Frequently Asked Questions
My physician uses words like ACUTE BACK PAIN and CHRONIC BACK PAIN. What’s the difference?
According to physician vernacular, there are two types of pain — acute and chronic. Acute pain is sudden, may come out of nowhere, and be severe and piercing in nature. It serves as a warning signal from the body that something is wrong. The good news is that with acute pain, eventually it will resolve itself when the danger has passed and the cause has been treated. Acute pain serves a useful purpose: it warns us not to continue some activity that is hurting the body.
Then there is chronic pain. Chronic pain relates to only those people whose back or neck pain has not gotten better with all the mainstream and alternative treatments. Usually, if a person has had back pain or neck pain for six months or more, a physician may tend to say you have chronic pain. Chronic pain doesn’t serve any useful biologic purpose. Also, with chronic pain, a physician may not be able to find an obvious physical problem that may be causing the pain. In other words, chronic pain can be a puzzling medical problem.
Consequently, chronic pain sufferers tend to doctor shop, going from one specialist to another, collecting expensive diagnostic tests and evaluations along the way. The pain condition becomes the predominant focus of the patient and family. Because pain limits the person’s activity, sometimes chronic pain sufferers gain weight and become out-of-shape which causes more complications down the road.
The first step in resolving chronic pain from back or neck injury is to try to find out exactly WHAT is causing the pain signal to the brain. This is like trying to sort out a massive short circuit after lightning hits your fuse box.
What is Failed Back Syndrome, or Failed Back Surgery?
Sadly, Americans are conditioned to seek a magic pill or magic procedure to miraculously provide an instant cure for back or neck pain. So many people are quick to resort to surgery. And sadly, there are surgeons out there who are quick to recommend surgery, often because they don’t know how to provide any non-surgical treatment options.
There are people with relatively simple back and neck problems, who are told surgery is what they need, and then undergo surgery for a somewhat simple disc problem. Then for some, they wake up with pain that is much worse than they had initially.
There can be several reasons why spine surgery may not go well. The most common reason is that the surgeon is not proficient, and not 100% specialized in spine. Just like anything else, practice makes perfect. A general orthopedic or neurological surgeon who does 30 spine surgeries a year will never be as proficient as a fellowship-trained spine surgeon who does 200 spine surgeries a year.
When spine surgery isn’t successful, the immediate thought is, “well, let’s do surgery again and get it right this time.” Unfortunately, while the first surgery may have removed the herniated disc, during the process of surgery a nerve may have been damaged, and no additional surgery can fix a damaged nerve. The only option involves blocking the pain coming from the damaged nerve. That can be done with drugs, but that creates long term problems. Other ways might use a spinal cord stimulator to electrically interrupt the pain signal. Failed Back Surgery syndrome is a complex problem to treat.
This is why surgery should always be the last resort. Even if something is simple, and the surgery “appears” to go well, nerves may be affected from the process of cutting. South Bend Spine tries to exhaust all non-surgical treatment options during the first six weeks. Then if that fails to relieve symptoms, you have the comfort of knowing you at least tried non-surgical options.
I’ve had physical therapy before and it didn’t work. Why should I start all over again with that?
Back pain patients are often out-of-shape, because they fear activity and exercise will make them worse. Studies show the opposite is true. Activity is the key to physical conditioning and mental outlook. It’s common for long-term back and neck pain sufferers to have back stiffness and weakness, which can be helped with physical therapy.
Second, most general physical therapy can be a waste of time, ONLY because non-spine trained therapists do things that feel good to patients, because they want them to come back. But palliative, “feel good” modalities like ice, heat, ultrasound and massage don’t make the back stronger, more flexible and more resistant to strain.
But a spine-trained physical therapist is completely different. They have hands-on techniques that can relieve pain symptoms. And they use special stretches that loosen injured tissues so they can move again. The spine specialized therapists at South Bend Spine have special training that gets you past pain symptoms.
How does an injection in my back work to relieve symptoms?
Injections in the spine have a dual purpose: provide relief from pain, and help the doctor determine the source of pain. For example, the injectionist may use injections to determine the precise level in the spine that may be causing pain. Once the diagnosis is made, a dose of steroid — a potent anti-inflammatory agent — can be injected near the pain generator, such as an irritated nerve root in the spine or in the facet joints of the back.
Various injection treatments reduce inflammation and pain by blocking the nerve impulses carrying the pain message. These blocks can help reduce postural stress and enable you to start with your spine therapist. So in that sense, injections are not an end in themselves, but more a bridge to therapy and long term recovery.
Generally, with back and neck pain, there are three types of injections: epidural steroid, facet joint and trigger point. Epidural steroid injection therapy is believed to be helpful in cases of sciatica where a steroid is injected into the epidural space surrounding the spinal cord and nerves.
Facet joints, when they work properly, enable spinal bones to glide over each other while the back is in motion. Over time, due to many factors, these joints can become painful.
Trigger point injections actually anesthetize the point of pain in a muscle or at another location that may be transmitting the pain signal.
All three of these injections produce temporary success in alleviating pain. They are most effective when combined with other treatments. They should only be used as a part of a comprehensive treatment plan.
What’s the difference between a simple strain or a more serious herniated disc?
Most people erroneously think that the more excruciating the pain, the more likely that you herniated a disc. That is not the case at all. In some cases a back spasm can knock you down to your knees. A person can have excruciating pain, but if it is mostly in the low back, it’s probably not a herniated disc. Typically, a herniated disc in your back will radiate pain down into your leg, or pain will radiate down your arm if you have a herniated disc in your neck.