Monday Medical: ‘The Good, the Bad and the Ugly of Back Pain’
March 3, 2013
Besides the common cold, back pain is one of the top reasons that people seek medical care. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work.
Steamboat Springs orthopedic spine surgeon Dr. Henry F. Fabian Jr. said the cause and treatment of back pain can be a challenging problem.
"The spine has many independent but interrelated working parts, including muscle, disks, fascia and other soft tissue," he said. "Additionally, there are many treatment options. It is confusing for patients to understand all the information and deal with all the misinformation available."
Fabian plans to provide guidance in a free March 12 lunchtime program at Yampa Valley Medical Center that will be repeated as an evening talk April 2. The presentation is titled "The Good, the Bad and the Ugly of Back Pain: What Works and What Doesn't."
The good refers to education that can counteract the bad and the ugly, which is the overload of information and misinformation.
Fabian likes to begin with a basic anatomy lesson that explains the spine and why things go wrong. His goal is to teach people how to ask the right questions so they effectively can evaluate whether a specific treatment might work for them.
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"For example, I had a patient from Michigan who had neck pain," he said. "She was receiving chiropractic treatment because her neck was 'too tight.' She also was receiving prolotherapy, another available modality from a different provider because her neck was 'too loose.'
"However, because the providers did not use that exact terminology, she didn't realize that these opposite treatments were counteracting each other."
Fabian groups treatment options into four classifications: tolerance, physical therapy and chiropractic interventions; interventional pain management; and operative.
"A person who has back pain may go through this entire spectrum over time," he said.
Because back pain is so common — it is estimated that 80 percent of Americans will encounter it during their lifetimes — it's a hot topic.
"Mention you have back pain, and you get suggestions from everybody: neighbors, coworkers, friends. Everyone has an opinion," Fabian said.
"There is so much information out there, particularly on the Internet, that can lead people down odd paths. They read about new treatments and try to fit their problem into a particular technology, which can be like trying to put a square peg in a round hole.
"If patients aren't given the right education, they can wander through misinformation from numerous sources," he said. "With education, they can pick up some cues that will help them with their judgment."
One of the major causes of back pain, which refers to everything from the neck to the low back, is degenerative arthritis in the spine. Fabian said this process starts for most people by the time they are in their 40s.
"At my presentations, I will have models and drawings to explain the building blocks of the spine," Fabian said. "People who attend will learn about each part of the spine and why, for example, when you overload a disk you will have successive failure up the spine.
"There is hope for a reasonable, logical approach to work through the jungle of information we are faced with in managing back pain. I want to give people those tools to navigate through and deal with their back pain."
In addition to Fabian's talk, there will be a presentation of data from The Spine Center at Yampa Valley Medical Center that highlights surgical outcomes and performance benchmarks. Fabian and The Spine Center were compared to more than 20 Spine Surgery Centers of Excellence from across the United States and were named "best in practice" in several categories. The hospital's commitment to evidence-based medicine and best practices will be highlighted.
Christine McKelvie is a writer/editor at Yampa Valley Medical Center.