“Ow! I hurt my back!” I imagine you have said this, out loud or to yourself, at some point in your life.
Most low back injuries involve lifting, bending or twisting in the wrong way.
There are many different little back muscles, all connected by tendons to the bones in your spine.
The medical staff at Shepherd Pain Institute ventures beyond narcotics to treat pain. Some examples:
•Nerve blocks – injections of medication into a specific area of the body. These are used to both diagnose and treat pain.
•Neuromodulation – implanted electrodes, or pacemaker-like devices, that stimulate the spinal cord.
•Biofeedback – using thoughts to control the body and relax certain muscles. This is both a treatment option and a coping mechanism.
•Manual (osteopathic) therapy – manual manipulations to bones that can sometimes relieve pain.
Listen in as Erik Shaw, D.O., discusses lower back pain and how Shepherd Pain Institute can help ease your pain.
The Latest Mainstream and Alternative Treatments for Chronic Back Pain
Featured Speaker:
Dr. Shaw completed his residency in Physical Medicine and Rehabilitation and his Anesthesiology fellowship in Pain Medicine at the University of Texas Health Science Center in San Antonio.
Learn more about Erik Shaw, D.O.
Erik Shaw, D.O.
Erik Shaw, D.O., is a staff physiatrist at the Shepherd Pain Institute. Dr. Shaw is double board certified in Physical Medicine and Rehabilitation and Pain Medicine. A Texas native, Dr. Shaw graduated from Texas A&M University with a degree in Biomedical Engineering and obtained his medical degree at the University of North Texas Health Science Center in Fort Worth.Dr. Shaw completed his residency in Physical Medicine and Rehabilitation and his Anesthesiology fellowship in Pain Medicine at the University of Texas Health Science Center in San Antonio.
Learn more about Erik Shaw, D.O.
Transcription:
The Latest Mainstream and Alternative Treatments for Chronic Back Pain
Melanie Cole (Host): At Shepherd Pain Institute, doctors offer a wide variety of treatments and comprehensive care for chronic back pain, which is one of the most common types of pain that people experience. Have you experienced chronic back pain? Well, if you have, you want to listen to my guest today, Dr. Erik Shaw. He’s an interventional pain management specialist at Shepherd Pain Institute. Welcome to the show, Dr. Shaw. Tell us a little bit about chronic back pain. What are the general causes for back pain?
Dr. Erik Shaw (Guest): Thank you for having me, Melanie. There are lots of different reasons that people can have back pain, ranging from degenerative disk to the little arthritis in the joints that connect the back to the spine muscles, weak abdominal and core muscles, and certainly injuries and sometimes surgery can actually make pain a little bit worse.
Melanie: What are the treatments available? I mean, it certainly would depend on the reason for your back pain, but because it’s so pervasive in this country, keeps people out of work, stops them from being active, and if you’ve ever experienced back pain, you know how bad it can be. What are you doing for people in pain management to help them manage this?
Dr. Shaw: As you said, it depends on the source of the back pain and how long it’s been going on. Certainly, if you look at the literature, up to 80 to 90 percent of adults have experienced back pain at some point in their lives and if it’s managed appropriately, typically, it will go away within four to six weeks, if not sooner, depending upon the nature of the injury. First and foremost, it’s important to remain active, keep strong abdominal and core muscles, do regular stretching exercise. Actually smoking causes a significantdegeneration of the discs of the spine and contributes a lot to low back pain, and there’s quite a bit of data on how smoking is deleterious, specifically for low back pain in addition to all the other health concerns that we have for smoking. So, that’s first and foremost. An active therapy exercise regimen is really critical for people. Failing that, if there’s some particular pain that they’re not able to exercise because of, then that’s when we can kind of intervene sometimes, but depending upon the literatureyou look at, roughly 40 percent of back pain is attributable to the disc and, of course, surgeons like to say, “Let’s just cut it out,” or effusion. Well, that can be helpful. Certainly a simple lumbar epidural or cervical epidural can be helpful. Facet injection which are the joints behind the spine that interlock each segment on one another, those sometimes can be arthritic and kind of get impinged. The muscles themselves can cause a lot of pain, and a good stretching regimen and strengthening of those muscles can really help things get a lot better. If someone has had surgery for a definitive problem and either were not successful or maybe successful for treating the pain that was intended but caused another long-term pain, either from the scar tissue or from the hardware or anything, then implanted devices such as spinal cord stimulators and intrathecal pumps, which have been around for decades each, and pretty-well established technologies can be very beneficial. Let me talk about each one individually. Spinal cord stimulator is an electronic device which is implanted floating behind the spinal cord and sends a little electric tingle into the spinal cord to block the pain signal and is pretty helpful for a lot of people with back and leg pain. Intrathecal pump is a slightly different take. It’s putting medicine into a reservoir which is implanted in the abdomen into a catheter and that gives you a little bit of medicine throughout the day. Instead of taking a tablet or a patch that goes into your system gets into your bloodstream, this is delivering the medicine right to where it needs to go so that you need a lot less medicine to do a much stronger job because it’s right at the level of the spinal cord or the nerves where the medicine needs to be targeted and has much less of a systemic effect.
