Finally, Help Is on the Way!

Finally, Help Is on the Way!

From Chicken Soup for the Soul: Say Goodbye to Back Pain!

Finally, Help Is on the Way!

Help for neck and back pain comes in many forms, and what works for one person may not work for another. Many of my patients tell me that they want to try whatever worked for their friend or family member. While that may seem like a good plan when you’re in pain, the truth is that your pain is your own — and what works for someone else isn’t necessarily the right thing to do to help you. It may be, but the critical part of helping anyone with neck or back pain is to know what the diagnosis is (or at least what the mostly likely possibilities include — the differential diagnosis list), and which treatments usually work for that particular condition.

Step Into My Office

Imagine that you are sitting in my office, and we’re having a discussion about your back pain. The way that I usually explain treatment options to my patients is in three categories with conservative care being the first one, injections as the second, and surgery as the third. On a whiteboard I would lay out the following options.

Treatment Options #1 — Conservative Management

Conventional care:

Avoiding exacerbating activities

Relative rest (not bed rest, usually)

Medications (over the counter or prescription)

Physical/Occupational therapy

Modalities (e.g., ultrasound, electrical stimulation)

Other treatments that are sometimes tried:

Osteopathy/Chiropractic adjustments

Massage

Acupuncture

Biofeedback

Mind-body strategies (e.g., progressive muscle relaxation)

 

Treatment Options #2 — Injections

Spinal injections (e.g., epidural steroid injections)

Muscle injections (e.g., trigger point injections)

 

Treatment Options #3 — Surgery

This may be recommended immediately, only after someone has tried other treatment options, or not at all—it depends on the diagnosis, the severity of the symptoms, and the surgeon’s belief that he/she can fix the problem with an operation.

 

Sometimes I recommend treatment stepwise, so that someone begins with therapies in the first category and then proceeds to the second category. If those don’t work, I then suggest a surgical consultation. But, it doesn’t always work that way. There are times when a patient needs to see the surgeon right away or injections make more sense than oral medications and physical therapy. There are many patients for whom surgery will never be an option, because they are too sick with other medical issues or their back problem can’t be fixed by an operation or they simply wouldn’t consider surgery no matter what (all medical treatment is recommended by doctors but it is up to patients to decide what they want to pursue — so physicians need to be respectful of their wishes when they say that they would not consider back surgery; of course, the doctors still need to explain all of the options, including surgery).

The stories in this chapter highlight a number of important points. In James’s case, he tried facet injections more than once. James wrote that his doctor said sometimes timing really makes the difference. This is very true. There are many times when a patient has said to me that he tried a treatment several months or even years ago. Whether the treatment worked then or not, it can be helpful to try it again. Over time, things change and it may be that treatments you’ve tried in the past will work again (if they did before) or may work now (if they didn’t work before).

Bill reports how he had back problems over many years that changed over time. He tried both conservative therapies and spinal injections and didn’t resort to surgery. Annette’s story explains how she tried both conservative therapies and injections before ultimately deciding that surgery was the “only viable solution.”

Help may come in many forms. There are likely therapies that you haven’t tried that might have the potential to help you. Sometimes what you’ve tried previously will work now. Other times, it’s a combination of treatments that makes the difference. In some cases, the surgeon’s mantra — “a chance to cut, a chance to cure” — holds true. Surgery can be the ultimate solution for some people. No matter what, seek out medical advice from physicians who are experts at treating neck and back pain. Educate yourself about treatment options that may help you. And, when in doubt, get a second (or third or fourth) opinion!

 

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