Common questions
Signs & Symptoms of Back Pain
Q: Aren't stiffness and aches in the morning just part of growing older?
Dr. Borenstein: As we grow older, we may have a little stiffness or back ache in the morning, but this should not last more than 15 to 30 minutes. Stiffness lasting for hours may be a sign of a more serious illness, such as an inflammatory arthritis of the spine. Symptoms such as these should be evaluated by a doctor.
Q: What symptoms signal the need to see my doctor?
Dr. Borenstein: In regards to back pain, make sure you consider the "red flags" in Back in Control! The red flags include back pain associated with 1) fever or weight loss, 2) increased pain when lying flat in bed, 3) prolonged morning stiffness lasting for hours, 4) bone pain over the spine suggesting a fracture 5) back pain associated with eating or menstrual cycle. These danger signs are associated with medical illnesses that should be evaluated by your doctor.
Q: Do men suffer back pain differently than women?
Dr. Borenstein: Men and women do seem to have different causes of back pain. Therefore, they suffer from different problems. For example, osteoporosis is a disorder that occurs more commonly in women than men. The inflammatory arthritis of the spine occurs more often in men than women.
Q: I hurt my back this past weekend working on chores around the house. I took ibuprofen (Advil) for the past two days and don't feel much better. Should I call my doctor?
Dr. Borenstein: Most episodes of back pain will improve or disappear within a week or so. Two days may seem like an eternity but is not a long time in the usual course of a back problem. Simple analgesics like Advil( are usually adequate to take care of a simple back problem. If the pain gets worse, or if the dose of Advil( you need to control the pain is much higher than the recommended dose on the box label, let your doctor know about this change in your health status. He or she may want to examine you to be sure you have no serious injuries.
Q: If I had an injury at some time in my life, what can I expect to feel going forward?
Dr. Borenstein: Mild injuries usually heal perfectly well and do not cause problems later in life. An injury that either has caused a major fracture so that bones are not aligned properly, or damaged a joint so that it does not move smoothly can cause arthritis. It is important to have timely evaluation and treatment of any injury. Follow your doctor's advice, so you can prevent problems later.
Q: If one of my parents has back pain, am I prone to experience it, too?
Dr. Borenstein: Some forms of back pain are genetic. That means that your parents can pass on certain physical characteristics which make you prone to developing certain back problems. Inflammatory arthritis of the spine is most commonly associated with a genetic factor, HLA-B27. This genetic marker predisposes individuals who come in contact with something in the environment to develop arthritis. There is also evidence that the chances of developing disc degeneration runs in families.
Q: Can stress cause back pain? What can I do to alleviate it?
Dr. Borenstein: Stress does not cause back pain. It makes it worse if you have it. The neck is a particular place where stress can cause muscles to tense and fatigue. The fatigue causes the muscle to ache. Recognizing that stress is making the problem worse helps alleviate it. Topical therapies like local heat can make the problem better. Get up, move around, and stretch. Staying in one place makes matters worse.
Medications & Treatments
Q: I have chronic lower back pain. For years, I have been taking a prescription medicine — one of the non-steroidal, anti-inflammatory drugs. How long can I safely take medicine like this?
Dr. Borenstein: Non-steroidal anti-inflammatory drugs, if taken as prescribed by your doctor or accordingly to the box label if purchased at the drug store, can be taken for years without developing any side effects. I have patients with rheumatoid arthritis who have been taking one of these "aspirin-like" medicines for a decade or more. People who are taking these medicines on a regular basis need to be followed by a physician to be sure that no side effects appear over time.
Q: I've heard some new medicines are "safer" than others. Is this true?
Dr. Borenstein: Generally speaking, some medicines are safer than others - especially when considering the length of time of use. The COX-2 inhibitors are a new class of non-steroidal anti-inflammatory drugs (NSAIDs) which were specifically developed to be safer than aspirin and the other NSAIDs. The COX-2 inhibitors are less likely to cause stomach problems like heartburn, gas, and bleeding ulcers. That does not mean that they are totally free of side effects. The COX-2 inhibitors have similar long-term effects on the kidney as the other NSAIDs which need to be monitored. The COX-2 inhibitors are most appropriate for people who have had stomach problems in the past or who are elderly.
