Suffering with Back Pain?
By Michael A. Catino, MD, and Jennifer Zahn, MD, MPH, Texas Spine, Orthopedics and Rehabilitation, Denton County LIVING WELL Magazine
Are you suffering with back pain? Has your quality of life gone to nothing? Have I got the solution for you!
Sounds very appealing doesn’t it? Everywhere you look you are presented with promises and promotions claiming to make your back pain better. Not only are they promising to make your back pain better but also doing it through a 3mm incision.
Really? Medicine has certainly changed over the years. These days, there are numerous commercials and advertisements crossing multiple medical specialties. This promotion explosion has been dramatic in spine surgery and non-surgical spine care. From using lasers to small incisions to even smaller incisions, promises through advertising are seen everywhere. But can you believe everything you read? Is all of this promotion really true? Certainly, if I required spine surgery, I would love to have my procedure done through a 3 mm incision in under an hour and go home pain free. But is this expectation reasonable?
So why is it some doctors claim they can make all of your spine pain go away with a very trivial procedure while others suggest something more extensive. A lot of it lies with the perspective of the physician you are seeing. Who is the doctor who is offering their recommendations? Is it your family doctor, an internist, a pain management physician, a physiatrist, a neurologist, a spine surgeon? All of these doctors will likely have a different perspective on what is causing your spine pain, which will dictate their treatment recommendations. To further complicate the matter, most radiographic findings of the spine will show a number of age appropriate abnormalities, most of which have nothing to do with your pain. Therefore, it requires a physician or team of physicians to work together in an effort to establish which one of these various findings is the most significant contributor to your specific complaints.
It is very important to remember, over 75% of the population will suffer from debilitating spine pain at some time in their life. The good news is, it will typically resolve on its own with or without minor supportive care. Anti-inflammatory medications, ice or heat, physical therapy and a home exercise/stretching program are helpful for over 90% of patients suffering from acute pain. The point here is 90% of patients with acute spine pain will recover without any significant intervention.
I have had several patients come to my office with back pain and tell me they have been diagnosed with a “bulging disc,” while other patients swear their “degenerative disc disease” is the culprit. Disc protrusions and bulges occur commonly as we get older and often times are not the source of back pain. Further, disc degeneration does not occur in a vacuum. As discs degenerate, it can result in curvature of the spine, degeneration of the spinal joints (facets), as well as secondary stiffness and deconditioning of the paraspinal muscles. All of these issues can have significant impact on patients’ overall complaints.
Nevertheless, the disc bulge has become the Holy Grail for some spine care providers. Shrinking the discs with lasers, decompressing the disc with multiple sessions of decompressive therapy, and performing various invasive disc procedures by nonsurgical practitioners have become increasingly common.
MRI studies of the spine are very sensitive and will typically reveal a number of abnormalities. It is the responsibility of the treating physician to not only evaluate the MRI but also correlate the key radiographic findings with your specific complaints and physical examination. Only when your complaints, exam, and radiographic findings support each other, is a valid treatment plan able to be formulated. A red flag should be raised when a treatment plan is provided based only on a radiographic finding.
Minimally invasive spine surgery is always an attractive option if surgery is ultimately required. Our practice routinely provides our patients with multiple treatment options, starting with the least invasive. Unfortunately, not everybody is a candidate for such intervention. Even the physicians advertising 3 mm incisions reveal on their websites that these procedures are only options for a subset of patients.
So ultimately…buyers beware! There is a lot of misleading information you are regularly bombarded with these days. The old adage “if it sounds too good to be true, it probably is” is certainly applicable here.
When selecting a spine care professional, chose one with a solid reputation and a history of providing conservative and focused care. Ask your primary care physician who they would recommend. Second opinions are also a good idea if you are not comfortable with your diagnosis and/or plan, especially if the treatment plan includes a more invasive option.
Doctors Michael Catino and Jennifer Zahn invite you to call them with any questions at 940-323-3400 or to schedule an appointment.