Back Pain

Defining Back Pain

Chronic back pain is defined as persistent or recurrent pain in the spinal area or lower, middle, or upper back that lasts for more than three months.

This type of pain may be dull, sharp, stabbing, or throbbing, and it can vary in intensity from mild discomfort to severe agony. 

Spine pain or back pain can significantly impact your everyday life, interfering with daily activities, work, and sleep.

It may be caused by various factors such as muscle strain, ligament sprain, disc degeneration, spinal abnormalities, or underlying medical conditions like arthritis or herniated discs. 

Treatment for chronic back pain typically involves a multidisciplinary approach, including medication, physical therapy, exercise, lifestyle modifications, and in some cases, interventional procedures or surgery.

What Causes Back Pain?

Back pain can stem from various causes, including:

1. Muscle or ligament strain. This is one of the most common causes of back pain. Activities such as lifting heavy objects, sudden movements, or poor posture can strain the muscles and ligaments in the back.
2. Herniated or bulging discs. The discs between the vertebrae can bulge or rupture due to injury or age related degeneration, putting pressure on nearby nerves and causing pain.
3. Degenerative disc disease. As people age, the discs in their spine can lose hydration and elasticity, leading to degeneration and pain.
4. Osteoarthritis. This condition involves the breakdown of cartilage in the joints and can affect the spine, causing pain and stiffness.
5. Spinal stenosis. This is a narrowing of the spinal canal, which can put pressure on the nerves and cause pain, numbness, or weakness in the legs.
6. Scoliosis. An abnormal curvature of the spine can lead to back pain, particularly as the condition progresses.
7. Osteoporosis. This condition causes the bones to become weak and brittle, increasing the risk of fractures in the spine, which can cause pain.
8. Tumours. Rarely underlying tumours can result in persistent back pain (primary or metastatic) and in patients at high risk, they must be evaluated further.
9. Traumatic injury. A fall, car accident, or other trauma can injure the spine, leading to acute or chronic back pain.
10. Medical conditions. Certain medical conditions, such as kidney stones, endometriosis, or infections, can cause back pain as a secondary symptom.
11. Spinal Surgery. Persistent post spinal surgery pain is a condition in which pain continues to persist despite surgery. It may be similar to the pain before surgery or occur as a new type of pain. The reasons could be insertion of hardware, change in biomechanics of the spine due to surgery, nerve damage or muscle deconditioning and atrophy.
12. Obesity. Excess weight can put strain on the back and increase the risk of developing conditions such as osteoarthritis or herniated discs.

It’s important to note that while many cases of back pain or spinal pain improve with rest and self-care, persistent or severe back pain should be evaluated by a healthcare professional to determine the underlying cause and appropriate treatment.

What is a Back Pain Specialist or Back Pain Doctor?

There are multiple reasons why someone might choose to see a back pain specialist or back pain doctor for chronic spinal pain or back pain.

• Expertise. Back pain specialists, such as orthopaedic surgeons, neurosurgeons, rehabilitation physicians, or pain management specialists, have specific training and expertise in diagnosing and treating back-related issues. They are familiar with various conditions that cause back pain and can offer specialised treatment options.
• Accurate Diagnoses. Chronic back pain can result from a variety of underlying conditions such as herniated discs, spinal stenosis, arthritis, or muscle strain. A back pain specialist can conduct a thorough evaluation, which may include imaging studies like X-rays, MRIs, or CT scans, to accurately diagnose the source of the pain.
• Personalised Treatment Plans. Once the cause of the back pain is identified, a specialist can develop a personalised treatment plan tailored to your individual needs. This plan may include a combination of therapies such as physical therapy, medications, injections, minimally invasive procedures, or surgery if necessary.
• Pain Management Therapies and Techniques. Chronic back pain can significantly impact your entire life, affecting your ability to work, perform daily activities, and enjoy leisure time. Back pain specialists can offer various pain management techniques to help alleviate discomfort and improve function, including medication management, nerve blocks, spinal cord stimulation, or other interventional procedures.
• Prevention and Education. Back pain specialists can provide education and guidance on lifestyle modifications, ergonomic principles, exercises, and preventive measures to reduce the risk of future back problems or exacerbations of existing conditions.
• Coordinated Care. In cases where back pain is complex or involves multiple medical specialties, a back pain specialist can coordinate care with other healthcare providers, such as physiotherapists, chiropractors, psychologists, or pain psychologists, to ensure comprehensive management of the condition.

