Low Back Pain: Signs & Symptoms of a Bad Disc

July 1, 2013September 27, 2016 / Thomas Cohn, MD

Low back pain from a bad disc is very common. By the age of 30, discs often begin to show signs of wear. By age 40 disc pain is normal.

The human body was initially built to last roughly 40 to 50 years. Up until about the mid 1800’s, most people would die by this age due to:

Trauma
Infections
Disease
Heart problems

Since that time, science and medicine has developed tremendously, and we have improved our longevity well into the 70’s and 80’s for many people. The problem as we live longer, is that we are out living the natural life expectancy and durability of many of our body parts. We are wearing out the spine, the disks, bones, joints and sometimes the nerves. As we age, our body parts age, become damaged, and cause us pain.

Signs you have a Bad Disc in your Back

The first sign that you have a bad back disc is often radicular pain – that is pain that starts in the back and radiates into the buttock or leg, either one or both sides. Sometimes it starts after moving wrong, bending and twisting, or lifting something too heavy. People who suffer from this often don’t know exactly what happened. They simply notice annoying, ongoing pain from the back into the leg.

Having low back pain and a bad disk is not unusual. A bad disk does not mean that you need surgery. However, having ongoing back pain means that you need to do more maintenance to keep going. Just like having an older car, an aging body needs more work on a regular basis to keep running. If you ignore everything, it will stop working well. But unlike an old car, you cannot just go to the local mechanic to keep things running. To keep the back well tuned, you need the advice of an expert and you need to invest in your own health.

Spinal Disc Treatment Options

Most back disc problems can be treated conservatively, without surgery. Treatment ranges from simple to aggressive based on what works and what is wrong. Surgical treatment should be reserved mostly for discs causing neurologic damage including weak muscles in the legs and loss of control of the bowel or bladder. This is rare though – less than 2% of all disk problems need surgery.

If the low back pain is radicular and has not responded to simple treatment in 4-6 weeks, it is time to find a Physical Medicine doctor who specializes in pain. These are experts in diagnosis and treatment of these problems. They can start simple, from medications and therapy, and move to the most complex solutions if necessary. Interventionalists are pain doctors who may also do injections to diagnosis specific problems and perform complex procedures that treat the pain without surgery. Often these doctors can determine if the pain may be coming from several different sources, and how to treat each of the specific problems so that life is not a pain.

Sciatica & Low Back Pain: Diagnosis and Treatment

June 24, 2013September 27, 2016 / Thomas Cohn, MD

Sciatica is a term used to describe low back pain that usually radiates into one or both legs. If the pain is radiating down the leg, it is likely being generated from a structure associated with the lumbar spine.

Radicular low back pain is pain usually generated from the lumbar spine. Rarely, it can be from surrounding structures, muscles and pelvic or lower abdomen organs. Radicular pain can be caused by any of the following:

Lumbar Discs
Lumbar Facet Joints
Lumbar Vertebra
Lumbar Nerves
Sacroiliac Joints

All the above structures are linked to the lumbar spinal nerves, and when irritated, send signals to the brain that are perceived as pain in the low back that radiates into the buttock or leg. Pain can be felt on one or both sides of the body with this condition.

How to Identify Sciatica

There are several common symptoms that could indicate sciatica, including:

Lower back or leg pain (either sharp or chronic)
A tingling sensation or numbness in one or both legs, that may extend down to the toes
Pain in the buttocks

Generally, sciatica only results in pain on one side of the body rather than both. People who suffer from sciatica can have widely varying symptoms. Some people experience intense shooting pain that makes it difficult to stand or walk. Others feel a subtler and less frequent pain.

Sciatica Treatment Options

Most radicular low back pain is not serious. The condition can generally be resolved by using conservative treatment methods, such as:

Ice and heat
Keep rest to a minimum – movement actually helps most structures to heal, allowing blood to flow to the region that carries the body’s own healing tools
Use over the counter medication to reduce pain

If the pain does not resolve within a week of trying these methods, then help from a primary care provider may be beneficial to obtain stronger medications and physical therapy. No matter what you do, most sciatica pain will resolve within a month.

If radicular low back pain does not resolving in a month, the patient should consult with a Physical Medicine specialist, especially one board certified in Pain Medicine. These physicians can listen to your symptoms, examine the muscles, spine and nervous system, determine what more testing is necessary and design an appropriate individualized treatment program for you.

How to Choose a Good Pain Doctor

June 17, 2013September 27, 2016 / Thomas Cohn, MD

Choosing a good doctor is always a challenge. There are many options to consider, including:

Insurance Requirements
Where you Live
The Degree of Specialization of the Physician you’re looking for

The best pain doctors will be those who have a broad range of experience, and a broad range of ability to evaluate and treat a variety of problems.

The Definition of Pain

The International Association for the Study of Pain defines pain as: “An unpleasant sensory or emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Pain is how the body interprets certain sensory signals in the nervous system, which includes how the brain processes the signals and determines how to react to them. Pain sounds simple, but becomes extremely complex due to many causes and interactions.

Qualities of a Great Pain Doctor

A good pain doctor needs to have many qualities in order to successfully manage what can be an extremely complex problem. Pain often comes from multiple sensory sources, and finding each sensory source is a challenge. The start to finding the source is listening to the patient, the story, and where and what is happening. The story is often critical, and a good doctor will be able to recognize what story matches various internal problems. An experienced doctor can match a story very quickly to the pain problem.

In addition to listening to the patient’s story, a doctor may also need to perform other tests in order to grasp the full scope of your pain, such as:

Analysis of a patient’s movements
Checking motion in various body parts
Examining the neurologic and musculoskeletal system
Scans and X-rays

The best doctors have done this many times, and can put complex information together rapidly to determine a treatment plan.

Finally, all the good pain doctors should at least be fully licensed, and have subspecialty boards in Pain Medicine. Backgrounds in Physical Medicine and Rehabilitation are also a huge plus. Expect a good physician to be familiar with your history and examination, and have a comprehensive treatment plan, and be willing to address a number of complex issues contributing to your unique problem.

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.