Better help for back and neck pain
Knowledge and innovation are making treatments for chronic back and neck pain more precise and effective.
Dr. Verapan is an orthopedic surgeon and serves as Director of Bumrungrad’s Spine Institute.
He is one of the world’s leading experts in endo-scopic spine surgery, a minimally-invasive surgical procedure for the treatment of chronic lower back pain. He also conducts training in the procedure for spinal surgeons from Germany, Thailand and across the Asia region.
Back pain and neck pain are two of the most common problems affecting adults of all ages. While most painful episodes are only temporary, those afflicted with chronic conditions endure long term suffering that can deal a serious blow to the quality of everyday life. As part of this issue’s special focus on bones and joints, Better Health turned to Dr. Verapan Kuansongtham, an orthopedic surgeon and Director of Bumrungrad’s Spine Specialists Center, for an expert look at how advances in treating chronic back and neck pain are helping patients enjoy healthier, less painful lives.
Pain that persists for at least three months without responding to treat- ment — usually medication and/or physical therapy — is classified as chronic. “Back and neck pain are very common in adults,” Dr. Verapan says. “Most cases aren’t serious and are often caused by bad posture habits or heavy physical activity that strains muscles and causes temporary pain.”
Patients can usually conquer an episode of back or neck pain with a combination of better posture, more rest and anti-inflammatory pain medication. However, should the pain persist or spread to other areas such as the arms or legs, patients should consult their doctor, as these symptoms may be a sign of a more serious nervous system condition.
Internal and external
There are both internal and external causes for back and neck pain. Possible internal causes include spinal conditions such as herniated discs, spondylitis, spondylolisthesis, scoliosis and spinal metastasis; common external factors include poor body posture, injuries and medical conditions arising from physical activities.
Poor posture — sitting in the same position for a prolonged period, sitting without proper back support, or slouching with the back or neck straining forward, among others — puts excessive pressure on back and neck bones. When these bad habits continue over many months or years, bones begin to degenerate, resulting in chronic back and neck pain.
While car accidents and sporting mishaps can result in painful back and neck injuries, they account for a relatively small percentage of back and neck pain cases. In fact, while an accident would seem to be the obvious cause for a patient’s painful symptoms, closer examination often uncovers a pre-existing problem like bone degeneration whose symptoms are triggered by an accident.
Making an accurate, precise diagnosis is the critical first step in successfully treating painful back and neck problems. “When a patient comes for evaluation, the doctor usually begins the diagnostic process by asking about the patient’s medical history,” Dr. Verapan explains. “This is an especially important first step; a precise diagnosis for a patient who has been suffering for a very long time — perhaps several years — usually warrants more than just a few minutes’ time to fully understand the exact source of the problem.”
It’s not unusual for chronic conditions to persist when patients aren’t properly diagnosed and the real cause is left unidentified. Some may be examined only by touch, and if the pain hasn’t spread to other parts of the body, any treatment they’re prescribed is unlikely to relieve their symptoms. With the pain still present, patients can become more desperate and change doctors in search of relief. “That makes a thorough, detailed medical history vital to proper diagnosis,” says Dr. Verapan. “Doctors also have a range of tests such as X-ray imaging and MRI scans to help identify the source of the problem so that the proper treatment strategy can be implemented.”
Herniated spinal discs are a leading cause of chronic back pain. The effect on surrounding nerves is evident in symptoms including tingling, numbness and weakness of the arms and legs.
Lumbar Spinal Stenosis
The next step is to determine the optimal course of treatment — usually a combination of medication, physio-therapy and rest. According to Dr. Verapan, there are many treatment options to be considered. But the following three procedures are among the best options as, in addition to success-fully relieving pain, they have also been shown to play a major role in boosting patients’ everyday quality of life.
Lumber spinal stenosis is usually caused by age-related changes in the spine which result in a narrowing of the spinal canal. The condition places added pressure on the spinal cord or spinal nerves, producing pain, weakness and numbness in the legs.
1. Local Steroid Injection
Local steroid injection is a non-surgical treatment for patients who fail to get relief from medication and physical therapy, but whose conditions don’t warrant surgery.
“Many patients are treated successfully with local steroid injection — even more than the number of patients who require surgery,” Dr. Verapan notes. “The specific injection can be curative while at the same time confirming that the area of injection is the source of the problem. MRI results sometimes identify multiple possible areas of degenerated discs.
To pinpoint a precise injection area, the doctor has to evaluate many pieces of information such as a patient’s clinical examination results, medical records, and the opinions of the surgical team.
This is all taken into consideration when formulating an effective treatment plan.” The anti-inflammatory medication lasts for about three months. For many patients, the pain disappears, but recurrence is possible if patients don’t correct their unhealthy habits such as poor posture or sedentary lifestyles.
“In more serious cases, spinal injection may help for a while, but the pain can return once the medication wears off,” Dr. Verapan explains. “The patient may eventually require surgical treatment as a last resort. By this stage, the doctor would already know the nature of the problem, so the surgery can be more precise, with smaller incisions and faster patient recovery.”
2.Endoscopic Spine Surgery
Endoscopic spine surgery is a procedure that uses a tiny camera to help treat chronic back pain caused by herniated spinal discs or lumbar spinal stenosis — degenerative spinal disorders stemming from repeated improper use of the spine over an extended period of time.
Dr. Verapan explains the procedure: “Endoscopic surgical techniques and tools were invented by a German doctor. The procedure involves a small incision requiring surgical skills as much as advanced equipment. Our surgical team has been working with German doctors to improve techniques and procedures as well as to develop more advanced tools. So we have now reached the point of becoming a medical knowledge center for endoscopy in Asia, with a team of surgeons capable of performing endo-scopic spine surgeries for more than 95 percent of cases of patients with herniated spinal discs and lumbar spinal stenosis.”
Endoscopic spine surgery is typically recommended for patients with spinal disorders that cause, and are coupled with, pain and weakness in the legs.
3. Artificial Disc Replacement
Artificial disc replacement (ADR) is a surgical procedure in which a damaged or degenerated spinal disc in the neck or back is replaced with an artificial disc. Following successful recovery from surgery, patients can enjoy normal body movement and resume their daily lives without pain.
“ADR is a significant improvement over conventional spinal fusion surgery, which placed a heavy burden on neighboring joints that could eventually lead to further disc degeneration,” notes Dr. Verapan. “But doctors still consider artificial disc replacement surgery as a last
resort option to be considered only when all other treatments prove unsuccessful.”
While treatments for spinal disorders continue to improve, the main cause of chronic back and neck pain — bad posture — remains unchanged. “After treatment,” urges Dr. Verapan, “patients who don’t want their pain to recur need to be vigilant about doing strengthening exercises for back muscles and practicing correct body posture.”
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