Overall, seeking care from a back pain specialist can offer patients with chronic back pain access to specialised expertise, an accurate diagnosis, personalised treatment, and comprehensive management strategies to improve their overall health.

Different Types of Chronic Back Pain

Back pain can occur in various regions of the back, including:

1. Lower back (Lumbar region): This is the most common area for back pain. The lower back supports most of the body’s weight and is highly susceptible to strain and injury due to its flexibility and the stresses placed on it during everyday activities, such as lifting, twisting, and bending.
2. Upper back (Thoracic region): Pain in the middle and upper back is less common than in the lower back. It typically occurs between the top of the shoulder blades and the top of the lumbar spine. Upper back pain can result from issues such as poor posture, muscle strain, or spinal abnormalities.

Back pain can also radiate or refer to other areas of the body, such as the hips, buttocks, thighs, or legs, depending on the underlying cause of the pain.

It’s essential to accurately diagnose the source of the pain to determine the most effective treatment approach.

Chronic Spinal Pain

Spine pain can occur along the entire length of the spine, including:

• Cervical spine: This refers to the neck region, consisting of seven vertebrae (C1-C7). Pain in the cervical spine can manifest as neck pain, stiffness, and discomfort that may radiate to the shoulders, arms, and hands.
• Thoracic spine: This is the mid-back region, comprising twelve vertebrae (T1-T12) located between the cervical and lumbar spine. Thoracic spine pain can present as pain or discomfort between the shoulder blades or in the upper back area.
• Lumbar spine: The lumbar spine is the lower back region, composed of five vertebrae (L1-L5). Pain in the lumbar spine is a common issue and can cause lower back pain, stiffness, and discomfort that may radiate to the buttocks and legs, often referred to as sciatica if it involves nerve compression.
• Sacral spine: This is the lowest part of the spine, consisting of five fused vertebrae known as the sacrum. Pain in the sacral spine may cause discomfort in the lower back, buttocks, and hips.

Spine pain can result from various causes, including muscle strain, ligament sprain, disc herniation, spinal stenosis, arthritis, fractures, or structural abnormalities.

The location and characteristics of the pain can provide clues to the underlying cause, and a thorough evaluation by a healthcare professional is necessary for accurate diagnosis and appropriate treatment.

Multidisciplinary Healthcare Teams for Back Pain Management 

Several types of healthcare professionals are involved in the diagnosis, treatment, and management of back pain. These include:

• General Practitioners: General practitioners play a crucial role in coordinating care for individuals with chronic pain. They may initially evaluate the patient, provide treatment, and make referrals to pain specialists or other specialists as needed.

• Back Pain Management Specialists: Pain management specialists focus on the evaluation and treatment of chronic pain conditions, including back pain. They may use a multidisciplinary approach that includes medications, injections, physical therapy, and psychological interventions to address pain and restore general comfort.
• Physical Therapists. Physiotherapists are experts in rehabilitative exercises and techniques to improve mobility, strength, and flexibility. They develop individualised treatment plans to address back pain and may incorporate modalities such as ultrasound, electrical stimulation, dry needling and taping.
• Occupational Therapists. Occupational therapists focus on helping their clients perform daily activities despite physical limitations or disabilities. They may provide ergonomic assessments, assistive devices, and adaptive strategies to manage back pain and prevent further injury.
• Psychologists and Counsellors. Psychologists and counsellors can help you cope with the emotional and psychological aspects of living with chronic back pain. They may use techniques such as cognitive-behavioural therapy, relaxation training, and stress management to improve coping skills and overall well-being.

Collaboration among these healthcare professionals is often necessary to provide comprehensive care for patients with back pain, addressing both the physical and psychosocial aspects of the condition.

How does a Back Pain Specialist Treat Chronic Back Pain?

A back pain specialist employs a variety of approaches to treat chronic back pain, depending on the underlying cause, severity, and individual patient factors. 

Here are some common methods used by back pain specialists to manage chronic back pain:.

