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Conservative Treatments, Back Surgery Show Similar Outcomes in Select Patients
By Vanessa Orr

At some point during their lives, 60 to 80 percent of American adults will suffer from acute lower back pain. And while up to 90 percent of these patients will recover from their pain within six weeks, some patients will develop more debilitating, longer-lasting symptoms. "The number of patients we're seeing with chronic lower back pain who don't respond to conservative treatments is increasing," explained Dr. David Provenzano, Medical Director of Ohio Valley General Hospital's Pain Treatment Center. "Once we've ruled out more serious issues like cancer, infection and herniated discs, we work with them to develop overall health strategies to help relieve their pain."

According to Dr. Provenzano, 50 percent of patients with acute back pain who undergo conservative treatment will recover within two weeks, and 90 percent of patients will recover within six weeks. Those with chronic back pain, however, might also need to make lifestyle changes including changing their diets, quitting smoking and exercising more in order to improve.

"While doctors used to prescribe bed rest, we now know that this is not the best way to treat low back pain," Dr. Provenzano said. "Muscles atrophy (weakness), which makes patients susceptible to future episodes, so we recommend that they undergo some form of physical therapy. Because patients who are obese and those who smoke have a higher percentage of lower back pain, we also suggest making changes in these areas."

There are a number of ways that both acute and chronic back pain can be treated. Medications such as muscle relaxants and nonsteroidal anti-inflammatories can be used for a short period of time. Older patients who have not responded to other forms of treatment may be treated with opioid pain medications. In younger individuals, doctors try to avoid the utilization of opioids for prolonged periods of time. A cornerstone of treatment should be patient comfort to assist the patient with the time required for the natural healing processes.

"A lot is being done with minimally invasive injections, such as epidural steroid injections for herniated discs which help to speed recovery, and joint injections for arthritis," said Dr. Provenzano.

For patients who do not respond to such treatments, back surgery may be recommended, although Dr. Provenzano advises that for a majority of patients, conservative treatments should be considered first. "Unfortunately, between 10 and 40 percent of patients who have had back surgery for lower back symptoms experience persistent or recurrent pain," he said. "Recent studies in the Journal of the American Medical Association and the New England Journal of Medicine compared patients who had surgery for herniated discs with those who underwent nonsurgical treatment. Both groups improved substantially over a one- to two-year period.

"A large percentage of patients will get better with conservative care, and there was no difference in outcomes between the two treatments groups after one year in the New England Journal of Medicine study published in 2007," he added.

Patients who have not responded to conservative treatment and who still suffer from back and leg pain may consider surgical intervention, as well as those who suffer from lumbar spinal stenosis who have not been helped with medications or epidural steroid injections. "At the Pain Clinic, our multi-disciplinary pain program is designed to give patients access to whatever types of treatment they need, which may include medications, physical therapy, injection therapy or referral for surgical intervention individually or in combination," said Dr. Provenzano. "You need to treat patients who suffer from low back pain in a multidisciplinary approach in order to get the best outcomes."

By helping patients change their overall health strategies, the Pain Center is also trying to prevent future back problems from occurring. "We promote exercise because it's very important to have strong core musculature in both your abdominal muscles and back muscles," said Dr. Provenzano. "We also work with patients on cognitive behavioral therapy in order to help them cope with the pain.

"For example, many patients with chronic back pain are afraid that everything they do will hurt, so they become anxious and frustrated," he added. "This fear-avoidance behavior can result in a patient heading in a downward spiral. As part of their treatment, we teach them ways to deal with the anxiety and emotions that they are feeling so that they can begin to heal."

For more information on Ohio Valley General Hospital's Pain Treatment Center, call (412) 777-6400 or visit the web site www.ohiovalleyhospital.org/pain

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