Expert Advice: How chronic back pain is treated

Host Amber Smith: Here's some expert advice from Dr. Vandana Sharma, from Upstate Medical University. How might chronic back pain be treated?

Vandana Sharma, MD: So chronic back pain, the treatment of this condition involves treatment of the cause. That's what I tell my patients when it comes to that. If I do not know where the pain is coming from, it will be very hard to treat the pain. So first, it involves finding out what is causing the pain, and that involves doing some studies such as doing bone scans, or EMG (electromyography) studies or nerve conduction studies, and then an MRI of your affected area of pain, mostly chronic back or neck pain. An MRI gives us a very clear picture of what could be the source of your pain. Once we know the source of the pain, then we treat it with a three pronged approach. One of them is, depending upon the medications, which is the simple and the basic way to start -- using over-the-counter analgesics like anti-inflammatory medications and Tylenol, using some more complicated medications such as anti-convulsants and antidepressant medications. And then thirdly, when the pain is not treated by just these medications and we move on to use opioids as our last resort, which we like to keep only for chronic pain that is extremely debilitating, and when no other way can be offered to treat pain, or for cancer related back pain. These are the conditions for medication management of pain.

Something that goes hand in hand with medication management is physical therapy and use of all other therapies that could help with treating the biomechanics of the spine, such as chiropractor management, using transcutaneous electrical leads, like TENS (transcutaneous electrical nerve stimulation) unit, and using acupuncture when your insurance covers. Unfortunately, insurance doesn't cover a lot of acupuncture modalities, even though they are very helpful in treating some particular causes of back pain.

And then thirdly is the spinal injections that can be done by a pain physician using X-ray guidance or sometimes, in some complicated cases, using CT guidance for placing those injections. When all these three modalities fail -- when we have used medications, you continue to do physical therapy, weight management, and along with that we do the spinal injections -- when all these things have failed, then we do a comprehensive evaluation by a surgeon as well, which could be an orthopedic spine surgeon or a neurosurgeon, who can again, go over the cause of the pain, whether it can be modified by the injections alone, or do they need a surgery at that point, which could be minimally invasive to something that's extensive, and that all goes into that arena at that point.

Host Amber Smith: You've been listening to pain medicine specialist Dr. Vandana Sharma from Upstate Medical University.