Q&A with Dr. Jido, Dr. Metzler, and Dr. Pannu on Chronic Back Pain

At MidAmerica Orthopaedics we offer comprehensive spine care from diagnosis to treatment and rehabilitation. We understand the emotional and physical difficulty of living with chronic back pain. A remarkable 80 percent of Americans will experience back pain at some point in their lives. Back pain can cause discomfort, annoyance, and limited mobility. Symptoms can range from mild to a debilitating condition keeping you from living your day to day life.

Our spine and pain management specialists are here to help answer your questions on back pain treatment.

Our Spine Team

Gurpal Pannu, MD

Dr. Pannu is an Orthopaedic Spine Surgeon with experience in both adult and pediatric spine surgery. Dr. Pannu aims to find non-invasive, and non-surgical treatment options for all his patients before embarking on a surgical journey with them.

Ebby Jido, MD

Among Dr. Pannu’s colleagues is Dr. Jido, a Pain Management/Anesthesiology specialist with 21 years of experience. Dr. Jido’s expertise focuses on a multidisciplinary approach to chronic pain treatment.

Dr. Robert Metzler

Working alongside Dr. Pannu and Dr. Jido is Physical Medicine and Rehabilitation (Pain Management) specialist Dr. Metzler. In his practice, Dr. Metzler works closely with physical and occupational therapists and utilizes their expertise in helping his patients to function at their best.

Together Dr. Pannu, Dr. Jido, and Dr. Metzler strive to work together to look at each case from a multifaceted approach to determine the best, most comprehensive, and least invasive course of treatment.

Spine Specialists Q&A

  1. Can any serious conditions be causing my back pain? If so, which ones and what are their symptoms?

    Dr. Pannu: The most common cause of back pain is related to myofascial disturbance. In other words, the muscles and tendons attached to the spine may become irritated either acutely or chronically. Another very common cause of back pain is arthritis, or degeneration of the spinal bones and joints. Lumbar stenosis is another common, but more serious condition. This refers to compression of the spinal nerve roots. Symptoms often include leg pain, weakness and numbness. Less common causes of back pain include infection and cancer. A spinal infection may manifest as back and/or leg pain, as well as fevers, chills and fatigue. Cancer involving the spine can also manifest as back pain with associated fatigue and weight loss.

  2. What are a few things that will make my back pain worse?

    Dr. Metzler: Your back pain will get worse if you exacerbate the underlying reason for the pain. For example, any type of pain that's caused by a strain of the muscles that are located on the back, the pain would be worsened by bending or using those muscles in uninted ways. Muscles can be aggravated from activities that are as simple as poor lifting technique (bend your knees!) Certain positions and activities can also worsen pain. Knowing what those activities are can help prevent a pain flare up.

  3. Are there things I can do at home or in my life to reduce my back pain?

    Dr. Metzler: My motto when I talk to patients, in most cases, is if you don't move it you'll lose it. I see a lot of my patients get into a pattern of feeling back pain, laying down because that reduces the pain and then all of a sudden they can't move or function anymore. When you start having a hard time getting up, it’s because your muscles are getting tighter from not moving. So I work on flexibility, range of motion and strengthening the core and glute muscles with my patients. As Americans, we are often sitting down, looking at our phone, or hunched over a desk—all of these things don’t help with back pain. Basic activity throughout the day like taking breaks to move around, stretching and short walks, will all help to reduce your pain.

  4. When is medication necessary?

    Dr. Jido: Sometimes medicine is necessary, but sometimes it's not. It all depends on the patient's condition. In a situation where medicine is necessary, it usually is reserved for short term basis or if any procedure wasn’t successful.

  5. If I'm prescribed medication, how long will I be taking it? What are the side effects? Is long term use harmful?

    Dr. Jido: The answer for how long you can take medication depends on the type of medicine. If we're dealing with opioid painkillers, these can be taken indefinitely. They do not cause organ damage as long as they're taken within the prescribed way. Unfortunately, with opiods we're going through the opioid epidemic right now. These medications have a greater abuse potential, so they must be strictly monitored by the doctor. On the other hand, anti-inflammatory medication has limited time. Anti-inflammatories can cause bleeding disorders, kidney problems or swelling, so it’s not recommended to take them for an extended period.

