Back pain is one of the most common disorders affecting Americans today. Statistics show that 80% of Americans will develop back pain at some point in their life. While it is true that the vast majority of lower back pain episodes are self-limiting and will resolve spontaneously, unfortunately there is still a group of individuals who will suffer from chronic lower back pain. There are many different types of treatment which range from conservative treatments such as physical therapy and medications, to more invasive interventions which include surgical intervention. What is most important is to make an accurate diagnosis first which allows treatments to be more appropriately applied. Treatment directed at a misdiagnosis can only fail long term.
It is extremely important with back conditions to also recognize that the pain may be multifactorial, which means that more than one structure may be injured, and therefore need to be treated, for an optimal outcome. That being said, one of my guiding principles is ‘less is more’. This means that simple, less invasive treatments should be tried first for back pain. If chiropractic treatment or physical therapy resolves the symptoms, then that is all that is necessary. If injections are required and they resolve the pain adequately so that it allows the person to function and return to their normal daily routine, than that may be sufficient. Surgical intervention should usually be reserved for cases which have failed to respond to more conservative, less invasive approaches. It is important to note that a small percentage of patients have conditions that need to be treated emergently with a surgical intervention. In these cases the patient will have physical signs of neurologic damage (such as weakness in an extremity or incontinence) and urgent repair of the underlying cause must be undertaken to prevent permanent damage. There will also be patients who will require surgery for back pain that does not respond to less invasive approaches but even for these patients it is crucial to determine which spinal level or levels are causing the symptoms to properly plan surgery. If open surgical treatment is required we will also help the patient identify the appropriate physician for their particular condition.
Some patients may benefit from minimally invasive spine surgery. Minimally invasive procedures are typically performed through very small incisions measuring less than 1 cm and are associated with more rapid recovery. Only certain types of spinal damage are amenable to this less invasive approach. Connecticut Pain Care is one of the few practices to offer these therapies in the CT area and will help you determine if you may be a candidate for these less invasive approaches.
Unfortunately, some patients who undergo open surgical intervention will (despite the best intentions of the surgeon) still have insufficient relief or even worse, sometimes worsening of their pain. Postoperative pain syndromes, also known as a failed back syndrome or post-laminectomy syndrome, require careful evaluation to determine the precise cause of the on-going symptoms. This will often allow a painful and injured structure to be treated conservatively without the need for further surgery. For patients who do not respond to less invasive interventions and for whom further surgery is not warranted, advanced implantable pain therapies may be helpful at treating more severe pain conditions (please see treatment sections on spinal cord stimulation and implanted spinal drug delivery systems).