By Dr. Michael A. Catino
My years providing care to seniors has taught me many things, including what is most often troubling them. Many patients come to my office with significant fears over conditions for which they have been diagnosed. Frequently they feel overwhelmed. Some have lost confidence that there are viable treatment options that can provide them with relief. As an example, someone who has been diagnosed with degenerative disc disease may think that their spine is destined for progressive destruction. Another person may have great concern over the bone spur that is surely the source of all their pain. And then there are those patients who have been suffering for years because they believe they are simply “too old” for surgery. Many who have been suffering from persistent pain are concerned about the possibility of cancer.
Let me see if I can alleviate some of those fears and provide some peace of mind.
Few of you reading this article don’t have degenerative disc disease for this is simply a natural degeneration of the spine over time. As the discs in our spine slowly “dry-out” and become less effective shock absorbers, the bones of the spine begin to be more stressed and this can result in the formation of bone spurs or other arthritic degenerative changes. So you see, degenerative disc disease is essentially age-appropriate spinal arthritis.
As you know, the best treatment for arthritis is staying active, exercising regularly and using an anti-inflammatory medication as needed to control inflammation. Unless bone spurs are causing significant nerve compression, they are not likely to contribute to backache.
Sciatica is the word that describes pain that goes down the leg, typically to below the knee. It is the result of significant compression of a spinal nerve and is often mistakenly described as “back pain”. Nerve compression typically occurs from spinal degeneration as described above, which in turn causes narrowing around the nerves. You may hear it described as spinal stenosis.
Many things can trigger these discomforts; engaging in excessive yard work, or walking at amusement parks, opening heavy windows, etc can cause inflammation of the spinal nerves and result in leg pain. These discomforts will typically improve as the inflammation subsides with brief rest, medication and possibly some therapy. Selective spinal injections remain an excellent second-line treatment option in select patients experiencing more significant or persistent pain.
When patients tell me that they are too old for surgery, I attempt to alleviate those fears by reminding them that arthritic conditions are most common in patients their age. Although most patients will not require surgery for these conditions, surgery may be a good option for those who have not responded well to non-surgical treatment. I think every senior patient I have seen knows someone who has had some dreadful surgical outcome after spinal surgery. The best surgical outcomes are achieved in patients who have been accurately diagnosed and have been treated with the least invasive procedure. There are many different types of spinal surgery and some have better track records than others. Only your surgeon can tell if and what operation would be the best option for you.
“Doctor, is it cancer?” is probably the most commonly heard question from patients experiencing pain that simply will not go away. Although a definitive diagnosis typically requires further radiographic studies such as an MRI, here are some general rules of thumb: cancers are typically associated with generalized weakness or fatigue, weight loss, night pain or pain that is progressive. Metastatic cancers to the spine may also be associated with other complaints such as shortness of breath, abdominal pain, breast changes or changes in bowel/bladder habits. If you or your family member has a history of cancer in addition to these complaints, you should contact your physician for further evaluation.
In summary, degenerative conditions of the spine resulting in disc bulges, bone spurs and spinal stenosis are very common in all of us as we get older. That said, it’s important we continue to listen to our bodies—even if it seems they’re talking to us entirely too much as we get older. I know daily back and leg pain can be very burdensome, but taking some minor steps will go a long way in providing relief. Watch your weight, stay active, exercise regularly and utilize a good anti-inflammatory on occasion usually is the recipe for successfully managing back and leg pain. Spinal injections and surgery remain good options for persistent pain in appropriately-selected patients. If you experience symptoms as described in association with a potential cancerous process, please contact your physician as soon as possible.