Return to Transcripts main page

CNN Live Today

Interview with Dr. David Borenstein

Aired August 15, 2002 - 11:31   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

LEON HARRIS, CNN ANCHOR: Eight in ten of us will experience it sometimes in our lives: back pain.
DARYN KAGAN, CNN ANCHOR: And the question about what causes it, and more importantly, what can you do to make it go away?

Our medical correspondent, Dr. Sanjay Gupta has some answers for us.

HARRIS: You OK?

KAGAN: Yes. Spit it out. Here's Sanjay.

(BEGIN VIDEOTAPE)

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Maureen Prease is a young and healthy college senior with everything to look forward to, but back pain is getting in her way.

MAUREEN PREASE, BACK PATIENT: The pain itself and sort of feeling like I'm falling apart. I'm 21 years old, this isn't -- I'm not supposed to have back pain. This isn't right.

GUPTA: Young and old alike, back pain effects 80 percent of adults at some point. Many are not even sure what caused it.

MICHAEL BILLER, PHYSICAL THERAPIST: Probably the most often is the person who comes and says, I don't know how I hurt my back. I woke up one morning, my back hurt, I couldn't get out of bed.

GUPTA (on camera): So why does back pain occur, and more importantly, where does it occur? On this spine model here, you will see that most of the time, the back pain actually occurs in the muscles going up and down the spine. Sometimes, it will actually occur in the joints in the spine, sometimes in the disks, and sometimes even a pinched nerve root.

The good news: 90 percent of the time, the back pain will get better on its own. Ten percent of the time, it will be more chronic, such as the case with Maureen, sometimes even requiring surgery.

DR. HOWARD LEVY, EMORY UNIVERSITY: The best thing do for somebody to do that hurts their back is to rest, rest for a couple days. Not an extended period of time, but one or two days. Take an anti-inflammatory or a non-aspirin pain reliever, and use ice or heat to relieve it. GUPTA (voice-over): If that doesn't work, go to your doctor. Maureen waited for almost a year when she finally saw her doctor. He then sent her to a physical therapist.

BILLER: Good. Now, remember, make sure you hold it for a couple seconds at the top.

If you don't have strong back and abdominal muscles, your spine won't have very much support, and it can translate into pain for the patient.

GUPTA: Pain that Maureen is slowly getting rid of.

PREASE: I'm getting stronger. The pain is diminishing. I'm hoping that it will just keep diminishing until it disappears.

GUPTA: Whether you are a senior in college or a senior in life, there is a good chance that you will one day have back pain, and an even better chance that you will beat it.

(END VIDEOTAPE)

GUPTA: From chiropractors to physical therapists, medications, maybe even surgery, a lot of people get back pain, but there are a lot of good treatments out there as well -- Daryn.

KAGAN: All right, Sanjay. A lot of questions. This has definitely hit a nerve, so to speak, with our viewers out there. We have you to answer the questions. Also, in our Washington bureau is Dr. David Borenstein, he is author of "Back in Control." I feel like we are well-staffed today to answer these questions -- good morning to both of you.

Let's go right to the e-mail. First one is from Sally, and she writes in -- oh, she has a long one -- "I had back surgery -- well, a while ago, and now experience terrible pain in the lower back and down my leg. I had an MRI scheduled, a visit with a neurosurgeon soon. What are possible causes of this? Am I facing more surgery? They did the simplest they could do, and then it was just clean out the disk material," -- and I don't know, she goes on and on.

Let's go to our own neurosurgeon. There we go. "it exploded into my back," and that is from Sally.

Sanjay, we will let our resident neurosurgeon take that one. More surgery for Sally?

GUPTA: Well, this is not an uncommon problem. Sounds like she had an operation three years ago, and now has had what we call recurrent pain. Let me actually just show an animation really quickly of why this sort of pain occurs in the first place.

Typically -- you can see here your lower back, and there you see the nerve root actually coming out of the side of the spine. Now notice, that is right by a disk, and when that disk herniates like you see there, it actually pushes on the nerve root. The operation Sally was describing is where they actually remove that herniated portion of disk so it no longer pushes on the nerve root.

A few things may have happened in Sally's case. She may have had a rerupture of the disk so there is new disk pushing on the nerve root. She may have some scar tissue around that. Either way, it sounds like she may need another MRI scan to try and figure out exactly what is going on.

