With almost as many misconceptions as complaints, back pain is common but misunderstood. “Seventy-six percent of Americans suffer from acute back pain at some time during their lives,” says Washington University physiatrist Dr. Heidi Prather. “But they will describe their diagnosis as ‘lower back pain.’ That’s not a diagnosis—that’s a symptom! You don’t say I have heart pain, for example; you say I have congestive heart failure or I’ve been diagnosed with coronary artery disease. Why do we treat the back differently?”
As director of Washington University’s new Orthopedic Spine Center, Prather and the spine center team are working to demystify back pain and provide comprehensive care to patients with spine injuries and disorders. The center’s staff includes five physiatrists and two spine surgeons, as well as a dedicated nurse practitioner and nurse coordinator.
“Our goal is to diagnose patients by examining their individual history and their movements, rather than just their structure,“ Prather explains. “If you have heart pain, you get a catheterization and it can indicate where the problem is, or an echocardiogram may tell us it’s congestive heart failure. With the back, it’s different.” An X-ray or MRI, Prather says, has often been the first step, but it may not be helpful. “You could examine any 10 people, and an MRI would indicate that three of them have a herniated disk, but they are experiencing no pain. Then you’ll have someone with horrific pain, but nothing shows up on their MRI.”
Although an MRI may indicate that nothing is structurally wrong, something is obviously wrong if a patient is in pain. “Perhaps 4 percent of the time we find the answer to someone’s back pain based solely on an MRI. It’s all about asking the right questions. How did it come about? How long have you had it? What provokes it? What relieves it?,” Prather says. “Maybe someone describes pain that prevents them from sleeping on their side, curled up with their hips flexed, for example. That person is describing flexion-based axial pain. We’ll implement their treatment based on a combination of factors, including their movement pattern, history and physical exam.”
This initial consultation is the starting point, says Prather, and there is always a Plan B if the patient doesn’t improve. “At that point, an MRI or an X-ray may be warranted, or a patient may be referred to one of our spine surgeons.” The synergistic effort is key, she adds. “We collectively look at patients and decide on a course of treatment. If there’s no improvement, surgery might be the next step.”
Prather believes education is a critical component of care. “Our goal is to have our patients leave armed with knowledge.” The goal, she adds, is to give patients answers and a treatment plan, and follow-up is an important part of that plan. “If you don’t come in for your follow-up appointment, we’ll hassle you! We want you to check on your status, even when you’re feeling better.” LN
On the Cover: Complementing the department’s existing clinical practice at Barnes-Jewish Hospital and Wash ing ton University School of Medicine, Washington University Orthopedics has opened a spine center at its outpatient facility in Chesterfield to provide comprehensive, specialized care to patients with spine injuries and disorders. Located at 14532 South Outer Forty Drive, the patient-centered practice includes physicians, nurse practitioners, physical therapists, massage therapists, nurses and medical assistants. For more info or to schedule an appointment, call 514-5300 or visit ortho.wustl.edu/spinecenter.
Photo by Bernie Elking Photography