Managing Back Pain
June 17, 2009
Pain management is a medical specialty devoted to the treatment and management of acute and chronic pain. Optimal medical care for chronic pain comes from a team approach and can often involve multiple caregivers, including primary care, pain management and/or rehabilitation physicians, chiropractors, physical therapists, nutritionists, and others. Some patients prefer a more holistic approach, and treating the mind, body and spirit can be helpful in many cases of chronic pain.
Regardless of who you see for pain, a thorough and comprehensive history and physical examination are the keys to getting to the bottom of any medical problem. There are many types of physical pain, but the most common that I see in seniors is back pain, which is the focus of this article.
Back Pain in Seniors
There are many challenges we face when growing older. Unfortunately for many of us, pain can become a constant companion. Back pain is so common, in fact, that many assume it is normal aging. That assumption causes trouble, though, when back pain is a sign of more serious underlying problems. While it is true that some wear and tear is normal as we age, pain is the most basic and common way that our bodies use to signal that something is wrong.
Think back to when you were a child. Can you remember the first time you fell and skinned your knees? It probably hurt worse than anything you could remember and stopped you in your tracks. To me, that's why God designed our bodies to feel physical pain - so that pain would cause us to stop and assess our situation. Ignoring pain can have disastrous consequences.
Pain can paralyze us, sometimes for a few minutes or sometimes for days, months or even years. In this article, first we'll look at some of the most common causes of back pain in seniors. Then we will look specifically at pain caused by back fractures, and how they can be effectively treated.
Avoiding Back Pain
There are some simple things we can do each day to avoid injury to our bodies, particularly our backs. Some of the best tips boil down to using common sense.
• When lifting, use your legs and avoid bending
• Don't push yourself too far, know your limits and take frequent breaks
• Work on sitting with good posture
• Make your home safer by getting rid of extension cords and throw rugs
• Avoid stepladders
• Consider home modifications for safety, such as handrails
• Strive to stay healthy and active
Common Causes of Back Pain
Here we will discuss some of the most common causes of back pain, particularly those seen in seniors.
Arthritis
The most common type of arthritis, due to "wear and tear" of our joints, is known as osteoarthritis. It commonly affects the back (often referred to as spondylosis), and is a leading cause of back pain as we age. Often, separating this type of pain from hip or knee arthritis can be challenging. Treatment depends on the location and the type of arthritis.
Muscular Pain
Muscle pain is a common cause of back pain. Muscle strain (a mild tear) is common, especially occurring after exertion. Involuntary muscle spasm can also cause pain. Conservative measures usually are used first.
Disc Bulges
Disc bulges, or herniated discs, are a very common cause of pain, particularly pain that shoots into the hips and legs. This can overlap with arthritis because some disc bulges are normal with aging. If conservative therapy doesn't help, minimally invasive procedures, like steroid shots, can be tried.
Osteoporosis
Simple osteoporosis affects millions and strikes men as well as women. It can result in loss of height of individual vertebrae and even our overall height. Just having osteoporosis is a common cause of back pain, even without getting a fracture. In this case, treating the underlying osteoporosis can help.
Back Fractures -
Vertebral Compression Fractures
With a VCF, the pain is usually more severe and painful than other causes of back pain. VCFs often occur after falls or accidents, but can happen without any known trauma. They are usually associated with osteoporosis. Other causes, such as cancer, should be ruled out. Luckily, VCFs are treatable with a high success rate using bone cement - employing a procedure called kyphoplasty. This procedure has been around for only about 10 years, so, unfortunately, most doctors don't have much experience with it.
What can be done?
So what can be done about back pain? There are options for treating most types of pain, and you don't have to rely on narcotics. It's important to speak with a physician about options because treatment depends of the cause of the pain.
Before you see your doctor, it is helpful to keep a pain diary. This will allow your physician to better diagnose your pain. Here are some things to keep track of:
1. Location. (neck, head, lower back, joints, hands, knees, shoulder, etc.)
2. Radiation - does it move around. (for instance: shoots down leg, etc.)
3. Quality. (stabbing, sharp, dull, aching, burning, etc.)
4. Anything that makes it better? (rest, ice, heat, walking, medicine, etc.)
5. Anything that makes it worse? (lying down, standing, exertion, walking, etc.)
6. Duration.
7. Severity. How bad is it on a scale of 1 to 10, where 0 is no pain and 10 is the worst pain imaginable?
Osteoporosis and Back Fractures
When we were still growing, our bodies actively stored up calcium in our bones. This occurs until about age 25 - after that point, it's all downhill. The body slowly loses calcium rather than stores it. Although many factors can increase the rate at which we lose calcium, it is a part of aging. Some things that speed calcium loss are poor diet, lack of exercise, smoking, sodas and steroids.
You can think of it like a retirement or savings account, where you have calcium instead of money - keep making the same small withdrawals and you run out over time. At some point the density gets low enough that we start having fractures - usually in the hip or spine.
Vitamin D Deficiency
According to the National Osteoporosis Foundation, there are certain people who are more likely to develop vitamin D deficiency. This includes people who limit sun exposure, have very dark skin, are obese, and the elderly. Also people who are living in nursing homes or have certain medical conditions such as nervous or gastrointestinal disorders are at increased risk.
The National Osteoporosis Foundation recommends that adults more than 50 years of age need a total of at least 1,200 milligrams (mg) of elemental calcium and 1,000 international units (IU) of vitamin D each day to prevent deficiency. This should include all food sources - so if you get adequate intake from the food that you consume, you don't necessarily need to take a supplement.
Roughly 90 percent of the patients I see with back fractures have a vitamin D deficiency. At this point, just taking the recommended amount won't help them and we usually have to place them on a prescription.
Numerous studies have also linked vitamin D to various health benefits, including involvement in the perception and experience of pain. So, ensuring that you're receiving enough vitamin D is a simple and natural way to fight pain in general. When selecting a vitamin D supplement, it's also important to make sure it is Vitamin D3 the type called "cholecalciferol." Your pharmacist can help with this.
Back Fracture Myths
Most doctors just don't understand back pain in general, but particularly vertebral fractures. Ignorance and misinformation often combine to hinder optimal patient care. Here are two things patients often tell me that aren't necessarily true."My doctor told me that I had a back fracture, but that it will get better on its own." Truth: Although many vertebral compression fractures will get better with conservative therapy, for many they won't. While we wait to see if it gets better, the patient is suffering, sometimes for weeks and months at a time. In my opinion, if VCF pain is severe for more than a couple of days, it's time to seriously consider fixing it.
"My doctor said that there is nothing we can do for it."
Truth: If your pain is caused from a VCF, there are procedures that can take that pain away in almost all patients. Most doctors just don't have any experience fixing these back fractures because they were trained in an era when there literally was nothing that could be done.
Summary
Pain is an important, God-given survival tool in the short term. However, chronic pain can be a nightmare. Optimal medical care for pain management usually involves a team approach, but a history and physical examination by a knowledgeable provider is important. Diagnosing the cause of back pain can be challenging. For patients with osteoporosis, treatment by a specialist is usually helpful. Also, using common sense to avoid injury, staying healthy and active and ensuring that you're receiving enough vitamin D are simple, natural and inexpensive ways to fight pain in general.