ROACH: It's Possible to Find Back Pain Relief in a TENS Unit |  lifestyles


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BYLINE: From Keith Roach, MD

TITLE: What is the next step in osteoarthritis of the spine?

DEAR DOCTOR. ROACH: I’m 68 and have osteoarthritis all over my neck, spine, hips, knees, shoulders, hands and it’s getting worse. A hip was replaced two years ago and my shoulder was replaced four months ago. Four years ago X-rays showed arthritis in my spine and severe stenosis in the lower lumbar spine (L4-L5). I’m now at a point where I can’t walk properly and it’s affecting my relatively new hip.

I would like to see a back specialist but not sure to whom. A back surgeon will try to talk me into surgery and may not offer me nonsurgical options. A chiropractor can cost me a lot of money without solving any problems. Which way is the most cost and time efficient? I’m really in pain. – ss

ANSWER: The bad news first: we have no treatments that can reverse, stop, or even slow the progression of osteoarthritis.

The good news is that there are some treatments, both surgical and non-surgical, that can give you relief. Before I go into that, I want to assure you that there are many spinal surgeons, both orthopedic and neurosurgeons, who operate very slowly and only do so when other treatments have not brought sufficient relief or when there is a clear indication, e.g. when it is progressing Weakness from compression of the spinal cord or a nerve root. I know this because these are the surgeons I like to refer my patients to.

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Also, let me say that spinal manipulation of the lower spine, a type of treatment commonly used by chiropractors, osteopathic doctors, and physical therapists, can improve pain levels and functional ability compared to several other types of treatments.

In my own practice, I typically treat lumbar spinal stenosis pain initially with a combination of physical therapy and medication. A surgical consultation is indicated when a person’s pain is not under control despite treatment or when they are unable to do the things they need to do because of the pain or weakness mentioned above. My patients have also usually tried epidural injections. These often fail, but some patients respond very well.

Anyone considering surgery for low back pain due to arthritis should know that the benefits of surgery diminish over time as arthritis progresses. Also, about 20% of people need a second surgery within eight years of the first one. After all, there are no guarantees: a select few people will have worse pain after surgery, and rare disasters will occur. Surgery should only be considered if a person’s quality of life is poor because of the condition.

DEAR DOCTOR. ROACH: I’m claustrophobic and can’t stand an MRI scan. My doctor recommended full body biplanar imaging (EOS). I’ve seen a picture and I’m concerned that it feels locked. — DD

ANSWER: The full-body biplanar imaging scanner is a room-sized device that uses very low-dose X-rays to create images of the whole body while standing, with the ability to create two-dimensional and three-dimensional images. It is commonly used to assess skeletal issues such as scoliosis or leg length discrepancies.

While the device is indeed large, it doesn’t close completely, and most claustrophobic people have no trouble with this type of scan, which only takes about 20 seconds.

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dr Roach regrets that he cannot reply to individual letters, but will include them in the column whenever possible. Readers may email questions to [email protected] or mail them to 628 Virginia Dr., Orlando, FL 32803.

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