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When does back pain become too much?

A black man holds his back while standing at a computer.

Your back pain most likely won’t require surgery, but if it does, here’s what you should know

Having back pain is almost as American as baseball, family weekends and summer concerts. It’s simply the norm as you get older.

Long-term chronic back pain is estimated as a $100 billion-a-year industry and is the top disability in the workforce in the US. It’s not a minor issue. But the fact is, the huge majority of people who endure this malady don’t need surgery — well over 90 percent can limit their activity and are fine within six weeks. And that’s a good thing.

Needing medical care means you may have a medical condition such as a herniated disc or spinal stenosis or its associated symptoms like sciatica. Back pain could also be a sign of another illness where the pain is a sentinel symptom.

How do you know when you need medical care? Even more important, how do you know when you will need surgery?

First things first

Understanding the cause is the first step to relief.

If you’re relatively healthy, you shouldn’t have back pain. If you do, try conventional treatment: get some rest; stretch it out; grab and hang from a pull-up bar (if available); use local treatment like a heating/cooling pad; or take anti-inflammatory medication as needed.

Seeking medical help

When conventional treatment doesn’t work and the pain persists for weeks, find medical attention with an internist or general physician. It may require further testing and diagnostic imaging to understand the pain’s source.

A clinician will ask if it is your first episode and if you are having issues urinating or with bladder function, or any other associated weaknesses. If not, activity modification, physiotherapy and anti-inflammatories may be the answer. You should not be prescribed narcotics (initially, see below) and will be reevaluated within six weeks.

The majority of patients improve during this timeframe. If pain doesn’t subside, you will need a magnetic resonance imaging (MRI) scan for further investigation.

Sciatica and other clinical issues

Severe back pain can be crippling and caused by muscle or ligament strains, bulging or ruptured disks, skeletal irregularities, arthritis or osteoporosis, and other systemic diseases.

Some people endure more chronic symptoms from spinal stenosis (narrowing of the spinal canal) that can lead to additional pressure on your lumbar area, causing debilitating symptoms. One — sciatica — can create a constant burning sensation from your lower back to your legs. Sciatica impacts nearly three million people in the US.

Medication, including opioids, has been used to help people with sciatica and spinal stenosis get through their day. A thorough medical evaluation is essential for the diagnosis of chronic back pain.

Is surgery right?

Usually, you tolerate the pain until you can’t anymore. An epidural from a pain doctor can help get you through a rough period. For some, inflammation may be reduced and pain will subside, If not, and the pain reemerges after the injection, you are a candidate for surgery.

If someone has severe back pain, leg pain or both caused by a disc herniation and can’t get out of bed or go to work, the best thing to do is to remove the disk. There are several types of surgical procedures:

  • Diskectomy is a full or partial removal the herniated portion of a disk, which decreases inflammation within the nerve by relieving the compression. 
  • Laminectomy is where a surgeon removes the bone overlying the spinal canal, which also relieves pressure and opens the canal.
  • Spinal fusion permanently connects two or more bones in your spine. It can relieve pain by adding stability to a spinal fracture and is occasionally used to eliminate painful motion between vertebrae that can result from a degenerated or injured disk.

Be careful of opioids

While opioids can be very useful in treating pain, it has been an instigator to the current epidemic, which has been estimated by the National Institute on Drug Abuse to claim 130 lives each day in the US after overdose.

Back pain has been a driver of this issue. People in pain get treated, but their lives can spiral downward if they misuse the narcotics, translating into more fatalities.

For the first time ever, the life expectancy for non-educated white males has decreased during the last five years, a direct result of the misuse of opioids and resulting addiction. This isn’t by chance yet an unintended consequence for treating pain.

Mitchell Levine, MD, is director of spine surgery at Lenox Hill Hospital and assistant professor of neurosurgery at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell. He specializes in complex and minimally invasive spine surgery, facial pain, trigeminal neuralgia and pain modulation procedures.

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