Millions of Americans live with chronic back pain. From shooting pain while walking or bending over to bursts of pain when sneezing, the discomfort isn't always limited to the back. The pain can also travel down the legs.

“In fact, up to 80 percent of Americans experience low back pain at some point in their lives. It is the second most common reason for doctor visits,” board-certified and fellowship-trained spine surgeon Dr. Sharad Rajpal explained during a free online health lecture.

Types of Back Pain

According to Dr. Rajpal, there are two major types of back pain:

  • Acute – Sudden, intense pain that typically resolves within a few days or weeks
  • Chronic – Deep, dull or aching pain that usually lasts over 3 months

“Roughly 30 percent of individuals experience acute back pain, while 60 percent suffer from chronic back pain. The rest of people fall into a third, in-between category,” Dr. Rajpal said. “There is an in-between timeframe of a few weeks to three months that's typically classified as sub-acute, which comprises about 10 percent of the patients.”

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VIDEO ALERT: Watch Dr. Rajpal's lecture on the "Latest Treatments for Back Pain"
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What Causes Back Pain?

Structural Problems

Dr. Rajpal discussed a number of structural problems that can cause back pain:

  • Deformity – This includes conditions such as scoliosis and other issues associated with exaggerated curvatures in the spine.
  • Trauma – Fractures of the spine and other injuries that may damage the spine come under this category.
  • Infection – Back pain resulting from spontaneous infections secondary to things such as intravenous drug use, skin or urinary tract infections.
  • Tumor – Cancer can affect the spine either primarily or secondarily from a metastasis.
  • Inflammation – Ankylosing spondylitis and other inflammatory conditions make up a small subset of individuals experiencing back pain.
  • Degenerative conditions – These occur naturally with age and are the most common culprits for chronic back pain.

Degenerative conditions often linked to chronic back pain include:

  • Disc herniation (bulging disc) - Dr. Rajpal explained that the terms “herniated disc” and “bulging disc” are often used interchangeably. “This happens when a disc tears and part of the disc’s internal material extrudes through the tear. If some of it remains, then it results in a bulge; if it completely extracts itself, then it becomes a herniation. Either way, they can both cause pain.”
  • Degenerative disc disease - This is an age-related, wear-and-tear condition. The cushiony discs between the vertebrae of the spinal column normally allow for flexing and extending of the spine, acting like shock absorbers. “Over time, the discs between the vertebrae start to deteriorate and break down. This causes anatomic changes that then result in nerve irritation or put abnormal pressure on the spinal joints,” Dr. Rajpal explained. He added that almost all adults have some varying degree of degenerative disc disease, which begins to develop during teenage years when the discs start to lose their hydration and fluid.
  • Spinal stenosis - In spinal stenosis, the spaces in the spinal canal start to narrow. “For most people, the stenosis results from degeneration and arthritis,” said Dr. Rajpal. “When the spinal canal narrows, the open spaces between the vertebrae start to get smaller and can pinch the spinal cord or the nerves around it, causing pain, tingling or numbness in your legs, arms or torso.”
  • Spondylolisthesis – This wide-spread problem in adults occurs when one vertebra is in misalignment from another vertebra. “There’s a true ‘slip’ of one bone over another one,” said Dr. Rajpal.

Strain

Muscle strains comprise the majority of back pain. Dr. Rajpal explained that muscle strains usually heal with non-operative treatments and time. This may include:

  • Rest
  • Heat
  • Ice
  • Anti-inflammatory drugs
  • Stretching

Sciatica

Sciatica is another common condition resulting in back pain. It occurs when the sciatic nerve becomes pinched, usually by a herniated or buldging disk in your spine. Dr. Rajpal said, "It typically results in burning or shooting pain, starting in the low back or buttock, radiating down the front or back of the thigh and leg, and extending down into the feet." Numbness, tingling or weakness can also be associated with sciatica. Typically, the condition only affects one leg.

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Nonsurgical Treatment Options

According to Dr. Rajpal, treatment options for back pain typically fall into two categories: non-operative and operative treatments. In general, operative treatments are reserved for individuals with more urgent situations such as severe pain or progressive neurological issues.

There are three types of non-operative treatments:

  • Medications – NSAID drugs such as naproxen and ibuprofen are typically recommended to relieve back pain. Gabapentin is also often used for patients with shooting pain into their legs. Opioid drugs are not recommended for the treatment of back pain in most situations.
  • Physical therapy – "The key is to work with a good physical therapist who understands your spinal problems and can teach you the proper exercises," said Dr. Rajpal. Core strengthening, flexion/extension movements and general physical fitness are common approaches associated with physical therapy. In addition, spinal manipulation can often be effective at treating back pain. However, Dr. Rajpal cautioned that this should be avoided if you experience severe or progressive neurological conditions.
  • Injections – Spinal injections can be tried in situations where medication and physical therapy haven’t been successful. The most common types of spinal injections are epidural steroid injections and facet blocks. The epidural generally treats leg pain, whereas the facet blocks treat back pain.

Modifying activities to decrease stress on the back is also important. Dr. Rajpal recommends maintaining activity as tolerated, and if bedrest is necessary, return to normal activities as soon as possible. He said certain changes in the home can also reduce the stress on your back such as sleeping on a medium-firm mattress.

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Surgical Treatment Options

Approximately 80 percent of patients will experience pain relief from these non-surgical treatments. For the 20 percent of individuals who don’t respond to non-operative solutions or have neurologic issues, surgery may be necessary.

Technology has advanced rapidly in recent years. Modern spinal surgery involves a computer- and robot-assisted process which allows for:

  • 3D visualization and reconstruction of the spine
  • Real-time anatomy and feedback/integration, which increases precision
  • More effective preoperative planning with intraoperative execution
  • Greater predictability
  • Greater surgical accuracy
  • Less invasive procedures, with smaller incisions and muscle splitting instead of muscle cutting
  • Decreased length of stay in the hospital

Dr. Rajpal explained that the right surgery for you will depend on the following factors:

  • Cause of your symptoms – Fracture, scoliosis, disc herniation, tumor or infection
  • Presenting symptoms – Are there any neurologic deficits present?
  • Age and overall health – Do you have any heart or lung conditions? Do you suffer from osteoporosis?

"For surgery, the most important things to consider are the patient’s goals, what the patient wants to achieve, and how we are going to get the patient to achieve that,” Dr. Rajpal stated. Based on the answers, the surgeon will discuss the treatment options, non-operative and operative, and then arrive at a mutual decision with the patient regarding the best course of action.

Types of surgeries include:

  • Microdiscectomy – Performed to treat a herniated disc
  • Lumbar laminectomy – Performed to treat spinal stenosis
  • Spinal fusion – Performed to stabilize or straighten the spine
  • Anterior cervical discectomy and fusion (ACDF) – Performed to remove a herniated or degenerative disc in the neck

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Mazor X™ Robotic-Guided Spine Surgery

Dr. Rajpal concluded his talk explaining that Boulder-area residents suffering from painful back conditions now have local access to an advanced surgical system that can make spine surgery safer and less painful.

BCH offers the cutting-edge Mazor X™ Stealth robotic guidance system, which allows BCH spine surgeons to use a less-invasive approach to complex spine surgery. BCH’s Foothills Hospital was the first Colorado hospital north of Denver to offer this revolutionary technology.

If you’d like to learn more about the treatment options for your back pain, schedule an appointment with Dr. Sharad Rajpal by calling (303) 938-5700.

Click here to view/download a PDF of slides shown during Dr. Rajpal's lecture.

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