Vail doc: Surgery doesn’t always cure back pain
Editor’s note: This is the final part of a two-part series on back injury myths by Dr. Scott Raub. Visit http://www.vaildaily.com to read the first five back injury myths. Myth 6: Spinal injections hurtWe use injections for diagnostic motives as well as therapeutic reasons. A lot of people believe having injections or other types of interventional pain procedures will hurt. When we do spinal injection procedures or interventional pain procedures, we use local anesthesia; and if the patient wants it, we offer conscious sedation. We don’t put people to sleep for these procedures but we will give them medication that provides a relaxing environment so they don’t feel as much pain or anxiety. Myth 7: All steroids are bad for meSome people believe that injections are a temporary solution or a band-aid to the real problem. There’s also a concern that there’s an adverse side effect to these medicines or that these are the same medicines used by some professional athletes. The medication we predominantly use is a steroid, but it’s not the same steroid that athletes use for performance enhancement. The steroid we use is for inflammation control. We utilize steroids by being very target-specific, placing the medication under x-ray guidance to the precise point of where the pain generator is. In many cases, steroid injections allow patients to start more therapy and then the natural course of things leads to an improved outcome. Myth 8: A cure exists for all spinal pain problems; “I can be fixed!”One of the myths we frequently encounter is when patients assume surgery will cure their problem. We don’t have a way to replace the anatomy that people had when they were 18 years old. Most surgeries either remove something or put something in you. Removing it might be removing a disc or bone and making room for the nerves. Putting something in you might include screws, rods, cages or grafts for a fusion. So we’re not restoring the anatomy. There are some patients who do truly need surgery; but surgery for back pain should only be undertaken after every other treatment option has been exhausted and the patient is still not able to live with the pain. We consider surgery when patients are taking more medications than they want to, when they’ve tried multiple different treatments (physical therapy, chiropractic care, and injections), and when the pathology makes sense. Back pain surgery is not always successful, so we select our patients very carefully.Myth 9: Prolonged bed rest is necessary following an acute episode of lower back painGood studies show that putting people with acute back pain on bed rest for no more than three days will produce a good outcome. Beyond three days generally has an adverse effect however. Many back pain episodes take more than a couple of days to get over, particularly with people who have recurrent bouts with back pain.Myth 10: An MRI always gives us the answer for the cause of painThere’s a myth that an MRI is always going to show where pain is coming from. The reason it’s a myth is because an MRI is really just a picture. An MRI shows anatomy and may show some abnormalities. But MRIs do not tell us how nerves are working and may not necessarily show us where the pain is coming from. In order to come up with a diagnosis, we take MRI findings and couple them with physical complaints and any physical findings. Sometimes we use MRIs as an educational tool to reassure patients that there isn’t anything serious going on. In some very rare cases, the MRI is able to pick up things that are more urgent and need to be addressed immediately. Dr. Scott Raub is a physiatrist with Vail-Summit Orthopaedics. He specializes in non-surgical spine care and electrodiagnostic testing. Be sure to visit the VSO website to watch the video of Dr. Raub talking about back pain myths on the VSO website at: http://www.vsortho.com/#doctors=/dr-scott-raub&community=/10-myths-back-injury.
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