The Complexity Of Pain Management

complex spine careBack pain patients often state if they just lost some weight, maybe their low back would feel better. It would be nice if it were that easy, but it is often much more complex. Usually someone who has back pain has multiple causes of the pain, from simple lack of strength in the muscles, to nerve irritation, degeneration of the joints and discs in the spine and problems with body mechanics. Yes, weight can stress every structure in the back and make things harder and more painful, but oftentimes all the other things causing pain may be more important in order to control back problems.

Controlling Back Pain

Asking most doctors about how to lose weight is often not very helpful. About 75 percent of medical schools do not provide the recommended 25 hours of nutrition training, and many older physicians have had minimal to no training in nutrition. Complicating everything is the fact that older research was often sponsored by major manufactures of food and conclusions of the studies were not scientifically sound. Current research is showing that every person often responds differently to a diet, and what is helpful for one person will not always work for another. The more one reads, the more complex the human digestive system becomes and our understanding is really limited. Everything affects us, from our genetics, to what our mother’s ate during pregnancy, to the bacteria in our gut.  

Eating a healthy diet is probably the most sound advice, and then pay attention to the amount you eat as well as when you eat. Healthy eating means eating less processed substances like pre-made foods. Some people equate this to eating from the fringes of the grocery store, where the fresh fruit, vegetables, salads, lean meats, and diary if often kept. Limiting simple carbohydrates like bread, potatoes, pasta, sugar and white rice can help many people as well. Protein sources from poultry, fish, beans, nuts and diary, and not from red meat are recommended in many diets.  If you have gastrointestinal problems like inflammatory bowel disease or celiac disease with gluten intolerance, diets change play an even bigger role in solve the pain equation. In general, a plant-based diet is often the healthiest.

Managing Weight and Back Pain

Since low back pain is caused by many factors, it is rare that the most important issue is weight. The most common factor is usually the lack of exercise. Often a patient will go to physical therapy and learn what to do but after the formal sessions, they do nothing on their own. Those who are overweight are no different than most patients; they are not actively exercising and taking care of their health. Every patient must find their own internal motivating factor to take care of themselves and exercise. Staying healthy takes a lot of work. There is no quick fix and those who actually do the best take care of their physical and mental health. Those who do the best follow through with the three components of exercise – stretching, strengthening and aerobic conditioning. If you are doing the work of exercising appropriately and eating a healthy diet, it is likely that weight will not be an issue.

Those who do have back pain and who are significantly obese often can improve their back pain with weight loss. However, the improvement is relatively minor with the loss of weight. The patients who notice the most improvement in pain are those who adopt a healthier lifestyle. Despite being obese, they start consistently exercising, often finding a way to participate in a pool exercise program so they do not stress their joints. They also have changed their eating habits, and the combined efforts usually lead to a sustained weight loss of 1-2 pounds per week. Believe it or not, it becomes obvious who actually is exercising, as they start feeling better and have markedly less pain. Low back pain affects millions of people nationwide, the simplest solutions often are the best – exercise and a healthy diet.

The following two tabs change content below.

Thomas Cohn, MD

Interventional pain doctor helping Minnesotans manage back, neck, foot, and other pain. Board-certified in physical medicine and rehabilitation with additional board-certification in pain management from the American Board of Anesthesiology (ABA), the American Board of Interventional Pain Physicians (ABIPP) and the American Board of Pain Medicine (ABPM).

Latest posts by Thomas Cohn, MD (see all)