Chronic Back Pain

When Does Back Pain Mean Surgery?

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By Henry Ford Health System Staff

According to the National Institutes of Health, about 80 percent of adults will experience back or neck pain at some point during their lifetime. Unfortunately, for 20 percent of people in that group, acute back or neck pain will become an ongoing health problem.

“If back pain isn’t managed the right way, patients are more likely to have recurrent problems,” says Ritu Zacharias, M.D., a spine expert and pain medicine specialist at Henry Ford Health System.

Back pain, of course, comes in many forms. Sometimes it’s an ongoing, dull ache (chronic); others, it’s a sharp, temporary pain (acute). In other instances, it strikes immediately following an injury or accident; other times it develops as a result of an aging spine.

FAQ: Managing Back Pain

There are many different strategies for managing pain, depending on the source. Pain that results from weakness is handled differently than a sharp muscle pain, for example. That’s why we asked Dr. Zacharias to answer frequently asked questions about back pain — and how to tell whether it’s time to consider surgery.

Q: What are the primary causes of back pain?

A: Causes for back pain are muscular (such as strains and sprains) and structural and spinal (such as herniated discs, spinal stenosis and nerve pain). Treatments vary for both types of back pain and can range from rest to surgery.

Q: What are some non-surgical options to treat back pain?

A: Most back and neck pain is a result of sprains and strains, which tend to heal on their own in about two to three weeks. Spinal pain is more serious and the source of the pain dictates treatment. If you have a herniated disc, you may require physical therapy and manual stretching to pull the disc back into place. If you have a bone slip or fracture, physical therapy can worsen the fracture. In these cases, surgical treatment may be required, depending on the extent of pain and whether there’s weakness.

Q: What are some things I can do to protect and support my back?  

A: The best strategy is to know when you have a problem and not overlook it. If you have a sprain or strain, use ice, heat and anti-inflammatory medications such as ibuprofen, and give yourself time to rest. For chronic back pain, physical therapy can be helpful. Not only will you learn appropriate stretches you can do at home, but your physical therapist will massage the muscles to help loosen up soft tissue and prevent muscular pain. Physical therapy can also help strengthen the core and back muscles to prevent a recurrence.

Q: When should I see a doctor?

A: If the pain lasts longer than two or three weeks, or if there’s muscle weakness involved, it’s time to see a doctor. In addition to a clinical exam, you may need x-rays or a CT scan or MRI to determine the source of the pain.

Q: How do I know if surgery is warranted?  

A: If pain is affecting your quality of life and ability to function, or if you suffer from persistent weakness in the spinal nerves or pain that impacts your mobility, surgery may be the best option. Trying to live with chronic back pain may lead to ongoing dysfunction and it could also increase your odds of getting hooked on pain medications. If your spinal nerves are affected and uncorrected for longer than three months, the damage is not reversible.

Q: What does spine surgery look like?

A: There are many different types of spine surgery. Some procedures require a few months of recovery; others have you back on your feet within a few weeks. When your doctor suggests a specific procedure, don’t be afraid to seek a second (or third) opinion and ask plenty of questions to make sure you are comfortable with and understand the options.

Q: How can I control my pain if I’m not a candidate for surgery?

A: There are a number of medications that can help control your pain, such as nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants and medications for nerve pain. These medications are not habit forming and you won’t become dependent on them. For patients with severe pain, prescription pain medication may be appropriate, but these addictive drugs should never be used for longer than three months.

Related Topic: All About Back Pain Video

Back-Saving Strategies

When you have back pain, exercise may seem like a bad idea, but it can actually help you feel better. “Walking and moving helps break down tissue and control some of the pain receptors that generate pain signals,” Dr. Zacharias explains. Other strategies that can help:

  • Ice: The cold temperature acts almost like nerve pain medication to block pain signals. It also helps reduce swelling and inflammation.
  • Heat: Heat allows muscles to relax and helps you stretch them.
  • Rest: If you have a sprain or strain, taking it easy for a few weeks may be all you need to recover.

Most important, don’t ignore an achy back. If you’re sore, in pain or if back or neck strain is interfering with your daily life, see a doctor or sports medicine specialist. If surgery is your best bet, keep in mind you may have a long recovery time.

“Recovery for most spine surgeries is 6 to 8 weeks, sometimes longer,” Dr. Zacharias says. “It’s best if you can prepare for that — get your home ready, line up family support and carve out time for recovery and physical therapy.”

Henry Ford offers a “Spine Prehab Class” for patients who are undergoing back surgery, so they can learn about the procedure and prepare for their recovery. “Knowledge is power, both before and after surgery,” Dr. Zacharias says.

To find a doctor or physical therapist at Henry Ford, visit henryford.com or call 1-800-HENRYFORD (436-7936).

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Dr. Ritu Zacharias is a spine specialist with clinical specialization in physical medicine and rehabilitation, and pain management. She is the director of  Medical Spine Services & Physiatry and co-director of Senior Spine Pathway at Henry Ford West Bloomfield Hospital. She also sees patients at Henry Ford Hospital in Detroit.