As many of us know, back pain is a common and annoying problem. A majority of adults will have at least one episode of back pain in their life – “throwing out” of the back. Thankfully, in a majority of cases, this improves with a little TLC and time. Unfortunately with some patients, the back pain can become a burden, and potentially life-changing.
The back is a unique area of our body. It is the joining of the upper body with the pelvis and legs, and has stresses and strains that can be more than the back was ‘designed’ for. Additionally, many of us have low back problems that run in the family – and although the genetics have not been formally elicited, these patients can have a particular susceptibility to injury. Injury is another cause of back pain, as is arthritis associated with overuse and old age. Understanding the nature of your back pain, and possibly what may have caused it is sometimes the first step in managing and treating the condition.
The symptoms of back pain are fairly straightforward – in fact, if you are reading this you most likely can identify! The location of the pain is important, as back pain in general can refer to any aspect of the back. Typical ‘back pain’ usually refers to lower back pain in the small of one’s back, just above the buttocks. The type of pain can range from a severe pain to a dull ache. It often gets worse or better depending on activity or exercise. It is important to get a sense of the possible cause (or what you were doing when it started), as well as understanding and communicating with your physician if the pain has changed, and how it has changed. Lastly, back pain can be an isolated event that improves with time (e.g.: six weeks), or episodic, pain that tends to recur perhaps once or several times per year. Occasionally, back pain doesn’t resolve (‘chronic back pain’) and these types of patients are understandably the most frustrated.
When back pain first appears, knowing your body is as important as knowing the history of the pain. Ask yourself the following questions before preparing to see your physician
- Is it just pain in the back?
- Where in your back?
- What makes this pain better or worse?
- Does the pain travel down your legs and when does this occur?
- Is there numbness, pins or needles, or weakness in your legs and/or feet?
- Are there unusual symptoms such as changes in your bowel or bladder?
Back pain from moving a sofa without symptoms in your legs that immediately starts to improve with a change in activity (such as stopping) is often very reassuring. On the other end of the spectrum, back pain that starts with changes in your bowel or bladder is an emergency. Initial treatment may be reduced activity and perhaps anti-inflammatory medications, with other types of symptoms requiring more immediate diagnosis and/or treatment. Evaluation in your local emergency department for significant pain, new numbness or weakness of the bowel and bladder should be considered immediately if these or other worrisome symptoms appear.
General treatment and expectations vary from patient to patient, and physician to physician. After evaluation by a physician, the initial plan of care often includes reduced or altered activity, anti-inflammatory, physical therapy or other modalities including, but not limited to ice, heat or chiropractic. Each care plan is designed by your physician with you in mind, varying from patient to patient. Occasionally, narcotic pain medications or muscle relaxants can help with the initial pain, and a short course of steroids may be prescribed. Additionally, for persistent pain, epidural steroid injections or other more invasive pain procedures can be considered after evaluation by a spinal surgeon. If the pain persists, imaging such as an x-ray or MRI may be considered. It is important to have your physician help interpret the results of your MRI with you; different findings have different meanings in different patients. It can be worrisome to have results that might state ‘multiple disk herniations’ and correlating your symptoms and physical exam to the imaging results carries significantly more weight and importance than the reading alone.
While most low back pain resolves with time, patients may require surgical consideration. Only a spinal surgeon will be able to outline whether you are a surgical candidate, and what option(s) you might have. Spinal surgery has evolved significantly in the last decade to become less invasive and more technologically savvy in some cases. Laser surgery, endoscopic surgery and ‘percutaneous’ surgery (with very small incisions) are all considered as options by your surgeon, along with more traditional, time-tested approaches to surgical intervention. It is important to recognize not all patients are surgical candidates, nor will all surgical patients have resolution of their symptoms.
Regardless of the cause, diagnosis and treatment, patients with low back pain have hope and reassurance there are many options available. Your primary care physician is the best resource for the initial diagnosis and management of back pain. If surgical consideration is needed, the spine specialists at Emory are available for consultation.
Do you have more questions about your back pain or need help selecting a physician?
About Dr. Mason
Dr. Mason offers a comprehensive and complete neurosurgery line with a patient-centered, multidisciplinary approach. He specializes in conservative case management and forward-thinking evidence-based treatments. His research interests include cerebrovascular disease and treatment, stroke outcomes and atypical variants of aneurysms, such as mycotic- and pseudo-aneurysms. Dolichoectasia of the cerebral vasculature is also of particular interest.
Dr. Mason is a Diplomat of the American Board of Neurological Surgeons. He is an active member of the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS). He has been an invited contributing editor of World Neurosurgery and Neurosurgery.