Low Back Pain: Causes & Treatment

June 12, 2013September 27, 2016 / Thomas Cohn, MD

Low back pain can be the result of a number of medical problems in a variety of areas, including:

Muscles
Bones
Ligaments
Joints
Nerves
Spinal Discs
Other Internal Pelvic Structures

Any of these can cause pain that may be interpreted as low back pain. Fortunately, 95% of the time, the cause will heal quickly and the pain will go away no matter what treatment is performed.

Back Muscle Strains

The most common cause of back pain most people suffer is a muscle strain. Pain from a strain is localized in the muscles along the low back and in the buttock and they feel like tight bands. Usually this is from over stressing the muscles by lifting too much, twisting, and bending.

With mild to moderate strains, one is usually just sore and stiff when moving. In more severe strains, one may feel like they can hardly move due to the pain. If the pain is more severe, start with simple treatments such as:

Heat and ice
Stretching to loosen up the back muscles.
Over the counter medications like acetaminophen, aspirin, and ibuprofen

Joint Irritation in the Low Back

The next most common cause of pain is irritation of the joints in the low back or pelvis region. The facet joints in the back occur on both sides of the spine at every level. They are the same size and structure as the joints in the fingers but carry the weight of the whole body. The sacroiliac joints connect the bottom of the spine to the pelvis. Both of these joints cause deep pain in the low back region, but it does not usually radiate beyond the area, and may be worse with certain movements. Again, simple treatment with ice and heat, and over the counter medications will help.

When to See a Pain Doctor

The more complex the pain, the longer lasting the pain, the more benefit there is in seeing a doctor. If the pain does not go away within a week, start by seeing a primary care doctor. Sometimes resolving the problem can be accomplished through physical therapy and stronger medications. Rest is not recommended more than a day or two. The more active you are, the more likely you can solve the problem.

If the back pain continues for more than 4-6 weeks, then it is time to find a Physical Medicine doctor who specializes in Pain Medicine. These are highly trained doctors who really understand the complex elements of the low back that can cause pain. They can determine which structures are causing the pain and guide a person through successful long-term treatment. A good pain doctor will diagnosis what is wrong, and work with you to find the best solution for your specific needs.

5 DIY Neck Pain Treatments

June 10, 2013November 17, 2015 / Thomas Cohn, MD

The neck is an incredibly complex part of the body that is in almost constant use. As a result, it’s easy to incur overuse injuries and chronic pain in the neck. Neck pain is, quite simply a “pain in the neck.” It can hinder your daily activities and put you in a bad mood. Below are 5 treatments for neck pain that you can do at home:

Good posture. Your neck is directly connected to your spine, and thus directly affected by your posture. When you slouch, your lower back bends forward, causing your neck to strain forward in order to compensate.
Over the counter pain relievers. Common pain relievers like aspirin and ibuprofen can decrease inflammation and pain in the neck. As with all medication, be careful not to overdo it with these pain relievers. Only take them as needed.
Heat & Ice. A combination of hot and cold can help relieve neck pain. Wrapping a handful of ice in a towel and resting it on your neck for 5-10 minutes can reduce inflammation, while applying heat (by taking a hot shower for example) can increase circulation.
Massage. Having someone rub your neck and shoulders is a great way to loosen up the muscles and help you relax.
Workplace habits. It’s important to stay at eye level with your computer at work. If your monitor is higher or lower than your eye level, you will strain your neck by constantly looking up or down. This can have a terrible toll on your neck muscles, especially if you’re on your computer for 8 hours a day.

If you still have persistent neck pain after trying these treatment methods, there may be a more serious underlying issue. If this is the case, it’s a good idea to consult a doctor who specializes in pain management.

Woman Struggles with Complex Regional Pain Syndrome (CRPS)

June 5, 2013May 24, 2017 / Thomas Cohn, MD

Amanda Siebe is a young woman living with a rare disease known as complex regional pain syndrome (or CRPS for short).

