December 15, 2022
Dr. Jerry Williams of Urgent Care 24/7 discusses very common, but very difficult problem, low back pain.
Dr. Williams is a neurologist, a child and adult neurologist. So mostly in his adult neurology career, he has taken care of a lot of chronic back pain. It's a very difficult problem to care for as a physician, but it's an even worse problem to deal with if you're the patient.
Back pains are a common complaint to medical providers worldwide. If you're watching this video, you are a loved one, or friend who is probably suffering from low back pain or has at some point. Well, you know, the thing about low back pain is there are so many things to hurt. In the lower back. You wait a minute, what are you talking about? Well, there's muscles, there's nerves, there's tendons, there's bone, your kidneys are back there. The frequency with which patients present with this complaint and probably one of those common things, we see it in Urgent Care 247 nationally. We treat low back pain patients in this generic wastebasket treatment.
That's not the right way to handle low back pain, because what you have to do, sounds elementary, but to get the right treatment plan, you have to start with the right diagnosis. That's something that Dr. Williams thinks neurologists, his specialty are very good at, as a rule is getting the proper diagnosis. So the first thing we like to do is try to nail down what's causing the pain, you know, is it musculoskeletal? Is it muscle? Is it bone? Is it a tendon? Or is it nerve related pain? And once or is it a combination thereof?
Once we have those, those details discerned then we can go with more pinpoint accuracy with our treatment regimens, to make sure that we nip it in the bud of where the pain is coming from. For example, a muscle relaxer for muscle spasm is not going to be as effective if you've got a primary impingement nerve impingement problem, say from a herniated disc, or if you've got primary bone pain, so trying using the physical exam, and in some cases, imaging either CAT scan or MRI are the two most common and looking for pathology and cause and thinking about if it's an injury related love back pain complaint.
What was the mechanism of injury that caused it? Was it overuse from heavy lifting or repetitive overuse? Or was a patient in a car accident or did they have a fall? Once we take into account the mechanism of injury, then we can go chasing the proper diagnosis and then we can narrow down the proper treatment plan. Now that we see a lot of patients with musculoskeletal pain we use a lot of non-steroidal anti-inflammatory drugs, intermittent doses of steroids and centrally acting muscle relaxers such as methocarbamol or cyclobenzaprine. If you've heard of those, which are robaxin and flexural, respectively, but we will also treat patients with medications that will help calm down the nerves.
If the pain is we think coming from nerve impingement or nerve irritation, and those can be very effective for patients. The one thing that Dr. Williams practice he has always avoided is chronic back pain patients who are not terminal. If they don't have a terminal illness if they have a terminal illness, it is a totally different ballgame but we don't use narcotics and chronic back pain patients. So the other thing that's really important is getting these patients especially early on into a good physical therapy program that can do core strengthening, wait weight reduction to get rid of any excess weight around their midsection which can put a lot of pressure on the lower back.
Exercise and appropriate physical therapy, weight loss, nonsteroidal steroids. Interval intermittent steroids typically, and medications that help calm down nerve pain if there's a nerve related component to the pain. One other thing that is a bit uncommon that people will sometimes have low back pain can come from shingles, where they have typically a subclinical meaning there aren't many lesions on the scan, of shingles, and they can be left with what's called a post herpetic neuralgia. If it happens to affect the sensory nerve distribution of the lower back, it can leave the patient with what's called a post herpetic neuralgia. And that post herpetic neuralgia can present as back pain that's uncommon, but it does happen.
The takeaway from this is there's lots of different things in the back that can hurt. Get the right treatment plan, you got to have the right diagnosis. If you or a loved one or friend are suffering with low back pain that you go get evaluated to get that proper diagnosis early on. Catching low back pain early and mitigating the causes of it can prevent you or the patient from becoming a chronic low back pain patient, which is not where you want to be. If you or someone around you is having these symptoms, please go get seen sooner than later.
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