Melanie: With medications, so many people with chronic back pain take narcotics, Vicodin and Norvad and all these different ones. Do they mask the pain or do they have an anti-inflammatory effect to help actually ease the symptoms?
Dr. Shaw: Right. Narcotics do mask the symptoms. They don’t have any anti-inflammatory properties. They’re quite deleterious in fact, and a lot of literature has come out to show that long-term chronic narcotics don’t really have a great role in helping to control pain from a non-malignant source. Now, it helps a little bit, and that’s fine, but more is not going to necessarily help more, and actually the more narcotics you take for a longer period of time is going to be quite deleterious to a person’s system affecting any number of different organ systems and causing all sorts of side effects, which in general are not helpful. Now, if you can demonstrate that the patient’s on a moderate, even high dose of narcotics, and it’s improved their quality of life and their function and they’re not simply sitting around and taking pills, to sit on the couch and watch TV and smoke cigarette, then that’s the argument to say that this person is doing well and they’re good opioid candidate. However, the vast majority of people tend to do worse unless you increase the dose of narcotics, and that’s when the implanted pump or the spinal cord stimulator can be helpful. In terms of anti-inflammatories as you spoke about, as we get older, the risk factors for Naprosyn and Ibuprofen and things like that for stomach ulcers, worsening hypertension, kidney disease, heart disease, stroke are all pretty significant and there’s a significant warning from the FDA for people over the age of 60, 65 with any of these comorbid conditions and anti-inflammatories. Those need to be used with caution and just not for patients to be on them on a regular basis daily.
Melanie: You spoke about exercise and the importance of keeping good core strength and being active and not smoking. What are some other behavioral modifications? If we have something like a bulging disc which can cause back pain at any given time and for no reason, are there ways to prevent these – lifting differently, learning proper techniques, keeping that strong core?
Dr. Shaw: Well, certainly, lifting technique is really important to maintain a proper mechanics of the back and to reduce the risk of injury. At the same time, degenerative disc, although typically referred to as a disease, is not really a disease; it’s a condition. Everyone, with time, if they walk upright long enough as mankind does, will have a degenerative spine, and the best way to deal with it is not to assume that just because I have back pain and I have a bulging disc, that the pain is absolutely coming from the bulging disc, because I mentioned it can be coming from the facets, or it could be coming from the muscles. Having a proper diagnosis is really important and to not just assume that surgery is the only answer. I really want to caution that people who jump right into surgery, thinking that it’s going to fix the issue, that’s probably not the case. In terms of maintaining natural health and keeping the spine healthy with time, obviously staying lean, stretching, routine exercise, walking, swimming, biking, is really important, and when you lift and pick things up, not to lift at the back, but lift with the legs. Squat, bend down, keep items close to your body because as you push them away from your body, they can increase the amount of stress that the disc has.
Melanie: Okay, so all of these wonderful tips and things that people can do: lifting techniques, biomechanics of the spine, finding out what’s wrong and what’s causing your chronic back pain. You mentioned facet injections and cortisone shots. People tend to go for these, however many times; they have an epidural as many times, until the doctor says no more. What does a facet injection do? When does a cortisone shot just it’s done, you can’t do it anymore?
Dr. Shaw: Yeah. The purpose of doing a steroid shot, whether it’s a lumbar epidural or facet injection with steroid is… steroid is a potent anti-inflammatory. Like Naprosyn, except it’s a steroid rather than non-steroidal anti-inflammatory, it should help for a good while. It shouldn’t be helpful for a week or 10 days. It should be a month or longer benefit, hopefully limited to no more than two or three rounds in a year because as you put steroid into the body, it affects the body’s natural production of steroid and that can cause significant hormonal problems in a person. So as long as you’re having good benefit, you do an injection or maybe two and the patient receives months of benefit, then it’s reasonable to proceed. If they don’t receive benefit, either that’s not where the problem is coming from or there’s not a significant amount of inflammation that the steroid can control, rather that the progress of arthritis is already so far along that there’s not a lot of active inflammation anymore and it’s just simply a painful mechanical condition. There are other techniques that we are able to do to help with that kind of pain. I don’t want to get into it a little bit more in depth; however, modest rational use of injections is helpful. When a patient is receiving multiple injections every couple of weeks or every month, that’s not helpful, that’s not rational. A treatment should provide adequate benefit for several months, sometimes longer, and those injections can be repeated but they have to have good benefit for a good long period of time.
