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.
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Understanding Back Pain
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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
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What is an orthopaedic surgeon?
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MD who specializes in treatment and health
maintenance of musculoskeletal system (bones, joints,
ligaments, muscles, tendons, cartilage and spine)
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What is an orthopaedic surgeon?
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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
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College
Medical School
Internship
Orthopaedic Residency
Fellowship (optional)
2 Years Practice
TOTAL
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16 years!
What do orthopaedic surgeons do?
Diagnose
 Treat
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 Medication
 Physical
 Exercise
 Brace
 Surgery
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Prevent
Therapy
Back Pain
Your Orthopaedic Surgeon—
Getting You Back In The Game
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Back Pain
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Structural Issues:
 Muscular
 Arthritic
 Disk
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Psychological Issues:
 Emotional
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stress
Medical Issues:
 Infections
 Inflammatory
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conditions
Symptoms
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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
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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
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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
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Rehabilitation Goals
 Increased muscle strength
 Increased endurance
 Increased flexibility
 Improve aerobic fitness
Healthy Spine Function
Cervical
Spinal Column
Thoracic
Lumbar
Sacrum
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Coccyx
Healthy Spine Function
Facet joint
Vertebra
Disc
Spinal canal
Vertebra
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Healthy Spine Function
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Healthy Spine Function
Trapezius
Latissimus
Obliques
Erector
spinae
muscles
Psoas
Gluteals
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Abdominal
wall
muscles
Burden of Disease
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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
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Getting You Back In the Game
Robert Dover
Olympic equestrian
Age: 44
Condition/Injury: Low Back Pain
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Diagnosis
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Herniated disc/sciatica
Sprain/Strain
Stress-related back
pain
Diagnosis
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Arthritis of spine
Symptomatic disc
degeneration
Facet Syndrome
Spondylolisthesis &
Spondylolysis
Diagnosis
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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
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Large Disc Herniation
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Are You At Risk?
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Job requires frequent bending and lifting
Twisting body when lifting & carrying an object
Lifting and carrying in a hurry
Are You At Risk?
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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
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Tighten stomach
muscles
Bend knees
Don’t twist
Spread feet shoulder
distance apart
Seeking Help
Primary Care Physicians
Orthopaedic Surgeons
Spine Surgeons
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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
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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?
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Active Therapies
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Exercise is key
 Aerobic conditioning program
 Special back exercises
Active Therapies: Exercise
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Active Therapies: Stretching
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Active Therapies
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Pain Programs
 Involve
multiple healthcare professionals
 Different treatments at different times
 Goal is to decrease pain, increase functioning
 Patient must be highly motivated
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Passive Therapies
Ultrasound and massage
 Water therapy
 Transcutaneous Electrical Nerve
Stimulation (TENS)
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Passive Therapies
Traction
 Corsets and braces
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Medication
8 Important Questions to Ask Your
Orthopaedic Surgeon
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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?
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Medication
7. Can I take this medication
with others I’m currently
taking?
8. How do I stop taking it
safely?
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Medication
Analgesics
 Anti-inflammatories
 Muscle relaxants
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Sedatives
 Anti-anxiety agents
 Antidepressants
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Invasive Conservative Treatments
Trigger point injections
 Facet injection
 Spinal epidural steroid
injections
 Selective nerve root
blocks
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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
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Surgery
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Finding a Surgeon
Asking Questions About Surgery
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Why?
Alternatives?
Benefits and for how long?
Asking Questions About Surgery
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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?
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Back Pain
Therapies
Medication
Surgery
Complementary
Approaches
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Resources
American Academy of Orthopaedic Surgeons
6300 N. River Road
Rosemont, IL 60018
www.orthoinfo.org
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Back Pain
What are your questions and concerns?
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Back Pain
 Thank you for participating today
 Remember, your orthopaedic surgeon can
help get you back in the game
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