Back Pain Remedies: What Works, What Doesn’t

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Chances are, you or someone you know suffers from back pain. Back pain can affect people who are active and those who are sedentary, though for different reasons. So what should you do when back pain strikes? Get a softer – or firmer – mattress? Stand at your computer rather than sit? Hang upside down? Research shows that some of these solutions work while others are a waste of time and money. UH physical medicine and rehabilitation specialist A. Paul Gazzillo, MD, sorts through popular back pain remedies and identifies the symptoms that signal it’s time to see a spine specialist.

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Podcast Transcript

Macie Jepson

All right, Pete. So, the last time we talked, it was acupuncture and the problem was your neck, right?

Pete Kenworthy

Mmm hmm.

Macie Jepson

Disc something?

Pete Kenworthy

Herniated disc. Yeah.

Macie Jepson

All right. For me it's back. It's not that the two of us are getting old at all.

Pete Kenworthy

Right.

Macie Jepson

Mine is, mine is a fractured vertebrae. It hurts sometimes. If I do yoga, it doesn't. And then if I'm not active, it hurts a lot. So, we've got issues. Come to find out we're not alone. And today we're diving into back pain because come to find out eight out of 10 people actually suffer from it. And there are some other statistics because we did our research that are absolutely staggering. Back pain is the second most common reason that people visit the primary care physician.

Pete Kenworthy

The leading cause of disability in men over 45.

Macie Jepson

Third most frequent cause of surgery.

Pete Kenworthy

And the fifth most frequent cause of hospitalization.

Macie Jepson

Hi, everybody. I'm Macie Jepson.

Pete Kenworthy

And I'm Pete Kenworthy. And this is Healthy@UH. So, for every statistic out there, there are 10 times the number of cure-alls for how to fix your back, right? What are you sleeping on? What are you sitting on? Should we even sit at all? Should we stand on our head? That's actually really a thing. Should you stand on your head? So, we invited University Hospitals Dr. Paul Gazzillo to the podcast to straighten things out for us. Dr. Gazzillo, thanks for being with us.

Dr. A. Paul Gazzillo

Thank you.

Macie Jepson

Dr. Gazzillo specializes in acute and chronic back and neck pain, and we are so glad that you're here. The numbers are staggering, Doctor. What are we doing wrong that these numbers are so high?

Dr. A. Paul Gazzillo

So, I'd agree with all the statistics that you just mentioned. I would say that our modern society has definitely resulted in a more sedentary lifestyle, whether we're at work sitting at a desk for a long period of time, or sitting in a car for a long period of time. So, a lot of sales jobs. People are driving many miles, many hours at a time. This is all very stressful on the back. On the opposite note, people who are in more manual labor positions may be working for long hours, extended hours doing a lot of heavy lifting, twisting, bending, and all of this puts a lot of stress on our spine.

Macie Jepson

So. we can't win. If we're sedentary or if we use our back a lot, we're likely to feel some pain eventually.

Dr. A. Paul Gazzillo

Eventually this, these are all potential risk factors. The other thing to note about back pain becoming more prevalent, our population is definitely starting to live a lot longer so that population over 60 is increasing. And, you know, as we age, there's higher risk of things like osteopenia, osteoporosis, and all of those are risk factors for back pain as well.

Pete Kenworthy

So, what are we talking about in terms of, in medical terms here? What are the leading causes of back pain? We talked about at the very beginning, I have a herniated disc that flares up every eight or nine months. You know, Macie talked about her back. What medically are we talking about are the most common things that people are dealing with?

Dr. A. Paul Gazzillo

I typically like to break it down between the younger population and older population. In the younger population, those under 40, 50 or so, you see a lot of lumbar strains and sprains, and this could be, you know, due to injury with lifting, twisting or bending without proper form. There's also a high risk of discogenic pain in the young population as well. And when that disc pushes on a nerve, that's when you have those radicular symptoms or what's also commonly referred to as sciatica.

In the older population, obviously all the above or aforementioned are common, but there's also a higher risk of developing arthritis. So, not only do you get arthritis in your shoulders, hips and knee, but you can also develop it in the joints of your cervical spine, thoracic and lumbar spine. And that can cause achy pain as well, typically worse with activity. So, not only do you develop arthritis, but there's also a risk of developing stenosis or narrowing of the spinal canal. And this can be seen in the neck, mid-back or lumbar area. And this could cause things like neurogenic claudication or pain and heaviness in the legs when you're walking. And this can also be seen in the younger population as well if they have any kind of congenital stenosis or other deformities of the spine.

