A recent reading in a new issue of one of the many medical journals that showed up at my home was an article on the management and treatment of low back pain for general practitioners. Usually I hope to pick up an interesting piece of knowledge to add to my treatment regimen, but unfortunately this article was a major disappointment. The focus of this article was on “nonspecific” low back pain. For a person with low back pain, this is the category of everyone who does not need surgery right away since they do not have a huge disc herniation.
Low Back Pain
Low back pain does have many specific causes and detailing the problem leads the practitioner to treatments that may be more effective. It is very important to understand that there are many structures in the low back region that can cause pain. Oftentimes multiple structures may be causing problems and treatment may need to include a number of different things. Solving only one of five problems leaves four issues that may be equal or worse and provide no relief for a patient.
To successfully treat low back pain, a practitioner must fully understand all the structures in the body and how they can contribute to pain. There multiple body parts involved including joints, nerves, discs, muscles, ligaments, bursas, and various organs in the lower abdomen and pelvis that all can contribute to pain sensations. On top of all the stuff in the direct area, the brain also can be an important factor since it is necessary to interpret the sensory signals and their meaning. If there are numerous sensory signals, the brain can short circuit on them and overly amplify the quality of pain. At this point, central sensitization occurs and normal sensory signals in the body can become interpreted as pain; the equivalent of a short circuit is present in the nervous system.
When low back pain is not easily fixed with time, simple medication and exercise, then getting higher level expertise with an expert in Physical Medicine doctor is helpful. Pain experts come in all varieties, but you should stick to those who have the broadest knowledge, since they will be more likely to be able to determine what is actually the problem and develop potential solutions. Many people claim to treat back problems, but only those who take the time to look into your history, to fully look at what has been done as far as diagnostic studies, and to conduct a physical exam will be successful.
The Pain Management Approach
Pain that has not been solved quickly is often a complex problem. Before I see a patient, I try to review their medical history and what has been done for diagnosis and treatment. A patient’s history and story about their problems often is the most important key to understanding what to do for a person. After hearing what the patient thinks is the problem, then a physical exam can often lead to a series of diagnoses. Most of the time, a person can tell me some odd information that is the absolute clue to helping a person with their pain problem. Tailoring the right treatment to a person is where experience is extremely helpful and what determines a successful management strategy. Many people are afraid that they are wasting the doctor’s time. Rarely if ever is a patient wasting my time, especially if they want to get better and are willing to try various treatments.
The human body is a wonderfully complex machine, and answering the question of what is wrong is very hard. Since in the low back, many things can be wrong, simple answers are rare. As people get older, everything in our bodies does deteriorate and degenerate. Some things in the body can be repaired, but many things like the discs and joints in the body show normal degeneration, sometimes by the age 30 or 40. Currently we have no way to reverse aging, and treatment of pain requires managing of symptoms. There often is no way to “fix” the problem, but we can find strategies to manage the symptoms better.