Not necessarily more surgery, but you have got to figure out what the problem is in the first place.

KAGAN: Sounds like it. And by the way, Sanjay, we have your spare spine with us right here. You didn't travel with it to New York City, but we have it very close by.

GUPTA: I feel like I'm there.

KAGAN: I know you feel better when the spine is closer.

Let's move on to our other e-mail, and this is for you, Dr. Borenstein, coming from Mark, and he asks, he has "a dull lower back pain. Seems to almost feel like the top of the buttocks. I get a burning like sensation radiating down my thighs. I have been to the doctors before, numerous physical therapy sessions, and even given a muscle relaxer and Motrin. What is your guidance?"

That sounds pretty common.

DR. DAVID BORENSTEIN, AUTHOR, "BACK IN CONTROL": That is a very common problem, and what we need to try and find out is what seems to make the problem better and worse. There are different types of physical therapy, and different types of medications that can be quite helpful, and when the first group did not work, sometimes a reevaluation to see if anything has changed in the lumbar spine is important, and then possibly changing the medicine and the regimen of physical therapy can be quite helpful for people who have this kind of chronic problem.

KAGAN: And we move on. Next e-mail is from Joseph, I believe. Yes, Joseph, asking, "I am curious as to your views are on chiropractors. Are they an effective means of treatment for non- serious back pain?" That is from Joseph.

Neurosurgeons don't always have the highest opinion of chiropractors. Sanjay, we will let you take this one.

GUPTA: Well, I will tell you, people have opinions on chiropractors, good or bad. I have found that a lot of my patients have had excellent relief from chiropractors, and some of them swear by them, including family members of mine as well.

I think that there are times when chiropractors can be very useful. I think there are times when there are actual more medical -- slash -- surgical problems in the spine that need to be taken care of by a doctor, but I think there is a real role for chiropractors. I would be interested to see what the doctor in Washington has to say as well. KAGAN: Yes, Dr. Borenstein, what do you write about with chiropractors?

BORENSTEIN: In my book, "Back in Control," I talk about chiropractors as being complimentary to the conventional therapy for low back pain. Chiropractors can be helpful for individuals to improve their range of motion, and to get them out and around. In other words, they try to encourage movement. And in that circumstance, a chiropractor or a physical therapist can, in fact, be quite helpful in trying to encourage people to move. What we found over time, is that resting too long can really make a problem for people with low back pain. So encouragement to try to go back to your usual activities as quickly as possible, with the appropriate use of medications, can be quite useful in this circumstance.

And in some circumstances, the chiropractor plays a role in getting that person back up and around.

KAGAN: And we have time for one more e-mail. This one is from Steve.

I understand it involves a skeleton. "Can you tell me how, generally, the shoes we wear can cause various types of back pain, and what features would be ideal in shoes to help," -- oh, it is Steve Skelton. Funny. We have Steve Skelton writing on a back issue. It is funny that it is a guy writing in. You know, we women are very guilty of wearing the wrong kind of shoes, doing that high heel thing. How much are we contributing to our own problem? Let's talk to Dr. Borenstein.

BORENSTEIN: Well, it depends on whether you have a sway back, that is an extra curve in the back. It have been shown that high heels by themselves do not necessarily have to cause back pain, but if you are up in them all day, they do put some strain on the back, and being -- having a lower heel can be important.

The other thing to remember is that many times with my patients, even those who have other forms of arthritis, is that I like an adequate amount of cushion, if at all possible, so they feel the cushioning in the shoe as opposed to the hard surface. Some people walk on very hard surfaces all day, and that can cause a strain on the back. So we try to make sure they have comfortable shoes at an appropriate height, and that can improve their back pain.

KAGAN: Sanjay, how about you? How many patients -- or do you ever see this happen? They are coming to you, looking -- thinking that they need spine surgery, and actually, maybe, just something as simple as changing their shoes might do the trick.

GUPTA: Absolutely, Daryn. I mean, most of the times, I would say about all of the patients that come into my office, probably around 10 percent actually end up needing any sort of operation. Most of the time, the pain can be simple muscular pain. The muscles, the large muscles up and down the spine can be a real problem. Very infrequently do patients actually need surgery. All the things -- Dr. Borenstein and I agree, there is a lot of stop-gap measures before you get to that point.

KAGAN: Got it. Dr. Sanjay Gupta in New York, Dr. Borenstein in Washington, D.C.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com