1. Medication Management: Back pain specialists may prescribe medications to alleviate pain, reduce inflammation, and improve function. Commonly prescribed medications include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, opioids (for short-term use only in severe cases), antidepressants, and anticonvulsants.
2. Physical Therapy: Physical therapy plays a crucial role in the management of chronic back pain. A physical therapist will design an individualised exercise program to improve strength, flexibility, and posture, as well as provide manual therapy techniques to reduce pain and improve mobility.
3. Interventional Procedures: Back pain doctors may perform various interventional procedures to alleviate pain and improve function. These may include epidural steroid injections, facet joint injections, nerve blocks, radiofrequency ablation, spinal cord stimulation and peripheral field/ peripheral nerve stimulation.
4. Minimally Invasive Procedures: In some cases, minimally invasive surgical procedures may be recommended to address specific causes of chronic back pain, such as herniated discs, spinal stenosis, or vertebral fractures. These procedures typically involve smaller incisions, less tissue disruption, and shorter recovery times compared to traditional open surgery.
5. Lifestyle Changes: Managing chronic pain may include recommendations for maintaining a healthy weight, adopting ergonomic principles in daily activities, improving posture, quitting smoking (if applicable), and incorporating stress management techniques.
6. Psychological Treatment: Seeing a psychologist or counsellor to provide psychological support and interventions such as cognitive-behavioural therapy can help cope with pain, stress, and anxiety.

By employing a multidisciplinary approach that addresses the physical, psychological, and social aspects of chronic back pain, Dr Mittal and her collaborative team of specialists can help patients effectively manage their symptoms, improve function, and enhance overall quality of life.

What Does a Treatment Plan for Back Pain Involve?

A treatment plan for back pain or spine pain typically involves a comprehensive approach that addresses the underlying cause of the pain, alleviates symptoms, improves function, and prevents future episodes. 

Here are the key components of a treatment plan for back pain:

• Medical Evaluation. The first step in developing a treatment plan is a thorough medical evaluation, which may include a review of medical history, physical examination, and diagnostic tests such as X-rays, MRI, or CT scans to determine the cause of the back pain.
• Pain Management. Pain management is a crucial aspect of the treatment plan and may involve various strategies, including medication management. Commonly prescribed medications for back pain include nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, opioids (for short-term use in severe cases), antidepressants, and anticonvulsants.
• Physical Therapy. Physical therapy plays a key role in treating back pain by improving strength, flexibility, posture, and mobility. A physiotherapist designs an individualised exercise program tailored to your needs, which may include stretching exercises, strengthening exercises, aerobic conditioning, and manual therapy techniques such as massage or spinal manipulation.
• Interventional Procedures. Depending on the cause and severity of the back pain, interventional procedures may be recommended to alleviate symptoms and improve function. These procedures may include epidural steroid injections, facet joint injections, nerve blocks, radiofrequency ablation, spinal cord stimulation, or minimally invasive surgical procedures such as microdiscectomy or decompression.
• Lifestyle Modifications. Positive changes to your routine can be essential for managing back pain and preventing future episodes. This may include maintaining a healthy weight, adopting ergonomic principles in daily activities, improving posture, quitting smoking (if applicable), and incorporating stress management techniques such as relaxation exercises or mindfulness meditation.
• Education and Self-Management Strategies. Patient education is a critical component of the treatment plan, empowering patients to actively participate in their care and make informed decisions about their health. Back pain doctors provide information on the condition, treatment options, and strategies for self-management, including proper body mechanics, activity modification, and resources for further support and education.
• Psychological Support. Support may be provided by collaborating with psychologists or counsellors to address issues such as pain-related anxiety, depression, or stress through interventions such as cognitive-behavioural therapy or relaxation techniques.
• Follow-Up and Monitoring. Regular follow-up appointments with your team are essential to monitor the progress of the treatment plan, adjust medications or therapies as needed, and address any new or worsening symptoms. Patients are encouraged to communicate openly and report any changes in their condition or response to treatment.

By incorporating these components into a comprehensive treatment plan, Dr Mittal can effectively manage back pain, improve function, and enhance the overall quality of life for patients.

The Challenges of Living with Chronic Back Pain

Living with chronic back pain or spinal pain presents numerous problems or issues that can significantly impact a person’s physical, emotional, and social well-being. 

