The transcript was edited to improve clarity.

Matthew F. Watto, MD:Welcome back to The Curbsiders. Tonight’s episode, we’re going to discuss back pain. This is the result of an interview Back Pain Update with Dr Austin Baraki. Dr Baraki shared some excellent tips on how to deal with back pain that is a common issue in primary medical. I’ll apply one of my most well-known teaching methods: If a patient is suffering from any type of back pain, they must be unable to move. Right?

Paul N. Williams, MD:That’s right Matt, we should suggest rest until you feel better for those who suffer from back discomfort? No. If you suffer from back discomfort beginning exercise early and a healthy diet can be beneficial. Many patients are worried that physical therapy could increase their pain and they avoid exercising. This isn’t a surprise. People believe that if they’re suffering from pain, they are causing more harm, which isn’t always the scenario. The pain will improve with time, and a amount of anticipation can go far to manage expectations of the patient regarding early mobilization, exercise, as well as physical therapy.

Watto: Absolutely. One of the objectives of treatment is to alleviate symptoms in the amount we can attain. We don’t expect the discomfort to disappear completely. This isn’t the case particularly if someone is on an ongoing medication. Another objective is to return to functioning. We would like them to be sleeping. We would like them to be able to be able to take motion.

There are medications available — NSAIDs or muscle relaxants which are in fact tranquilizers. However, the majority of treatment for back pain does not involve medication. It requires active movements which is why we need to discover a form of exercise that patients enjoy doing. Treatments that are passive, or given to patients aren’t as effective.

WilliamsWe need to be very clear that we’re talking of chronic back pain here. In the case of chronic back discomfort, we have a few effective medications for back pain, however acute back pain usually improves regardless of what you do. We have nothing to provide pharmacologically to treat long-term back pain. back pain. The most effective treatments usually include the physical exercise of some type.

WattoLet’s talk about the assessment of back pain. One thing that is always asked when we discuss back pain is whether we should have an imaging exam as well as is there a good time to have it? Dr. Baraki was extremely clear on the best time to get imaging. Two large patient buckets could require imaging.

The first is a patient who is suffering from a serious issue which requires an imaging to determine the cause or, in a chronic situation, a patient that requires surgery and where imaging is a part of the presurgical assessment. We discussed warning signs.

The red flags are those of major traumas, in which there is a evidence that there may be something going onespecially if we have a strong suspicion of an infection or there is evidence that the patient has been injecting substances. In the event that the person has had a history of cancer we’d be concerned about the possibility of a recurrence. These are the primary warning signs. For a patient with osteoporosis, or is taking chronic steroids, you may be able to live using plain film rather than an MRI to check for fractures.

Another question I’d like to ask you is what is the best time to get images? Are there any risks that we should be aware of?

WilliamsI enjoy podcasts even when that I’m not listening to because I like listening to them more. Dr. Baraki discussed the specific language used in radiology reports like spondylitis, Spondylolysis, as well as multi-level degenerative diseases. They sound negative but if they’re being reframed as degenerative age-related changes, they sound much more pleasant. When talking to patients, it is best to not use medical terminology and simply say that we observed certain changes you would expect from an individual who is your age. This sounds much more professional than saying that we had multilevel degenerative disorder that could be an alarming pathology even if you’re not a medical professional. In order to avoid being inaccurate We should make sure that we don’t provide an exact diagnosis since that’s not the case for the chronic condition of lower back pain. In most cases, a variety of things are taking place and you could not be able to pinpoint a single diagnosis, which isn’t likely to aid in any way.

WattoThere’s data that shows that If the report on radiology uses the terms that both the patients and the clinician consider as less dangerous, they are less likely to undergo more aggressive treatment. The idea of calling an incident of back pain “lumbar strain” assists the patient in understanding that it’s a typical thing. Nearly everyone will suffer from back discomfort at some moment in their lives and most of them will recover. In the majority of cases, there’s no underlying cause.

It was a wonderful discussion with Dr. Baraki. Click here for Back Pain Update with Dr Austin Baraki to hear the entire discussion. For the next episode I’m the Dr. Matthew Frank Watto.

WilliamsAnd me, Dr. Paul Nelson Williams.

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