It began when Amanda sprained her ankle during a shift at the restaurant at which she works. Initially she just dealt with the pain and continued to work on the injured ankle. But in a few days her ankle had grown inflamed and very painful.

After that she attempted to continue working with crutches to take the weight off of her ankle, but another fall forced her to take time off of work. The ankle still did not heal. After roughly a year of suffering, Amanda was finally diagnosed with CRPS.

CRPS is a condition where the body’s nerves record every type of stimulation as pain. For example, simply poking the impacted area with your finger may feel like a stabbing knife. CRPS can eventually move to other parts of the body as well over time.

Click here to read Amanda’s story.

Dr. Cohn Comments

Pain is a complex entity. In medicine it is only considered a symptom. However, pain is the major factor that leads people to visit their doctors. Acute pain is most often related directly to some injury, trauma, or illness. The diagnosis is often easy and the treatment is rapid and then the pain is gone forever. When pain becomes chronic, the pain itself can become self-perpetuating despite the original source being healed. In medicine today, pain has often developed into such a problem with complex roots that a new specialty exists – Pain Medicine.

CRPS is a very complex problem, whose exact cause and treatment is poorly understood. Even among pain practitioners, many do not see the problem, and the challenges associated with it make these patients hard to treat. However, there are a few excellent practitioners who actually understand the condition and have developed a good track record in treatment of this condition especially for ankle and foot disorders, such as Dr. Lance Silverman.

CRPS is from an over active sympathetic nervous system that is being constantly stimulated from an ongoing injury in the ankle or foot region. In the case of multiple ankle sprains, or even a single untreated sprain, the ankle and foot region has damaged structures that have not healed and stimulate pain signals. Two things are needed for successful treatment:

Aggressive surgical repair of all damaged structures by a qualified foot and ankle orthopedic surgeon, and
Pain management by a skilled pain management expert who can handle all aspects of medication, interventional care, and coordinate physical and if necessary psychological care.

Finding the team of the Orthopedic Specialist and Pain Medicine doctor who do this all the time is the trick. I often partner with Dr. Lance Silverman (an ankle & foot orthopedic specialist) in such matters. Working together, we routinely help patients heal effectively and get back to a normal life.

Acute Pain vs. Chronic Pain: Definitions & Differences

June 3, 2013September 27, 2016 / Thomas Cohn, MD

There are many definitions of pain. Because pain is often subjective, everyone will define and describe it in their own personal terms.

Dictionary vs. Medical Definition of Pain

The dictionary describes pain as physical suffering or discomfort caused by illness or injury. Medicine becomes very technical in its description of pain, often concentrating on the physical aspects, structures involved, and trying to determine if it is “real.” The International Association for the Study of Pain (IASP) defines pain as:

“An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.”

Pain has both physical and emotional correlates. If someone has pain, there is usually a physical cause in the body that needs to be found. Pain may also have significant emotional correlates in the brain. The processing centers in the brain for many pain signals sit next to the areas that control emotional stability. Therefore, if people have significant amounts of pain, spread of pain signals to emotional areas of the brain can easily occur, affecting mood and depression.

Pain is always subjective. It is a learned experience, and it is very individualized. A person learns what pain is through experiences related to injuries as a child and as they grow up.

Acute vs. Chronic Pain

In medicine, pain is the interpretation of certain sensory signals, generated from a variety of receptors in the body. When the sensory signals are ongoing, most people interpret these as pain, and seek treatment to relieve them. There are two primary types of pain:

Acute pain is from definite tissue injury and will fade after the cause is identified and treated. A common example is cutting a finger – it hurts, it heals, and the pain is gone.
Chronic pain occurs when damage causes ongoing sensory signals for long periods of time, and in some degree becomes independent of the actual tissue damage. This type of pain is difficult to stop, and often the best treatment is working on systems to manage the pain.

Understanding the complexities of pain, the body, the sensory nervous system, and the overall interactions in the body are some of the important aspects for a medical doctor who treats patients with pain. A good pain physician understands people and medicine and how all these interact, allowing them to find the causes and improve the quality of your life.