Treating back pain can be very challenging, requiring the expertise and coordination of more than one medical specialty.

Certain spinal conditions, such as back pain, are very common. However, treating these conditions can be very challenging, requiring the expertise and coordination of more than one medical specialty, including physical medicine, pain management, and surgery.

“Back pain is a very common complaint, but a very non-specific complaint. Back pain and leg pain can be caused by many different things, including spinal stenosis, disk herniations, and instability. The procedures that we offer are really tailored to the specific patient with a specific disorder, based on imaging and exam,” says orthopedic surgeon Dr. Chrisotopher Bono, Co-Director, Brigham and Women’s Comprehensive Spine Center.

To ensure the correct diagnosis and treatment for spinal disorders, patients who are referred to the Brigham and Women’s Comprehensive Spine Center are evaluated with state-of-the-art diagnostic procedures and imaging. Often, the first step is conservative, non-operative treatment by physiatrists, pain management physicians, and other specialists.

“Our role as physiatrists is to help with the conservative care and non-surgical management of spine issues. We want to sort out where the pain is coming from and how much of a functional impairment there is. After doing a thorough exam and review of medical history, we develop a treatment plan, which will often incorporate the use of physical therapy, an exercise regimen, activity modification, careful use of medications, and interventional therapies, such as local injections under ultrasound or x-ray guidance,” explains physiatrist Dr. Zacharia Isaac, Medical Director, Brigham and Women’s Comprehensive Spine Center.

If surgery is needed, orthopedic and neurosurgical spine surgeons at  Brigham and Women’s Hospital (BWH) and Brigham and Women’s Faulkner Hospital offer a complete range of surgical procedures, from decompression and spinal fusion to complex spinal reconstruction. Additionally, ongoing research by BWH spine experts is focused on improving outcomes and establishing standards for spine care at both BWH and hospitals across the nation.

“There are measures we are taking to make sure surgery is more successful and our techniques are less invasive,” explains neurosurgeon Dr. Michael Groff, Co-Director, Brigham and Women’s Comprehensive Spine Center. “Overall, though, the most important advancement has been the collaboration of all of the various care providers in making the outcome for any given patient the best that it possibly can be.”

One BWH research project recently published in the journal Spine studied the relationship of pain level in a patient and the role that played in the decision to have surgery. “It sounds very intuitive that pain plays a role in the decision-making, but it had never been established in any kind of literature,” says Dr. Bono. “We demonstrated a very clear relationship between pain intensity levels at the time that a patient made surgical decisions. Based on the data from the study, we now encourage patients who are having an acute episode of pain to go home and think about it, and once the pain has passed they can then make a better decision about whether surgery is the right option for them.”

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