Melanie: Okay, Dr. Shaw, in just the last minute here, give us your best advice about people suffering from chronic back pain and why they should come to the Shepherd Center for their back pain care.
Dr. Shaw: Well, at Shepherd Center at the Shepherd Pain Institute, we have a holistic approach to back pain. We try to understand the whole person, the specific diagnosis of the back pain, whether it’s disc, nerve, facet, muscle; the mechanics that may be contributing to why that specific problem is going on; corrective physical exercise and therapy that can help that; injections when needed; modest medications and psychology if the patient has a significant amount of depression or anxiety associated with the pain.
Melanie: Thank you so much. You’re listening to Shepherd Center Radio. For more information, you can go to shepherd.org. That’s shepherd.org. This is Melanie Cole. Thanks so much for listening.
The Latest Mainstream and Alternative Treatments for Chronic Back Pain
Melanie Cole (Host): At Shepherd Pain Institute, doctors offer a wide variety of treatments and comprehensive care for chronic back pain, which is one of the most common types of pain that people experience. Have you experienced chronic back pain? Well, if you have, you want to listen to my guest today, Dr. Erik Shaw. He’s an interventional pain management specialist at Shepherd Pain Institute. Welcome to the show, Dr. Shaw. Tell us a little bit about chronic back pain. What are the general causes for back pain?
Dr. Erik Shaw (Guest): Thank you for having me, Melanie. There are lots of different reasons that people can have back pain, ranging from degenerative disk to the little arthritis in the joints that connect the back to the spine muscles, weak abdominal and core muscles, and certainly injuries and sometimes surgery can actually make pain a little bit worse.
Melanie: What are the treatments available? I mean, it certainly would depend on the reason for your back pain, but because it’s so pervasive in this country, keeps people out of work, stops them from being active, and if you’ve ever experienced back pain, you know how bad it can be. What are you doing for people in pain management to help them manage this?
Dr. Shaw: As you said, it depends on the source of the back pain and how long it’s been going on. Certainly, if you look at the literature, up to 80 to 90 percent of adults have experienced back pain at some point in their lives and if it’s managed appropriately, typically, it will go away within four to six weeks, if not sooner, depending upon the nature of the injury. First and foremost, it’s important to remain active, keep strong abdominal and core muscles, do regular stretching exercise. Actually smoking causes a significantdegeneration of the discs of the spine and contributes a lot to low back pain, and there’s quite a bit of data on how smoking is deleterious, specifically for low back pain in addition to all the other health concerns that we have for smoking. So, that’s first and foremost. An active therapy exercise regimen is really critical for people. Failing that, if there’s some particular pain that they’re not able to exercise because of, then that’s when we can kind of intervene sometimes, but depending upon the literatureyou look at, roughly 40 percent of back pain is attributable to the disc and, of course, surgeons like to say, “Let’s just cut it out,” or effusion. Well, that can be helpful. Certainly a simple lumbar epidural or cervical epidural can be helpful. Facet injection which are the joints behind the spine that interlock each segment on one another, those sometimes can be arthritic and kind of get impinged. The muscles themselves can cause a lot of pain, and a good stretching regimen and strengthening of those muscles can really help things get a lot better. If someone has had surgery for a definitive problem and either were not successful or maybe successful for treating the pain that was intended but caused another long-term pain, either from the scar tissue or from the hardware or anything, then implanted devices such as spinal cord stimulators and intrathecal pumps, which have been around for decades each, and pretty-well established technologies can be very beneficial. Let me talk about each one individually. Spinal cord stimulator is an electronic device which is implanted floating behind the spinal cord and sends a little electric tingle into the spinal cord to block the pain signal and is pretty helpful for a lot of people with back and leg pain. Intrathecal pump is a slightly different take. It’s putting medicine into a reservoir which is implanted in the abdomen into a catheter and that gives you a little bit of medicine throughout the day. Instead of taking a tablet or a patch that goes into your system gets into your bloodstream, this is delivering the medicine right to where it needs to go so that you need a lot less medicine to do a much stronger job because it’s right at the level of the spinal cord or the nerves where the medicine needs to be targeted and has much less of a systemic effect.
Melanie: With medications, so many people with chronic back pain take narcotics, Vicodin and Norvad and all these different ones. Do they mask the pain or do they have an anti-inflammatory effect to help actually ease the symptoms?
