I have back pain and my surgeon says I may benefit from a spinal cord stimulator. Should I go for it?

The medical treatment of back pain sucks. In the last 2 decades, surgeons have gotten together with the pharmaceutical companies and developed devices that can be implanted into the spinal cord. The devices consist of an electrical generator that delivers pulses to a targeted area of the spinal cord. The devices are implanted using a surgical procedure and are powered by an implanted battery. How these devices work is not known but thousands of such devices are inserted each year. So do these implants work for pain relief?

From the literature, spinal cord devices for pain work in less than 3% of patients with only some types of back pain. The data show that these devices are absolutely crap for failed back surgery and any other type of complex back pain.

Unfortunately, the field of pain control is full of surgeons who have turned business people and have started to insert these devices in anyone who walks into their office. These pain devices are not reimbursed by any insurance company, are prohibitively expensive and most times do not work. So even if you have any common sense, one of the things you should do is avoid surgeons who want to scam you out of your hard earned money by inserting devices which basically suck.

I have had severe low back pain from a slipped disc for years. Do you think carbamazepine may help?

Many people have chronic back pain for which there is no good therapy. While there are potent narcotics available, most doctors will not prescribe long-term narcotics because they are addictive, have serious side effects and there is always a hassle with the DEA. For many people with chronic back pain, it is a real struggle to lead a decent quality of life.

In the last 2 decades, many doctors have been prescribing a variety of other drugs for pain. One of these drugs is carbamezepine. This anti seizure drug is widely prescribed for a variety of chronic nerve pain syndromes but the question remains, “is it effective?”

Review of the literature indicates that carbamazepine does work for chronic nerve pain, at least in the short term. Most people report moderate pain relief. However, at least 1/3 of patient s also developed minor side effects ranging from skin rash to abdominal cramps. Therefore, if you have chronic nerve pain, perhaps you can ask your doctor for a trial of carbamazepine. The drug does take a few weeks to become effective and is not cheap.

Are there any other alternative treatments for back pain? I am not satisfied with my doctor and the way he treats my back pain.

Because of the failure of conventional medications to help everyone with back pain, many people have been turning to alternative medicine. Herbs like willow bark, devil's claw and capsicum may help alleviate the pain but do not improve range of motion. Other means of treating back pain include chiropractic care, acupuncture, Massage, relaxations and cognitive behavior techniques. Recently yoga has been advocated as a method of relaxation and improving posture.

Unfortunately, the results of back pain with any of the above methods are not great and less than 10% of people have any benefit. It is hard to recommend anyone of these above methods because most lack scientific proof that they work.

The best way to treat back pain is to avoid it in the first place. Prevention means regular exercise, discontinuing smoking, maintaining a healthy weight, standing upright, keeping a good posture and lifting heavy items in a proper manner.

I have been recommended back surgery. Can you tell me the success rate? I am 49 years old.

There are many types of surgical procedures for back pain including fusion, removal of discs or vertebrae. The results of surgery are mediocre at best and recurrence of back pain is common. Before you jump in line for surgery, get to know your surgeon and talk to other patients who have had surgery- you may just want to stick to physical therapy and use of pain medications. Just read on cyberspace on how people have done after back surgery- the majority are in worse shape and completely disabled. Back surgery is also very expensive and the good results are not guaranteed. There are no refunds in back surgery. Unless you want a life of pain and untold suffering, you should think twice about back surgery.

I have low back pain. My doctor recommends surgery. What do you think?

Surgery for back pain is not always needed but commonly performed. Surgery is best for people who have severe nerve compression and unrelenting back pain. Surgery is usually reserved when people have failed other supportive measures after a trial period of at least 6-9 months. If you are recommended surgery the first time you see a physician, you need to get another doctor. Even as a last resort, surgery is not always a great choice because the results suck. Best advice is enter an exercise program, lose weight, stop smoking and keep away from surgeons.

My doctor says traction therapy may help my low back pain? Is this true?

Your doctor is buffoon and only wants your money. In the last 20 years, hundreds of traction devices have been developed for back pain. Most of these devices have been developed with the help of doctors who often own the company or have major shares. There are many types of traction therapies- some work while you stand, others work while you lay down on a table, some can be used at home and others work while you sleep. Cochrane review looked at the latest data on traction devices and found no evidence that these machines benefit anyone with back pain. Moreover these traction sessions go on for months and are costly. Some of the traction sessions cost $200 per hour. By the end of 16 weeks, you spend as much on these B.S. therapy as you would on brand new car- the only difference is that the doctor buys the car with your money and you continue to walk.

If you have any common sense, avoid traction nonsense and save your hard earned money. The majority of reports on cyberspace indicate that traction for back pain sucks and is a scam.

What type of surgery is available for herniated disc?