Pete Kenworthy

So, you talked about younger versus older, and then you talked about sitting, standing, working. How much of this is genetic, right? How much of this was going to happen to me anyway versus what did I bring on myself?

Dr. A. Paul Gazzillo

We definitely know that there is a component of back pain that is genetic. There have been studies done looking at twins, and we are starting to see that there is a genetic component to back pain. However, I would say that just like any other disease such as heart disease, when you know that these things might run in your family, it's even more important to modify your lifestyle. And you can really take control of a lot of your risk factors: so, maintaining a healthy weight, staying active, being physically fit, maintaining a solid core is also very important. I like to use the analogy of if you think of your spine as a bridge, the support cables and ropes of that bridge are your core musculature, gluteal musculature. So, the stronger they are, the more stress and pressure you can take off of your spine.

Macie Jepson

So, what would you say to someone who says, you know what, Doc, I can't work out because I have a bad back?

Dr. A. Paul Gazzillo

What I would tell them is typically the worst thing you can do for back pain is nothing. So, I encourage those with pain to honestly try to stay active as much as possible. For them it's maybe even more important than what those patients who don't have a lot of back pain. That being said, keeping in mind what particular movements seem to really exacerbate the pain, sharp pains, things that really aggravates you, bring it to your knees, obviously, you want to avoid that. But that's when working with someone like a physical therapist can really help you because they will see what type of motions and what type of exercises you're able to tolerate. They'll try to centralize your pain and hopefully get you stronger without causing you any undue pain or stress.

Pete Kenworthy

I want to get into some of the things we would call, I don't know, myths or just trying to figure out what fact from fiction here. And we hear a lot with back pain, oh, I need a stiffer mattress or a softer mattress. Or I need some sort of special neck pillow or an inversion table. Right? Or I'm going to stand at work or sit on a ball. Right? How many of these actually, is there a magic pill, I guess, is the question? How many of these can actually help?

Dr. A. Paul Gazzillo

That's a great question. There's been a lot of different studies out there looking at different types of mattresses and pillows. From my experience and from what I have learned, it seems like a lot of it is very individualized. It often depends on how you like to sleep, if you're a back sleeper, stomach sleeper or a side sleeper. Typically if you sleep on your stomach or your back, typically you want somewhat of a firmer mattress to help maintain alignment of your spine, which is ultimately the goal. Similarly, with a pillow, if you could have someone take a look at you as you're laying down. The main thing is you want to maintain good alignment and posture. If you're a side sleeper, you often have to contend with your shoulders and hips. So, if you can imagine a more conforming mattress is often better in that scenario to help maintain good alignment of your spine.

Macie Jepson

Sounds to me like it’s important to find out first of all what’s going on with your body.

Dr. A. Paul Gazzillo

Certainly.

Macie Jepson

So, at what point do you say, hmm, might need to go see a doctor?

Dr. A. Paul Gazzillo

As you mentioned, everyone experiences back pain at some point in their life. If it's something that is severe in nature or you have shooting pains going down your leg and it's really limiting your daily activity, that's typically when I'd recommend being evaluated. If, you know, you lifted twisted, you know, did something small and the pain seems to immediately start to improve or get better with good old over the counter anti-inflammatories or ice, you might be just fine as long as that, those symptoms don't get any worse.

Pete Kenworthy

There are procedures that are keeping people out of the operating room with injections or, and you just mentioned, or integrative medicine. What is the latest? What are we looking at for helping the bad back?

Dr. A. Paul Gazzillo

Some of the things that we offer here at University Hospitals is fluoroscopic guided injections, things like epidural injections, which can be very helpful for radicular pain or that pinched nerve type of pain as well as potentially discogenic. These can also sometimes be beneficial for central canal stenosis as well. For the achy facet joints, we can do steroid injections directly into those joints to help relieve pain or try to block the nerve that goes to that joint and basically sends the pain signal from that joint up to your brain. So, there's many different options, and when it comes to back pain, there's often more than one thing going on. So, part of our job is to do a complete evaluation as well as take a thorough history and exam and try to distinguish exactly what is the main cause of your pain. And often it's more than just one area.

Macie Jepson

Can we talk a little bit more about integrative medicine? Chiropractic, acupuncture, massage. We have Connor Integrated Health Network here. Do they come into play?

