Tips for easing back pain without surgery

HOUSTON CHRONICLE

Pitchers suffer an inordinate number of arm injuries in large part because the human body wasn't designed to fling baseballs 90 or more miles per hour. And, for that matter, the human body may not have been designed for us to even walk upright, surmises Houston pain specialist Dr. Uday Doctor, because of the world of hurt our spines can cause us.

Doctor is chief of pain management at the Texas Orthopedic Hospital. He stays busy because of the inherent design flaws in our backbones vis-à-vis how we use our bodies in jogging, lifting heavy objects and whacking golf balls.

Doctor, who is board-certified to practice interventional spine care, is hardly alone in his field. There are more than 150 physicians in the area who are pain management specialists. And who knows how many chiropractors, acupuncturists and physical therapists also earn a living off our agony?

As we reach a certain age, most of us start to hurt, which wreaks havoc on the quality of our lives, affecting mood, motor functions and concentration.

Doctor suggests that there are two kinds of chronic pain, that which is caused by cancer and that which emanates from diseased and damaged nerves.

The former, he said, is treated by throwing the book at it with little regard for the consequences. Side effects and the risk of addiction are secondary concerns.

"You're just trying to relieve suffering," Doctor said, "and that's especially true if the patient is terminal. All you're trying to do is make them more comfortable."

For those coping with nerve pain, however, it's trickier because addiction issues and side effects of the most potent painkillers do matter. We don't want to spend every waking moment groaning and grimacing, but we certainly don't want to turn into junkies, either.

Attacking the problem with surgery is no black-and-white solution. Spinal operations, in particular, remain a dicey proposition, and it's the spine -- particularly the disks separating the vertebrae -- that's often the source of pain. For example, while a stabbing ache in the shoulder could be a torn rotator cuff, it's more likely to be the byproduct of a herniated disk between the C6 and C7 vertebra, "pinching" the nerve leading to the shoulder.

Dr. Tom Blair, a retired pulmonary specialist at St. Joseph's Hospital, has battled back problems for 40 years. He takes Naprosyn, a prescription-strength anti-
inflammatory drug, and stays as active as he deems prudent. He thinks shutting down completely because you're hurting inflicts psychological damage that exacerbates physical discomfort.

Blair's advice? Educate yourself. Make every effort to know your body -- so you'll know why you're hurting -- before deciding what to do about it. And, he adds, "Don't turn yourself over to somebody you don't have good references on or who won't explain what they're doing, and why they're doing it."

The old-school way of thinking about pain offered two options, sucking up and living with it or swallowing hard and going under the knife. Fortunately, there are other options. For example, Doctor and his partners at SpineCare Consultants (www.spinecare1.com) are practitioners of the nerve root block, which attacks pain without major invasive surgery.

Yes, they will stick a needle or two in your neck or lower back. But that's a far cry from having an epidural, never mind fusing vertebrae.

And most insurance plans cover it even without a referral from a primary-care physician.
"We find the nerve that's inflamed and we put (anti-inflammatory) medication directly on it," Doctor said. "It's critical to isolate the source of the pain. Say your shoulder hurts. In the old days, we'd probably scope it. If that didn't work, then we'd operate on your neck."

Michael Cokinos, president of Cokinos Energy Corp., says the nerve block ended his searing back, arm and hand pain. But, ever fearful of a stress-induced relapse, Cokinos regularly visits a chiropractor, Dr. Ron Grabowski, who Doctor recommended. Grabowski's mission is to keep Cokinos' C7 vertebrae from re-settling on the nerve.

"I thought I was going to have to live with (the pain) the rest of my life," Cokinos said. "But I feel like I'm 150 percent of my old self. I'm working out again and feeling great. What a relief."