Most individuals should undergo a trial of one or more of conservative treatments for at least 6-9 months before any decision is made about surgery.  If you are told to have surgery right away and you do not have acute nerve compression, get a second opinion.

Surgeons have a lot of fancy names for back surgery. But in simple the two currently available surgical options for herniated discs include:

- minimally invasive surgery (small incision)

- open decompressive surgery to remove pressure off the nerve

If you have a herniated disc, the best thing to do is have a  consultation with a physician who specializes in back disorders. Remember read about the procedure and surgery is always the last option. There are no refunds when things go wrong.

My doctor says I need surgery for my herniated disc. Is this Ok?

If you can help it- avoid surgery. However, sometimes there is no choice if there is severe nerve compression. In any case, the decision to undergo surgery is complex and needs to be thoroughly discussed with the surgeon. You need to get a surgeon who is more interested in your back than the money. Plus, the surgeon must be competent. Thirdly, check out the surgeon’s experience and record. Ask to talk to his/her former patients. And most important, get to know the procedure and its possible complications. Surgery for back pain has a very poor track record of success. In the entire USA, you are not likely to meet more than a handful of people who will claim that their back surgery was satisfactory. Not only are some back surgeons terrible, they also do not really care about their outcomes.

What are treatment options for herniated discs?.

The currently available non surgical methods to treat herniated discs include:

- Use of over the counter pain medications (Advil)

- Use of prescription pain medications

- Use of heat packs

- Use of ice packs

- Application of TENS

- Wearing braces or corsets

- Hydrotherapy once the pain has subsided

- Use of ultrasound

- Traction devices to help ease pain and increase range of motion

- Stretching of muscles

- Aerobic exercises

Not all these treatments work in everyone. Physical therapy is probably the most efficacious but it is also expensive. The treatments have to be undertaken for at least 12-16 weeks for benefit. If you have no money, best advice is to walk, lose some weight, do not smoke and eat a healthy diet. Unfortunately, there is no easy magic bullet for back pain.

I have developed back pain and been told that I have a herniated disc. What should I do?

The first treatment for herniated discs is always non surgical. This hold true as long as there is no loss of bowel or bladder control. If a surgeon recommends surgery before trying out any other therapies, you need to get a new physician.

Generally the pain can be moderate/severe during an acute episode of disc herniation and last anywhere from 2-10 days. The majority of individuals will improve without any aggressive treatment. In most cases, this simply means rest and pain control. Gradual decrease in pain will occur over the next two months

I have just developed back pain. Can low back pain resolve on its own?

Definitely, if one is patient enough pain from herniated discs will subside with time. In the majority of cases this may take anywhere from 6-16 weeks. Of course, you will need some pain medications for the first few weeks. Once the pain has diminished, one can start physical therapy.

Over time, the herniated disc will shrink and limit compression on the nerves. Shrinkage of the herniated disc can take anywhere from 4-6 weeks. It is important to understand is that regardless of treatment type, spontaneous shrinkage does occur to some degree in all individuals. That is why it is extremely important not to undergo any surgery before this time.

Who should make the decision about treatment for back pain?

In general both the patient and physician should discuss the issue. However, since many patients have no idea how serious their back disorder is, they may not always be aware of all the possible options. Patients are always at a major disadvantage when it comes to dealing with surgeons. Physicians and surgeons in general will recommend therapies which they know are expensive- irrespective whether they work or not. The best advice is to read up on your back pain, talk to other people and not agree to any treatment without a second opinion. It is the rare patient who ever improves with back surgery

How does one make diagnosis of herniated disc?

The diagnosis of a herniated disc can be made very easily with an MRI. Plain x-rays are often done by doctors but these imaging studies are a waste of money and often delay proper treatment in some cases. However, even with a diagnosis of herniated disc the treatment is somewhat difficult. There is no one treatment that works in everyone. Even the same treatment may not work in the future. For most patients with back pain, the treatment has to be individualized. Unfortunately, most health care professionals simply write a pain prescription, send the individual for physical therapy exercise clinic (most likely owned by the physician or his colleagues), and then recommend surgery.

I have been told I have a herniated disc. Just what is a herniated disc?

A herniated disc is one of the most common reasons for long term disability in young people in North America. Basically, all of us have a jelly like substance in the vertebral joints. This substance playa a vital role in protecting the nerves and also cushions the joints from compressing against each other. Sometimes, during trauma or lifting weights this jelly-like substance leaks and impinges on the nerves which are leaving the spinal cord. When the nerves are pinched or compressed, the patient feels pain. When a herniated disc develops, it can limit how an individual functions on a daily basis- the chief reason is because of continuous pain. The pain is a dull ache which often radiates to the back of the legs. The majority of herniated discs occur in the lower back.