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Downstate Times

The Newsletter for SUNY Downstate
University Hospital of Brooklyn

Back Pain Lecture Draws Full House

by Sandy Dell
Director of Marketing
University Physicians of Brooklyn, Inc.

"Back Pain" proved to be a very popular topic at a recent community health seminar. Dr. Paul A. Pipia, chief of physical medicine and rehabilitation and assistant professor of physiatry in orthopaedic surgery and rehabilitation medicine, said that back pain is the second most common reason—after the common cold—that people visit their primary care doctor. Ninety percent of people will experience neck or back pain in their lifetime.

Anyone can develop back pain at any age, and men and women are equally affected, although smoking and being overweight significantly increase the risk. Other contributing factors are paraspinal sprain/strain, frequent bending and heavy lifting, degenerative arthritis, herniated or bulging disks, depression, and anxiety.

To effectively treat back pain, and hopefully prevent it from becoming a chronic issue, it is important to get an accurate diagnosis. This is the specialty of "physiatrists" such as Dr. Pipia. To determine the cause of back pain, the physician will do a complete physical examination, often followed by diagnostic tests such as x-rays, MRI, ultrasound, nerve conduction studies/ EMG, bone scan, etc.

"Most back pain does get better with a combination of medication, physical therapy and activity modification," said Dr. Pipia. "Surgery is always a last resort."

Initial treatment usually includes over-the-counter pain relievers, a heating pad to improve blood flow to the area and relax the muscles, or cold packs to reduce the swelling and inflammation. A short period of rest can be beneficial, but Dr. Pipia warned against prolonged inactivity. If this does not work, the physician may prescribe stronger medications or a combination of drugs, along with physical therapy. The physical therapist will teach the patient to strengthen the core muscles that support the back, and perform passive therapies to reduce pain and inflammation (ultrasound, massage, electrical stimulation (TENS), traction, wearing corsets and braces, etc.). Downstate's Dr. Tsai Chao also employs complementary approaches such as acupuncture, which some people find effective.

Interventional procedures are another often effective option. Dr. Sanjeev Agarwal, chief of interventional pain management, performs epidural or facet joint injections in which he directs a needle containing an anti-inflammatory and anesthetic drug directly into the problem area under the x-ray guidance of a fluoroscope. If the back pain is related to structural anatomical problems that haven't responded to conservative therapy measures, the patient may then be referred to a spine surgeon, such as Downstate's Carl Paulino, MD.

To make an appointment with any of the highly trained and experienced, board-certified specialists in the Department of Orthopaedic Surgery and Rehabilitation Medicine, including all physicians mentioned above, please call 718-270-2045.


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Dr. Paul A. Pipia, chief of physical medicine and rehabilitation