Low Back Pain

Low back pain is one of the most common presenting complaints to physician offices, emergency rooms, and to orthopedists in particular. It can occur as a result of trauma, excessive lifting, or innate problems like disc disease and arthritis. It is incumbent upon the examining physician to try to determine the exact nature and location of the pain and to offer specific treatments. The first step is taking the detailed history and conduct a careful physical examination. This can suggest definite clues about the site and mechanism of injury or pain, and guide the physician toward whatever further testing may be indicated. Plain x-rays can yield considerable information and may suggest whether something more advanced like a CT scan or MR may be indicated. The evaluation part of the encounter should ideally flow along with the treatment part so that both are parts of the same process, i.e.' discovery and treatment, etc. Sometimes, however, this rhythm becomes difficult to maintain. Pain can more or less settle into the lower back, and vary in intensity and associated symptoms. The rhythm of discovery and treatment is interrupted, and sometimes the process of pain simply has to be addressed as a disorder in and of itself.

One such disorder is a chronic stable herniated disc in the lower back. It can be a source of   considerable discomfort, but it's really not such that surgery is a viable option. Pain management would probably be the proper treatment response to this condition. A first tier of treatment would probably be a NSAID like Motrin, or arthritis- strength of Tylenol. A muscle relaxant may help with associated stiffness. Gentle heat may be beneficial when the back area is particularly symptomatic. However, there sometimes comes a point where the Pain Management physician has to consider the use of narcotic and non-narcotic pain medicines. The entire complex of symptoms of the lower back disorder will often then begin to reverse its accelerated symptom phase, and allow the person to return to a baseline level of function.

Other back problems can spin out of control much the same way as the disc disease. Degenerative arthritis of the lower back is one prime example. The litany of symptoms is very similar and may require similar pain management. There are certain ligaments which join the lower back bones and which can become strained, scarred and inflamed. The same treatment scenario for the pain would probably be started as in the other conditions. The pain manager has to know when stronger medicines, e.g., narcotics, might be in the best interest of the patient.

This is at the core of the practice of pain management in the lower back as in other areas. It is the knowledge to maintain pain control at a baseline, along with the knowledge and willingness to use "bigger guns" in a safe fashion as necessary. No specific therapy is going to work for every single person. Pain management understands this and has an armamentarium of treatment options to maintain a minimized pain state. These treatment specifics can be negotiated with the patient to prevent chronic and acute pain.