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Back Pain

About two-thirds of adults will suffer from back pain at some point in their lives. In fact, back pain is second only to upper respiratory problems as a leading symptom-related reason for visits to a physician. However, the source of back pain can vary greatly, as can the proper treatment methods.

“The majority of back pain is not disabling and will go away. If the back pain persists beyond six weeks, and leg pain, leg numbness, or weakness develops, then medical attention should be sought,” says Dr. William Shaffer, associate professor of orthopedic surgery at the University of Kentucky College of Medicine and a surgeon with UK HealthCare.

Nonsurgical treatment
Most back problems respond to nonsurgical treatments, such as anti-inflammatory medication, ice, heat, massage, and physical therapy. Usually, back pain will get better within four to six weeks.

“Acute severe back pain with no leg pain, no numbness, or weakness can usually be treated with nonsteroidal, anti-inflammatory drugs and a few days of bed rest,” Shaffer says. “The only treatment that has been shown to shorten a period of acute severe back pain is manipulation, such as from an osteopathic physician or chiropractor.”

Do I need surgery?
An operation will usually not be considered unless other measures have failed. Surgery is typically reserved for times when a nerve is pinched, the spinal cord is compressed, or there’s too much movement between the spinal bones.

“Back pain with normal testing is best handled nonoperatively,” Shaffer says. “Rarely—and then only after one to two years of good conservative treatment—there is a small group of degenerative disk patients that may benefit from surgery.”

Doctors may recommend surgery for neck or back pain accompanied by symptoms of nerve damage, including sciatica—a pain that radiates down the arms or legs caused when the sciatic nerve is injured or becomes inflamed.

“Surgery is not the primary treatment for back pain,” says Shaffer. “Surgery for back pain is indicated only if a structural issue such as a tumor, infection, fracture, or instability can be found on diagnostic testing, usually a CAT scan or MRI.”

Priority consultation
Shaffer and UK’s chairman of the Department of Neurosurgery, Dr. Phillip Tibbs, have developed an innovative system to coordinate care for their patients. The system, called Priority Consult, helps identify the cases that are candidates for surgical intervention, to ensure that patients get the proper care more quickly.

Here’s how it works: a care coordinator takes a detailed medical history and collects any recent X-rays, MRIs, or other scans of the patient’s spine. A surgeon then reviews this information, and within days the patient is called back with the surgeon’s recommendation. This assessment routes patients in the right direction before an appointment is ever made, cutting wait times, because physicians are seeing only the patients who really need their particular expertise.

“Priority Consult helps doctors and patients by getting patients to the right physician,” says Tibbs. “This allows each specialist to focus on patients that really need to see them, and lets them be seen sooner, because the doctors are able to screen other patients who are better served by a different consultant.”

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