Dubai, UAE – Dr Tom Saw, Consultant Family Medicine, with a special interest in Sports medicine and interventional pain management, UPANDRUNNING Sports Medical Center, talks about how simple management techniques can prevent bigger problems later on in life.
Why is there a perception that back pain is difficult to treat?
A lot of the treatments are poorly managed and when people don’t get treated appropriately it creates a perception that it is difficult to treat. One of the other real issues is that people don’t get a firm diagnosis of what’s causing the back pain and so they are not being treated to its cause. One thing I work very hard to get is a very definite diagnosis so that we can make sure patients get the right treatment, and if there’s no improvement with a specific treatment we may have to look at the diagnosis again.
What is the process followed for an accurate diagnosis?
We believe very firmly on a patient-centered approach. We start with a 45-minute medical assessment with a sports physician to look at the past medical history of patients, issues they might have at work ergonomically, or if they had previous trauma to their backs. We find out what the back pain entails — if the back pain radiates through their legs, it could suggest more of a difficult cause. Or they might get just localised pain at their lumbar spine, which may suggest a problem in their facet joints. And then there is what we describe as a red flag or worry symptoms such as if the pain is associated with weight loss, or with problems of the bladder or bowels. All these factors need thorough investigation.
When do you recommend people with back pain see a sports medicine specialist?
If you have a back pain that is radiating down the neck or shooting type of pain in the legs such as sciatic pain then you will need somebody to help you get better. What I normally tell my patients is to just rest in a comfortable position for the first 24 hours and then slowly mobilise, don’t lift, don’t exercise, take a simple analgesic or anti-inflammatory medication such as Panadol and let it settle. After 24 hours, I suggest they start gently mobilising, walking and carrying out simple everyday activities, but avoid any significant impact on sports or classes. Beyond that, if they are still getting pain after about 72 hours, it’s better to see a specialist to help speed up recovery.
“All interventions have to be done under x-ray control to deliver the medication as accurately, safely and effectively as possible”- Dr Tom Saw
Is there anything people can do to ease the pain on their own?
People have to look at the obvious cause. It may well be the ergonomic or posture issues at work that are causing the problem or you may have got hurt going too heavy at the gym. Use an ice pack or for most people, a simple analgesia will give pain relief or stretches such as touching your toes or leaning your back. If you look at the obvious cause of the pain, it can be simply be avoided.
What types of treatments are used to treat chronic back pain and how successful have they been?
What we look at is a step-wise approach. We need to know whether patients have had an ergonomic assessment if the workplace desk set-up is comfortable, or if they are doing anything unusual. One of the things that have become more apparent over the past 20 years is the move away from surgery for back pain. There’s still a place for surgery for sciatic pain but only about 4 per cent of patients with sciatica can go for surgery. Most settle for physiotherapy or simple analgesia or injection techniques. We may adopt a ladder approach. Initially, we look at simple stretches, or an active physiotherapy management programme for the back.
What is the difference between interventional and non-interventional treatments?
Non-interventional treatments include simple pain relief or a hands-on treatment with a physiotherapist. When we talk about interventional it means doing something physically to the patient such as an injection to allow us to get the medication to speed up the healing of the back pain as close as we can. The big advantage of doing that is that we can get away with doing much lower doses of treatment. Our treatments are guided down to a few millimetres of the nerve. All our interventions are done under X-ray control to help us deliver the medication more accurately, safely and as effectively as possible.
What does the future hold for back pain treatments?
There’ll be a couple of steps forward. We are getting better at guiding our treatments. There is now camera technology and things getting smaller and smaller. We will actually be able to put the camera down the needle and see what exactly is going on. We are already doing stem cell treatments for healing some tendon and other joints. Probably over the next five to ten years injectable stem cells to the back will be a great area. Countries such as Sweden and other European countries are trying to prevent back pain by looking at treatments and preventions and increased ergonomic awareness. While treatments will improve, it’ll be better if we don’t need them in the first place.
Dr Tom Saw is available for consultation at UPANDRUNNING. For appointments please use the button below-