Transcription:
Do You Suffer From Back Pain? Relief is Available

Melanie Cole (Host): Chronic low back pain can result from a wide range of problems and used to be something many patients simply had to learn to live with. In recent years, however, researchers have learned a great deal about pain and it’s led to pain management treatments that can provide relief. My guest today is Dr. Kenneth Choi. He’s a board-certified Anesthesiologist and Fellowship-Trained in Pain Management and a member of the medical staff at Texoma Medical Center. Welcome to the show, Dr. Choi. What about this burgeoning field of pain medicine -- it seems to be a field that’s growing and relatively new -- tell us about the field of pain management.

Dr. Kenneth Choi (Guest): The field of pain management is rapidly changing, even up until the 90’s through the early 2000’s, our concept of pain management was to -- as I mentioned earlier in this podcast – to treat with oral medications, such as Oxycontin, Percocet, and we realized that this may not have been the best approach as these medications aren’t as benign as we thought they were. Now we are facing opioid epidemics and we need to figure out as a country, and as a medical community, how to solve patient’s chronic pain without resorting to using these medications as a first-line treatment. Pain Medicine is really developing to find ways to treat back pain, treat neck pain, treat all these other forms of pain using Precision Medicine, meaning medications or interventions that are tailored to the specific cause of the patient’s pain. We’re also developing different forms of ways to determine what medications are working for this patient and which medications may not, so there’s a lot of exciting things that are happening in our field that’s just evolving every day.

Melanie: Tell us what are some of the most common causes of chronic low back pain?

Dr. Choi: The back is composed of many different structures and the source of back pain can be very complex to find out. The back pain can be coming from the ligaments and muscles. It can also be coming from the joints in the spine. It can also be coming from the nerves that give pain sensation to the back

Melanie: People have tried a myriad of different ways to relieve back pain – it’s one of the bigger problems in this country. Tell us about the new understanding of chronic pain as a Pain Medicine specialist.

Dr. Choi: There’s been a lot of advancement in the treatment of low back pain. Initially, people were treated with medication, such as narcotics, and we found that these medications don’t tend to work very well in the long run so we’ve developed more and more interventional procedures to try to target to the source of the back pain. These include procedures such as epidural steroid injections, lumbar medial branch blocks -- which is the lumbar, meaning the low back area – and we can also burn these nerves to give semi-permanent pain relief. There are also forms of, what we call, neuromodulation where we try to change the signals that are going from the back and legs to the brain. This includes therapy such as a spinal cord stimulator.

Melanie: Since pain is pretty subjective and it’s hard to define somebody’s pain from another person’s, what do you tell people when it’s time for them to seek treatment, about those various treatments out there?

Dr. Choi: So my general recommendation is that back pain should not be chronic, meaning greater than three months. If you’re noticing that you’re having back pain that is not getting better after one or two days, you should definitely go see your primary care physician to have that evaluated. At that point, the primary care provider will determine if you would need to see someone that is a specialist in low back pain. If they try certain medications, such as Tylenol, or over-the-counter medications, ice, rest, heat, and these things do not resolve the back pain, at that point it would be a good idea to speak to a specialist regarding the different treatment available.

Melanie: So let’s start with injections – and you mentioned steroid injections, epidurals – is that the first line of defense, Dr. Choi, and what’s involved in that?

Dr. Choi: The steroid injection depends on, again what the cause of the back pain is. A good specialist in pain management will do a thorough history and physical evaluation to determine what is the most likely cause of the low back pain or leg pain. In the situation where the specialist believes that the back pain is secondary to a nerve pinch, such as, what we call spinal stenosis -- sometimes people will refer to this as sciatica, where there is a pain going down the leg secondary to a nerve irritation -- then a steroid injection would be applicable. A steroid injection is typically done under X-ray guidance to make sure that the steroids are deposited in the correct places in the spine.

Melanie: And then how long might something like that last?

Dr. Choi: That depends on patient-to-patient and how severe their disease process is. As the disease process becomes more severe, the steroid injections may not last as long, or may not work at all. I typically tell my patients that these steroid injections last weeks to months. Now, the important aspect of back pain treatment is that the patient should also undergo other forms of treatment, such as physical therapy, so that they’re able to strengthen their core muscles in their stomach as well as improve their back flexibility and posture so that when the pain does come back, the back is supported and the pain may not be as severe.

Melanie: And Dr. Choi, what about spinal cord stimulators and surgically implanted electrotherapy devices, where do those fit into the picture?

Dr. Choi: When patients do not recover or get better with conventional therapy, including medications, physical therapy, interventional procedures, such as those steroid injections that I just mentioned, then they would either be referred to be considered for surgical intervention including a laminectomy and fusion done by a spine surgeon. Despite if they had the spine surgery and continued to have back pain and leg pain, these patients would be a candidate for spinal cord stimulation. The most common indication that we use spinal cord stimulation is for what we call Failed Back Surgery Syndrome or Post-Laminectomy Syndrome where the patient continued to have back pain and leg pain despite having surgery.

Melanie: And what about some of the other minimally-invasive procedures -- maybe ablation procedures -- speak to some of the others that might be available for people suffering from chronic low back pain.

Dr. Choi: You mentioned radiofrequency ablation and that is an excellent therapy for patients that have low back pain that would be secondary to arthritis-related back pain. There are a pair of joints at each of the spine bones called facet joints in our spine. These joints are innervated by nerves called medial branch nerves and we can find the location on X-ray and burn those nerves and this would create pain relief for the patient for up to roughly nine months to twelve months and this can be completed indefinitely.

Melanie: Are there certain people for whom you do not think are candidates for any, even these minimally-invasive procedures, or even an epidural, Dr. Choi – are some people just not a good candidate? Maybe the elderly, or people who just have had recurrent stenosis?

Dr. Choi: There are many patients that wouldn’t qualify for steroid injections or minimally-invasive procedures, such as ablations and even spinal cord stimulation. There are certain patients that aren’t able to tolerate these injections secondary to their medical condition. For people that have blood-thinning medications that they cannot come off of, for patients that perhaps have other components that play into chronic pain, such as psychological or psychiatric disorders, may not respond as well to these injections and neuromodulation techniques. These are some of the things we look out for.

Melanie: So then, please, what would you tell patients that are suffering from this type of pain? And if you’re not somebody who’s ever had back pain, it’s difficult to understand the debilitating effects that it can have on your quality of life. What should people with severe back pain think about when seeking care?

Dr. Choi: Back pain is one of the most common indications for a patient to see their physician, and it’s also a major cause of disability – Osteoarthritis, in general, is a major cause of disability in the United States. I would tell patients that they are not alone and that chronic pain really disturbs a person’s mood, a person’s desire to live. It doesn’t just cause pain, it causes your quality of life – just as you mentioned – to be severely diminished. I would suggest that anybody that’s listening to seek out help because there are ways that back pain can be treated and very effectively. It just needs to be explored and figured out.

Melanie: Why should they come to Texoma Medical Center for their care?

Dr. Choi: Texoma Medical Center has a very multidisciplinary approach to any form of the disease, including pain, including all of the other specialists that treat their various disease processes and pathology. Our team is dedicated, they are kind, and particularly I can speak for my own staff, they are very efficient and they will also reach back to my patient. Any patient that steps in my office, typically are very satisfied with their care and treatment.

Melanie: Thank you, so much, Dr. Choi for being with us today. You’re listening to TMC Health talk with Texoma Medical Center. For more information, you can go to TexomaMedicalCenter.net, that’s TexomaMedicalCenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. This is Melanie Cole, thanks, so much, for listening.