Many medical problems are fairly easy to manage. You see your doctor, get medication or other treatment, and, after a few days, you feel better. But for those experiencing chronic back pain or neck pain, it’s usually not quite that easy. Finding lasting relief often takes some time, and feeling better may involve trying more than one treatment option.
“Once a problem has been identified, we have to figure out how to treat it,” said Dr. Rey Bosita, a spine surgeon on the medical staff at Texas Health Center for Diagnostics and Surgery (THCDS). “One of the beauties of working at THCDS is that we have every diagnostic and treatment modality available, so you don’t need to drive all over town to find relief.”
Back pain is a leading cause of disability and ranks among the most common reasons people miss work or go to the doctor. Spine conditions are complex, and everyone’s spine is different. A patient may have no pain, yet the same patient’s MRI might show significant abnormalities (such as herniated disc or spinal stenosis.) Conversely, another patient may have serious pain and present with a normal MRI. Finding the cause of back pain or neck pain is both an art and a science. That means that patients must work with their doctors to identify an approach that works.
When to See a Doctor for a Spine Condition
Back pain can range from mild muscle aches to a shooting, stabbing or burning sensation. The pain may radiate down the leg or worsen when the patient increases activity by bending, twisting, lifting, standing, or walking.
In many cases, back pain gradually improves over time; however, that is not true in every case. Patients should consult with a medical provider when:
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Back pain or neck pain persists more than a few weeks
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Pain is severe and does not improve with rest or activity modification
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Pain radiates to one or both legs, especially below the knee
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There is significant weakness, numbness or tingling in one or both legs
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There are changes in bowel or bladder function (incontinence)
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There is significant trauma, such as a bad fall or accident
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Pain is accompanied by unexplained weight loss
In rare cases, back pain can indicate a serious problem, requiring immediate medical attention.
The treatment for back or neck pain begins with a consultation with your doctor, who will examine your back and assess your strength and range of motion.. The doctor might also ask you to rate your pain on a scale of zero to 10 and ask questions about how well you are functioning. These assessments help determine where the pain is coming from and how functional you are. Visiting with the doctor can also help rule out more-serious causes of back pain.
If there is reason to suspect that a specific condition is causing your back or neck pain, your doctor may order an x-ray, MRI or CT scan. An x-ray shows the alignment of bones and detects the presence of arthritis or broken bones; however, x-ray images alone will not show all problems with the spinal cord, nerves or discs. An MRI or CT scan can reveal herniated discs or problems with the spine including disc herniations, spinal stenosis, or even spine fractures and instability. In some cases, the doctor may also order blood tests, a bone scan, or nerve studies.
Conservative Treatment for Spine Conditions
Treatment of back pain usually starts with conservative care. A period of “waiting and seeing” is a standard step in the treatment of back pain or neck pain. Medication may help manage the pain also.
“If a patient is experiencing minimal symptoms, usually we can observe them, maybe give them some medications, and hopefully they'll just get better,” said Dr. Bosita.
Medications for back pain or neck pain may include over-the-counter (OTC) pain relievers, nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve), and even aspirin. If OTC pain relievers are unsuccessful, the doctor might use prescription NSAIDs, muscle relaxants or topical pain relievers (creams, salves, patches or ointments). Narcotics -- drugs containing opioids, such as oxycodone or hydrocodone -- may be used for a short time under close supervision by a doctor. Nerve medications (gabapentin or Lyrica/pregabalin) may also be used.
Bed rest is typically not recommended for back pain or neck pain. Patients should try to stay active as they are able; light activity, like walking, usually helps reduce back pain. Patients may need to modify or avoid activities or movements that causes back pain to flare.
According to Dr. Bosita. “The next stage of treatment would be physical therapy to try to regain strength, improve range of motion, and improve flexibility. Patients need to build back core strength and range of motion, which can often become diminished in patients who have back pain,” he said. The “core” includes abdominal, back, hip, buttocks and pelvic muscles. Our core muscles are engaged in almost every movement we make, from walking, lifting or bending over to pet the dog.
A physical therapist can teach the patient exercises to increase flexibility, strengthen the back and abdominal muscles, and improve posture. Regular use of these techniques can also prevent pain from returning. Physical therapists will also provide education about how to modify movements during an episode of back pain and avoid pain while remaining as active as possible.
Studies show that core-strengthening exercises are among the most effective treatments for treating acute back pain, as well as for preventing future occurrences.
“If pain medication and physical therapy do not provide relief,” Dr. Bosita adds, “the next step might be spinal injections, either in the neck or in the back. Those can be done here at THCDS as well.”
Spinal injections are performed with X-ray guidance, called fluoroscopy, to ensure that the medication is correctly and safely placed. These involve injecting an anesthetic or an anti-inflammatory medication, such as a steroid (cortisone), near the affected nerve. The injection reduces the inflammation and can lessen or eliminate the pain.
The Right Surgical Treatment for Spine Conditions
If these conservative measures are tried, and don’t provide relief, your doctor may recommend spine surgery as your next option. Spine doctors generally do not recommend surgery as the first treatment. Surgery is usually the last choice if all other treatments have failed. Determining the best surgical option may involve additional imaging studies and careful consultation with the patient. In most cases, surgery is not recommended unless the source of the back pain or neck pain can be clearly pinpointed.
“A very small percentage of patients who have back pain – whether due to a herniated disc or spinal arthritis or spinal stenosis -- may need spine surgery,” said Dr. Bosita. “Developing a surgical treatment plan starts with talking to the patient. We must figure out exactly how bad the problem is. Our realistic goal is to to make them feel better by doing as small a surgery as possible. Some patients may benefit from a minimally invasive discectomy. Some patients may need a fusion. Some patients may need a disc replacement."
Dr. Bosita also adds that “thousands of spine surgery procedures have been performed at THCDS.”
“Our goal is to try to do the right surgery for the right patient for the right problem at the right time,” said Dr. Bosita. “We're proud of the fact that our results are very good. That’s because we start by determining what the patient’ s goals are, and then identifying diagnostic and conservative treatments to determine if surgery is needed.”
Dr. Bosita says that good communication is critical to getting good results. His advice for patients who are considering spine surgery: “Find a doctor you feel comfortable talking with and who will listen. Even after the surgery is done, it is very important to have good communication with your surgeon so that they know exactly how you're feeling.”
If you or someone you know has been dealing with neck or back pain, take the next step and make an appointment with an experienced spine specialist. Our patient navigator is standing by to help you find the doctor that is right for you! Call or email today.