Back pain was the topic of the June Deseret Morning News/Intermountain Healthcare Hotline. In addition to the phone-in segment on June 14, we invited readers to submit questions by e-mail.
The Deseret News selected a dozen of the questions, which were then tackled by Dr. Reed Fogg, director of the Intermountain Spine Institute at The Orthopedic Specialty Hospital, and Dr. Terry Sawchuk, board certified in physical medicine and rehabilitation, with an emphasis in interventional physiatry. We tried to get a representative sample of the questions, making sure we touched on all the topics that came up.
The doctors were given the questions as they were submitted, but some have been edited for online presentation.
Here are the answers provided by Sawchuk and Fogg:
Question: I had most of my disc cut away at the L5 about 10 years ago. Is it possible to have an artificial disc material inserted to give me better support and comfort at the L5 region?
Answer: The success of an artificial disc is dependent upon the age of the patient. It is most successful with someone in the age range of 25-55 with one bad disc but no arthritic changes in the bones and healthy nerves. I would suspect you would do better with an intervertebral spacer and fusion. (Fogg)
Question: What medicine can I take for a sore back? I am allergic to aspirin.
Answer: Being allergic to aspirin, you may also be allergic to medications known as anti-inflammatories. I would suggest initially you try acetaminophen (Tylenol). (Sawchuk)
Question: More than 20 years ago, I fell down from high ground and had to have a cast for my back. It's not painful now, but when I went to Seattle, where it rains often, I found I could not sit in front of a computer for more than a few hours. I have no problem in Salt Lake, but wonder if I can go to Seattle, which I like a lot. Is there a cure for it?
Answer: Sometimes back pain is exacerbated related to weather patterns. It doesn't mean anything specific in terms of a diagnosis. Yes, I think you can go back to Seattle if you wish. As far as diagnosis, treatment or cure, more information is needed . (Sawchuk)
Question: I have some fused vertebrae and have considered spinal decompression. Do you ever recommend the procedure?
Answer: Spinal decompression or traction is currently a very popular form of treatment for back and leg pain.
The concept of traction has been around for many years. In the 1950s and 1960s, everyone with back pain was placed in the hospital on bed rest. Traction was used on the patient for about 10 days. It did not work very well and has been discontinued.
I have no argument with a trial of traction, but believe that rather than paying for a long program up front, you should pay for one visit at a time and continue only if you find improvement. (Fogg)
Question: My L4 & L5 discs are riding upon one another, with no cartilage between them. The pain used to be periodic but now is nearly constant. I cannot lie on my back and sleep. It hurts to bend over and brush my teeth. Most chairs are difficult to sit in without pain. I experience pain when walking more than 30 yards. What do you recommend that I do?
Answer: It sounds like what you're describing is degenerative disk disease, which can become worse over time. Given the severity of your pain and the functional limitations it's now placing on you, it probably is time to consult with a physician. You can start with your primary care physician, who can help you determine your next step or who you need to see. (Sawchuk)
Question: I am now a 63-year-old male. In 1972 due to a malformed L5 and Spondylthesis, I had my L4, L5, and sacrum fused. The fusion failed to hold and was repeated in 1975 but also failed.
I have lived with a lot of pain and physical restriction ever since. Four years ago, while looking at an MRI for something else, the doctor noted that I have arthritis in my fusion. Last November and again last month, I moved in such a way that I set off some very, very severe pain through the fused area; although no pain down the leg. This pain had me in bed for several days each time and each time I gradually recovered, but I am very concerned that it will happen again.
Has modern medicine progressed to a point that I should consider another fusion?
Answer: I do not have enough information to give you an opinion on your failed fusion. I would recommend a CT scan and evaluation by a physical medicine specialist, such as Dr. Terry Sawchuk, Dr. Brent Bowen or Dr. Michael Jaffee. (Fogg)
Question: I am now in my late 50s, very tall and 370 lbs. I first injured my back 15 years ago, moving a piano. I tore the right sacroiliac ligament. After considerable pain and disability, it healed almost completely about three years later.
Then I injured my left side, falling about six feet onto a platform. I landed on the left hip-buttock area and had an extremely sharp, breath-stopping pain just to the left of my spine at about the point of the top of the hip. While the acute pain gradually subsided, there remains an almost constant, usually dull pain and sense of dislocation. I had a CAT scan, which showed no broken bones, but the scan summary said there are "multilevel osteoarthritic changes with multiple disc bulges and facet hypertrophy at all levels."
