Relieving Your Lower Back Pain Transcript Highlights Paul Christo, MD November 14, 2013 Welcome! Thank you for joining us for “Relieving Your Lower Back Pain.” This Facebook chat will be co-hosted by Dr. Paul Christo, one of America’s leading experts on back pain, who will be covering the many possible causes of back pain and various treatment options.

Dr. Christo is an Associate Professor at Johns Hopkins Medicine in the Division of Pain Medicine, Department of Anesthesiology. He lectures nationally and internationally, serves on journal editorial boards, teaches, co-edited three textbooks on pain, and has published over 70 articles and book chapters on many topics related to pain treatment. Dr. Christo hosts “Aches and Gains” with Dr. Paul Christo, the first national talk show on overcoming pain that airs weekly on SIRIUS XM Radio-Family Talk 131. (www.siriusxm.com/familytalk). Follow Dr. Christo on Twitter or Facebook for more information on cutting edge pain treatments.

Dr. Christo – Low back pain is one of the most common disabilities in the Western world. In fact, it affects about 80% of Americans at some point during their lives. The costs are massive, and estimated somewhere between $100-200 billion annually. The causes can be complex, but discogenic pain, or pain that comes from the intervertebral discs accounts for most of the cases of chronic LBP. Medicines, physical therapy, and even spinal fusion or artificial disc replacements have been used to treat disc pain in the back.

Dr. Christo –  Gregory, if the pain continues for more than 3 months, I would seek the care of a pain specialist. We believe that chronic pain begins when pain persists for 3 months or more, so I’m pretty aggressive about seeking help sooner rather than later.

Dr. Christo –  Joanne, Yes. Meditation and other cognitive behavioral techniques like relaxation, guided imagery, and biofeedback can all help. I did a show on Biofeedback that you’ll find useful: Biofeedback, posted on October 26, 2013 http://www.paulchristomd.com/biofeedback

Dr. Christo – Joanne, Hypnosis is helpful for back pain too and underutilized.  Here is the show I did on Hypnosis: Hypnosis, Healing, and Pain Relief, posted on September 14, 2013 http://www.paulchristomd.com/hypnosis-healing-and-pain-relief Comment:  I really appreciate that you look beyond just medications and injections and individualize treatment depending on the patient!

Dr. Christo –  Eliza, RSD can be treated with medicines, nerve, blocks, cognitive behavioral therapy, and spinal cord stimulation. I start with medicines like neurontin or lyrica, then nortriptyline, or opioids, if necessary. Certain sympathetic nerve blocks can be useful, and spinal cord stimulation as well.

Dr. Christo –  Rona, surgery is often the last option for treating pain. But, surgery can also be needed in certain situations, like a severe disc herniation in your spine. I advise my patients to be wary of jumping into spine surgery, especially.

Dr. Christo– Rena, a toradol injection would be fine even if you’re taking meloxicam. Generally, using two anti inflammatories isn’t recommended, but a one time toradol injection should be fine.

Dr. Christo –  Abel, fusion is useful for stabilizing the spine if the spine is unstable. It’s also helpful for radiating pain or shooting pain more than low back pain alone. Make sure you ask the surgeon how much pain relief he/she believes you’ll get from a fusion. If you have a chance, listen to the show on Low Back Pain, posted on December 11, 2011. http://www.paulchristomd.com/low-back-pain

Dr. Christo –  Marilyn, Consider trying nortriptyline or cymbalta. Also, the pain doctor could consider exchanging some of the pump medicines. For instance, you could try ziconotide (prialt). Alternative therapies: hypnosis and biofeedback, healing touch. (See above reference to Dr. Christo’s October 26, 2013 broadcast on biofeedback).

Dr. Christo – Renee, RFA is radiofrequency ablation. It’s typically used for treating neck, thoracic, low back pain that’s due to arthritis of the joints. A diagnostic block with local anesthetic is first done, and then the RFA if the diagnostic block produces relief. The RFA coagulates the small nerves that provide sensation to the joints and effectively, inactivates them so that pain is reduced. Typically lasts for several months.

Dr. Christo –  Pamela, Epidurals typically contain a steroid (solumedrol) and sometimes a local anesthetic. Other steroids can be used, though. Specific injections called transforaminal epidural steroid injections that target specific nerves may be helpful depending on the location of the pain down the legs.

Dr. Christo – Here’s a great show on spinal cord stimulation too: Innovations in Spinal Cord Stimulation, posted on October 26, 2013

Question: I have arthritis in my si joints and between L5 and S1.  My back cracks all the time and to be honest it usually feels good when it does.  Is this detrimental?
Dr. Christo – Megan, the cracking is probably a release of pressure inside the facet joints of the low back. Chiropractors typically do this. I don’t think it’s detrimental.

Question:  I’m 30 years old. I had Cushing’s syndrome which caused osteoporosis. Fractured my spine at T7 with no trauma, herniated T10-11. Was diagnosed too late for kyphoplasty. One year out I’m still having a lot of pain. Is my back still healing?  Is there any chance it will improve this far out? Can only be up for about 4 hours a day and the rest of the time I have to go lie flat.
Dr. Christo –  Tiffany, you may want to consult a spine surgeon just to see if stabilizing those spinal segments would help reduce the pain. Otherwise, I would make sure that your cortisol levels are normalized so that the osteoporosis doesn’t worsen. I think that controlling the osteoporosis is your best bet.

Question: I was diagnosed with what the back doctor described as Facet Syndrome.  Initially I was driven to the doctor with numbing in lower legs and various burning and pain sensations making it difficult to sleep.  I underwent a steroid injection between L4 & L5.  They said it was unnecessary to treat with surgery.  Now after a year I can’t sit, stand, walk for more than 30 minutes without excruciating pain and having to change positions.  Could you please advise on treatment options I can look into in addition to the chiropractor I go to?
Dr. Christo –  Tom, I would try facet blocks with local anesthetic to see if that helps. If it does, then try the RFA (radiofrequency ablation) of those joints for longer term pain relief. Also, engage physical therapy.

Dr. Christo – Joanne, Neuroplasticity relates to the ability of the nervous system to change. It means that the nervous system can heal, but it also means that the nervous system (brain, spinal cord) can be sensitized to pain, and develop chronic pain.

Dr. Christo – Here’s another interesting show, Pooches, Pets & Pain Relief. It talks about the power of pets (dogs) in reducing pain, including back pain. PainPathways and I would like to dedicate this show to the memory of Dr. Dawn Marcus. Pooches, Pets, and Pain Relief, posted on September 14, 2013

PainPathways Hi everyone! This is Amy North, editor of PainPathways Magazine. On behalf of Dr. Richard Rauck, we’d like to thank Dr. Christo and all those who participated in tonight’s chat! We are excited to be offering this great forum for information and inspiration. Have a good night everyone!

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All information provided is for educational purposes only.  Neither PainPathways nor Dr. Paul Christo are responsible for a medical diagnosis.  Individuals should seek a physician for evaluation and a personalized treatment plan.