Back pain: When to get help

Back pain is a common ailment that affects a growing number of Americans. The vast majority of symptoms will improve over time and not require any type of medical intervention. But, when does back pain need to be evaluated by a healthcare professional?

Most injuries to the back and neck would be considered strains or sprains. I am commonly asked whether heat or ice is best suited for these conditions. As a general rule, when an acute strain or sprain occurs, an inflammatory process has been initiated. The goal should be to decrease the inflammation. Ice and over-the-counter anti-inflammatory medication are best utilized to decrease the inflammation.

In the old days, bed rest was prescribed to treat these conditions. Our current understanding is that bed rest leads to rapid deconditioning and weakens the spinal muscles. We recommend gentle stretches and continued light activity during the healing phase. Narcotic pain medication is a poor idea in acute injuries, as there is no anti-inflammatory component in these medications and the patient has the risk of developing a dependence.

Patients with a long history of back pain may be suffering from degenerative conditions of the spine such as arthritis and degenerative disc disease. The mainstay of treatments for these patients is routine aerobic exercise such as walking or swimming along with a stretching program. I recommend an exercise routine that can be completed within 30 minutes to ensure that it can be maintained for the long term.

When symptoms are severe and are associated with radiation of pain in the arms or legs and/or if weakness is present in the arms or legs, I recommend an evaluation from a spine specialist. Often times this is a sign of injury to a disc which may be compressing a nerve. In these situations, an expeditious evaluation can significantly improve the clinical results.

Emergent evaluations are needed when there is an inability to control bowel movement or bladder as well as severe night pain that wakes a patient up from sleep.

Modern treatment regimens focus on early detection and diagnosis followed by targeted treatment to avoid chronic pain. During treatment, the patient should take the opportunity to learn about new lifestyle, diet and exercise routines to help maintain a healthy spine. Chiropractors and physical therapists can often work on maintenance programs with patients as well.

Our understandings about surgical treatments and pain injections have also progressed over the years. Injections can be very helpful for the treatment of acute injuries, such as a disc herniation, but their long-term effectiveness and use in treating chronic conditions have been called into question.

There is an increasing body of evidence supporting minimally invasive spine surgery leading to decreased recovery times for patients. These advanced techniques are based on decreasing the muscle dissection and blood loss associated with open procedures. Spine surgical procedures can be done on an outpatient basis with little down time for the patient.