By Avrom Gart, MD

I was fourteen years old when I was first introduced to something that became a close companion for the remainder of my life - back pain. It was a hot summer day as I dug my right foot into the dirt, preparing to hit a baseball over the fence. Unfortunately, I didn't hit a homerun, but merely topped the ball down the third-base line. As I began my charge to beat the ball to first base, I felt a sudden jolt of pain shoot down my right leg, propelling me to the ground.

The next 20 years or so were spent battling this nagging and sometimes painful companion in an effort to remain in charge, refusing to be kept out of the game or benched for the season. Numerous experts and wise men were called upon to consult my problem. I began doing my own reading, and experimented with everything from Chinese herbs and acupuncture to injections of cortisone into my spine, in order to achieve any level of relief. It was only natural that upon graduation from medical school that I chose to specialize in the conservative treatment of back pain, and now find myself a Medical Director at the Cedars-Sinai Institute for Spinal Disorders.

Most people will encounter back pain at some point in his or her lifetime. It is almost inevitable; just as we all can see the effects of aging in our faces and bodies, our spine also grows old. Our bodies are made up of almost 80% water. Within the spinal column, this fluid is located within compartments of cartilage called discs. Just as an individual is prone to tear cartilage in the shoulder or knee, it is only a matter of time before one of the discs are injured either due to a traumatic accident, a sports injury or eventually from repetitive wear and tear. Once the covering of the disc is no longer intact, a cascade of inflammation and degeneration is subsequently set into play.

The conservative management of back pain has come a long way since I was a teenager. We now have sophisticated exercise equipment, as well as advanced medications to help diminish both inflammation and pain. Ultimately, the management of back pain will demand a compromise in lifestyle, as well as a commitment to keeping in shape.

The medical specialty of conservative pain management has recently evolved, and has gained considerable recognition for its ability to help individuals manage and cope with ongoing symptoms, while continuing to remain active. The use of various injections to both diagnose and treat neck or back pain has become routine in modern medicine. The ability to accurately target and deliver medication into the spine via a needle, accompanied by X-ray visualization, has advanced this field into the 21st century. We now can more precisely identify the source of a person's pain and correlate these findings with the results that we see on X-rays, as well as other advanced imaging techniques, such as MRI scans.

Once an accurate diagnosis has been made, then a specific exercise program can be formulated with the aide of a certified physical therapist, carefully monitoring progress until the individual is independent in his or her own home exercise program. While stretching and strengthening exercises are a large part of this routine, the use of traction and other modalities, such as electrical stimulation, heat and cold therapy are all evaluated for their effectiveness. Oral medications, including anti-inflammatory drugs and muscle relaxants, have become quite specific in their action with fewer side effects than in previous years. Oftentimes the body will react differently to one medication versus another, and therefore some amount of patience is required to find the medication that is right and effective for each patient. The use of non-prescription, over-the-counter supplements are also encouraged in an effort to help fortify the spine, at the same time diminishing unwarranted side effects.

Lastly, the most recent scientific developments have involved the use of minimally invasive surgical techniques, often performed through a needle on an outpatient basis, designed to repair injuries to the spine. Although reserved for those individuals who fail to respond well to more conservative measures, they still carry with them low risk and favorable outcomes. For those individuals whose discs cannot be repaired, we now offer an artificial disc replacement. Growing in popularity, this procedure is considered to be a last resort, yet an effective end to those who continue to suffer.

Learning to overcome back pain is not only a science, but an art. It requires both acceptance as well as determination, but ultimately can teach us a lesson that can be used to overcome other problems that we may encounter on the road through life.