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.”
Watch Dr. Rajpal's lecture on the "Latest Treatments for Back Pain"
What Causes Back Pain?
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
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.
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:
- Anti-inflammatory drugs
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
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
- Cause of your symptoms – Fracture, scoliosis, disc herniation, tumor
- 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
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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