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Low Back Pain Treatment in Portland, OR

Low Back Pain TreatmentLow back pain is a condition that affects over 80% of adults at some point in their lives and up to 20% of people at any one time. It is the fifth most common reason people visit the doctor and direct costs are over $28 billion per year. There are many causes of low back pain and the majority of cases will improve spontaneously. For those who do not improve, there are a large number of treatment options.

Anatomy of the Lower Back

The lumbar spine consists of a large, cushioning disc in the front of the spine and two facet joints supporting the back, or posterior, portion of the spine. The paraspinal muscles surround the posterior elements of the spine and help off-load pressure on the discs. The bones of the spine protect the lumbar nerves, which come together into the femoral and sciatic nerves that supply signals to the leg muscles.

Causes of Low Back Pain

The majority of low back pain is thought to originate from the lumbar spine and its surrounding musculature. Intra-abdominal problems, such as kidney stones, infections, and tumors, can also produce low back pain, but these causes usually produce other symptoms in addition to low back pain.

We believe that the discs, facet joints, and muscles within the lumbar spine are the main pain generators. In cases of a sudden twisting or turning motion leading to pain with movement, the pain is usually due to a strain of the muscles. Such a strain, or tear, typically resolves without treatment within days to weeks. Occasionally, healing may take up to three months.

Pain originating from the discs may occur from a sudden movement, but it can also originate without any precipitating cause. Typically, disc pain is worst with sitting, bending, or lifting weights. Isolating pain to one or more specific discs is challenging, as all discs degenerate with age and no existing test accurately shows which particular disc is painful.

Because of the increases the forces across the joints, pain from facet joints typically comes when patients extend their low back. Nerve impingement is another source of low back pain and comes in two forms:

  • A herniated disc pressing on the spinal nerves can cause low back pain but typically causes significant leg pain as well.
  • Spinal stenosis, or a generalized compression of the spinal nerves, can cause low back pain; leg heaviness and weakness, and difficulty walking are more typical complaints.

Although there are many known causes of low back pain, it is often unclear what the primary cause of low back pain is in a particular patient. Non-operative, conservative treatments such as stretching, physical therapy, medicines, and acupuncture can be helpful. Surgical intervention is not advised when the cause of pain cannot be identified.

Low Back Pain Treatment in Portland

Primary care providers are the first-line for managing low back pain. Physical therapists, chiropractors, massage therapists, and acupuncturists are also common first-line providers. Consultation with a spine surgeon, who could be either an orthopedic surgeon or a neurosurgeon, should be reserved for patients that continue to have pain after several weeks of first line treatments.

Options for Treating Low Back Pain

Activity modification is the first treatment recommended for low back pain. Although many patients do feel better lying down, days of mandatory bed-rest has not proven helpful. Bending, twisting, and lifting should be avoided.

Medications are another first-line treatment. Non-steroidal anti-inflammatory drugs, such as ibuprofen and naproxen, can help decrease inflammation and pain. Muscle relaxants can help with spasms. Occasionally narcotics are used short-term in cases of severe pain.

Physical therapy that includes a stretching and strengthening program can help muscular and discogenic pain. Performing proper back maintenance exercises is also valuable to help prevent recurrent low back pain. Many patients find acupuncture, chiropractic or osteopathic manipulation, or massage therapy helpful.

Injections can provide relief for low back pain. Epidural injections place steroid around pinched nerves to decrease swelling; they usually provide more relief of leg pain than back pain. Facet blocks, where injecting a local anesthetic numbs the facet joints, can eliminate pain just from those joints. If the numbing medicine is effective, a rhizotomy (burning of the nerve to the facet joints) can be performed in the hopes of permanently eliminating pain from those joints. Typically, injections are not the answer for isolated low back pain.

Surgery is the last option for low back pain. Surgery is only successful if the main source of pain can be identified. The decision to go forward with surgery is a complex one best made after careful discussion with a spine surgeon.

Back Pain Treatment in Portland, OR

Dr. Gavin Button is a Board-certified orthopedic surgeon who has extensive training and experience in both general orthopedics and spine surgery. Specializing in neck and low back conditions, Dr. Button utilizes innovative medical techniques in the treatment of his patients. To make an appointment, call his Portland office at (503) 234-9861.