Some of these challenges include:

• Persistent Discomfort. Chronic back pain often leads to persistent discomfort, ranging from mild to severe, which can interfere with daily activities such as walking, sitting, standing, and sleeping. This constant pain can affect all parts of your life and make it difficult to concentrate or enjoy leisure activities.
• Limited Mobility. Back pain may restrict mobility and range of motion, making it challenging to perform tasks that require bending, lifting, or twisting. Reduced mobility can lead to dependency on others for assistance with activities of daily living and decrease independence, leading to social isolation, inability to work, or otherwise actively participate in one’s own life.
• Impact on Work and Productivity. Chronic back pain can impair work performance and productivity, leading to missed workdays, decreased job satisfaction, and financial strain. Some individuals may need to modify their job duties, take extended leaves of absence, or even retire early due to their back pain.
• Emotional Distress. Dealing with chronic pain can take a toll on one’s mental health, leading to feelings of frustration, anxiety, depression, and irritability. Coping with the emotional distress of chronic back pain may require support from mental health professionals and strategies for stress management.
• Sleep Disturbances. Back pain can disrupt sleep patterns, causing difficulty falling asleep, staying asleep, or achieving restful sleep. Poor sleep quality can exacerbate pain perception, worsen mood disturbances, and contribute to fatigue and daytime drowsiness.
• Social Isolation. Chronic back or spinal pain may limit social activities and participation in hobbies or recreational pursuits, leading to feelings of isolation and loneliness. Social support from family, friends, and support groups can help mitigate feelings of isolation and provide emotional encouragement.
• Impact on Relationships. Chronic back pain can strain relationships with family members, friends, and romantic partners due to changes in mood, behaviour, and participation in activities. Effective communication, empathy, and support from loved ones are essential for maintaining healthy relationships.
• Financial Difficulties. Managing chronic back pain often involves medical expenses, including doctor visits, diagnostic tests, medications, physical therapy, and sometimes surgery or other interventions. Additionally, indirect costs such as lost wages, transportation expenses, and home modifications to accommodate a chronic pain condition may be incurred.
• Fear of Re-injury. Fear of exacerbating existing back pain or sustaining new injuries to one’s back or spine may cause you to avoid physical activities or movements, resulting in deconditioning, loss of muscle strength, weight gain and further functional impairment.
• Depression and Frustration. The chronic nature of back pain can lead to feelings of frustration, hopelessness, and despair, especially if treatments are ineffective or symptoms worsen over time. It’s essential for chronic pain sufferers to maintain hope and continue working with healthcare providers to explore new treatment options and improve their quality of life.

Overcoming the challenges associated with chronic back pain requires a comprehensive approach that addresses both the physical and emotional aspects of the condition, along with support from healthcare providers, loved ones, and community resources.

How do I Find a Back Pain Specialist Near Me?

To find a back pain specialist near you, you can start by discussing your back pain concerns with your general practitioner. They can evaluate your symptoms, provide initial treatment, and refer you to a pain management doctor.

You can also seek recommendations from friends, family members, or colleagues who have experience with back pain treatment. They may be able to recommend a reputable specialist based on their own positive experiences.

Reach out to nearby hospitals or medical centres and inquire about their spine, orthopaedic, neurosurgical or chronic pain departments. They may have dedicated spine centres or clinics staffed by back pain specialists. These facilities often have multidisciplinary teams of experts and access to cutting-edge treatments and research.

During your search for a back pain doctor near you, be sure to take into account less obvious factors such as the specialist’s location, office hours, and availability when choosing a back pain specialist. Look for a back pain doctor who assesses your symptoms, medical history, treatment preferences and has the correct qualifications and local experience in looking after your chronic back pain.

Ultimately, trust your instincts and choose a back pain specialist who listens to your concerns, communicates effectively, and offers confidence in their ability to provide high-quality care.

If you are in the Melbourne area, contact the Persistent Pain Solutions clinic to connect with Dr Mittal who can help diagnose and treat your condition effectively.

Persistent Pain Solutions for Back Pain in Melbourne 

Dr Meena Mittal and her collaborative team of healthcare professionals are deeply committed to providing compassionate care to every person who arrives at the Persistent Pain Solutions clinic seeking solutions for their chronic back pain.

We understand the physical and emotional toll that chronic or long term back and spinal pain can take on patients and their loved ones. That’s why we focus on offering empathy, understanding, and support in every interaction. 

From the moment you enter our doors, you’ll be met with a warm and welcoming environment where your pain and concerns are understood and your priorities are valued. 

Dr Mittal takes the time to listen, engage, and evaluate your condition.

Together, a personalised treatment plan tailored to your unique challenges is developed and instituted.

Compassion is fundamental to health and healing, and Dr Mittal is dedicated to guiding you on your journey to relief from chronic back pain and improvement in your overall quality of life.