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Getting to the Root of Back Pain

Published in Pain Center, For the Health of It Author: Sakshi Kaul,MD

Back pain is the leading cause of disability in the world. It doesn’t just cause people to not just miss work — but it impacts people’s personal lives, interferes with their favorite activities and reduces one’s quality of life.

Sakshi Kaul, MD, a pain medicine specialist with CentraCare Pain Center, recently discussed back pain on WJON’s Health Matters podcast with Jay Caldwell. An excerpt of their discussion is below and has been edited for length and clarity. The full interview is available at wjon.com.

Q: As a provider at CentraCare’s Pain Center, what types of patients do you see?

Dr. Sakshi Kaul: I essentially see patients with any type of pain. Back pain is the most common concern that brings patients to our clinic. But I see neck, spine and other kinds of pain too. If you have pain, you can come see me.

Q: When someone has back pain, what are the common causes?

Dr. Kaul: There’s many different aspects to what can contribute to one person’s back pain and make it different from another’s. You could have pain from muscles that have been injured or overworked, or pain from discs that have been injured, or nerves that are being irritated or joints that are being irritated. And, in fact, sometimes back pain doesn’t even necessarily come from the back. It’s something we call a referred pain pattern.

For example, if you had a kidney infection, you could possibly present with some upper back pain and that might be your first symptom. So really pain is merely a sign or a signal from the body that something is wrong and needs to be paid attention to. Our job, as pain doctors, is to get to the bottom of what exactly that pain signal means because honoring that sort of communication from the body can go a long way in figuring out the root cause of the problem.

Q: How do you identify where the pain is and what's causing it?

Dr. Kaul: We start with getting a detailed history from the patient, in their own words paying special attention to the factors that typically make it worse, when it started, what was going on around the time that it started, etc. We typically conclude with an exam and then provide a diagnosis and possible treatment options.

Q: How do you identify if back pain is caused by disc issues?

Dr. Kaul: To understand if it’s a problem of the disc, you have to understand different aspects of the physiology of the disc. The disc is essentially a circular structure that has a jelly substance inside and a fiber substance outside. And it has a lot of nice bounce to it.

If your spine is straight, what we call it a neutral, upright spine. The pressure on the spine comes from the top. So if you’re carrying 50 pounds straight and center, then that disc will have pressures going out in all directions, evenly. And usually that’s not enough to injure a disc.

But how you know that you’ve injured a disc, or that it’s a disc problem, is when you do certain things that would increase the pressures on the disc — more to aggravate the disc even further. And what we find is that bending and lifting is probably the worst thing one can do to their discs, especially on a repeated basis. If you already have injured a disc, you will find that bending and lifting will make it even more particularly painful.

Q: How would you heal a disc injury or treat pain caused by a disc?

Dr. Kaul: The body can do a lot to heal itself, if you give it the time that it needs. Many people can’t stop their everyday living and work tasks, but there is an opportunity to do things a little differently — changing the body mechanics of lifting, bending, twisting, pushing, etc. Once you learn to do things a little bit differently, patients are able to continue to do activities without injuring their discs. This gives the body time to heal.

The other thing that can help discs heal is giving tools to help the body heal. If you smoke, you’ll be interested to learn that smoking significantly reduces blood flow to discs. When a disc is injured, you want to be able to have blood flow, to be able to deliver nutrients and extract waste. The disc takes a lot longer to heal if you’re smoking than if you’re not.

The same thing applies to other medical issues, such as diabetes or hypertension. These medical conditions also will make it take a lot longer for you to heal from injury. It helps to get down to the root cause of those medical conditions and to eat healthy and to work on those things. When one part of your body is healthy, it’s a lot easier for the rest of your body to be healthy as well.

Q: Is rest the only solution to disc pain?

Dr. Kaul: Quite the opposite. Rest is not the solution, but finding a pain-free way of doing things most certainly can be. We work with our patients to find those tricks that remove the pain in everyday activities.

I ask my patients to become aware of their core muscles, which are the muscles in your belly, on the side of your belly and in your back. The muscles in your back, known as the postural muscles, are actually quite tiny compared to the muscles in your legs or in your glutes or quads. These are large muscles you have in your legs and they’re designed for power and force.

Learning how to vacuum, without straining the back, is an example. I ask my patients instead of moving their back, to put the vacuum handle at the center of your belly and keep your spine strong and neutral while you walk straight forward and straight back. It feels a little awkward at first, because it’s not a normal way that they would vacuum — but it helps prevent back pain.

The body thanks you when you perform activities in a way that does not hurt it. Biomechanics (the mechanics of movement) throughout your activity, throughout your work, can go very, very long way in a speedy recovery to the disc. If you treat it the way it’s supposed to be treated, it will give thanks.