Medical Director of Spine Center Answers Common Questions on Back Pain
According to the National Institutes of Health, about 80 percent of Americans experience low back pain in their lifetime. For some, the pain only lasts for a short period of time then goes away. But for others, back pain can last for years, seriously affecting their quality of life.
As the Medical Director of South Shore Health's Spine Center, I hear a lot of questions from patients about back pain. Here are some answers to some of their most common questions.
My doctor says I have degenerative disc disease. What causes it and should I be concerned?
The term “degenerative disc disease” sounds frightening, but disc degeneration is like a settling of the spine as we grow older. It happens to everyone if we live long enough.
The discs that act as cushions or shock absorbers between the bones in the spine become dry and thinner with age. The human body is usually able to adapt to disc degeneration on its own, particularly if you stay active. The rate of degeneration is determined primarily by genetics and family history.
Most recreational, work, and sports activities are only minor contributors to these changes in the spine. Exposure to more aggressive activities that place repetitive stress on the spine—such as body building or competitive basketball with its high jumping—can play a part in the degenerative process.
For most people, these changes in the spine don’t cause pain. But if you find yourself more guarded in your movements and are cutting back on activities that are meaningful to you, it’s time to consult with a spine specialist, such as a physiatrist—a doctor who specializes in Physical Medicine & Rehabilitation.
What is a disc herniation, and what causes them?
Disc degeneration can result in disc herniation—a condition where a disc in the spine has weakened enough to allow its soft, central portion (called the nucleus) to bulge out past the disc’s outer wall and into the spinal canal. Chemicals released from inside the disc can then cause inflammation and back pain that may extend into the leg. Contrary to popular belief, a herniated disc is very rarely the result of a single incident of heavy lifting or physical exertion.
Can I prevent disc herniations?
Because disc degeneration is the result of the aging process and genetics, it can be difficult to prevent. Fortunately, studies show the problem—as well as the pain—usually resolves on its own with time and conservative treatment. Surgery is rarely necessary.
What can I do to prevent disc degeneration or disc herniations?
While we don’t know how to prevent a disc herniation, there is evidence that maintaining a healthy lifestyle may offer some protection. Even people who are extremely fit and exercise on a regular basis can get a herniated disc. Fortunately, the condition usually subsides with time. Of course, someone who is in good physical condition may find it easier to bounce back and recover.
For the small percentage of people who continue to suffer with no improvement, surgery may be needed. After a thorough evaluation of your specific situation, your doctor will work with you to find the best approach for you.
How are disc herniations treated?
Your doctor will be able to help you manage your pain and symptoms as your body heals itself. Treatment generally includes short-term medications to take the edge off of the pain, restful sleep, and time for your body to heal. Early on, walking and gentle exercises are recommended. Your doctor may also recommend a spine injection to reduce inflammation. This is especially helpful when leg pain is severe.
Do I need medicine to manage back pain caused by disc degeneration or herniations?
Many people get over these conditions in just a few weeks. It is important to use just what is necessary to take the edge off of the pain. Over-the-counter medications are usually safe, but always check with your doctor if you are unsure. Medications to help with sleep and reduce muscle spasm are also often prescribed.
If stronger pain medications—such as opioids—are recommended, these should be closely supervised and taken for only a short period of time. It is best to use strong pain medications only for the most severe pain in combinations with other treatments, such as ice and heat to help with muscle spasms and pain.
Many people get some relief from acupuncture, massage, chiropractic or osteopathic manipulation, and other complementary therapies. Meditation and cognitive behavioral therapies are also great ways to relieve pain, reduce stress, and cope with pain.