Since the injury, I have had completely unpredictable episodes of spasm and extreme pain, About four years ago, my back was becoming increasingly unstable with more frequent acute episodes that would demobilize me for long periods. Just over a year ago, I increased the frequency and intensity of the exercises that have been the only reliable means of relief particularly a fairly vigorous form of water aerobics. This has helped decrease the number and, to a lesser extent, the severity of the acute episodes. But I worry constantly that the next jolt might put me down again.
Despite not seeing anything in the CAT scan, might there be damage to the bony parts of my spine that might be fixed with surgery?
Answer: You are in a very difficult situation. At 370 pounds, there is little that can be offered to you from a surgical point of view. I believe all of your lower back is showing signs of wear and tear.
I would suggest decreasing you weight. It might also be helpful to consider an epidural injection of cortisone and physical therapy for core strengthening. (Fogg)
Question: I had an operation and for the next five months, my spine felt like bleach was being poured down it, poisoning my body, using my spine as the conduit. I also had pins and needles throughout my body that have very slowly gone away. I don't know that any anesthesia was used through my spine during the operation, but wondered if that could cause it.
I also have degenerative hips and spinal discs. I am only 50 and was surprised I am already getting these problems. Is exercise the best way to prevent future deterioration?
Answer: I am confused as to what type of back operation you had and what type of anesthetic was used. Your pain sounds like some type of nerve irritation. Multilevel degeneration of the spine in someone as young as 50 suggests excessive use as a youth from athletics, heavy labor or genetics. I would suggest a physical conditioning program to decrease weight, increasing trunk strength with no impact and learning proper body mechanics. (Fogg)
Question: Recently I have been diagnosed with spinal stenosis at the C5-6 and C6-7 areas by a neurosurgeon. I was wondering what treatment options exist? I have heard of positive results from a friend regarding a chiropractor who utilized the DRX-9000. Is this a possible form of treatment? If so, does this treatment provide immediate (six months to a year) results or is it a long-term/life-long treatment process? Also, would physical therapy be a method of alternative treatment?
I had back surgery in 2001, removing the L4-5 and L5-6, and don't relish the thought of undergoing another surgery. I also have pain radiating from my lower back into my left and right ankles and producing a numbing feeling in my two small toes on my left foot. Do you have any recommendations?
Answer: Treatment options vary depending on the degree of stenosis and the findings or symptoms of your physical examination. There are situations where surgery would be recommended before any type of nonsurgical treatment.
With regards to the DRX-9000, I am not aware of any specific studies for spinal stenosis. Physical therapy may be an option, again depending on your symptoms and the findings of examination. (Sawchuk)
Question: I never had back pain until I was training for a marathon a couple of years ago. My lower back started to ache and I just attributed it to being 52 (my husband is a few years older and went through the same thing. His went away after a couple of months of taking ibuprofen). My doctor said to ease back on my training, so I did. As I got into several months of training my leg gave way during a long run. I went to a physical therapist, who said it was an inflamed SI joint and through some intense therapy I was able to run the marathon.
It still bothers me two years later. Is there anything that can be done to alleviate this lower nagging back ache/pain? I don't run any more; I do a lot of biking so that I don't put a lot of pressure and pounding on my back. Ibuprofen helps some, but not completely. Is this just something I have to learn to live with? Should I get an X-ray done on my lower back to rule out anything more serious? I'm in good shape otherwise and very active physically.
Answer: I would suggest with back and leg pain that you probably need an MRI scan to see if there's pressure on the nerve or something. A more complete evaluation may open up other treatment options for you. (Sawchuk)
Question: I'm a 57-year-old male who has constant back pain once again. I had back surgery 11 years ago for spinal stenosis and felt great until the pain started coming back two years ago. Physical therapy didn't help. I still do exercises that they gave me after back surgery and that seems to keep me loosened up a bit. I take 1600 MG of ibuprofen a day, just to make it through. My job requires heavy lifting. I had an epidural injection last year but it did nothing. Is there anything to help besides surgery once again?
Answer: You need an evaluation, which includes an MRI, examination and consultation with a specialist. You've had many of the first steps to relief and when those things have failed, then surgery may be the best option. Is changing jobs an option? You may wish to consider alternative employment. (Sawchuk)
Question: What exercises are best for back pain? I do yoga and Pilates.
Answer: I think those are both excellent for core strengthening. Some aerobic activity along with that can be helpful. But if you're doing both, you're doing pretty good. (Sawchuk)