I have had pain for months, been treated by my family doctor and I'm still in pain. What now?

This is very difficult. First, make sure your diagnosis is well established. Then develop a good pain management program to match your particular diagnosis. Such a plan might include any or all of the following:

  • Stretching and strengthening your muscles and ligaments including Physical Therapy (PT)
  • Low impact aerobics such as walking, swimming, stair-climbing machine or stationary bicycle
  • Carefully monitored use of narcotic, non-narcotic and anti-inflammatory medicines
  • Vitamins
  • Spine support such as lumbar roll for sitting and driving, cervical pillow, magnet therapy, support furniture (ergonomic chair/desk/computer/ etc.)
  • Physician performed injection therapy such as Trigger Point Injections or Epidural Steroid Injections
  • Biofeedback
  • Heat and Ice as appropriate
  • Church or spiritual support

You must consider that your pain could be permanent and that like high blood pressure (hypertension) or diabetes you will need to learn to live day by day to the best of your abilities. Pain management will help you to live with chronic pain but may not necessarily eliminate it.

When will I get better?

No one can answer this with absolute certainty. It takes 8-12 weeks to strengthen your muscles/ligaments and several weeks to regulate your medicines. Stress, anger, hostility and frustration will increase your healing time. You will need to become disciplined with your exercises, medicines, and stress management techniques.

Why do I sometimes feel worse after physical therapy?

Your therapist has to teach you, through an exercise program, to stretch your tight muscles and ligaments and then to gently strengthen them. This may require numerous visits. Your successful recovery depends on you performing your exercises regularly at home. As with any strengthening program this takes about 8-12 weeks. Do not expect your pain to decrease until the inflammation in your muscles/ligaments has been reduced and the strengthening process has begun.

Why aren't my medicines working?

All medicines require up to 2 weeks to develop a consistent level in your bloodstream. No changes will be made unless you are having uncomfortable side effects. Not everyone responds to the same medicines and it may take a month or more to find the right the ones that help you. Take all your physician prescribed medicines. Remember to keep doing your exercises during this period.

Why do I have to visit a doctor before I can get a refill on some medicines?

Some medicines (such as some pain relief medicine) require close medical supervision. Your doctor will want to meet with you to help you manage these medicines.

Does my weight affect my recovery?

If you are carrying around an extra 20 pounds or more it only makes sense that a sensible weight loss program will help. But remember there are overweight people without spine pain. Right now it is more important that you focus on your exercise program and your medicines.

Does my job affect my recovery?

Unless you have a very physically demanding job, usually not. There are athletes in football, basketball, weight lifting, wrestling and other very physically stressful sports with well documented spine problems that perform their jobs every day. Also remember that there are retired people with spine pain.

My pain is not "all in my head" so why do doctors sometimes refer patients to a psychologist?

Pain is generally not caused by stress or by emotions. However, stress, anxiety, and feelings such as worry, frustration, depression, or anger can make the physical pain seem even worse. Unfortunately, the very fact
that a person has frequent or long lasting pain can by itself be stressful. Pain can also have a negative effect on other parts of a person’s life, which may lead to increased stress. Over time the person may begin to experience feelings of worry, frustration or depression. Any of these factors can interfere with recovery and may cause further pain. A psychologist or psychiatrist who specializes in behavioral medicine understands the complicated interaction of pain, stress and emotions. They can sometimes determine how the different factors are affecting the patient’s pain and can then teach the patient skills to manage those factors. Treatment may include training in stress management, anger management, relaxation techniques and/or biofeedback. If the patient has become depressed, the psychologist or psychiatrist works with the patient and the pain management physician to treat the depression while the pain is brought under control.

What about surgery?

Surgery is a highly individual decision and should be discussed with a board certified surgeon specialist. Usually an attempt at therapy, medicines, and/or injections is undertaken prior to surgery being considered.

What do I do if I have surgery and I am still not better?

Work with your doctor to develop a good pain management program. An excellent example of why you still hurt after the offending disc has been removed may be related to the “couch on the carpet” tale. When you move your couch off of your carpet there remains a little dent in the carpet. You wonder how long it will take until the carpet returns to normal. There are several factors involved such as how heavy was the couch (or the disc) how old is the carpet (or how old you are) and how long was the couch on the carpet ( or how much degeneration in your spine). Unfortunately, sometimes the carpet or the patient never recovers completely. In these cases it is important to focus on the pain management program you and you doctor have developed.

Possible treatments include:

  • Physical Therapy & Exercise
  • Chiropractic
  • Vitamin Therapy
  • TENS & Electrical Stimulation
  • Acupuncture & Acupressure
  • Aerobic Exercise
  • Hydro Therapy
  • Medicines
  • NSAIDS (anti-inflammatory)
  • Muscle Relaxants
  • Pain Medication (narcotic and non-narcotic)
  • Magnet Therapy
  • Massage
  • Injection Therapy
  • Epidural
  • Facet
  • Paravertebral
  • Heat/Ice Therapy
  • Biofeedback
  • Surgery