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Healthy Living: Here are some back pain facts, treatment options

If you or a loved one has low back pain, you are not alone. It is not only the second most common reason people seek care, but it accounts for 15 percent of all sick leave. In patients younger than 45, low back pain is the most common cause of disability, and lifetime occurrence of low back pain on the general population can range 60 to 90 percent.

The cause of low back pain can be challenging to diagnose, and this fact has led to many false assumptions about both the causes and care. As a neurosurgeon who specializes in back pain, I would like to debunk some of the common myths, and help guide you in options for care.

Many people believe pain is incurable. They hear that degenerative disc disease has no treatment options, and that spine surgery has high complication rates, poor outcomes and extensive recovery. In fact, the outcomes we typically see in patients with low back pain are overwhelmingly positive, with 90 percent of patients improving within a month. For sciatica, we tend to see about 60 percent of our patients improve within six months.

MRI findings in the general population tend to show that as we age, we develop asymptomatic abnormalities such as disc degeneration or arthritic joints in our spines. But this does not mean we all need surgery; that should be reserved for a minority of carefully selected patients.

Potential sources of low back pain can come from muscles, tendons, ligaments, joints, bone fractures, instability, nerve irritation and severe disc degeneration. Tests to pinpoint the cause of back pain can include X-rays, MRIs, dynamic X-rays, myelograms with CT scans, electro-diagnostic testing or any combination of these.

Nonsurgical treatment of low back pain can include activity modification such as limited lifting, bending, prolonged sitting and twisting. It could also include an exercise program, nutrition and smoking cessation. Other more direct treatment options include over-the-counter anti-inflammatories, prescribed analgesics, muscle relaxants, steroids, chiropractic care, physical therapy and epidural or facet joint injections.

Patients that might benefit from surgery are those who are unable to control the pain and have failed conservative measures. In patients where surgical consideration is entertained, the first focus should be consideration of minimally invasive techniques. These techniques have demonstrated less blood loss, less muscle injury, smaller incisions, potential return back to normal activities earlier, less post-operative pain and shorter hospitalizations.

However, not all patients are candidates for minimally invasive surgery. Careful discussion with your health care provider can help answer any questions about the best treatment options for each individual. If you have back pain, please take the first step. Ask for help.

Dr. Juan Bartolomei is a neurosurgeon on staff at Lawrence + Memorial Hospital.

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