Dr. A. Paul Gazzillo

So, they have a lot of providers who work with chronic pain as well as acupuncturists and chiropractors who do adjustments, do deep tissue massage as well as dry needling and, of course, acupuncture. So, all of these things are pretty conservative modalities that can definitely provide relief and are even less invasive than things like injections or, certainly, surgery.

Macie Jepson

I want to go back to some of the gimmicks out there because my suite mate has a standup desk, and right down the hall someone's sitting on one of those big balls. And I want to personally try an inversion table. So, I mean, please tell me some of those work.

Dr. A. Paul Gazzillo

There are studies currently ongoing with a lot of these different modalities that we can use.

 I am a big proponent of the ergonomic desk or making sure that you're sitting in a proper position with good posture. That can be very helpful as well as the ability to maybe take it from a seated position to a standing position. That way throughout the day you can adjust your posture and how you're, if you're sitting or standing during your work hours. And this way you can help relieve any stress or pressure on your back that could be caused from doing either one for a prolonged period of time.

The yoga balls are also great when you're using those because you're working on your core musculature and maintaining good posture as you sit there. If you could imagine, if you have too poor a posture on a yoga ball, you're probably going to topple over. So, that's part of the key there. And it could also be used, you know, throughout the day for other exercises as you wish.

Inversion table. Some people really do like them, as far as the ability to stretch out. It does take off some stress and pressure on the spine. I will note that a lot of the data is somewhat mixed on those because it does show short-term relief, but it's somewhat lacking in the long term benefits. So, if it's not something that you're using regularly or even multiple times a day, you may not have that sustained relief. That being said, if it provides good relief, it's easy enough to do as long as you're safe, and you have somebody with you.

I have heard of patients who have unfortunately either gotten stuck or even had a fall off an inversion table, causing further injury. So these are all things that can happen. So, as long as you take the appropriate measures and you're safe, I think it's a reasonable thing to try.

Pete Kenworthy

So, lots of people have back pain as was well documented here. Let's figure out where we start, right? So, let's say you're listening to this and you have back pain, where do I go? Do I go primary care? Do I go to an ortho doc? Do I go to a neurologist? Where do I start?

Dr. A. Paul Gazzillo

So, if it's back pain that's been gradually increasing and isn't quite severe in nature, and you're going to see your primary care doctor for a routine checkup or another issue, that's often when back pain comes up.

So, the treatment, you typically will start with a primary care physician who if they're comfortable enough, we'll get you into the proper physical therapy, maybe even prescribe some anti-inflammatories for you, recommend heat, ice, other conservative treatment options.

When the pain becomes progressively worse, and you're not getting improvement or you're having significant pain shooting down the leg or any kind of neurological changes like numbness, tingling, that's certainly when you want to see a spine specialist.

Now, typically a good 90 percent of patients are very well served seeing someone who maximizes conservative treatment options like myself, a spine specialist who can make sure they're receiving the appropriate therapy, alternative treatment options, medications as well and potentially interventional injections as we mentioned.

So, things like epidural injections or fluoroscopic guided facet joint injections can really be beneficial. Now, if someone has significantly progressive weakness or numbness or their balance is off significantly or they have bowel or bladder changes or incontinence issues, those are all red flag signs that you want to watch out for. In that scenario, you'd be best served probably seeking surgical treatment options sooner than later as we want to stop that from getting any worse.

Macie Jepson

Doctor, thank you for joining us. Is there anything you want to add as we wrap up?

Dr. A. Paul Gazzillo

Sure. I would just like to mention that those with back pain can certainly benefit from a thorough history as well as physical exam as back pain can often be very difficult to diagnose, particularly if you're someone who doesn't see or deal with back pain routinely.

There are also many different treatment options out there, and making sure that we have the best idea possible of what's the cause of the pain really directs that care. So, seeing someone who specializes in back pain can often be very beneficial to make sure that you're getting the appropriate physical therapy, medications, recommendations on ice, heat, other conservative modalities that we discussed earlier or even, you know, getting the appropriate injections as there are often multiple targets and multiple causes of back pain. Or, if needed, surgical treatment options as well.

Pete Kenworthy

Dr. Paul Gazzillo, we appreciate your time. Remember, you can find and subscribe to this podcast on iTunes, Google Play, Stitcher, or wherever you get your podcasts. Just search University Hospitals or Healthy@UH, depending on where you subscribe.

Macie Jepson

And, as always, for more health news, advice from our medical experts and Healthy@UH podcasts, go to UHhospitals.org/blog.