Back pain is one of the primary reasons patients end up seeing a physician, primary care doctors included. So I think it’s important to realize that you have to be very tenacious in diagnosing the actual cause of the pain because we don’t want to just treat the symptoms. It’s important to understand the anatomy, and in particular the relationship between the segments of the spine, the bones themselves, the intervertebral discs and also the nerve roots in the spinal cord and how closely aligned they are together. To have a better appreciation for a patient’s symptoms, it’s important to understand the relationship between the primary pain generating components of the spine.
Getting a good history is one of the most important parts of the evaluation. You can really get so much information by talking to the patient and really getting a good sense of when their back pain occurred, what caused it and the kind of symptoms they’re having. And a thorough orthopedic and neurologic exam can tweak out the symptoms that may be pointing more toward a disk issue or more toward muscle spasm.
The non-surgical treatments are really the mainstay of treating back pain. This includes pharmacological intervention like muscle relaxants, anti-inflammatories and analgesics for pain. We can also incorporate physical therapy and patient education on body mechanics and home-based exercises. There are office-based procedures such as trigger point injections for muscle spasm. And if the patient hasn’t improved with conservative treatment, we can perform epidurals or medial branch blocks or some of the more invasive types of injection procedures.