The Physiatrist’s Corner: Healing Low Back Pain (Part III)
This is the third article in our three-part series on low back pain (Part I, Part II) 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.”
Beyond the medicine cabinet
I work closely with each patient to find the most effective treatment plan that balances evidence-based recommendations with the patient’s safety and beliefs.
After serious medical conditions are ruled out as possible causes of back pain, I offer the least invasive treatments first, particularly options that may be effective with less potential side effects.
I may recommend non-pharmacologic treatment options, such as physical therapy for therapeutic exercise as well as the development of a home exercise program.
Non-pharmacologic approaches to treating back pain
I also may suggest the following non-pharmacologic options, which can be helpful for patients with chronic pain.
- Mindfulness-based stress reduction (MBSR)
- Cognitive behavioral therapy (CBT)
- Therapeutic yoga
- Therapeutic massage
- Progressive muscle relaxation
- Tai chi
- Osteopathic manipulative treatment (for spinal manipulation)
Cost and accessibility
The type of treatment I prescribe is based on the diagnosis as well as the patient’s medical history, preferences, and accessibility to integrative options.
These non-pharmacologic options often are beneficial, but cost and access must be considered. Most insurance companies do not cover the cost of these treatments, so I work with each patient to find options that are manageable and search for affordable programs in the community.
For patients interested in acupuncture, I can provide information regarding local community/group acupuncture programs with sliding scale payment options which improve access and affordability.
Remaking the workplace into a healthy environment
I urge my patients to consider ergonomics and suggest adjustments that can be made in the workplace to help maintain proper posture to prevent increased stress on the spine.
For those who work at a desk, I often recommend standing and walking around every 30 minutes. The use of a stand-up desk is another option to consider.
Maximizing function, optimizing quality of life
For those suffering from chronic low back pain that limits daily functioning, I may recommend a comprehensive, interdisciplinary pain management rehabilitation program, such as a Functional Restoration Program.
Interventional pain management options, such as epidural steroid injections, sacroiliac joint injections, or facet-targeted interventions under x-ray guidance, and musculoskeletal ultrasound-guided injections may be indicated as well.
The treatment plans I provide focus on maximizing function and optimizing quality of life.