Dr. Shaw: Right. Narcotics do mask the symptoms. They don’t have any anti-inflammatory properties. They’re quite deleterious in fact, and a lot of literature has come out to show that long-term chronic narcotics don’t really have a great role in helping to control pain from a non-malignant source. Now, it helps a little bit, and that’s fine, but more is not going to necessarily help more, and actually the more narcotics you take for a longer period of time is going to be quite deleterious to a person’s system affecting any number of different organ systems and causing all sorts of side effects, which in general are not helpful. Now, if you can demonstrate that the patient’s on a moderate, even high dose of narcotics, and it’s improved their quality of life and their function and they’re not simply sitting around and taking pills, to sit on the couch and watch TV and smoke cigarette, then that’s the argument to say that this person is doing well and they’re good opioid candidate. However, the vast majority of people tend to do worse unless you increase the dose of narcotics, and that’s when the implanted pump or the spinal cord stimulator can be helpful. In terms of anti-inflammatories as you spoke about, as we get older, the risk factors for Naprosyn and Ibuprofen and things like that for stomach ulcers, worsening hypertension, kidney disease, heart disease, stroke are all pretty significant and there’s a significant warning from the FDA for people over the age of 60, 65 with any of these comorbid conditions and anti-inflammatories. Those need to be used with caution and just not for patients to be on them on a regular basis daily.
Melanie: You spoke about exercise and the importance of keeping good core strength and being active and not smoking. What are some other behavioral modifications? If we have something like a bulging disc which can cause back pain at any given time and for no reason, are there ways to prevent these – lifting differently, learning proper techniques, keeping that strong core?
Dr. Shaw: Well, certainly, lifting technique is really important to maintain a proper mechanics of the back and to reduce the risk of injury. At the same time, degenerative disc, although typically referred to as a disease, is not really a disease; it’s a condition. Everyone, with time, if they walk upright long enough as mankind does, will have a degenerative spine, and the best way to deal with it is not to assume that just because I have back pain and I have a bulging disc, that the pain is absolutely coming from the bulging disc, because I mentioned it can be coming from the facets, or it could be coming from the muscles. Having a proper diagnosis is really important and to not just assume that surgery is the only answer. I really want to caution that people who jump right into surgery, thinking that it’s going to fix the issue, that’s probably not the case. In terms of maintaining natural health and keeping the spine healthy with time, obviously staying lean, stretching, routine exercise, walking, swimming, biking, is really important, and when you lift and pick things up, not to lift at the back, but lift with the legs. Squat, bend down, keep items close to your body because as you push them away from your body, they can increase the amount of stress that the disc has.
Melanie: Okay, so all of these wonderful tips and things that people can do: lifting techniques, biomechanics of the spine, finding out what’s wrong and what’s causing your chronic back pain. You mentioned facet injections and cortisone shots. People tend to go for these, however many times; they have an epidural as many times, until the doctor says no more. What does a facet injection do? When does a cortisone shot just it’s done, you can’t do it anymore?
Dr. Shaw: Yeah. The purpose of doing a steroid shot, whether it’s a lumbar epidural or facet injection with steroid is… steroid is a potent anti-inflammatory. Like Naprosyn, except it’s a steroid rather than non-steroidal anti-inflammatory, it should help for a good while. It shouldn’t be helpful for a week or 10 days. It should be a month or longer benefit, hopefully limited to no more than two or three rounds in a year because as you put steroid into the body, it affects the body’s natural production of steroid and that can cause significant hormonal problems in a person. So as long as you’re having good benefit, you do an injection or maybe two and the patient receives months of benefit, then it’s reasonable to proceed. If they don’t receive benefit, either that’s not where the problem is coming from or there’s not a significant amount of inflammation that the steroid can control, rather that the progress of arthritis is already so far along that there’s not a lot of active inflammation anymore and it’s just simply a painful mechanical condition. There are other techniques that we are able to do to help with that kind of pain. I don’t want to get into it a little bit more in depth; however, modest rational use of injections is helpful. When a patient is receiving multiple injections every couple of weeks or every month, that’s not helpful, that’s not rational. A treatment should provide adequate benefit for several months, sometimes longer, and those injections can be repeated but they have to have good benefit for a good long period of time.
Melanie: Okay, Dr. Shaw, in just the last minute here, give us your best advice about people suffering from chronic back pain and why they should come to the Shepherd Center for their back pain care.
Dr. Shaw: Well, at Shepherd Center at the Shepherd Pain Institute, we have a holistic approach to back pain. We try to understand the whole person, the specific diagnosis of the back pain, whether it’s disc, nerve, facet, muscle; the mechanics that may be contributing to why that specific problem is going on; corrective physical exercise and therapy that can help that; injections when needed; modest medications and psychology if the patient has a significant amount of depression or anxiety associated with the pain.
Melanie: Thank you so much. You’re listening to Shepherd Center Radio. For more information, you can go to shepherd.org. That’s shepherd.org. This is Melanie Cole. Thanks so much for listening.