My name is Stephen Levin. I'm a Johns Hopkins Pain Medicine specialist practicing at Howard County General Hospital. There are multiple different origins of back pain. They can range from the very minor to the very severe. Muscle strains or sprains can cause spasm and the most common cause of back pain...fortunately, they can be very self-limited and go away by themselves. Patients can suffer inflammation or arthritis, which can affect the joints in the back including the sacroiliac joints and the facet joints which can cause pain with movement.
There can also be pain that is referred from the hip. Patients can also experience degenerative disc disease which can cause what we call axial back pain, which is pain in the middle of the back and in some cases those discs can herniate and create what we call sciatica or radiculopathy and this is a result of pressure from the disc on the nerves in the back. Posture or scoliosis, which is a curvature of the back, can lead to biomechanical back pain, which is pain caused by abnormal movement. Some individuals can experience infections which can lead to back pain. Some of those are very unusual infections that include tuberculosis or lyme disease or can be a more common from bacterial infections and that can infect the bone or the epidural space. Patients or individuals as they age can experience thinning of their bone or experience osteoporosis and that can be so severe that the bones fracture and cause back pain.
And in some cases patients with kidney, breast, lung, thyroid and prostate cancers can have their disease spread to the back and that can also cause back pain. The diagnosis of low back pain starts with a careful medical history along with a complete physical examination. If those examinations suggest concerns, then blood tests, x-rays, CT scans, and MRIs are sometimes needed in aiding the diagnosis. In some cases, we use diagnostic injections that are x-ray guided to help facilitate the diagnosis. Most people experience back pain in their lives. The peak incidence of back pain can occur at two different times in life. One time that it occurs most often is in the mid-30s when people's discs start to dry out and they can be susceptible to injuries from lifting which can cause disc herniation. Later in life the incidence will go up again and will be associated with degenerative processes associated with aging so patients will experience more arthritic problems in the back or the thinning of their bones or osteoporosis.
In general, it's good to avoid lifting injuries, poor body mechanics, and it's also good to maintain a good body weight and have a balanced exercise program. Doing these things can lessen the likelihood that you'll experience back pain in your life. Determining the best treatment for back pain can involve the thoughtful application of interventional techniques, medication management, as well as rehabilitative and wellness programs. Our program offers a full spectrum of the most sophisticated medication management, highly specialized interventional pain management techniques, as well as rehabilitative and wellness programs. The mainstay of conservative treatment for patients with back pain is the use of physical therapy.
It can be also very helpful for individuals to use short courses of non-steroidal anti-inflammatory medications, muscle relaxants, oral steroids, or even in some cases a short course of opioid therapy to facilitate the physical therapy. Consulting with one's primary doctor can be a good place to start for individuals experiencing back pain that lasts more than a week or is severe. They can help to determine if consulting with a pain management specialist could be helpful. Most back pain, while uncomfortable, is not a medical emergency. However, in cases where people lose sensation in their limbs that is associated with weakness, or a loss of control of their bodily functions, then more immediate medical attention is necessary. From a pain management perspective there has been a steady evolution of treatments. There has been a steady advancement in the highly specialized interventional pain management techniques, including high frequency neural stimulation. There has been the advent of even more sophisticated medical management options and there have been the advent of innovation rehabilitation strategies that have been very helpful for individuals.
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