What is acute back pain?
The most common condition that the physiatrists of Long Island Spine Rehabilitation are called upon to evaluate and treat is acute back pain. Acute back pain can be defined as back pain which persists for up to six weeks. It may be described by patients as an aching, burning, or stabbing sensation, and the quality of the pain can be sharp, dull, well-localized, or more diffuse in location. The intensity of pain may range from mild to severe and may fluctuate. The symptoms from this typically benign condition can be quite debilitating with exacerbations resulting from fairly trivial maneuvers such as a simple bend, light lift, a cough, or sneeze. The pain may radiate into one or both buttocks or even into the hip or thigh area. Back pain may also begin following a more strenuous activity or acute trauma but often is seemingly unrelated to a specific activity. Acute back pain is often thought of as the result of repetitive overuse rather than pain arising from a singular event. The pain may begin suddenly or develop more gradually over a period of weeks.
Who experiences acute back pain?
At least 80% of individuals experience a significant episode of back pain at some point in their lives. At any given point in time, approximately 15% of individuals report that they are experiencing at least mild back pain. Some consider the symptom of back pain to be an anticipated part of the human experience. Acute back pain events remind us that despite the brilliance of our spinal design, we do come with design flaws, and these include the potent of ability of the spinal structures to generate pain. Injury to these pain generators can result from more stressful events but most commonly from repetitive daily wear and tear.
What causes back pain?
New patients reporting to our office are typically and understandably concerned about the severity and origin of their pain. At Long Island Spine Rehabilitation Medicine, a good deal of time is spent educating our patients. Education and information is of particular importance in instances of debilitating and acute back pain, as patients with this condition are often frightened by the intensity of their symptoms.
There are a number of causes of back pain, ranging from a muscle strain to a disc herniation, spinal joint pain, and spinal stenosis. 50% of acute acute back episodes nearly completely resolve within two weeks, and 80% by six weeks. The duration and severity of a single episode cannot be predicted simply based on the onset, location of pain, or even the initial severity of symptoms. The physiatrists of Long Island Spine Rehabilitation Medicine will take a detailed history and perform a comprehensive examination to make certain that your pain is of a more benign and musculoskeletal origin and not related to a more concerning medical condition.
Is this pain dangerous?
The seriousness of back pain is relative. Symptoms of acute back pain, while initially often severe and debilitating, are usually benign and self-limited. Even pain arising from a suspected disc herniation will resolve over time. Much more rarely, however, back pain is caused by a more serious process such as a fracture, infection or cancer. Acute episodes of back pain associated with neurological deficits, fever, severe night pain, or pain arising in patients with an active cancer or infection history requires a more prompt and comprehensive medical evaluation.
How should back pain be managed?
Our understanding of the recovery process from such painful episodes has evolved considerably over the past several decades. While the level of discomfort associated with acute episodes of back pain can be significant and debilitating, strict bed rest is generally not advised. At this time, it is recommended that patients actually remain mobile and increase their activity as their symptoms allow. Studies have shown that those who progress their activity in this fashion while recovering from an acute back pain event will ultimately realize a more prompt return toward their baseline level of function. The use of superficial modalities such as icing or heat might also provide a level of comfort during the recovery process.
Do I need an X-ray or an MRI or a CT Scan?
In most cases of acute back pain, imaging of the spine is not necessary. When pain persists or is associated with a neurological deficit, or if there is concern of an underlying medical condition or fracture, imaging of the lumbar spine would be indicated.
In some instances, there may be a role for imaging of the spine. Initial imaging modalities can include X-rays, and advanced imaging approaches such as MRI and CT scans are typically reserved for persistent or more concerning cases of back pain. CT and MRI scans provide more detailed pictures of the spine and can also identify most disc herniations and nerve compressions, which cannot be seen on a regular X-ray films.
Medications used to control pain are known as analgesics. Most episodes of acute back pain can be treated with non-prescription medications such as aspirin, acetaminophen, naproxen, or ibuprofen. If you have severe persistent pain, you may be prescribed stronger analgesics for a short period of time. Medications are prescribed by your treating physiatrist in an individualized fashion and only after a careful consideration of your past medical history and current medication regimen. Sometimes your doctor will prescribe muscle relaxants to help with pain control, particularly during evening hours. With any medication, the goal in prescribing is to maximize benefits realized through as low a dosage as possible, while minimizing adverse side effects (such as constipation and drowsiness).
Physical therapy can be helpful for those patients with more stubborn or lingering symptoms of back pain or in those patients with recurrent complaints who might benefit from more formal spine education. An important component of your treatment plan is exercise therapy that is specially designed to reduce your back symptoms. Our doctors have identified a group of therapists throughout the region that have attained specialized training in treating patients with spinal conditions. We can assist you in locating these therapists so that you receive the best spine care available.
The physiatrists at Long Island Spine Rehabilitation Medicine work closely with spine therapists certified by the McKenzie Institute. These therapists have spent many hours treating patients with spinal disorders and have passed written and practical examinations assessing their knowledge and hands-on skills.
The scientific literature has shown that non-surgical treatments for episodes of acute and debilitating LBP are a safe, recommended and often effective approach for this condition. The physicians of Long Island Spine Rehabilitation Medicine, experts in the field of non-surgical spine care, are uniquely trained to evaluate, educate, and treat patients presenting with the full spectrum of symptoms which may cause acute back pain.
Most episodes of acute LBP are typically transient and do not require more aggressive interventions. In those cases where debilitating back pain persists despite a trial of conservative treatment, there may be a role for a trial of spinal injection procedures such as selective spinal injections performed with fluoroscopic guidance. These are targeted therapeutic injections that bathe the inflamed spinal pain generator or are injected into a spinal joint, such as a facet or sacroiliac joint.
Both our experience and the spine literature suggest superior clinical outcomes when spinal injections are employed for a chief complaint of lower limb as opposed to lumbar pain. Otherwise stated, the pain generators resulting in lumbar pain alone are not as likely as an inflamed spinal nerve resulting in radicular pain or “sciatica” to respond to a targeted spinal injection procedure. These injections are
performed in a target and diagnosis specific fashion and are offered to aggressively control the acute inflammatory phase of injury and as a component of a comprehensive rehabilitation program.
In patients with chronic or recurrent lumbar pain where a greater emphasis is placed upon identifying and localizing the responsible pain generator, diagnostic spinal injection procedures may be employed to identify the specific pain source.
The physiatrists of Long Island Spine Rehabilitation Medicine have completed unique and highly specialized fellowship training in spine medicine and interventional spine care. Injection procedures are performed in our practice by your treating physiatrist, utilizing the latest in imaging technology, and in a comfortable office setting with a skilled and seasoned medical team.
What About Surgery?
Fortunately, the majority of patients with back pain do not need to undergo surgery. However, if your symptoms fail to respond to a reasonable trial of non-surgical approaches, our physicians may refer you to a surgical colleague. We are affiliated with regional surgeons with expertise in the surgical approaches to spine.