Say Goodbye to Back Pain

Say Goodbye to Back Pain

by Marian Betancourt, Emile Hiesiger M.D.

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Anyone who experiences chronic or even minor back pain knows there are plenty of remedies for temporary pain relief -- but how do you know you're treating the correct problem in the most effective way? Top neurologist and pain management expert Emile Hiesiger draws on the newest medical information to target back pain at its source. From whiplash and sciatica to osteoporosis and spondylolysis, from faulty facets to herniated disks, Dr. Hiesiger identifies the origins of common problems, and arms you with essential information on

  • Diagnostic tests and what they mean

  • Key questions to ask your doctor

  • Medical and surgical options from nerve blocks to vertebroplasty

  • Exercises and lifestyle changes for pain relief and prevention

  • Physical therapy

  • Prescription drugs

  • And much more

Practical and accessible, this one-stop resource will take you
from symptoms to diagnosis to cure, so you can say goodbye
to back pain -- forever!

Product Details

ISBN-13: 9781416595816
Publisher: Pocket Books
Publication date: 11/01/2007
Format: NOOK Book
Pages: 384
File size: 688 KB

About the Author

Marian Betancourt has written numerous books on health and women's issues. Her most recent books include What's in the Air?, a guide to managing seasonal and year-round allergies; and Playing Like a Girl: Transforming Our Lives Through Team Sports. She has written for the Associated Press, Philadelphia Inquirer Magazine, Sports Illustrated, and other national publications.

Emile Hiesiger, M.D., is one of America's top neurologists and pain management experts. A clinical associate professor of neurology and radiology at New York University School of Medicine, he has been listed in New York magazine's "The Best Doctors in New York," and was cited by American Health as "one of the best doctors in America." Hiesiger is a fellow of the American Academy of Neurology, and the author of Your Pain Is Real.

Read an Excerpt


By the time people come to me with back pain, they have been to many other doctors and have been suffering for many years. Their pain has become the three-ton elephant in the room. Persistent back pain, the second most common human affliction after the common cold, affects 31 million Americans at any given time. Chronic, moderate-to-severe low back pain affects over two-thirds of patients enrolled in chronic-pain centers. Unfortunately, many Americans live in physical and often emotional agony from poorly controlled back pain. Because it can be hard to find the source of the pain, some doctors blame it on the patient's emotional problems. Unfortunately, the patients and their families believe this.

Diagnosis is an art as well as a science, and diagnosing back problems is challenging because the cause of the pain is often hidden and may not show up on X-rays or other scans. Pain travels along the complicated nervous system pathways, so the source of pain is often far from where it is perceived. Because chronic pain affects our emotions and everybody has a different pain threshold, this adds to the difficulty and frustration in finding treatment that works. When we cannot verify the presence of pain or measure its severity, the result is insufficient understanding and treatment by society, the medical profession, insurance companies, and the family and friends of the person in pain. There is almost always a physical cause of back pain. A conscientious doctor, willing to face the challenge with a cooperative patient, will almost always identify it.

Treatment for spinal pain should begin with the simplest, most conservative therapy before invasive therapy is even considered. For example, most herniated disks eventually shrink, and the pain and weakness or numbness they caused resolves. Yet far too many people are rushed into surgery. This often results in being married forever to the medical system and more spinal surgery. As you will see in this book, very few conditions warrant surgery.

The cause of back pain is often multifaceted and in many cases back pain can be relieved, lessened, or even prevented by changes in lifestyle. Weight loss, proper exercises, and posture, as well as good pain medication, should be used intelligently and creatively to maximize your pain relief before you consider any more invasive procedures. I know this is easier said than done, but it is not impossible. There is no reason for your aching spine to destroy you or your quality of life.

