A pain in the back Featured

8:46am EDT July 31, 2006
Back troubles can cause pain to individuals and businesses alike. In fact, approximately four out of five adults have had at least one bout of back pain sometime during their lives, and it is one of the most common reasons for health care visits and missed workdays.

Consisting of bone, muscles, nerves and other soft tissues, the back is an intricate structure with many components that can break down. “The back is an extremely complex organ,” says Dr. Michael Ferrante, director of the UCLA Pain Management Center and a professor of anesthesiology and medicine. “Arguably, the spine is the next-most complex organ outside of the central nervous system.”

Ferrante spoke with Smart Business about what causes back pain, how it can be avoided and how to select quality health care professionals when dealing with back ailments.

What are some common causes of back pain?
I would divide back pain into three large groups. No. 1 would be disorders of muscle. This can occur if you’re out of shape, if you spend a lot of time in a poor posture or if you overuse your back. No. 2 would be disorders of the spine itself and, by spine, I mean the bony structure of the spine. No. 3 is a grouping that includes nervous disorders of the spine. This is usually leg pain where either you have an irritation or compression of a nerve root and it manifests itself as leg pain.

How can back pain be treated?
Sometimes you can do nothing. A classic example of this would be a lower back sprain. You just take it easy and within a few weeks it’s going to get better. The next level up would be getting physical therapy. If something is lasting six months or longer you need to see some physician outside of a primary care doctor who is going to be able to give you a sophisticated diagnosis and sophisticated workup. Acupuncture is another option at any stage because it certainly does no harm and it could very well help. You should be careful, however, that herbal medicines don’t have a side effect with other forms of medications that you may be taking.

How can back injuries be avoided?
First, you have to stay aerobically active, particularly for the low back. People who already have disc disease or knee problems do very well with elliptical systems. Instead of the pounding on the spine and knees that occur with running, elliptical systems take the kinetics and move them forward and backward. Also, back injuries can be avoided by improving posture at work. It sounds like what your mother always told you about having good posture, but it really is a truism. Bad posture puts repetitive strain on ligaments, joints and muscles.

What steps can a business owner take to safeguard against back injuries at the workplace?
Have someone do an ergonomic evaluation. Just by changing some very simple things like how keyboards are placed and how employees sit can prevent injuries. Also, if you get health club memberships for your employees, it not only encourages them to get aerobic activity, but it might also be financially beneficial because employers may get a reduction on the premium of their health insurance.

How can someone with back pain identify a good physical therapist?
You have to tailor the physical therapy to the particular mechanism that is causing the pain. If people are not getting some type of physical therapy that is attempting to eradicate or solve their particular problem, then I would suggest that they look elsewhere for physical therapy. There’s nothing wrong with feel-good maneuvers, but they have to be coupled with things that are going to strengthen the weak muscles and cause postural realignment.

What are some characteristics that one should look for when seeking a back-pain specialist?
Find a doctor who is going to be able to ferret through the vast different diagnoses. Find someone who asks the question, ‘Can I explain this pain and on what basis?’ A lot of practitioners of spine medicine practice template medicine — everybody gets one type of treatment. I don’t advise that, because it doesn’t seek to answer the question of what’s causing the pain. Also, it is important that the doctor start off with the least invasive and least complex treatment and then work their way up.

It’s a matter of finding a doctor who is insightful, finding a doctor who doesn’t immediately jump into the most invasive and financially rewarding option for him- or herself, and finding someone who really acts as an advocate for you.

MICHAEL FERRANTE is director of the UCLA Pain Management Center and a professor of anesthesiology and medicine. Reach the Pain Management Center at (310) 794-1841.