Peter Hibberd, M.D., is a doctor whose advice is based on more than 28 years of hospital outpatient and inpatient experience. He is an experienced emergency medicine physician, surgeon, and consultant. Dr. Hibberd is certified by the American Board of Emergency Medicine. He is also a fellow and active member of the American Academy of Family Physicians, an active member of the American College of Emergency Physicians, and a member and fellow of the American Academy of Emergency Medicine. Dr. Hibberd has earned numerous national and international professional certifications, memberships, and awards.

What Can I Do for Long-term Back Pain?

Monday, 08 March 2010 09:29 AM

Question: I have disk degeneration in my lower back, two forms of scoliosis and sciatica, and a very badly deformed tailbone. My doctor has ordered MRIs, CT scans, a bone density test, and EMG test over the past seven years. .

I take 350 mg of Soma, and 10 mg of Norco for pain, without results. I also tried physical therapy, but it only made things worse. I use Lidoderm patches and had to stop working. What else can I do?

Dr. Hibberd's Answer:

Back pain can be difficult to treat successfully when patients are only treated with "cookbook" approaches. By far, most acute musculoskeletal (spinal) back pain, whether related to disc disease or not, will self-resolve given sufficient healing time. While our "treatment" does make the healing period more comfortable, it often has little effect on the ultimate time for full healing.

Exceptions are related to traumatic fracture and dislocation that need immediate stabilization, or infection/inflammation that may need immediate intervention either medically and/or surgically. An underlying malignancy, or an inflammatory or infectious disease, may be mistaken as back-related, and is where you are wise to avoid self-diagnosis.

It is best to have back pain properly evaluated by a medical doctor soon after it begins to avoid back pain that is resistant to treatment as well as to diagnose unrecognized disease.

You are long overdue for a complete re-assessment. See your medical doctor for evaluation to exclude underlying disease that may be causing back pain not responding to conservative measures. Remember that studies performed (CTT, MRI, etc.) are mere "snapshots in time,” and that unrecognized disease on initial studies may become recognizable on appropriate follow-up studies.

Once underlying disease is excluded, re-evaluate treatment options with your spinal specialty team usually composed of your medical doctor, neurosurgeon, orthopedic surgeon, neurologist, and physiatrist (a rehabilitation physician who is an expert at diagnosing and treating pain).

If you live in a remote area where these specialties are not available, it may be worth your while to obtain an opinion from a referral center, such as a nearby university-based teaching hospital, or a private center, such as Mayo Clinic or Cleveland Clinic.

There are also times when we need to challenge our health care team, especially when the results are not as expected. If your doctor doesn't answer your questions or follow through with a reasonable treatment plan that seems workable for you, fire them if necessary and get an alternate opinion!

© HealthDay

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