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Deborah Howell (Host): You know, at some point, just about everyone has experienced some form of back pain, but many of us just live with it. But what if there was a better way to live? I'm Deborah Howell. And today, we'll find out more about pain management for back pain with an expert in the field. Dr. Ashraf Khan is an anesthesiologist and pain management specialist with McLaren Oakland.

This is McLaren's In Good health, the podcast from McLaren. Welcome, Dr. Khan.

Dr Ashraf Khan: Thank you.

Deborah Howell (Host): Wonderful to have you today. Now, as a pain management specialist, is back pain the most common chronic pain complaint you see?

Dr Ashraf Khan: Yes, that is the most common pain problem that a pain practitioner sees. And I see that same thing in my practice. About 60% of the patients, they have low back pain. And as a matter of fact, every fourth person who comes to see their primary care physician, they have low back pain. And the other 40% is consistent with head and neck pain, cancer pain, upper extremity, lower extremity pain, or even post-surgical pain. But yes, low back pain is the most common.

Deborah Howell (Host): And what are some common causes of chronic back pain?

Dr Ashraf Khan: As far as back pain is concerned, common causes are muscular or ligamentum strain, sprain strain-type of situation. Then, you have bulging discs. Discs, they act as a cushion between the bones and they can be affected. So bulging discs is another cause. Herniated disc, like a ruptured disc. And again, the disc material is like a cushion or a jelly-like material, which is between the lumbar discs. And once that disc is ruptured, then you have enzymes that are released from the disc and they can irritate the nerve.

The common causes are degenerative disc disease and facet joint dysfunction. These are like arthritic changes like facet joint, sacroiliac joint dysfunction. And so arthritic changes are the other causes.

Then, you have lumbar spinal stenosis, lumbar spondylolisthesis, and osteoarthritis and spinal deformities, whether they are congenital or whether they are acquired. So these are some of the main causes.

Deborah Howell (Host): That's quite a large menu.

Dr Ashraf Khan: Yeah.

Deborah Howell (Host): So people have often equated pain management with pain medication, but that isn't always the case, is it?

Dr Ashraf Khan: No, it's not often the case. But as far as patients are concerned, that's what they view that, "You know what? I'm going to go to a pain physician and I'm going to get narcotics." Yes, narcotic is one of the modalities that we use, but there are other things that are first-line treatments for this problem.

For example, if it is like a mild pain, we will give them anti-inflammatory medications, muscle relaxants, anti-depressant medicines, anticonvulsant medications, and then physical therapy. So we try these modalities. And then on top of that, you know, me being a pain specialist, we do injection therapy for these patients. And if none of those things work or they're giving minimal relief, then injection therapy is also beneficial for them.

It's not like one thing that's going to help these patients, it's multimodal treatment for them, that combination of these medication is what's going to help them the most plus physical therapy plus injection therapy.

Deborah Howell (Host): Tell me a little bit about that injection therapy you've been referring to.

Dr Ashraf Khan: If you have a herniated disc or a bulging disc, for those medical problems, we do lumbar epidural steroid injections, lumbar foraminal injections, and also a procedure called lysis of epidural adhesions. So we do these procedures for them. And, if they have arthritic changes, for that, we do lumbar medial branch block followed by radiofrequency ablation.

Deborah Howell (Host): I know everybody's different, but how effective can these treatments be in general?

Dr Ashraf Khan: With any medical problems, if these problems are caught in the very beginning, the results are good. If patients wait too long, then naturally results are not that great. But early on, by early on, I mean, within first three months, if these treatments are instituted, they get very good relief. In some of these patients, especially with disc bulges, they may even get complete relief. As I mentioned, with this back pain or with any pain entity, there isn't one treatment that's going to do the trick.

Deborah Howell (Host): So when is it time to go see a doctor?

Dr Ashraf Khan: As soon as they can. It's not like they have to wait. Some people may procrastinate and they may wait for sometime. But it is better to see them within first three months, if it is not getting better. I would not postponed it beyond three months. Otherwise, the problem becomes chronic.

Deborah Howell (Host): Sure. And we don't want that. What's the goal of treatment and what can a patient expect after treatment?

Dr Ashraf Khan: the goal of treatment is that these patients need to live with tolerable, livable pain. Small segment of patients, they are going to have good relief, perhaps complete relief, but the other segment of the patients that does not, they're going to have pain most probably the rest of their lives. And the goal is that tolerable, livable pain, that as long as they can be functional with their daily activities at home, with their household chores, functional at their work, that they are able to hold a job, that is perhaps the objective of these treatment modalities.

Deborah Howell (Host): Got it. Is there anything else you'd like to add to our conversation today?

Dr Ashraf Khan: As far as treatments are concerned, it's more like a tailored treatment towards each patient. And if it needs to be bedrest, physical therapy, lumbar bracing and chiropractic treatment, osteopathic manipulation treatment, along with the medication and under medications, as I mentioned, you can have Tylenol, anti-inflammatory medications, muscle relaxants, antidepressants, anticonvulsant medications, and then oral steroids that can be given; TENS unit, that is transcutaneous electrical nerve stimulation, you know, TENS unit, we employ that. So those are more or less some of the treatments.

As far as injection therapy is concerned, just to be a little bit more comprehensive, as an interventional pain physician, these patients can benefit from trigger point injections, transforaminal injections, caudal injections, lumbar medial branch, followed by radiofrequency ablation, sacroiliac joint injections, biofeedback, relaxation techniques, better mechanisms that they can cope with their pain.

Fifty percent of the pain patients, they have depression or anxiety. So I do send these patients to see psychologists, psychiatrists, and they will teach them like biofeedback, relaxation techniques, better mechanisms, so they can cope with pain. And then, some of the other modalities that I use are like spinal cord stimulators.

Deborah Howell (Host): It sounds like patients have a lot of good options and it's definitely, definitely suggested that the moment you feel something wrong with your back or your spine or your neck, go see your doctor. Correct?

Dr Ashraf Khan: Yes, Deborah.

Deborah Howell (Host): We've been speaking with Dr. Ashraf Khan, an anesthesiologist and pain management specialist with McLaren Oakland. Thank you so much for being with us today.

Dr Ashraf Khan: Thank you, Deborah.

Deborah Howell (Host): And we want to thank you for checking out this episode of McLaren's In Good Health. To learn more about Dr. Khan, please visit mclaren.org/khan, and that's spelled K-H-A-N. If you found this podcast to be helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you.

I'm Deborah Howell. Thanks for listening and have yourself a terrific day.