The Physiatrist’s Corner: Healing Low Back Pain (Part II)
This is the second article in our three-part series on low back pain (read Part I and Part III) written by Dr. Danielle Sarno, a board-certified physiatrist with a sub-specialty in interventional pain management at Brigham and Women’s Hospital (BWH). In this series, Dr. Sarno addresses key points in the recently updated guidelines from The American College of Physicians, and discusses her own diagnostic and treatment approaches for patients with low back pain. For a description of physiatry, see “Why You Should See a Physiatrist.”
Treating back pain requires a supportive team
In addition to physical therapy, a home exercise program, short-term medication management, integrative therapies, and interventional pain management options, a vital aspect of healing low back pain is receiving proper psychosocial support.
Pain often can be associated with depression and anxiety. Screening for social or psychological distress is important, as some people may feel hopeless and/or anxious when they are in pain.
As depression and anxiety can exacerbate pain symptoms, these mental health components can be addressed as part of a comprehensive pain management plan.
The following can help patients better cope with pain:
- Cognitive behavioral therapy
- Mindfulness training, or meditation
- Hypnosis with guidance from a pain psychologist
- Book: Neuroplastic Transformation Workbook by Michael H. Moskowitz M.D. and Marla DePolo Golden, D.O.
The doctor's role in providing reassurance
For people experiencing debilitating pain, it's important that they receive emotional support from a physician who listens attentively.
An effective pain management plan hinges on clear and open communication between the doctor and patient.
During a visit, I provide education about diagnoses and treatment options and I work with each patient to determine an individualized plan that aligns with their preferences. The patient should always feel included in the decision-making process.
Another important component to a patient’s recovery is believing that he or she is not permanently “disabled.” A doctor can provide reassurance by discussing the prognosis and the treatment options, including non-pharmacologic and pharmacologic therapies.
Since recurrences of back pain are common, continuing a home exercise program developed by a physical therapist can help reduce the risk of future episodes.
To optimize function and improve quality of life, I also discuss lifestyle modifications, including:
A multidisciplinary approach
Treating pain, particularly chronic back pain, requires a multimodal and multidisciplinary approach, targeting the pain from different angles.
I often connect patients to local resources, such as:
- Rehabilitation programs (e.g., Spaulding Rehabilitation Network)
- Pain psychology
- Mindfulness-based stress reduction (MBSR) courses
Comprehensive treatment may involve collaboration with a patient’s healthcare team, including the primary care physician, other medical specialists, physical therapist, social worker, and/or pain psychologist.