Transcript Document
UNDERSTANDING BACK PAIN I. M. Doctor, M.D. My Office My City, State The information in this presentation was provided to the presenter by the American Academy of Orthopaedic Surgeons and may be modified. Endorsement of this presentation by the AAOS is not implied or inferred. Thank you to A. Herbert Alexander, MD for his significant contributions to the content of this presentation. 2 Understanding Back Pain 3 Orthopaedics and The Bone and Joint Decade Types of back pain Diagnosing the causes of back pain Who is at risk for back pain? Understanding Back Pain Seeking help Therapies to help back pain sufferers Medications Surgery Nonsurgical treatments Complementary approaches 4 What is an orthopaedic surgeon? MD who specializes in treatment and health maintenance of musculoskeletal system (bones, joints, ligaments, muscles, tendons, cartilage and spine) 5 What is an orthopaedic surgeon? 6 The expert in treating the musculoskeletal system The expert in maintaining musculoskeletal health The expert in understanding both operative and non-operative treatment options Educating an Orthopaedic Surgeon College Medical School Internship Orthopaedic Residency Fellowship (optional) 2 Years Practice TOTAL 7 4 4 1 4 (1) 2 16 years! What do orthopaedic surgeons do? Diagnose Treat Medication Physical Exercise Brace Surgery 8 Prevent Therapy Back Pain Your Orthopaedic Surgeon— Getting You Back In The Game 9 Back Pain Structural Issues: Muscular Arthritic Disk Psychological Issues: Emotional stress Medical Issues: Infections Inflammatory 10 conditions Symptoms 11 Throbbing, aching, shooting, stabbing, dull or sharp pain Pain down one or both legs with very little pain in the lower back Numbness or weakness in the legs Symptoms 12 Pain down in the lower back & legs in certain positions such as standing or walking Sleep problems, decreased energy, depression, and anxiety Pain that stress and emotional issues causes or makes worse General Treatment 13 Examination by an orthopaedic surgeon Period of activity modification Perhaps medication to decrease pain and inflammation Complete inactivity is not advised for more than a couple of days General Treatment 14 Rehabilitation Goals Increased muscle strength Increased endurance Increased flexibility Improve aerobic fitness Healthy Spine Function Cervical Spinal Column Thoracic Lumbar Sacrum 15 Coccyx Healthy Spine Function Facet joint Vertebra Disc Spinal canal Vertebra 16 Healthy Spine Function 17 Healthy Spine Function Trapezius Latissimus Obliques Erector spinae muscles Psoas Gluteals 18 Abdominal wall muscles Burden of Disease 19 Lower back pain is the one of the most commons common causes of missed work Eight out of ten adults will experience back pain at some time Burden of Disease 58 million ambulatory care visits for back and neck pain 82 million work days lost 20 Getting You Back In the Game Robert Dover Olympic equestrian Age: 44 Condition/Injury: Low Back Pain 21 Diagnosis 22 Herniated disc/sciatica Sprain/Strain Stress-related back pain Diagnosis 23 Arthritis of spine Symptomatic disc degeneration Facet Syndrome Spondylolisthesis & Spondylolysis Diagnosis 24 Spinal fractures Lumbar spinal stenosis Chronic back pain syndrome Actual Clinical Case Example: Conchita Espinosa Chediak Age: 41 Condition/Injury: Large herniated lumbar disc, severe back pain, and foot drop 25 Large Disc Herniation 26 Are You At Risk? 27 Job requires frequent bending and lifting Twisting body when lifting & carrying an object Lifting and carrying in a hurry Are You At Risk? 28 Overweight Do not exercise regularly Do not engage in recreational physical activity Smoker Plan ahead, don’t hurry Move in close when placing object on high shelf Lift with leg muscles 29 Tighten stomach muscles Bend knees Don’t twist Spread feet shoulder distance apart Seeking Help Primary Care Physicians Orthopaedic Surgeons Spine Surgeons 30 Seeking Help Before Your Appointment Prepare to describe your symptoms Gather medical history Make list of medications Write down concerns and questions and bring them 31 Seeking Help During Your Appointment 1. What should I expect from my treatment? 2. What effect will my treatment have on my daily activities? 3. What can I do to prevent further disability? 32 Active Therapies 33 Exercise is key Aerobic conditioning program Special back exercises Active Therapies: Exercise 34 Active Therapies: Stretching 35 Active Therapies Pain Programs Involve multiple healthcare professionals Different treatments at different times Goal is to decrease pain, increase functioning Patient must be highly motivated 36 Passive Therapies Ultrasound and massage Water therapy Transcutaneous Electrical Nerve Stimulation (TENS) 37 Passive Therapies Traction Corsets and braces 38 Medication 8 Important Questions to Ask Your Orthopaedic Surgeon 1. 2. 3. 39 Why are you recommending this medication? How will this medication help me to feel better? What are the benefits and when will we know if it works? Medication 4. How do I take this medication? 5. What are the side effects? What to do if I have side effects? Are they temporary? 6. Is it okay to use generic? 40 Medication 7. Can I take this medication with others I’m currently taking? 8. How do I stop taking it safely? 41 Medication Analgesics Anti-inflammatories Muscle relaxants 42 Sedatives Anti-anxiety agents Antidepressants Invasive Conservative Treatments Trigger point injections Facet injection Spinal epidural steroid injections Selective nerve root blocks 43 What to show here? Surgery May Be Your Choice When… Leg pain rather than back pain Non-operative treatments are ineffective Symptoms match test findings Symptoms prevent daily living activities 44 Surgery 45 Finding a Surgeon Asking Questions About Surgery 46 Why? Alternatives? Benefits and for how long? Asking Questions About Surgery 47 Risks? What is procedure called? How is it done? Results? Asking Questions About Surgery Duration of recovery? Assistance at home and how long? Disability after surgery? Physical therapy? Return to normal activity? 48 Back Pain Therapies Medication Surgery Complementary Approaches 49 Resources American Academy of Orthopaedic Surgeons 6300 N. River Road Rosemont, IL 60018 www.orthoinfo.org 50 Back Pain What are your questions and concerns? 51 Back Pain Thank you for participating today Remember, your orthopaedic surgeon can help get you back in the game 52