Conservative treatment usually works best.
It’s a plain fact. Most people will suffer from back pain at some
time during their life. Chronic back pain—moderate to severe discomfort
that continues over a long period of time or recurs more and more frequently—is
one of the main reasons people go to see their doctor.
“There is a natural course for back pain,” said Michael Goldin,
M.D., a board certified physical medicine and rehabilitation specialist
with Washington Township Medical Foundation. “Most people are going
to get it, most of the time it gets better, and most of the time it returns.”
According to Dr. Goldin, the key to managing chronic back pain is to figure
out how to reduce the frequency and severity of repeat bouts of debilitating
discomfort. Usually, it can be managed with conservative treatment. Most
of the time, surgery is not the answer.
If you suffer from chronic back pain, you should be evaluated by a medical
professional trained in diagnosing and treating back pain problems. The
main goal of the evaluation is to rule out serious conditions that need
more urgent treatment. It is not crucial to identify a specific pain generator
during the early stages of back pain.
“There are a number of different causes of chronic back pain,”
Dr. Goldin continued. “It could be related to joints, vertebral
discs, bones, muscles, tendons, or nerves, to name a few possibilities.”
Here in Silicon Valley and surrounding areas, another factor contributing
to the increased frequency of back pain is workplace ergonomics.
“One common presentation that I see is overuse injuries related to
prolonged computer work and desk work,” reported Dr. Goldin. “Our
bodies were not designed to sit at a computer or study at a desk for many
hours a day. Lifestyle and postural modifications may be needed to ensure
people use optimal biomechanics when working.”
Evaluation by a trained physician will help rule out some of the more serious
causes of chronic back pain. Then, treatment options can be discussed.
Treating the problem
Back pain treatment usually involves doing a course of physical therapy
to help the individual learn specific exercises to alleviate symptoms.
If necessary, pain medication may be used to help reduce the pain while
learning these exercises.
“I commonly tell patients that exercises will have to be done forever—this
means the rest of their life,” emphasized Dr. Goldin. “Muscles
are designed to be used. If they are not used, they weaken. Without physical
activity, as we age, muscles weaken more quickly.”
At times, a back brace may help, but there is a risk that using a brace
may cause muscles to get weaker. The benefits of a brace must be weighed
against the risks.
If conservative treatment with medication, therapeutic exercise, bracing,
and/or workplace modifications does not control the pain adequately, the
doctor may perform an injection. This can focus treatment at a specific
“One or a combination of these treatment options can usually control
chronic back pain effectively without the need for surgery,” stated
Occasionally, if these techniques do not sufficiently control the symptoms,
he will recommend that the patient see a surgeon.
In recent years, more non-surgical options for diagnosing and treating
chronic back pain have emerged with the growth of a medical specialty
called Interventional Radiology (IR). With IR, trained physicians perform
a range of minimally invasive procedures using imaging techniques to visualize
and understand back pain and other maladies. IR techniques can also be
applied to treat the problem.
The interventional radiologist is adept at using a wide variety of imaging
tools not directly available to many other physicians. Having these options
can be particularly helpful in the case of complex, hard-to-diagnose back pain.
“Advanced technology and extensive imaging skills help us determine
the cause of back pain less invasively and often with greater accuracy,”
said Bruce Lin, M.D., a physician in the Interventional Radiology (IR)
program at Washington Hospital.
In the future, Washington Hospital’s IR program will offer neuromodulation
treatment for chronic back pain. The minimally invasive procedure uses
electrical stimulation to help calm hypersensitive nerves. For back pain
patients who have tried other conservative treatments without success,
neuromodulation may be the answer.
“Neuromodulation will be only one of many image-guided tools in our
toolbox and algorithm to combat chronic back pain,” stated Dr. Lin.
“We will be able to try this approach if a patient does not adequately
respond to medical management, including spinal injections, ablation using
radio waves or electric current to interrupt the transmission of pain,
and even surgery. The science and innovation in neurostimulation, which
is often underutilized, can improve the quality of life for patients who
are debilitated by chronic pain.”
Washington Hospital’s IR program is also looking into adding musculoskeletal
ultrasound imaging to its list of diagnostic services. This technique
uses sound waves to produce pictures of muscles, tendons, ligaments and
joints throughout the body, helping to diagnose sprains, strains, tears
and other soft tissue conditions. Ultrasound is safe and noninvasive.
To find out more about Washington Hospital’s Interventional Radiology
program, visithttp://www.whhs.com/ and click on Services. For information about physical therapy services,
contact the Washington Outpatient Rehabilitation Center at (510) 794-9672.
For more information about Washington Township Medical Foundation,
To learn more the medical practice of Interventional Radiology, go to the
website of the Society of Interventional Radiology by clicking