By Dr. Ronald S. Dubin

Guest Columnist

 

Low back pain (LBP) is a very common complaint that will affect everyone at some point. It can be an acute episode which resolves fairly quickly or chronic that is defined as greater than three months. Common causes of LBP include Arthritis, spinal stenosis or narrowing of the spinal canal, bulging or herniated discs, spondylolithesis where one vertebrae slips forward from the vertebrae just below it, or myofascial pain syndrome (fibromyalgia) in which the etiology of the pain is unexplained (diagnosis of exclusion).

Many times an MRI will show certain findings as noted above but the cause and effect of this finding cannot be definitively related to the pain. Much less causes of back pain can include infections or tumors. Most people over 40 will always have an “abnormal” MRI. So seek alternative opinion(s) whenever there is uncertainty.

Let’s talk about chronic LBP which is most concerning to people. The diagnosis usually is made with an MRI which then leads to various treatment options. These basically are operative or nonoperative alternatives. We will discuss the latter option since this is usually the best course of treatment even for chronic LBP. These modalities include physical therapy which includes such modalities as retraining your posture, stretching and flexibility exercises, core strengthening, heat, iontophoresis or using ultrasound to disperse a steroid solution to the soft tissues. PT can also use “dry needling” where small needles are placed under the skin for electric stimulation.

Diet for overweight people must always be considered as excess weight can be the primary cause of LBP. Smoking has a large correlation for chronic LBP and must be eliminated. Lifestyle modifications are also important to consider especially where you can identify one or two things you do every day that precipitates the pain. This can be as simple as avoiding stooping or bending or carrying less weight when able. Exercise is vitally important. Walking is the mainstay of exercising. Consider joining a walking group near your home which will make sure you get out on a routine basis and will be less boring then doing it yourself. Cumberland Gap National Park is perfect for this – trails abound, you can observe the wonderful natural settings while enjoying a peaceful conversation with your friends. Do you know how lucky we are to have this park in our backyard? Many folks would give their right arm for this. Take advantage of it.

Chronic LBP can lead to frustration, irritability and even depression. Try yoga or other cognitive and relaxation strategies to avoid thinking about your pain. Lastly, epidural injections are available. Many people have tried this where a needle is placed in the “epidural space” which is right adjacent to your spinal cord and steroids and a numbing medication is instilled. This has worked successfully for some people but the effects usually lasts for a few days only.  Epidural injections are usually no more effective than getting an “intramuscular” injection of steroids in your arm or buttock. This is much safer, less expensive, and has largely the same effects as epidural injections. In my practice I rarely use epidural injections unless a patient really wants it because their friend or relative had a successful outcome (usually not the case). There was an interesting article published in the International Journal of Environmental Research and Public Health, 2022 Jan 19(1) 231 which concluded that epidural injections seem effective in relieving symptoms in the short term only but there is no evidence of this showing any long term results.

Let’s now discuss surgical options as a general category. Again, this is a last resort plan as failed back surgery is a serious condition that is hard to effectively treat. There are many procedures available depending upon the diagnosis and surgeon’s preference and training. I will not discuss the actual techniques available but the most important thing is making sure that the diagnosis is what is really causing the pain. Failure of surgery is frequently because of the failure to make the correct diagnosis preoperatively. If sciatica is your main problem and the MRI shows a pinched nerve, be sure that the history, physical exam and the MRI is consistent with your problem. I frequently will order a nerve test to confirm the diagnosis.

Hope this little article helps in bringing you a better and more healthy back.

 

Ronald S. Dubin, M.D.

President, Kentucky Orthopedic Clinic

Middlesboro – Corbin, Kentucky

rdubin256@hotmail.com