Back Pain Treatment I
What is your approach to a patient with back pain and what are the most important things all back pain patients should know?
Joel Hellmann, MD:
Dr. Hellmann works for a large health insurance company and lives in Massachusetts.
As both an Occupational Medicine and Emergency Medicine specialist, I see back pain patients under different circumstances. As an Occupational Medicine specialist, I would be doing the primary care of back pain. Most people treating back pain, I expect, would use more or less the same initial patient history and intake evaluation and, unless there was a contraindication, would probably recommend similar initial treatments. My particular specialty has a work-place oriented perspective on back pain. In assessing, diagnosing, and providing rehabilitation recommendations to a patient, I need to consider the patient's work environment and the ways that the patient uses his/her back to perform in his/her job, and the potential risks that that job might pose for recurrent injury.
As an Emergency Medicine Specialist, I tend to see people who have just injured their backs, people who are in acute pain, or people who are unhappy with or have failed to respond to preliminary treatment prescribed by another healthcare provider. Emergency Physicians are available 24 hours a day in the Emergency Department for face-to-face emergent care. As an Emergency Physician I also have certain medications that can be administered intravenously and/or intramuscularly that other physicians may not have ready access to or may not be available in their office setting.
Different healthcare providers provide different services to patients with back pain. What gets offered is more often related to the secondary treatment of back pain - back pain that does not respond to initial conservative management or is more complicated than musculoskeletal pain such as that associated with evidence of neurological involvement. Where I might be able to provide services specific to Occupational or Emergency medicine, I would not be able to offer other treatments and services such as surgical intervention.
Here is what I think it is important for everyone with back pain to know:
- They need patience with the healing process. Do it right the first time.
- An understanding that an ounce of prevention is worth a pound of cure with respect to ongoing problems with their backs.
- When to seek immediate care, the signs and symptoms that may indicate there is something more serious than a muscular problem.
- How to perform basic and necessary activities of daily living such as getting into and out of bed, into and out of a car, sitting on and get up from a toilet, and other activities of personal hygiene without causing more discomfort or re-injuring themselves.