Low Back Pain is the most common source of pain and disability in modern society and the number one cause of work-related absences. Statistically, 60-85% of people will experience low back pain at some point in their lifetime. The longer someone is out of work with back pain, the less likely he will return to his previous occupation; this not only has a substantial adverse economic impact, but negatively affects a patient's overall sense of well-being.
With the economic cost to society estimated to be several billions of dollars annually, proper and timely treatment remains of utmost importance.
Many causes of back pain exist, the most common being muscle-related pain (strain injuries), joint-related inflammation and arthritis (facet related pain, sacroiliac joint), intrinsic disk (discogenic), or nerve-related (sciatica, herniated disk). Other less common causes include referred pain from the pelvic and abdominal structures, and in some cases represent a manifestation of malignancy.
A proper workup to determine the source of such pain should include a detailed history of the patient and how the injury occurred, a comprehensive physical examination, and, in some cases the use of laboratory studies and radiology (CT scan, MRI, x-rays). While many patients may present with the same generalized complaint of low back pain, the underlying pathology may vary in each case. For example, many believe that spinal disorders are always manifested by pain in the back, when in fact pain or weakness in the legs without back pain could still be related to the spine. Also, it is not unusual for pain to be multifaceted in origin with each source requiring its own specific therapy.
An alternative therapy endorsed by some is chronic pain management with opioids. This is particularly common in Florida, where prescription medication abuse is a significant public health concern. According to the Florida Department of Law Enforcement and State Office of Drug Control, prescription drug fatalities in 2009 totaled 2,488 (average of 7 deaths per day), with oxycodone alone causing 1,185. This represents a 26% increase from 2008 and a 249% increase from 2005. Management of acute pain, (for example arising from a broken leg) with opioids on a short term limited basis has been well established as appropriate care. However, with the exception of pain arising from cancer, long term use of opioids has not been universally accepted by the medical profession to be effective given its potential side effects of: dizziness, nausea, vomiting, constipation, physical dependence, tolerance, respiratory depression, delayed gastric emptying, opioid-induced hyperalgesia, immunologic and hormonal dysfunction and potential for addiction. Patients should, therefore, consider consulting an interventional pain management physician about alternative methods for relieving their pain before beginning a regimen of chronic opioid management.
An interventional pain management physician is highly trained in techniques that allow medications and treatments to be precisely delivered at the area or areas causing the pain. In many cases, an x-ray machine is used to guide needles delicately and safely towards nerves and joints where strong anti-inflammatory medications are placed. Commonly performed procedures include: Epidural Steroid Injections (for such disorders as disc herniations and radiculopathy), Medial Branch Blocks/Facet Injections for facet/spinal joint related pain, Lumbar Sympathetic Block for sympathetically medicated pain (Complex Regional Pain Syndrome (CRPS, RSD), Sacro-iliac joint injections, and Radio-frequency ablation/Rhizotomy.
The vast majority of patients tolerate these procedures with minimal to no discomfort and are able to return promptly to their workplace and other normal daily activities. Economically, this benefits the patient, the employer, and the economy as a whole by helping to maintain an active productive workforce with little or no economic or personal disruption to the employee and the employer.
The adverse economic impact resulting from the failure to promptly treat the pain from back and neck injuries and to enable the injured party to promptly return to work is substantial. Case managers, adjustors, patients, and physicians all share the same goal: to provide high quality and cost-effective treatment to an injured worker to allow him to return to work and his daily routine quickly and safely. If other conservative therapies have failed to achieve this goal, then the medical treatment provided by an interventional pain management physician may be the appropriate therapy for the injured worker.
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Written by: Benjamin Parish, MD
Orthopaedic Center of South FL
600 South Pine Island Rd, STE 300, Plantation FL 33324