Back surgery as the last resort: Dr. Nicole Brand, sports medicine/physiatrist, helps to discover new and alternative treatments for chronic back pain available at Bergen Medical Associates
Back pain plagues most of us at some point. Whether it’s from an injury, overuse or aging-related arthritis, this pain can impede our daily activities, making it difficult to work, exercise and live a full life. Dr. Nicole Brand, a physiatrist and pain management specialist at Bergen Medical Associates, answers common questions about the causes, treatment and prevention of back pain.
What are common causes of back pain?
There are many causes. All the structures that make up and support the spine can be a source of pain. This includes the muscles in the back, which can get strained over time or because of particular incidents. Joints can become arthritic and inflamed. The discs in between the joints can herniate. Irritation of nerves and fractured bones also cause pain.
What are the common symptoms of back pain?
In addition to the pain itself, patients also report feeling stiffness, tightness, muscle spasms and limited range of motion and mobility.
When should you seek medical attention?
There are two different paths. The red flag symptoms that require immediate medical attention include when back pain is associated with a feeling of weakness, numbness, loss of control of the bowel or bladder, fever or chills or unexplained weight loss. These could signal serious conditions. You should see a doctor immediately in these cases.
More typically, patients see a doctor when back pain becomes severe and debilitating or when symptoms persist, despite taking conservative measures such as rest, ice and over-the-counter anti-inflammatory medications.
How is back pain diagnosed?
When patients come to Bergen Medical Associates complaining of back pain, my first step is to take a detailed medical history and conduct a thorough physical examination. This provides information that helps rule in or out potential causes. We then determine if other diagnostics are called for, including imaging, nerve studies or other procedures.
What are the different levels of treatment?
Typically, we try to start more conservatively. That means modifying activities, oral or topical medication, ice, heat, physical therapy, massage, chiropractic or acupuncture. We have relationships with top-notch physical therapy facilities that provide these therapies so we can co-manage the case with them.
If more treatment or alternative treatment is needed, we would consider injections. The most common are epidurals, which act like a steroid. Medicine injected that is a combination of anesthetic and steroid is used to treat inflammation of the nerves around the spinal cord.
For arthritis-related back pain, we can perform nerve block and ablation. In this procedure, the physiatrist first numbs the nerves in the back with a local anesthetic. That’s a diagnostic procedure to determine if we can temporarily decrease pain. If we get good relief, we can ablate or burn the nerves so that they do not transmit pain. This is a very safe procedure that usually provides relief for a year, sometimes more.
Is it safe to exercise with back pain? What are good prevention strategies?
In general, it is safe to exercise with back pain, depending on the severity and cause of the pain. I may recommend activity modification, if the pain is more acute. It’s important to talk with your doctor to make sure your workout program is appropriate. Lifting heavy weights and walking are two very different things.
We also like our patients to exercise once back pain is relieved. This is one of the best ways to prevent pain or prolong relief by improving flexibility and strengthening your core muscles. Maintaining a healthy weight also helps because it puts less strain on the back. Another preventative strategy is maintaining good biomechanics. That means when you’re lifting something heavy, your lifting position is such that it avoids straining the back. It means being conscious of your back position when you’re doing things that can strain the back.
What can patients expect when they come to see you?
I like my patients to be active participants in their care. My goal is to help guide them and get them to a point where they have the tools to prevent and treat their pain. I like to spend time explaining the cause of the pain and reviewing the imaging so they understand why we are choosing a certain treatment plan.
With offices in Emerson, Paramus, Ridgewood, Northvale and Montvale, Bergen Medical Associates offers primary care and 12 areas of specialized care. The multi-specialty group fosters an environment of collaboration among the physicians, which results in a seamless continuum of care for the patients.
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