Q: My doctor has recently told me that my prescription brand is no longer covered by my insurance and that only the generic is available under my plan. Are generics for back pain and joint problems okay?
Dr. Borenstein: Generic medicines are approved by the U.S. Food and Drug Administration before they be sold at the pharmacy. Sometimes generic medicines are made by the same company which makes the "brand name" drug. Some are made by other companies whose formulations may differ slightly, so that patients may get the same benefit from the generic as they do from the "brand name" medicine. That response differs from person to person. Keep in mind that just because a generic is cheaper, does not mean the medicine is less effective. Likewise, just because a generic is available will not guarantee optimum results to all patients. However, you should talk to your doctor if your generic medicine does not work as well.
Q: I've heard there may be safety problems with Tylenol (acetaminophen) if I take too much of it or take it too often. Is this true?
Dr. Borenstein: The top dose of acetaminophen over a 24-hour period is 4000mg. That amount equals 8 extra-strength Tylenol tablets. The major side effect of acetaminophen is damage to the liver. People who take the maximum dose of the drug and drink alcohol are at risk of developing severe liver damage.
Q: My doctor has suggested I see a chiropractor. What can I expect a chiropractor to do to help me?
Dr. Borenstein: Chiropractors are health professionals that mobilize patients with spinal problems. They use a variety of techniques, including manipulation, to make the spine move better. Some people find the therapy from a chiropractor very helpful in improving motion and decreasing pain. As your doctor to recommend a physical therapist or a chiropractor who has experience taking care of your particular problem.
Q: I have been seeing my general doctor for years for my health care. Since I have increasing back pain, I would like to ask for a referral to a specialist. I don't want to hurt my doctor's feelings by going to another doctor. I know my insurance will cover a specialist only if my primary care doctor asks for the referral. What's the best way to approach this?
Dr. Borenstein: I always feel that open, honest communication offers the best chance of getting to the specialist. If your back pain is getting worse, an evaluation by a specialist is a good choice. Any information that your primary care physician has already obtained can be of great help in your evaluation. Collect that information prior to your visit to the specialist. Take it with you so that the specialist does not need to repeat tests that have already been done. Be sure that your specialist sends a report about your visit to your primary care doctor.
Nutrition & Exercise
Q: I've heard some herbal remedies are good for bone and joint health. Can you tell me any I should try?
Dr. Borenstein: The combination of herbal remedies most often prescribed for bone and joint problems is glucosamine and chondroitin. These supplements are commonly used for problems with the knees and hips. These supplements have not been demonstrated to be helpful for problems in the spine. Just think about how different the structure of the spine and knees and hips are. They are made up of different types of cartilage. The cartilage in the spine does not respond as well as that in the hips and knees. Herbal remedies that help pain may be of some benefit. If you are going to experiment with herbal remedies and you are already taking a prescription or over-the-counter drug, you should consult your doctor, as the combination of herbal remedies and some other medicines can cause extreme, irreparable harm. Use caution when considering a combination of remedies.
Q: My doctor has told me I need to walk about one mile, three times a week. Some days I don't feel like I can - won't exercise hurt me if I already don't feel well?
Dr. Borenstein: Remember the "comfort zone" in Back in Control! Start off slow, with a distance or duration of exercise that is completed without any discomfort. Build up your distance or duration slowly over time increasing a small amount each time as long as you do not have pain. The hope is that before too long you will be able to walk one mile, 3 times a week and enjoy it.
Q: Are certain foods good for "back health"?
Dr. Borenstein: condition associated with weak bones. You can get calcium from milk or dairy products, but those can mean a good deal of extra calories. Calcium supplements supply adequate amounts of calcium without the extra calories. REMEMBER! Do not take your daily calcium dose all at once. The body can only absorb so much calcium at one time. Break up your intake over the day.