes and never laid a hand on you, the diagnosis of back strain is probably wrong. A good history and physical examination is often correct 85-90% of the time. Tests like MRI's should be used to either confirm a diagnosis already known or to distinguish between one or two different diagnoses. Since many people over age 50 have significant findings on their MRI even if these patients do not have back pain, be careful with MRI's not connected to a comprehensive office visit. The finding in the office needs to correlate with any test.

Sometimes back pain goes away as fast as it came on. In some situations it stays longer than you want. Either way, I hope these tips can help you navigate through this problem.

Dr. K.

(WebMD-Ten Ways to Manage Back Pain)
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Some information from the internet

I like to do research for as long as I can stand it (there is a psychological pain that comes about from reading about or talking about my scoliosis). Here is some stuff I've found today:

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Surgery Choices

The main type of surgery for scoliosis involves attaching rods to the spine and performing a spinal fusion, which is used to stabilize and reduce the size of the curve and stop the curve from getting worse by permanently joining the vertebrae into a solid mass of bone.

Other techniques are sometimes used, including instrumentation without fusion, a technique that attaches devices such as metal rods to the spine to stabilize a spinal curve without actually fusing the spine together. This is only done in very young children when a fusion, which stops the growth of the fused part of the spine, is not desirable. The child usually has to wear a brace full-time after having this surgery.

What To Think About

The timing of surgery for scoliosis in children is controversial. Some experts believe that surgery should be delayed until the child is at least 10 years old and preferably 12 because spinal fusion stops the growth of the fused part of the spine. However, the rest of the spine will continue to grow normally in children who are still growing.

Surgical treatment in children and teens usually requires several days in the hospital and limitations on activity for approximately a year. In adults, the average hospital stay is longer.

Adults who have surgery for scoliosis that results from changes in the spine due to aging (degenerative scoliosis) are more likely than children to have significant complications. Even though surgery usually reduces their pain, other complications may occur, such as pseudoarthrosis and wound infections.

(WebMD-Scoliosis-Surgery)

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Should I have surgery for Scoliosis?

Introduction:

Surgery for scoliosis is only done to correct severe spinal curves. Most cases of scoliosis are not severe and do not require surgery. Consider the following when making your decision on whether you or your child should have surgery for scoliosis:

• If your spinal curve is less than 25 degrees, have it examined by a doctor every 4 to 6 months to see whether the curve is getting worse. Treatment is not necessary.
  (this is the category I fell into when I was in high school)
  
• If your spinal curve is between 25 and 45 degrees, treatment may be necessary and may involve bracing. Bracing is usually effective in preventing a spinal curve from getting worse, but it cannot correct a curve. Bracing will not help an adult's scoliosis. (this is the category I fall now. As I have told people, bracing will no longer help me.)
  
• If your child has a spinal curve greater than 45 degrees, or if you have a spinal curve greater than 50 degrees, and the curve is getting worse, surgery may be considered.

Medical Information:

What is scoliosis?

Scoliosis is a condition in which the spine curves abnormally from side to side, rather than being straight. The spine may also be twisted (rotated). Scoliosis involves spinal curves, greater than 10 degrees, that are usually S-shaped or C-shaped.

Scoliosis occurs most often in girls who are 10 to 16 years old. In the general population, about 1 in 100 people (1%) have some type of scoliosis.¹

See an illustration of scoliosis.

What kind of surgery is done for scoliosis?

The main type of surgery for scoliosis is a spinal fusion. In this procedure, the curved part of the backbone is straightened with rods, wires, hooks, or screws. Then small pieces of bone are put over the spine. These pieces of bone will grow together with the spine, fusing it into proper position.

Instrumentation without fusion is a technique in which metal rods are attached to the spine to stabilize a spinal curve without fusing the vertebrae together. This is only done in small children when fusion of the spine, which stops growth in that area of the spine, is not desirable. The child usually has to wear a brace full-time after having this surgery.

What are the risks of surgery for scoliosis?

New problems that could develop from surgery for scoliosis include the following:

• Problems associated with back surgery, such as nerve damage, lung problems, or spinal cord damage.
• In a child, spinal fusion will stop growth in the area of the spine that is fused.
• General complications from surgery, such as blood clots or infection or complications from anesthesia. The risk of these complications is higher in older adults.

Talk to your doctor about your or your child's chances of developing problems from surgery.

Other problems include lost time at work or school for recovery and the possible need to wear a body cast or brace for a few months after surgery.

What are the risks of not having surgery for scoliosis?

A severe spinal curve that is progressing and is not treated with surgery is likely to get worse.

As scoliosis gets worse, the bones of the spine rotate toward the inner part of the curve. If the upper part of the spine is affected (thoracic curve), the ribs may crowd together on one side of the body and become widely separated on the other side. The curve may force the space between the spinal bones to narrow. The spinal bones may also become thicker on the outer edge of the curve.

In severe curves, the misshapen ribs may reduce the amount of air the lungs can hold and may cause the heart to work harder to pump blood through the compressed lung tissue. Over time, this may lead to heart failure.

Scoliosis that is present at birth or that develops in infants may be worse in the long run than scoliosis that develops later in life. If an infant or young child with a severe spinal curve does not have surgery, it is likely that the spinal curve will get worse. This is because the more growing the skeleton has to do, the worse the curve may become.

How effective is surgery for scoliosis?

Surgery for scoliosis effectively prevents further curvature of the spine and usually can make the curvature less severe. Surgery may also help decrease pain and allow people with scoliosis to do more daily activities than they would otherwise.

Each person who has scoliosis is different. Talk to your doctor about what impact surgery for scoliosis is likely to have on you.

Wise Health Decision:

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about surgery for scoliosis. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

Does scoliosis have a major impact on your life?	Yes	No	Unsure
Do you (or your child) have scoliosis caused by an underlying factor that can be treated?	Yes	No	Unsure
If you (or your child) have a severe spinal curve, do you want to wait to see if it progresses?	Yes	No	Unsure
Do you have a spinal curve greater than 50 degrees that is progressing?	Yes	No	NA*
Does your child have a spinal curve greater than 45 degrees that is progressing?	Yes	No	NA
Do you (or your child) have a spinal curve less than 25 degrees?	Yes	No	NA
Are you comfortable with having surgery?	Yes	No	Unsure
Does your home or work situation allow you to take the time necessary to recover after surgery?	Yes	No	Unsure
Has bracing or another treatment for scoliosis been effective?	Yes	No	NA
Do you (or your child) have severe scoliosis that is irreversible and caused by a disease or an unknown factor?	Yes	No	NA

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to have or not have surgery for scoliosis.

Check the box below that represents your overall impression about your decision.

Leaning toward having surgery

Leaning toward NOT having surgery

Yes

(WebMD-Should I (or my child) have surgery for scoliosis?)

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If I come up with more later, I'll post it.