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When to see a doctor for back pain

People often ask what is spinal stenosis. And I’ll use a model to kind of describe what that is. Now, this is the site where spinal stenosis actually occurs. And spinal stenosis can occur for several reasons as we look at the spinal canal. There’s a ligament which sits here in the back of the canal called the ligamentum flavum. As we age, that ligament can thicken. And as it thickens, it can compress the nerve roots inside the spinal canal.

Secondarily, again, looking from the side at these cartilage discs, it’s not uncommon as we age for these discs to start to degenerate. which of these areas is most likely gonna be causing the pain. And usually we can do that with a minimum of invasive testing and usually without resorting to a lot of diagnostic testing as well. There are some instances when patients are at higher risk for having serious causes of back pain, such as cancer, or infection, or fractures. And certainly if any of these risk factors may apply to you, then you will want to let your doctor know about those things, so that we can pursue those avenues appropriately and make sure that it’s not a serious cause of your back pain that we’re dealing with.

In many instances, folks are very curious to know what to do if their back has been bothering them for a few days. Perhaps they’ve injured themselves or they’ve overdone something and now they’ve been dealing with their back pain for a few days, and so what do we do now? And so I think rule number one is don’t panic. So, back pain is very, very common. And the overwhelming majority of cases of back pain usually do not require anything aggressive. And most cases will actually get better with just the passage of some time, and maybe some conservative treatment such as over the counter anti-inflammatory medications.

If we’ve allowed some of those less invasive treatments to pass and if someone is still having a lot of trouble, then it would be appropriate to seek treatment from a physician. So if someone is having severe pain that’s not allowing them to engage in their usual activities. Or if they had any of the other risk factors that we were talking about, such as a higher risk for cancer, or an infection, or any type of fracture, then you would want see a doctor a little bit more quickly. But in most cases, if your back has been bothering you for a few days, then we can usually just let some time pass, take some of the over the counter anti-inflammatory medicines. You may want to apply some ice to your back, and in most instances the pain will get better on its own. If you’ve been dealing with pain for a while, when do we need to actually see a doctor? And actually who do we need to see? Because there’s a lot of doctors out there that treat back pain. And so the answer is, is that it sort of depends.

So for example, if someone has had a trauma and they develop back pain afterwards, then that’s a reason to go and see a doctor pretty quickly. If someone has had cancer in the past and has developed back pain sort of unexpectedly or without any explanation, then that’s a reason to go see a doctor relatively quickly. But then, the large majority of folks will wanna consult a physician if they’re having pain that just simply isn’t getting better. So meaning that you’ve allowed some time to pass, you’ve modified your activities to some degree. You’ve taken some of the over-the-counter medications. And despite doing those things, you’re continuing to have pain. So then you would want to go and consult with someone. In most instances, the right person to consult would be to see your general medical physician.

There are other providers that are out there such as chiropractors and physical therapists, specialists such as myself that deal exclusively with back pain, and there’s also back surgeons as well. But in most instances, if you’re able to consult with your primary medical doctor, they can usually point you in the right direction and deliver any appropriate therapies that might be necessary. A common area of concern is for folks wondering what other options there are besides having surgery for their back. And the beauty of it is, is that there are actually a large number of treatments that are out there as options to surgery. And also most people usually will not require surgery for their back. So at the Duke Spine Center, we partner very closely with physical therapists. We have a large number of treatments that we can offer. So for example, we have some providers that are able to offer treatments such as acupuncture.

There’s different medications that we would want to try, there also are treatments such as spinal injections. And that’s just a way of delivering a very potent anti-inflammatory medication directly to the problem spot of your spine. We also work with some behavioral pain management specialists that can help you develop effective ways of coping with the pain. And then some of the other treatments also include one called a spine stimulator, which is a small piece of hardware that can be implanted underneath the skin, that essentially deliver signals that help block the pain signal. And surgery is usually not required except in instances where someone is having progressive neurological deficits, or if they have problems with the alignment of their backs, such as severe scoliosis or other slippage of some of the vertebrae.

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