"The field is rapidly growing and allowing us to offer more and more options for patients.”
Some studies suggest up to 80% of people will experience back issues at some point. Spine or low back pain is “one of the top reasons that patients see their physicians,” said Jonathan French, MD, a specialist in physical medicine and rehabilitation (also known as physiatry) at Novant Health Spine Specialists - Mint Hill.
Back pain can be a challenge to diagnose because there are multiple pain generators in the spine. Dr. French and his colleagues, including Jacob Wang, MD, an interventional pain management specialist with Novant Health Spine Specialists - Randolph Road, focus on pinpointing the source and developing a custom treatment plan for each patient. Treatments vary depending on the patient’s overall health, how long the pain has lasted and its intensity. “Is it just a nuisance,” asked Dr. French, “or is it preventing them from participating in their daily activities and doing what they enjoy?”
In many cases, the first step isn’t surgery. Novant Health’s team educates patients about their conditions and provides a range of services, from surgery to interventional procedures to physical therapy. Physiatrists and pain management physicians closely collaborate with patients and their primary care physicians to build comprehensive treatment plans, including massage therapy and acupuncture when appropriate. Novant Health neurosurgeons, such as Adam Back, MD, with Novant Health Spine Specialists - Randolph Road, are available if surgery is the best choice.
When it’s not possible to eliminate pain, physicians strive to reduce it to a manageable level. “The field is rapidly growing and allowing us to offer more and more options for patients,” Dr. Wang said.
He uses epidural injections, joint injections and sympathetic nerve blocks to ease pain. He also takes advantage of what he calls “bridge” procedures when a patient isn’t quite ready for surgery, or surgery isn’t indicated because of comorbidities.
Medications can be very effective in some patients. Dr. French uses several options for medication management, including medications and muscle relaxants. He limits prescribing opioids as much as possible, given the risk of dependency. They are sometimes necessary for an acute episode, “especially if someone’s having an acute sciatica from an acute disc herniation or has an acute compression fracture,” he said.
Physical medicine and rehabilitation is a lesser-known medical discipline that centers around nonsurgical, conservative management of orthopedic problems. Dr. French heard about it from a friend in medical school and liked that it combined neurology, musculoskeletal medicine and spine medicine. He ended up completing his residency in the field at the University of Virginia, followed by a pain management fellowship at Virginia Commonwealth University.
For his part, Dr. Wang arrived at medical school planning to pursue pediatrics. He realized during his training that he especially enjoyed the procedural aspects of healthcare.
“Orthopedics really spoke to me,” he said, “but I had my first child in medical school and didn’t know if I could commit the time for a surgical residency at that point.” After his medical school graduation, he earned a Master of Public Health degree but ultimately decided pain management was his calling. Dr. Wang completed his fellowship in pain medicine at Duke University Medical Center.
Some primary care physicians refer patients to Drs. French and Wang when those patients have back pain along with other pressing issues such as obesity, high blood pressure or diabetes. The referral gets the patient specialized care, while the primary care physician can concentrate on helping the patient build overall health. The goal, Dr. French said, “is to get the pain controlled and patients back to functioning and doing what they most want to do.”