Back in Action
Many Americans suffer from back pain, but is there such a thing as relief?
Even when speaking to her for the first time, Beth McDonald sounds like a new woman.
In 1989, McDonald, a competitive gymnast, suffered a fall and tore the sympathetic trunk nerve in her left ankle. Her condition quickly worsened and traveled to her spine, leaving her in constant debilitating pain and requiring a surgical procedure called a lumbar sympathectomy. The pain persisted, fiery sensations racing up and down her legs.
“I felt like the skin was melting off my legs,” she says.
Next came a series of operations and medications – nerve blocks, 25 pills a day, a constant thirst for morphine – until 1993, by which time the Orlando resident’s spine situation had grown so painful she requested doctors amputate her left leg. The pain persisted.
By 2006, McDonald was nearly out of options. She had undergone 33 surgeries, seen more than 120 doctors and her pain still had a staunch grip on her life and everything in it. Her condition ruined a marriage, made her first pregnancy extremely difficult and prevented her from participating in even the most basic activities.
“I looked like a pretzel,” she says. “I was all hunched over in my wheelchair. I was looking at the floor.”
Yet another trip to another doctor, Dr. G. Grady McBride, a spine surgeon at the Orlando Regional Medical Center, presented what he calls a “quasi-salvage procedure,” one that he had performed a number of times with varying degrees of success: an implantable device called a neurostimulator.
“When I first met her,” Dr. McBride recalls, “she was a proverbial train wreck from a medical standpoint.” Dr. McBride felt McDonald was a candidate for the neurostimulator due to her pain source in her legs, and after a quick trial he went ahead and fitted McDonald with one, which, similar to how a pacemaker regulates a heartbeat, intercepts pain signals on their way to the brain and modifies them into a “pleasant buzzing” sensation, Dr. McBride says.
The results were as swift as they were dramatic.
“Within a month, she was off all narcotic rugs,” Dr. McBride says. “That’s the real test. When she came back in, she was like a whole new person. When she came back in, I almost didn’t recognize her.
“With somebody like that, any success you can get you just thank God for because you just never really know,” he continues. “It had to be one of the most rewarding and incredible results from doing this procedure.”
“I’m really happy and I’m not crying all the time,” McDonald says. “I can spend time with my family now. I can do what they do. I got to walk up the White House. I’ll never be able to participate in gymnastics again, but I can watch my children do it.”
Fortunately, most people who suffer from back pain do not experience as extreme symptoms as McDonald did, nor do they require surgical procedures. After all, studies estimate as much as 80 percent of America’s population has suffered from back pain at some point in their lives.
“More people have back pain than don’t have back pain,” says Dr. John Ratliff, an associate professor of neurological surgery at Thomas Jefferson University Medical College, Philadelphia, and a member of the American Association of Neurological Surgery.
Because the back and spine are a complicated system of bones, nerves, joints, muscles and jelly-like support structures called discs, it is extremely difficult to pin down exactly what causes a person’s back pain. Doctors will often examine patients in order to eliminate possibilities rather than pinpointing the specific pain generator.
“You can see the anatomy. The problem is you can’t see pain,” says Dr. Louis Jenis, a neurosurgeon at the Boston Spine Group and Tufts School of Medicine. “That’s why there’s so much research into diagnosis rather than just treatment at this point.”
Most back pain that occurs when sitting is a result of a disc condition; pain from stretching or activity is often a muscular issue; pain caused by extending the back usually is symptomatic of a problem with the facet joints, which rest between vertebrae in the spine.
Patients should not expect a definite answer from their doctor on the first visit, Dr. Jenis said, a thought Dr. Ratliff corroborates.
“One size does not fit all,” he says. “There’s not one solution for back pain.” Generally, a doctor will analyze a patient’s location of pain, injury and illness history, and any movements or body positions that relieve or exacerbate the pain in order to determine possible causes and treatments. For most people, Dr. Ratliff says, back pain can be relieved through core body strengthening and light physical therapy. He often advises patients to take no more than a day or two of rest to allow any acute irritation or injuries to wear off and then to resume physical activity. Staying in bed for extended periods is a bad idea, he says, since inactivity leads to a loss of conditioning and weight gain, two factors in causing back pain.
“The whole global picture of not participating in daily activities leads to a nasty cycle,” Dr. Ratliff says. In order to maintain the benefits of such conditioning, patients must stick to a consistent plan.
“As you work that, you get some relief from your back pain, Dr. Ratliff says. “It’s not a magic bullet. It’s not like you’re 15 years old again. If you stop training, all those gains you’ve accrued will be lost.”
Sometimes beginning activity again may cause some more pain, but Dr. Jenis says that’s the price you pay to get back in shape.
“Back pain does not mean that they are hurting themselves,” he says. “Back pain does not mean they are at risk at developing chronic symptoms. The best way to deal with back pain is to keep using it.”
Before resorting to surgery but after exercise has failed to relieve symptoms after a couple months, Dr. Ratliff and Dr. Jenis recommend seeking a second opinion from a specialist such as a physiatrist or sports medicine doctor, engaging in aquatic physical therapy, receiving injections into a pain source to see if a temporary cure is all that’s necessary, or receiving ablation therapy, a treatment, Dr. Jenis says, that uses “high radio frequency waves in an area such as the facet joint to de-enervate the area.”
Acupuncture is effective for some patients; Dr. Ratliff says he has patients who put off surgery for years using the treatment. Ultimately, at least 90 percent of those with back pain do not need surgery.
Only after at least two months of chronic symptoms would Dr. Ratliff even consider surgery for a patient, unless other warning signs such as loss of bowel control or severe neuropathic leg pain like McDonald’s manifest, the very pain that suggested to Dr. McBride that a neurostimulator could be the key to her relief.
“Surgery is always your last resort,” Dr. Ratliff says.
For McDonald, the pain based in her spine required 34 last resorts. But sheer perseverance got her through her plight, and now she has a boyfriend, a new baby, a prosthetic device that allows her to walk and a fresh start.
“I spent 17 years with a very hard life and a lot of pain, but you never give up,” she says. It sounds like a movie, and it may be one eventually. Paramount Pictures is currently negotiating for the rights to McDonald’s story.
“My boyfriend keeps telling me we should look at Sissy Spacek [to play me], but I was 22. I don’t know if they can use that much makeup,” she laughs.
McDonald’s best advice for others dealing with pain like hers is that narcotics are a permanent answer, and that the marvels of modern technology can provide one provided they keep searching.
“No matter what you go through in life,” she says, “there’s always sunshine on the other side if you stay strong and stay positive.”
 |
