02-22-2023 Primetime Living - Flipbook - Page 18
18 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, February 22, 2023
BACK PAIN
Get your back
on track
Advances in care for neck
and low back pain
By Linda L. Esterson, Contributing Writer
I
t’s no surprise that many studies show the neck and low back are two of the
most prevalent areasofchronic pain in the body. Approximately 39% of adults
report some level of back pain in the past three months, and the incidence of
chronic back pain is nearly 46% for those over age 65.
According to Jay Karri, M.D., M.P.H.,
an assistant professor of orthopaedics, neurology and anesthesiology at
the University of Maryland School of
Medicine, back pain can occur as a collective result of physically demanding
stresses from military service, manual
labor, athletics (professional or recreational) and many other jobs and hobbies. However, it can also result from
normal aging, and wear and tear on the
body.
“Some people can hurt their back with
injuries as simple as lifting a heavy box
or twisting awkwardly,” says Dr. Karri.
“Regardless of how the injury occurred,
research is now also pointing to genetics
and family history of back problems as
contributing factors.”
The neck and lower back consist of
soft tissues, muscles, tendons, bones
and nerves, which creates a host of pain
generators, or specific conditions related
to those structures. In order to determine
the best course of treatment, spine spe-
cialists must first understand which parts
of the spinal anatomy are affected and
what is causing the chronic pain.
Four common conditions are associated with chronic neck and low back pain
in the aging population:
*Myofascial pain – Myofascial relates
to the muscle and surrounding soft tissues. The pain tends to be more dispersed and nonspecific. It can extend
across the entirety of the low back and
often involve multiple parts, including the
mid-back, and includes structures that
are removed from the midline.
*Disc degeneration or disc bulges –
Discs are soft tissue structures located
between the bones in the spine, all the
way from the neck to the tailbone. They
act as cushions to absorb and displace pressure that comes from certain
positions and movements. While some
wear and tear of the discs is common
with age, these discs may be a source
of pain, especially if they “herniate” or
bulge. A bulging disc may also push
upon surrounding structures including
nerves and cause spinal stenosis and/or
radiculopathy (pain that shoots down the
arm or leg).
*Arthritis – The spine is supported by
small joints which are similar in structure
to large joints like the hip and knee.
These small spinal joints, called facet
joints, can similarly develop arthritis that
can cause localized neck or low back
pain. Just like with a disc bulge, severe
facet arthritis can pinch nearby nerves
and cause various conditions including
spinal stenosis and/or radiculopathy.
*Osteoporotic fractures – In older
individuals, bones can become soft or
brittle, a condition called osteoporosis.
These weakened osteoporotic bones are
susceptible to fractures in the spine following injuries that can be as minimal as
a fall from standing. These osteoporotic
fractures typically occur in the mid back
to upper low back and result in severe
pain. While osteopenia or osteoporosis
can start to appear in people as early
as 50 years of age, those in their 70s
and above are most susceptible to these
spinal fractures.
The importance of diagnosis
When a patient presents with neck or
low back pain, their physician will conduct an in-depth evaluation which often
includes obtaining a history and physical
examination. This evaluation is crucial
to diagnose the exact cause of the pain
and associated functional impairments.
Sometimes additional tests may also be
needed to clarify the diagnosis and can
include blood work and imaging tests
(such as an X-ray, MRI or CT scan of the
spine) to help identify fractures, cancers
and various systemic illnesses.
Gold standard treatments
When dealing with neck and low back
pain, physicians will suggest treatments
that are targeted to address the underlying conditions. A patient’s care plan
is typically personalized based on their
individual risk factors or co-morbidities,
health goals, and preferences. Treatment
options are largely characterized as
being pharmacological (medication) or
non-pharmacological (non-medication),
and interventional (minimally-invasive) or
conservative (non-surgical).
Pharmacological treatments for back
pain are very common, especially given
the availability and widespread use of
over-the-counter pain medications. The
major medication classes that can be
helpful for back pain, according to Dr.
Karri, are acetaminophen, anti-inflammatories, steroids, muscle relaxants, topical agents, neuropathic medications and