How to Safely Address Back Pain

Lower back pain is one of the most common complaints physicians see among their patients. In fact, pain is second only to instances of upper respiratory infections. How can individuals achieve relief from the pain in the safest, most effective way?

Doug Keehn, DO, Pain Management Physician at Fort HealthCare, shares helpful information about back pain, including the different reasons a person might have pain and treatment options.

Value of Conservative Treatments

At Fort HealthCare, Dr. Keehn sees patients along the entire pain continuum—from acute back pain arising from being too aggressive with yard work to individuals who have had multiple back surgeries and are in a state of chronic pain. After making sure there’s no potential fracture in play, the next steps are to employ conservative treatment modalities such as anti-inflammatories, physical therapy, and chiropractic in some cases. Dr. Keehn understands this approach can be frustrating for individuals who are impatient to get relief.

“The whole reason we send them to physical therapy is that most patients get better with conservative management in six to eight weeks, really without any further intervention. That’s why we employ those conservative management techniques first. A lot of patients will respond to that conservative management with a little bit of time.”

Minimally Invasive Treatment Options

Beyond conservative treatment, management of back pain varies, depending on what category of pain it falls under. Dr. Keehn describes the two subsets as axial back pain and radiculopathy, which people often refer to as sciatica.

With axial back pain, people may respond well to conservative treatments. If not, there are a few different options available, including nerve blocks and nerve cauterization. Both are common minimally invasive procedures.

Regarding radiculopathy, Dr. Keehn performs a thorough neurologic examination, particularly if the patient has severe pain in the buttock or radiating down the leg. This is to ensure the patient doesn’t have something called cauda equina syndrome, which can be severe enough to be emergent.

“That’s where you would have a disc herniation that would be so big it would be pinching off your pelvic nerve roots,” cautions Dr. Keehn. “A lot of times imaging is indicated, and that is when we would get an MRI.”

Again, physical therapy is prescribed first to see if it provides relief. Dr. Keehn also routinely advises pain medications and nerve medications, as well as injection therapies.

“Approximately 65-75% of those patients, depending on which paper you read, will get significant relief of their symptoms from a combination of physical therapy, medications, cortisone injections, and time,” he adds. “Among those who fail conservative management or do not get relief of their symptoms with conservative management, we send them to see our surgical colleagues to discuss surgical decompression to decompress that nerve root.”