THE DOCTOR IS IN
Living with lower back
pain
Part I
Dr. Rami Rustum
Pain in the lower back has been a growing
problem in many aspects:
1- It’s the most common reason to
pay a visit to pain clinic.
2- It’s the # 1 reason for missing
days at work in men and second to
Premenstrual Syndrome (PMS) in women.
3- In Dollar amount, the cost of
treatment is about $40 billion/ year and
has been rising.
4- The complexity of the problem since
the source of the pain can not be
identified in many cases. Or if
identified, the treatment may only
provide partial relief.
5- Failure to report (???)
Since our goal is to raise awareness
about issues concerning your health and
well-being, we need to shed the light on
the last statement in the above problems
list.
For this discussion, I will consider the
lumbar spine as a model, understanding
that this may apply in great deal to
cervical and thoracic spine:
Q- What structures
constitute the lumbar spine?
A- Bone (vertebrae),
muscles, ligaments and soft tissue,
nerves and discs
These structures exist in certain balance
providing precise mechanical stability to
the body and any problem in any part for
whatever reason will result in pain!
*Bone: Consider osteoporosis, arthritis,
age-related changes in the joints
attached to the vertebrae (called Facet
joints), bone infection, bone fractures
(compression fractures), hip degenerative
changes and possible metastatic cancer
disease from the colon, prostate,
bladder, ovary, lung, etc.
* Muscles and soft tissues: Muscle strain
as a result of taking a wrong turn can
trigger severe pain and significant
muscle spasm. In the meantime, weakness
of the lumbar spine muscles and increased
elasticity in the ligaments may allow the
bone (vertebrae) to move on each other
and slip!!
 Also remember, any infection
in the adjacent tissues (abscess), or
tumor growth may be felt as pain in the
back.
* Nerves and Discs: Where the excitement
is!! Consider disc bulge or herniation,
nerve impingement by the bulged/herniated
disc, or bone narrowing around the nerves
as a result of arthritis. In rear
cases, small cysts may grow on the nerves
applying pressure which may cause
numbness or burning sensation.
Over the next few months, I will discuss
the most common problems in the lower
back, sharing with you our experience at
Lawrence General Hospital Pain Management
Center in offering the up-to-date
treatment for certain cases.
Finally, I would like to present a few
quick real stories for patients seen at
our Pain Center for lower back
pain.
The common dominator among these cases is
the patient’s failure to report or
address the problem with the PCP or the
pain specialist as it started! I
hope that you learn from them as a smart
reader:
* 81 year-old female with lower back pain
for about eight months believed it was
related to bad arthritis and becoming
old.
The patient requested some pain
medications or cortisone injection. No
tests were done. Lumbar spine MRI was
ordered showing fracture in one vertebra
as a result to metastatic cancer from the
lung!
* 42 year-old male with a few months
complaint of mild abdominal pain
radiating to the back and causing
significant back discomfort, presents for
evaluation and possible back
injection.
The patient believed the pain was related
to muscle strain. Further workup showed
evidence of pancreatic cancer with lumbar
spine bone metastatic disease!!
* 63 year-old male with gradual onset of
mild back pain, but more pain in the
right leg for about 3-4 months. The pain
started after snow shoveling, so it was
believed to be caused by disc bulge.
Lumbar spine MRI was normal. Occlusion in
one of the arteries in the leg was
suspected! Patient underwent immediate
successful surgery at LGH to restore
blood supply to the leg.
In most cases, the problem can be the
patient him/herself neglecting the pain
for months and years thinking that it
will eventually go away on its own!!!
That is a major problem to us as
caregivers and that will be problem #5 in
the list above!
Rami R. Rustum, M.D. is the director of
the Pain Management Center at Lawrence
General Hospital. For any questions or
concerns, please email Dr. Rustum at: ramirustum@comcast.net
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