When a patient seeks care for back pain, there are a number of strategies physicians can utilize.

“The best carpenters have the most tools in their kit,” said Dr. Tyson Sloan, a physiatrist in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “And I try to carry a wide array of tools.”

As a physiatrist, or a medical doctor who specializes in physical rehabilitation, Sloan adopts a hands-on approach as he tries to pinpoint the reason for the pain and ways to alleviate it in the future.

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The two most common types of back pain he treats are pinched nerves and arthritis. What’s the difference between these two types of back pain? A pinched nerve often comes on suddenly after a specific activity which may have caused the strain, while arthritis typically occurs overs time in patients who are 50 years and older.

Sloan uses outpatient, low-invasive, non-surgical procedures to help decrease pain for the most common back ailments when options such as exercise, physical therapy, yoga and massage are not working to decrease pain.

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Pinched nerves

A pinched nerve occurs when too much pressure from tissue, a disc or bones in the back are placed on nerve fibers. This physical contact of the disc on the nerve causes inflammation and when they take up more space along the spinal nerves, the back muscles respond by “cramping and locking up,” creating even more pain.

“A pinched nerve in the back can cause more inflammation than nearly anywhere else in the body,” said Sloan. “Unfortunately, back pain is the gift that keeps on giving.”

Sloan usually suggests an MRI for patients who have been in pain for several weeks and have not been able to get relief from either rest or cessation of the activity that aggravated the injury. He also recommends physical therapy as a good option to strengthen the muscles around the bulging disc and help support the spine.

He stresses that physical therapy is like going to school.

“You need to learn the exercises they teach you because you can use them for the rest of your life,” he said. “I really try to avoid opiates as they are not useful in alleviating the inflammation causing back pain. They mainly just help treat the anxiety a person might have about the pain.”

If necessary, Sloan will use fluoroscopic-guided steroid injections. Fluoroscopy is an imaging technique using X-rays to show images in real time.

“Steroids are a fantastic anti-inflammatory,” Sloan said. “This technique allows me to pinpoint the source of the pain and where the injection needs to go to provide pain relief for the patient.”

Back arthritis

Patients with arthritis in their backs have usually been suffering for a while before they land in Sloan’s office.

A good clue to whether you might need medical attention is if you can stand in one position for five minutes without pain. Sloan calls it the “dishwashing example.” If you can’t stand at the sink washing dishes for five minutes without pain, it could be arthritis.

To help him determine if arthritis is the culprit, Sloan will use a numbing injection at the site and see if the patient responds positively.

“If it gets rid of the pain for several hours to a few days, that tells me it’s arthritis,” he said.

Again, if physical therapy is not successful to ease pain, he uses a technique called radio frequency ablation. During this procedure, radio waves are sent through a needle placed precisely on the nerves of the arthritic joints. “Burning” the nerves prevents the pain signals from being sent back to a patient’s brain. The technique usually provides relief for about a year, sometimes longer. When the nerves grow back and if the pain resumes, the ablation can be repeated.

“We do these procedures to try and help the patient avoid back surgery,” said Sloan. “In many cases, we can avoid surgery altogether, or at the very least, put it off for years.”

Mary Gay Broderick writes for UCHealth. She can be reached at marygaybroderick@comcast.net.