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June 8, 2015
Back pain is something most of us can relate to at some point in our lives. Some studies show 60 to 80 percent of us will have at least one incident of low back pain. In fact, low back pain is the leading compensable cause of injury in the workplace in the United States.
Ask anyone who has a back that hurts, and oftentimes you'll see misery on their faces. Indeed, about $25 billion a year is spent on the evaluation and treatment of people with this condition.
For physicians and patients alike, low back pain can be an unsolvable problem. Better knowledge of the condition, treatment options and realistic goals are evolving as our understanding increases. I hope this article sheds some light for those who have direct or indirect experience.
Usually, back pain has a short course. Typically, 95 percent of sufferers get better within three months and are back to normal. It is the other 5 percent who account for 85 percent of treatment. Note, too, that the longer an individual is away from his workplace due to back pain, the lesser the chances he'll be able to return to work. This is why physicians try to get people back to a productive lifestyle.
What causes back pain? Why does my back hurt all the time, especially at the end of the day? Why does my back hurt worse now that I am older? These are classic questions we hear in our office. Unfortunately, the answers aren't always clear.
Back pain can be due to a referred pain from another part of the body, "pinched" nerves, abnormally curved spines, injury, tumors or the classic mechanical cause. Finding which one is the challenge we as doctors have to make you feel better.
Most of us know our spine is made up of bone and intervertebral soft tissue discs. These discs act as cushions between the segments to allow the spine to be flexible. I tell my patients these discs are a lot like jelly doughnuts: soft jelly in the middle with a crusty outer shell. A herniated disc occurs when the jelly squirts out and the radiating pain down the leg is due to pressure on a corresponding nerve. Ouch, that's gotta hurt.
As we get older, just like jelly doughnuts, these discs will dry up and tend to get smaller. Then, our vertebral segments start to come closer together, and our backs get more stiff as we lose our flexibility. Have you ever heard an older person say he is shorter than was when he was younger? Watch an elderly person walk, and oftentimes you see someone who ambulates in a stiff, direct manner. This disc degeneration is called degenerative disc disease, or DDD for short.
To treat DDD, our first line of defense is always conservative. Emphasis on exercise to promote flexibility, as well as maintaining a reasonable weight, are very important. I tell my patients they need to stay in the ballpark of their high school graduation weight. Doing this, the effects of stress on their backs can be optimized to carry the correct load on a daily basis. This is why one of the more common complaints among pregnant women is back pain. They are just not used to the added stress on the joints and muscles.
There are many ways to diagnose back pain, but some of the more common ways are X-rays, MRI, CAT scans and nerve tests. Newer treatments, increased experience and more sophisticated diagnostic techniques are always on the horizon.
If your back does not hurt you, consider yourself lucky. It is one of the hardest things we as physicians treat. Maintain an exercise program, watch your weight and eat right. All these things you've heard before, but how true they are.