As you get older, knee and back pain can become an uncomfortable fact of life, but dealing with it does not have to be a scary and mysterious process. Dr. Mukund Gundanna, spine surgeon at Brazos Spine, shares warning signs and common treatment options for those who deal with chronic pain.
Knee pain can be broken down into two categories: acute and chronic pain. Acute pain is sudden, often resulting from an injury, and is relatively less common. Chronic pain is everyday pain, without any particular cause other than wear and tear. It often waxes and wanes depending on the particular activity.
“Most knee pain is the chronic type,” says Dr. Gundanna. “The first step is to determine what makes it hurt. If it hurts it, avoid that activity. Sometimes that activity is a necessity or something you love to do. Like if you really love to golf and you can’t imagine your life without it, then that’s a problem.”
The next step is pain management with medication. Gundanna says most people do not know they can take multiple types of pain medications if they treat pain differently. Doctors typically recommend or prescribe three types: an anti-inflammatory, like Advil, that works at the site of the pain to reduce swelling; an analgesic, like Tylenol, that makes the brain not process the pain; and a muscle relaxer that goes to the nearby muscles to make them calm down.
“The next thing to do is give injections of anti-inflammatories directly into the knee,” says Dr. Gundanna. “It’s much more powerful than medicine taken by mouth because the joint is in a sort of capsule, and once medicine is put in there, it tends to stay.”
If all else fails, surgery may be needed to reconstruct one or all parts of the knee: inside, outside, and knee cap.
“The most common type of knee surgery is total knee replacement where they do all three compartments,” says Dr. Gundanna. “There’s nothing beyond that. But the surgery is pretty good nowadays. The metal and plastic used is really, really long-lasting.”
When it comes to back pain, the causes and treatments are very similar to knee pain, and it is just as, if not more, common than knee pain, explains Dr. Gundanna.
“Almost everybody has at least one week of disabling back pain in their life, and it usually resolves itself in about six weeks because it was a muscle strain or disc injury,” says Dr. Gundanna. “Don’t panic if you have severe back pain.”
Some signs that back pain is out of the ordinary is if you get severe back pain often, don’t know why it started, or experience weakness and numbness too. If back pain is accompanied by pain running down your leg, that likely means nerves are also irritated. If you experience any of these symptoms, Dr. Gundanna recommends you see your doctor.
“Some common treatments are physical therapy, chiropractic work, or acupuncture,” says Gundanna. “The main thing is: there has to be an end point. Establish goals and work towards them. Develop a home exercise program, so that after you leave you can continue it. Twelve to 18 visits are a reasonable amount of visits.”
As with knee pain treatment, there are levels of medication, injections, and non-surgical treatments. Dr. Gundanna recommends seeing a specialist like him to decide what steps to take next if back pain persists after visiting your primary care provider. Most insurance providers, except certain health maintenance organizations, do not require a referral to see a spine specialist.
“We can execute the plan, and if you need surgery, I can provide it,” says Gundanna. “That doesn’t waste resources or patients’ time and is more cost effective.” Nonsurgical plans often work well. Dr. Gundanna notes that only about one in five people who come see him end up needing surgery.
In the last 10 years, minimally invasive techniques have transformed spine surgery — a massive change, says Dr. Gundanna. Previously, open techniques disrupted a lot of the patient’s anatomy during surgery and could harm muscles and bones in the process, making for a long recovery.
Almost all spine surgeries can be done minimally invasively, says Dr. Gundanna. He says he feels that open traditional surgeries have given spine surgery a bad rap. “They didn’t respect patients’ muscles, ligaments, posture, balance, and alignment,” he says. “Minimally invasive techniques respect all these things. If in 2019 a patient is having spine surgery, it should be the new kind.”
