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Back Pain Causes And Treatments

Dr. Daniel Silver - Silver Orthopedics November 30, 2017

We've all had it and would like to know what's causing it and how get rid of it. I'm of course talking about BACK PAIN.

Back pain presents in a variety of ways and to different degrees from mild to severe. I can last minutes to days, weeks, and years in some cases. Today I will lay out the various causes, some of the anatomy, and treatments.

Back pain that remains just in the back can be caused by poor muscle strength, minor injury, sprain and strain, and /or degenerative discs. The more serious causes back pain usually radiate into the butt, thigh, leg, and foot. Rarely, back pain is a presenting symptom of prostate and other forms of cancer. Each of these causes of back pain needs to analyzed and treated specifically.

Diagnostic methods have improved over the last 40 years that I have been practicing orthopedic surgery. When I first entered practice MRIs were just starting to be used. Prior to that, myelograms were used. Dye was injected into the spine occasionally with some complication. Now the high quality MRI is so detailed and non-invasive that accuracy is great and there are no complications. There is not even radiation exposure because the study only involves a large powerful magnet and ultrasound. Details of discs, nerves, bones, and inflammation are seen readily. When back pain is present for at least 4-6 weeks I will order an MRI. Once I have an accurate diagnosis treatment can progress.

Examples of treatment for mild sprain and strain of muscles is to order muscle relaxants pain medicine and physical therapy. Stretching type exercises also are helpful. In overweight patients weight loss is recommended. Usually, within three to four months this type of back pain goes away. Maintaining a stretching and strengthening program should keep the back pain away.

In more serious back pain diagnosed clinically and by MRI, the diagnosis is usually a combination of herniated disc (herniated nucleus pulposus or HNP) and degenerated discs and joints. These conditions usually require several weeks to months of treatments. Treatment starts out conservatively with medicine for inflammation, pain, muscle relaxation, and sleep. Physical therapy is ordered and performed two to three times per week using massage, ultra-sound, electrical stimulation, and various chiropractor techniques. Trigger point injections are also quite effective. Acupuncture is also used with some success.

If, however, pain persists and especially if there is a lot of leg pain, numbness, tingling, and weakness; more invasive measures are required. First, epidural steroid injection should be tried even if the disc is herniated and pressing on the nerves. There can be quite a bit of relief from these injections. Second, if there is no benefit from all conservative treats and epidurals, then micro-discectomy is recommended. If there is instability of the spine at the level or levels operated a more extensive operation is required called a fusion. A very low percentage of back pain requires surgery, and an even lower requires fusion.

Certainly, back pain is common and has to be dealt with. If you go to a reputable doctor initially orthopedic surgeon or chiropractor, the most conservative treatments will be tried first and only as a last resort will invasive treatments like epidural injections or surgery be recommended. The worst thing you can do if you do have back pain is to ignore it. Talk to you next time.

If you have questions or need some advice, contact Dan Silver, M.D. at 818 784-9593 or