Dr. Jerry Sobel is a board certified Physiatrist with more than 25 years of clinical experience in treating a number of different acute and chronic back conditions including:
- Low back pain with or without sciatica
- Neck pain with or without nerve pain in the arm
- Sciatica due to disc bulges and herniated discs and spinal stenosis
- Spinal stenosis
- Degenerative disc disease
- Arthritis include facet joint arthritis and pain
- Sacroiliac joint pain
- Spondylolysis and spondylolithesis
More than likely if you are reading this you are or have suffered from acute or chronic back pain. Back pain is a very common complaint affecting upwards of 80% of the population at one point or another during their lives. The good news about acute back pain is that most people get better even without medical intervention in a few weeks to months. On the flip side, the pain can often times become intermittent with each episodes lasting a few weeks and occurring randomly over a period of many years. Chronic back pain on the other hand, frequently does not get better without some type of medical care whether that being medication, spine injections, physical therapy, regular exercise or surgery.
Categorizing Back Pain
Acute back pain can usually be placed in one of three categories- nonspecific pain, radiculopathy, i.e. sciatica or pinched nerve, and more serious medical problems. The more serious medical issues include tumors, infections, fractures and autoimmune diseases. In this category people will at times complain of fever, chills, night sweats, unexplained weight loss, pain worsened with rest or at nighttime only, a history of cancer or a family history of autoimmune problems. Thankfully, these are all very uncommon in the multitudes of individuals that seek medical care for back pain in any given year.
The difference between nonspecific back pain and radiculopathy is that the former is pain that is only in the back or neck and does not radiate down and is not associated with numbness, tingling or weakness in the affected limb. Nonspecific back pain can be caused by joint pain and arthritis referred to as facet syndrome and spondylosis or pain from back muscles and ligaments. I would include sacroiliac joint pain in this category.
The definition of radiculopathy also known as sciatica (when in the legs) is :
irritation of or injury to a nerve root (as from being compressed) that typically causes pain, numbness, or weakness in the part of the body which is supplied with nerves from that root.
Sciatica or nerve pain can be of a burning, stabbing, electrical or shooting like sensation and can be associated with numbness, tingling and weakness.
It is important to differentiate back pain from sciatica or nerve pain. Someone with back or neck pain alone are usually advised to continue to try and move and function because movement and activity can help with the healing process. Many years ago bed rest was prescribed for acute back pain and patients would be put in the hospital and on traction. When it was finally studied as to whether or not bed rest lead to a faster recovery it was found that in fact the opposite was true. Those that had bed rest took longer to get better than individuals that tried to remain active. When it comes to sciatica nerve pain some rest is actually advised or at the very least to modify activities so as to not flare up the nerve pain too much.
Acute vs Chronic Back Pain
Back pain lasting longer than three months is considered chronic while that under three months is acute or sub-acute. Why do we as physicians make this distinction? It is because the treatment of acute and chronic back pain syndromes is different. After several months of back pain there are changes that occur in the body that often times need to be addressed in order to have improve recovery. People with chronic pain not only have to contend with their pain but also the secondary effects of the pain including the loss of muscle strength, flexibility and cardiovascular endurance. These physical impairments can result in work and family problems, financial issues and changes in mood.
Pain management is not only about reducing or eliminating pain it is also about reducing the fears of movement known as “kinesiophobia” and the fears of re-injury. Sometimes the biggest barrier to getting better is not the pain itself but the fear of making it worse. Determining whether a person’s pain is “safe” or not can make all the difference in the world. By safe pain I mean that if back pain or sciatica nerve symptoms increase with activity that no further harm will occur. Would you believe that there are different models with respect to the treatment of chronic pain syndromes? There are and they are called the bio-medical model of disease and the bio-psychosocial model of illness. More on this to come.