Dealing with back pain
Back pain is common for people of all ages, and sometimes surgery is not the only answer.
BY: Dr Chua Soo Yong
Back pain is one of the commonest ailments that affect people from all age groups. Of course with age, the discs in our back as well the joints have undergone more “wear and tear” and hence, the incidence might increase. The main causes of back pain changes with differing age groups, hence getting to the root of the cause is very important.
For seniors, the symptom of back pain is associated with leg pain, numbness or weakness especially when walking. This is a fairly common recurring theme among patients that I see. This affects their walking distance, as they have to look for a bench to sit to rest before they can continue walking again – a problem known as spinal stenosis (spinal canal tightness). Besides nerve compression symptoms, arthritis with age also contributes significantly to back pain symptoms.
Most incidences of back pain get better with a course of analgesia (painkillers), medication and physiotherapy but those that persist for more than six weeks should be taken more seriously. Some patients I see also seek alternative forms of treatment like chiropractor or acupuncture prior to seeing me. Most of them see me because they haven’t had much symptomatic relief from these initial treatments.
Besides persistent back pain that does not improve after simple treatment, there are some other symptoms of back pain that we have to pay attention to and take more seriously: Back pain occurring at night that disturbs your sleep; back pain that is associated with poor appetite, unexplained weight loss, fever, or weakness in the limbs; and back pain after a fall should also be treated with caution and you should seek professional medical advice. This is to rule out back pain from a more “sinister” cause that would be dangerous for instance, a fracture, cancer or spinal infection.
When the answer is surgery
Not all back pain needs to be treated with surgery. It all depends on the diagnosis. This can only be determined after a proper medical check-up. Only five to 10 percent of patients with back pain that I see require surgery. Most do not, and continue to improve without going under the knife.
If surgery is the answer, there are different forms of surgery that will help your specific condition. This can only be determined after consultation with a spine specialist. Spine surgery is very safe in this day and age – it is very scientific and exacting. With newer novel techniques and options that have only been made available in recent years, for instance needle-based radio-frequency ablation techniques that address spinal disc damage and prolapse, as well as nerve pain generators, many patients can be treated on an outpatient basis or with a minimally-invasive approach that does not require long hospital stay and reduces “down-time”. The spine specialist will be able to assess if you are a suitable candidate for such procedures that do not require general anaesthesia.
However, if you do require formal spinal surgery, which requires you to be under general anaesthesia for more extensive structural work to be done, your spine specialist should be able to choose the most suitable procedure for you, weighing the risks and the benefits. If you are concerned about paralysis after surgery (it is a very common source of anxiety among most patients), this is extremely rare with the new techniques of today. This includes advanced anaesthesia, expert surgical technique, spinal navigation and spinal cord neuromonitoring (which monitors your spinal cord during surgery to ensure safety and a better outcome).
Preventing lower back pain
The best thing you can do for yourself is to try and avoid surgery if you can. This can be achieved by:
- Keeping active by participating in community activities, mass exercise programmes or daily group exercises with friends.
- Keeping your joints mobile by exercising them and maintaining good range of motion and flexibility.
- Doing lightweight bearing exercises to keep bones strong such as lifting light weights.
- Strengthening your core muscles that keep your spine supported by doing targeted physiotherapy exercises, pilates or yoga.
All this will ensure that your spine and its supporting structures are kept healthy and strong, and prepared for the challenges that it will face with age.
Dr Chua Soo Yong is a consultant orthopaedic surgeon, and spine specialist and surgeon at the Centre for Orthopaedics.