I am neither a proponent nor opponent of any medication, physical therapy, surgery, implantable devices, or anything else. There are many therapies to help you deal with chronic spinal pain, depending on the diagnosis and your personal situation. Diagnosis, not just pain management, is the key to successful treatment. Getting the correct diagnosis and subsequent high-quality treatment may well cost you money out of pocket, a very good reason not to allow yourself to go down the financial tube before getting yourself turned around with proper treatment. I want to liberate you from the pain clinic and medical system as much as possible so you can go on about whatever life you may have on this planet. We have all recently been reminded just how tenuous life can be. Live it to the fullest.

Throughout the book you will find stories of people who thought they would never get rid of their back pain — yet did. Because your spine is a living — and aging — part of your superstructure, it may cause pain again over the years. In my own case, as I sit for long hours at my desk writing this book under the stress of a deadline, I have been doing everything I tell you not to do. This stress and my minimally arthritic back have worked together to create back pain. However, despite minor arthritic changes in my spine, I don't always have back pain. My stress level fluctuates, as does strain on my back, while sitting for hours on end writing a manuscript or standing still slightly bent over a patient for long periods of time during a difficult procedure.

I hope this book will take some of the mystery out of why your back hurts and what you can do about it. By learning exactly how your spine, muscles, and nerves work, you will gain insight into how they can be damaged or cause pain.

The first part of the book is meant to enlighten you about your spinal anatomy, how to get your pain properly diagnosed, and how to find the right doctor and treatment.

The second part examines the most common sources of back pain and how they should — and should not — be treated.

And, finally, there is a chapter on prevention, so you can avoid future back pain at home or at work or away. There are key points at the end of each chapter to help you digest what you've learned.


Copyright © 2004 by Emile Hiesiger, M.D., and Marian Betancourt

Table of Contents




Chapter 1

  • Understanding How Your Back Works
  • Spinal Bones: Vertebrae
  • Spinal Joints: Facets
  • Spinal Disks
  • The Sacrum and Coccyx
  • The Spinal Cord and Spinal Canal
  • Spinal Ligaments
  • Back Muscles
  • Spinal Wear and Tear and Back Pain
  • Medical Causes of Back Pain
  • Key Points

Chapter 2

  • Why a Good Diagnosis Is Hard to Find
  • The Complications of Chronic Back Pain
  • Referred Pain: The Cause Is Not Always Near the Effect
  • Test-Negative Pain: When the Cause Can't Be Seen
  • The Initial Physical Examination
  • Key Points

Chapter 3

  • Will Pictures Tell the Story? What to Know about Diagnostic Tests
  • Conventional X-rays
  • Magnetic Resonance Imaging (MRI)
  • Computed Axial Tomography (CT)
  • Myelogram
  • Discogram
  • Electromyogram (EMG)
  • Diagnostic Nerve Blocks
  • Bone-Density Tests
  • Bone Scan
  • Laboratory Tests
  • Key Points

Chapter 4

  • Finding the Doctor Who Can Really Help You
  • Shopping for a Doctor
  • Physicians Who Treat Back Pain
  • Interviewing Potential Doctors
  • What You Should Know about Pain Specialists
  • Key Points

Chapter 5

  • How to Get and Pay for the Best Treatment for Back Pain
  • Do Your Homework
  • Getting the Most from Your Health-Insurance Plan
  • Key Points


Chapter 6

  • Muscle Injuries and Myofascial Back Pain
  • Diagnosing and Treating Back Muscle Injuries
  • Myofascial Pain
  • Treating Myofascial Pain
  • Gluteus Maximus Syndrome
  • Piriformis Syndrome
  • Sciatic-Nerve Entrapment
  • Key Points

Chapter 7

  • Facet Syndrome: Painful Spinal Joints
  • Diagnosing Facet Pain
  • Treating Facet Pain
  • Key Points

Chapter 8

  • Chronic Whiplash Pain
  • Symptoms of Whiplash
  • The Difficulty of Diagnosing Whiplash
  • Treating Acute Cervical Whiplash Pain
  • Treating Chronic Pain or Late Whiplash Syndrome
  • Key Points

