Back Pain Transcript

Opening: This audio segment on chronic low back pain is brought to you by The Resource Center of the Department of Pain Medicine and Palliative Care at Beth Israel Medical Center in New York City, and is made possible through a generous grant from The Mayday Fund.

Chronic Low Back Pain. What You Should Know.

Do you suffer from chronic low back pain? You’re not alone. It’s one of the most common chronic pain syndromes. It’s one of the main reasons people visit their doctors. The good news is that there are many treatments available to reduce the pain. Before we talk about those, let’s discuss some of the causes and symptoms.

What Are the Causes of Low Back Pain?

Damage to pain sensitive areas in your back from arthritis, disk problems or chronic injury can cause pain. Sometimes pain is due to injured nerves. Often there are several problems at the same time. Stress and other psychological factors play a part in how severe the pain is, how long it lasts, and how much it interferes with your life.

What Are the Symptoms?

Many people have what is called a limited range of motion. They can’t bend over or lean or stand up straight. Some have pain that travels down into their leg or foot. Others have a tingling feeling or numbness. Many patients can’t function normally because of the pain. Depression is more common in chronic back pain patients than in the general population. Patients often have insomnia and fatigue.

How Do You Diagnose Chronic Low Back Pain?

Low back pain that lasts for three months or more is called chronic. Pain that doesn’t go away should be evaluated by a doctor. Your doctor should take your complete medical and family history. He or she should do a thorough physical exam and a blood work-up. You should give your doctor a description of the pain. Tell your doctor where the pain is and how it started. Let the doctor know how severe it is.

Your doctor may suggest lab tests or imaging techniques. Magnetic resonance imaging, or MRI, is used to look at your spine, muscles and nerves. Computed tomography, or CAT scan, gives your doctor a good look at the bones and disks in your back. Sometimes other tests are needed, such as myelography or electrodiagnostic studies.

Managing Chronic Low Back Pain

Treatment for Chronic low back pain may last from a few weeks to months or even years. A multimodality approach is often best. This means using several different therapies, like drug therapy, physical therapy, psychological approaches, and complementary therapy, in combination with one another.

Your doctor may suggest that you try a nonsteroidal anti-inflammatory drug. These are drugs you may be familiar with, like ibuprofen or naproxen. There are also some new drugs on the market, drugs called COX-2 inhibitors. These drugs that are less likely to produce ulcers and stomach upset.

The doctor may give you a trial of an adjuvant drug. Adjuvant drugs are medicines that are usually used for some other problem but work well for some patients’ pain. For instance, your doctor may ask you to try an antidepressant, even if you’re not depressed, to see if it helps your pain.

The doctor may give you an opioid drug or narcotic. These drugs, like codeine or morphine, are sometimes used for severe chronic pain. Long-term opioid therapy is used for carefully selected patients who can be monitored by their doctors and who can properly manage their medicines.

Other therapies are called interventional. These include injections, nerve blocks, and some high tech therapies like spinal stimulation or the use of a spinal pump.

Physical therapy can help some patients. Exercises like walking, swimming or riding a stationary bike can help strengthen weakened muscles and reduce stress on your spine. Remember that every patient’s therapy is different. It’s important to check with your doctor before starting any exercise program.

For other patients, psychological treatments are very helpful. You may find that biofeedback or learning relaxation techniques works for you.

Acupuncture, massage, meditation, herbal remedies, chiropractic, and hot and cold packs, are called complementary therapies. These are often used along with traditional therapies.

Some patients are very disabled by their back pain. A formal program in a multidisciplinary pain center may be best for them. Although some patients with chronic low back pain need surgery, most do not. A careful evaluation followed by a multimodality approach often can reduce pain and improve function.

We hope this segment has provided you with some basic information about chronic low back pain. Remember, with all the treatment choices available, there’s every reason to stay hopeful that your problem can be helped.