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SALEM COMMUNITY HOSPITAL...Managing your low back pain

May 29, 2011
Salem News

At least four out of five adults will experience back pain at some point in their lives.

"Many cases of back pain are the result of a muscle strain," explained Tracy L. Neuendorf, D.O., F.A.O.C.A., Board Certified in Pain Management and Anesthesia. "A muscle strain, commonly referred to as a pulled muscle, occurs when the muscle is over-stretched or torn, resulting in damage to the muscle fibers. The area around the muscles can also become inflamed, which may cause the muscles in the back to spasm and result in severe lower back pain and difficulty moving.

"Lower back pain from a muscle strain occurs most frequently from lifting a heavy object, lifting while twisting, or from a sudden movement or fall. The pain is usually localized in the back and there may be muscle spasms or soreness upon touch. The good news is that this type of back pain generally heals within a few weeks or months."

The vast majority of lower back pain conditions will get better with time and can be managed with non-surgical treatments, such as osteopathic or chiropractic manipulation, physical therapy or pain medications. If the lower back muscle pain is severe, the person may be advised to rest. Pain medication and/or ice and heat applications may be recommended to help reduce pain from the strained muscle.

"Back pain that lasts longer than three months is referred to as chronic back pain and may indicate an underlying condition like a herniated disc or degenerative disc disease," Dr. Neuendorf continued. "Chronic lower back pain may be progressive, or may occasionally flare up and then return to a lower level of pain.

"The degree of pain a person experiences may be unrelated to the extent of physical damage. For example, back spasms from a simple back strain can cause excruciating lower back pain that can make it difficult to walk or even stand, whereas a large herniated disc or completely degenerated disc can be painless. It is also important to note that many types of low back pain actually have no known anatomical cause."

There are many structures in the spine that can cause pain, including:

- The large nerve roots in the low back that go to the legs and arms may be irritated

- The smaller nerves in the spine may be irritated

- The large, paired lower back muscles may be strained

- The bones, ligaments or joints may be damaged

- The intervertebral disc may be damaged

Common types of lower back pain in young adults:

1. Leg pain (Sciatica): Pain that radiates through the buttocks, as well as pain and/or numbness that radiates down to the foot, is often caused by a disc herniation in the lower spine. This type of pain is usually worse after long standing or sitting.

2. Low back pain that occurs with certain positions and movements (such as bending or running) is commonly caused by a syndrome called degenerative disc disease. Symptoms of degenerative disc disease can become chronic and may tend to fluctuate and at times become significantly worse.

3. Low back pain that worsens when standing or walking may be caused when a vertebral body in the low back slips forward, causing stress on the disc below it, which in turn may cause low back or leg pain.

Common types of low back pain in adults over 60:

1. Lower back pain or stiffness that is most pronounced first thing in the morning and later in the day is often caused by degenerative arthritis, also known as osteoarthritis, a condition that involves the breakdown or lack of cartilage between the facet joints in the back.

2. Leg pain (sciatica) that occurs when walking or standing upright may be caused by conditions, such as lumbar spinal stenosis or degenerative spondylolisthesis. Both conditions place pressure on the nerves at the point where they exit the spine. Walking or standing increases pressure on the nerve and results in leg pain.

Epidural Injections for Low Back Pain

"Epidural steroid injections may be an effective, non-surgical treatment option for some forms of low back pain and leg pain," Dr. Neuendorf concluded. "A lumbar epidural steroid injection delivers anti-inflammatory medicine directly to the affected area of the body to reduce inflammation that may be irritating the nerve root and causing low back or leg pain. The goal of the injection is pain relief. Epidural steroid injections deliver medication directly or near to the source of the pain. In contrast, oral steroids and painkillers have a less-focused impact and may have unacceptable side effects. Additionally, since the majority of pain stems from inflammation, an epidural steroid injection can help control the inflammation.

"The effects of the injection can provide relief from pain for one week up to one year, and may be especially beneficial for a person suffering from an acute episode of back or leg pain. This type of injection can also provide sufficient pain relief to allow an individual to progress with a rehabilitative stretching and exercise program. If the initial injection is effective, the person may receive up to three in a six-month period."

Pain relief for people with arthritis, cancer, back or nerve pain, sports or work-related injuries, chronic headaches or other painful conditions, may benefit from treatment by board certified pain management and anesthesia physician Tracy L. Neuendorf, D.O., F.A.O.C.A. Dr. Neuendorf conducts a pain management clinic at Salem Community Hospital's Outpatient Department, which is available to patients by physician referral. For more information or to schedule an appointment, call Dr. Neuendorf's office at the Doctors Pain Clinic, 1070 East State Street in Salem, 330-332-5501.



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