Chapter 9

  • Pain from Spinal-Disk Herniation
  • Diagnosing Nerve Pain from Disk Herniation
  • Treating Pain from Cervical-Disk Herniations
  • Treating Pain from Lumbar-Disk Herniations
  • Lifestyle Changes
  • Surgery for Disk Herniation
  • Key Points

Chapter 10

  • Discogenic Back Pain
  • Diagnosing Discogenic Pain
  • Conservative Treatment of Discogenic Pain
  • When to Consider Surgery
  • Key Points

Chapter 11

  • Spinal Slippage and Instability: Spondylolisthesis and Spondylolysis
  • Diagnosing Spinal Slippage and Other Problems
  • Treating Spondylolysis and Spinal Slippage
  • Surgery
  • Key Points

Chapter 12

  • Spinal-Canal Narrowing: Stenosis
  • Lumbar Spinal Stenosis
  • Stenosis in the Upper Back and Neck
  • Diagnosing Spinal Stenosis
  • Treating Spinal Stenosis without Surgery
  • When Surgery Is Necessary
  • Key Points

Chapter 13

  • Osteoporosis of the Spine
  • Diagnosing Osteoporosis
  • Treating Spinal Compression Fractures without Surgery
  • Treating Osteoporosis by Halting Bone Loss
  • Weight-Bearing Exercise
  • Key Points

Chapter 14

  • Benign and Malignant Spinal Tumors and Cancer Pain
  • Tumors of the Spinal Column
  • Back Pain from Metastasized Cancer
  • Treating Back Pain from Metastasized Cancer
  • When Back Pain Is Caused by Cancer
  • Treatment
  • Key Points

Chapter 15

  • Recognizing and Treating Other Causes of Back Pain
  • Fibromyalgia
  • Inflammatory Diseases of the Spine
  • Coccydynia
  • Infection
  • Vascular Abnormalities
  • Scoliosis
  • Pregnancy and Menstruation
  • Key Points


Chapter 16

  • Physical Therapy and Exercise
  • Using Physical Therapy Effectively
  • Stretching and Strengthening Your Back Muscles
  • TENS (Transcutaneous Electrical Nerve Stimulation)
  • Aerobics for Endurance and Stamina
  • Key Points

Chapter 17

  • The Challenge of Finding the Drug -- or Drugs -- That Will Ease Your Back Pain
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
  • How to Use NSAIDs Effectively 242
  • Corticosteroids
  • Antidepressants
  • Other Nonnarcotic Drugs
  • Myths and Truths about Using Narcotics for Back Pain
  • Drug Tolerance, Dependence, and Addiction
  • How to Use Narcotics Effectively
  • Balancing Relief and Side Effects
  • Key Points

Chapter 18

  • Radiofrequency Lesioning and Other Interventional Treatment for Back Pain
  • Epidural Steroid Injections
  • Facet and Nerve-Root Blocks
  • Cutting off the Pain Impulse:Radiofrequency Lesioning
  • Similar Techniques
  • Cryoanalgesia
  • Vertebroplasty
  • Implantable Devices
  • Key Points

Chapter 19

  • Treating Back Pain with Surgery
  • Lumbar Discectomy
  • Foramenotomy
  • Laminotomy, Laminectomy, and Partial Facetectomy for Lumbar Stenosis
  • Spinal Fusion: Approach with Caution
  • Complications of Back Surgery
  • Doctors Who Perform Spinal Surgery
  • Key Points

Chapter 20

  • Eastern Needling and Other Integrative Means of Pain Relief
  • Acupuncture
  • Manual Manipulation
  • Mind-Body Therapies
  • Key Points


Chapter 21

  • Watch Your Back! How Lifestyle Can Hurt or Help
  • Avoiding Excess
  • Warm Up First
  • Develop a Posturepedic Body
  • Watch Your Weight
  • Prevent Recurring Back Pain
  • Enjoy Painfree Traveling


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