[이상원 칼럼] Treat Back Pain Step by Step

▲ Lee Sang-won, CEO of Yonsei Barun Hospital (Doctor of Medicine, Neurosurgeon)

Representative lumbar diseases that plague the middle-aged are disc and spinal canal stenosis. In the disc, the nucleus between the vertebrae escapes due to aging or shock, irritating the nerves, causing pain. On the other hand, in spinal canal stenosis, the ligaments and bumps around the spine become thick due to aging, or the narrowed nerve paths due to foreign matters compress the spine and nerve roots, causing nerve symptoms such as pain and tingling.

Disc and spinal canal stenosis have slightly different causes and symptoms, but they have a common point that severe pain makes daily life difficult. If the symptoms are severe, it is difficult to walk a short distance rather than exercise, so it is easy to become a state of lack of exercise. Lack of exercise exacerbates chronic diseases such as high blood pressure and obesity, decreases physical strength, and decreases physical function and vitality. It is easy to fall into a vicious circle, such as recurrence or worsening of pain, but this vicious circle does not break easily unless the pain is resolved.

In the past, when it comes to back disease treatment, surgery was often considered, but in reality, most back pain treatments do not require surgery. Only around 10% of all back pain patients need surgery. If the symptoms are mild at the beginning of the disc or stenosis, it is often improved if it is continuously managed with conservative treatments such as injection treatment, manual/physical treatment, and exercise treatment.

If the symptoms are severe or if conservative treatment for more than 6 weeks is not effective, the next step of active treatment can be considered. Recently, treatments that can effectively treat spinal diseases without surgery involving incisions, general anesthesia, and tissue damage are emerging. By using precise equipment such as an endoscope, it is a method of selectively treating only the part of the cause of pain, so that damage or bleeding of the surrounding tissues is small and recovery is quick. Since the burden on surgery is small, it can be applied to the treatment of elderly patients or chronic diseases such as high blood pressure, diabetes, heart disease or kidney disease.

However, not all spinal disorders are subject to non-surgical treatment. In the case of severe or severe patients with very severe symptoms, the last option, surgical treatment, should be considered. If emergency surgery is necessary due to severe disk damage, if symptoms do not improve even after non-surgical treatment for more than 3 months, or if there is a leg paralysis or stool disorder, surgical treatment is inevitable. Even for surgical treatment, it is rare that large incisions and general anesthesia are required as in the past. The least invasive surgery method, which is relatively less burdensome, should be considered first.

If the cause of the pain has been eliminated with appropriate treatment, the last stage of treatment is consistent management. This is an essential step to maintain a healthy spine that doesn’t hurt for a long time. Management should be started immediately at the end of pain treatment. Correcting the imbalance of the spine and pelvis through manual therapy or ligament strengthening treatment for a certain period of time and strengthening the tissues around the spine can help prevent recurrence or other spinal diseases.

It is also important to manage your weight and strengthen the muscles around the spine with constant exercise. Exercise must be accompanied in order to restore muscle strength weakened by spinal disease and prevent recurrence. However, after treatment, the waist is weak, so it is better not to overdo it. Immediately after treatment, slowly start exercising to increase your back flexibility and strength. Afterwards, it is good to find an exercise that suits you and increase the exercise time slowly. If it is difficult to choose the right exercise, it is also helpful to consult a professional.

In addition, if a patient with back pain smokes, he must quit smoking. When you smoke, the blood vessels that supply nutrients to the disks constrict, reducing blood and making it difficult to supply nutrients. Discs that are not sufficiently nourished will lose their healing ability and damage to the discs will accumulate. As recovery slows and progresses to degenerative discs, the risk of recurrence increases as well.