SAN FRANCISCO (KCBS RADIO) – Low back pain is not only a struggle for those who suffer from it, but it is also a challenge for medical professionals to address.
“Lower back pain is hard to treat for most people,” UCSF Health pain medicine physician Dr. Prasad Shirvalkar told KCBS’ Bret Burkhart on this week’s episode of As Prescribed. “Most of the drugs we have out there really don’t work very well for most people.”
He said the process for most doctors with their patients is really one of trial and error.
“We don’t know up front who is going to benefit from, let’s say, Celebrex or who is going to benefit from a muscle relaxer,” the pain medicine doctor and neurologist explained. “There may be a signal there for personalized medicine that we unfortunately just don’t have yet.”
Dr. Shirvalkar said the most common approach for any pain patient is through a non-invasive therapy – treatments like physical therapy, acupuncture, and oral medications. From there, it can scale up, depending on how the early treatments go.
The next step would be injections like epidural injections or nerve blocks. The next step beyond that would be more invasive procedures, like spinal cord stimulation.
“The reality is if you have low back pain for a long time, one of the real difficulties is it is hard to know where it is coming from,” Dr. Shirvalkar said.
That is because it is hard to ‘see’ where the pain is.
“Based on imaging, we try to see if there is anything wrong with your MRI or your CAT scan, but the truth is the imaging doesn’t always correlate with someone’s symptoms,” he explained. “We don’t even have good imaging methods, I would argue, to identify where someone’s back pain is coming from.”
The physician is hopeful that as technology continues to evolve that there will be more tools that doctors in the future can use to help them identify what is causing pain for a patient and find the appropriate treatment for them from the start.
In an ideal world for most people, the goal is to not have low back pain develop at all.
“There is no silver bullet,” Dr. Shirvalkar said about preventing pain from developing, “But the best answer I think is the age-old answer of exercise.”
He said the best thing about exercise for preventing back pain is that it helps strengthen the muscles in your back which can help stabilize your spine.
“The joints in your spine are not working as hard, you’re less likely to have disc bulges or arthritis,” the doctor elaborated.
He did note that until we have a better idea of what causes arthritis – whether it be genetic or environmental – it is difficult for most people to avoid back pain in their lifetime.
As for the types of exercise Dr. Shirvalkar said the best for minimizing the odds of developing back pain are aerobic exercises and ones that focus on your core. He did add that bad form when doing these exercises will do more harm than good, so he recommended working with a trainer or a physical therapist when starting out.