    Dr. Metzler: Anytime I approach a patient, I try to figure out how and where the patient feels pain. It can be a nociceptive pain, which is like that dull ache you feel when you bang your elbow on a table. Or neuropathic pain, which is a burning sensation there or a shooting pain that goes down the leg. There is a big difference in treating pain depending on what's causing the pain or the type (nociceptive or neuropathic) of pain that you experience. There are some blanket medications that will treat both. But, I think we all try to really hone in on what the underlying cause, the pain generator, is and how we can target it most specifically. This will help mitigate unnecessary side effects and give the patient a better result in reducing their pain.

  6. What are some alternative treatments for back pain other than medication?

    Dr. Jido: There are plenty of alternative treatments for back pain. One includes steroid injections within the lower back, neck or upper back. A medication is injected into the spine that goes to the nerve receptors that are causing the pain. There are other injections performed under x-rays that are steroid based. These work to reduce inflammation. There’s a variety of nerve destruction treatments that help with each type of pain disorder.

  7. How will having back pain affect my life?

    Dr. Metzler: Back pain is tough. Having back pain for long periods of time, chronic back pain, can affect all aspects of your life. It can affect the way you interact with others because you're more irritable. This might be because you're not sleeping well at night because the pain is keeping you awake. It can affect your focus at work due to being uncomfortable sitting at a desk. If you’ve had a number of treatments in the past and nothing seems to be working, I think it’s important to take a step back and see if there’s a cycle to the pain. Oftentimes if you're not sleeping well, your back pain is going to feel worse and you’ll be more irritable, as opposed to the other way around. So I also work with patients to improve focus, sleep, and mood if these are problems that coexist with their chronic pain.

  8. How can other problems develop from my back pain?

    Dr. Pannu: Our musculoskeletal system is very complex and interconnected. As our bodies try to compensate for back pain, we tend to load our joints in unnatural ways. This can lead to further joint degeneration in areas away from the spine itself.

  9. What special accommodations do you recommend for school, home or work if you're experiencing this back pain?

    Dr. Metzler: It depends on the nature of the pain, the severity, and what you do for work. What affects one person one way will affect a different patient an entirely different way. We really try to hone our recommendations for each patient. We look at what their home environment is like and what their daily activities are to help the patient function at their best in whatever the environment may be.

  10. How often do I need to come for an office visit?

    Dr. Jido: This depends on the problem itself. Sometimes only one appointment visit is necessary. There are some patients that I’ve seen for literally a decade, even up to 15 years. It all depends on the chronicity of the problem. Certain situations, like simple steroid injections, may be done just once and the patient does well. On the other hand, with chronic conditions these patients either get treatments every several months or frequent check-ups if they're on an opioid medication.

  11. When is surgery recommended for back pain?

    Dr. Pannu: Back pain itself is rarely treated successfully with surgery. Surgery should be reserved for back pain that is associated with buttock, thigh, and leg pain and/or weakness and numbness. Those types of symptoms are consistent with spinal cord or nerve root compression. We only consider surgery after non-operative modalities have failed, such as physical therapy, medications and injections.

  12. What is physical medicine and rehabilitation?

    Dr. Metzler: I'm a physical medicine rehabilitation specialist (physiatrist) at MidAmerica. PM&R is an area of medicine that focuses on overall function. Also known as rehab doctors, we are experts of the brain, spinal cord, muscles, nerves, and everywhere in between. My ultimate goal as a rehab doctor revolves around what your goals are. Do you want to run a 5K? Walk up the stairs? Get through yoga class without having pain? Or address back pain so that you can feel confident picking up your daughter? When talking to patients, my approach as a rehab doctor typically involves a thorough history and examination. The treatment that I offer includes therapies, modalities like bracing, medications, procedures (injections) or a combination of all of the above.

  13. How can pain management help my chronic back pain?

    Dr. Jido: Pain management improves the quality of life. It may not be 100%, but definitely reduces pain to the extent that your quality of life can improve. I work with patients who aren’t able to work due to their back pain, with pain management they can return to work. Back pain can also limit the ability to spend quality time with family and loved ones. I believe it's very important to control the pain so you can continue living life.

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