Back pain is one of the most common reasons for people to see their doctor.
More than 90% of people will experience back pain during their life, and the vast majority of flare ups in back pain will settle without intervention. Most of these flares will show considerable improvement after 2 weeks and will have dissipated by 6 weeks. The frequency of flare-ups is dependent on the individual case.
It is important that you understand that the discs between your vertebra change with time. The same collagen that is in our skin forms part of the disc and just as we look older as we age, our discs also look older as we age. Disc bulges (as opposed to herniations or sequestrations) are a normal part of the aging process and most people over the age of 35 will have one or more disc bulges on their scan. This is normal. It is only if the disc changes result in nerve compression or instability that I would consider surgical management.
The non-surgical interventions that have been shown to be effective in the management of chronic back pain are:
For an acute, severe flare (in the absence of significant leg pain or a prior history of cancer) chiropractic manipulation, muscle relaxants and anti-inflammatories may also be of benefit. Bed rest for more than 48 hours for an acutely painful episode has been shown to be counter-productive.
I personally do not believe in the use of opiod pain killers for the management of chronic back pain and I will not provide scripts for these types of medication as doses need to be monitored carefully by your usual doctor to prevent the development of tolerance and dependence issues.
In most circumstances I will not operate if the major complaint is back pain. Situations in which surgery may be indicated include:
In patients without these types of pathology I do not generally persue operative management. There has been a recent meta-analysis published comparing the outcomes of operative and non-operative management of back pain which shows only minor improvements with surgery. For this reason I believe the potential benefits are outweighed by the risks. I can provide this reference for you on request.
If you wish to come and see me regarding your back pain the consultation will revolve around:
If you have a combination of back pain and leg pain then there may be an element of nerve compression contributing to your leg symptoms and there are potential surgical cures for this. I will take a thorough history and examine you and if your clinical findings fit with the scan results surgery may be offered to alleviate your leg symptoms. Sometimes this surgery will improve, but not cure, back pain.
I do not want to waste your time. If your expectation is surgical management of back pain, it is very unlikely that I will persue that course. If you would rather see a spinal surgeon who is more proactive in the surgical management of back pain I can provide you with their contact details.
This information is not exhaustive and if you have further questions I would be happy to answer them.