Lower Back Pain affects about 80% of American adults at some point of their lives. There are many reasons for it: disc herniation, disc bulge, nerve impingement, spinal stenosis, vertebral fractures, arthritis, etc. There is a multitude of symptoms associated with it as well: the pain could be sharp, stabbing, dull, radiating, and intermittent. Location could be local or diffuse or follow the precise nerve path territory. When the nerve roots get irritated patient can have numbness, burning, tingling or even muscle weakness besides the focal lower back pain. In 2010, a study ranking the most burdensome conditions in the US placed lower back pain at 3rd place.
Lower back pain diagnosis can at times be extremely difficult given the wide variety of tissues in the lumbar area and its’ vicinity that could potentially be causing that pain. Besides the usual suspects such as sprains and strains, ruptured discs, traumatic sports injuries, spinal stenosis, and scoliosis, the physician must rule out infections, tumors, kidney stones, abdominal aortic occlusion and/or aneurysm, etc. Other things that need to be ruled out include but are not limited to: fibromyalgia, endometriosis, ovarian cysts, rheumatoid arthritis, etc. As one can imagine the list goes on and on. Extensive medical history and physical exam are supplemented by a wide choice of imaging and diagnostic studies: X-rays, CT scans, MRIs, discography, EMG studies, bone scans, ultrasound imaging, etc.
The treatment options available to the physician can also vary from extremely conservative (medications, hot / cold packs, and bed rest) to more and more proactive modalities. Physical therapy is a frequently utilized treatment option. Patients are taught core strengthening exercises, home exercise programs, ways to prevent injury and re-injury of the inflamed tissues. Physical therapists frequently utilize traction devices, biofeedback, massage therapy, TENS units, etc. Medications can vary from over-the-counter (OTC) NSAIDs to prescription strength NSAIDs and COX-2 inhibitors. If that fails, there is always an option of conservative opiates management. Part of the medication therapy includes use of antidepressants, anticonvulsants and neuropathic medications as well as topical compounded creams. Chiropractic professionals are well known for their spinal manipulation and spinal mobilization techniques. Acupuncture is yet another treatment modality that came to us from the ancient Far East.
Minimally invasive interventional pain management procedures are also an option for those who suffer from pain. The job of a well-trained and experienced pain management specialist is to try to minimize patient’s pain and hopefully delay or even completely avoid the surgery. It is pain management specialist’s responsibility to properly diagnose, treat, and to create an individually tailored treatment approach for every single patient.
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