MANAGING BACK PAIN DURING COVID-19

COVID-19 has made life harder and more uncertain for everyone – but those struggling with chronic back pain find themselves in a particularly difficult situation. You might want to go see your doctor, but you know that some hospitals can be overwhelmed right now.

This confronts you with a tough decision. Do you cancel your procedure, stay home and try to manage your back pain as best you can? Or do you reach out to your doctor and stay on schedule for your treatment?

As it turns out, patients aren’t the only ones grappling with these decisions. Doctors are as well. The Centers for Medicare and Medicaid Services (CMS) recently issued guidance to doctors and hospitals on how to handle surgery during the COVID-19 pandemic.

To keep ventilators and other key supplies available for patients battling the novel coronavirus, the CMS urged medical practitioners to postpone all non-essential surgeries and procedures until the pandemic is under control. 

To help doctors determine which procedures qualify as “essential,” the CMS created three tiers, with each tier ranked by the urgency of a procedure and linked with a recommended course of action. Doctors can use this system to figure out which procedures merit the use of a hospital’s limited supply of equipment and available bedding.

So you may be wondering – which category does your own back condition fall under?

Before we continue, it’s important to note that not every hospital is facing the same load of COVID-19-positive patients. While some, namely those in large metropolitan areas or those serving an older population, are more likely to be at capacity, others have space and staff available. This being the case, talk with your neurosurgeon about the COVID-19 load at their hospital. 

TIER TIME: FIGURING OUT WHAT MATTERS MOST

All Tier 1 procedures are considered non-essential. Procedures that fall under this category are known as “low acuity surgeries” – surgeries for conditions that aren’t especially acute. Surgeries in this category include cataract removal, colonoscopies, carpal tunnel release and endoscopies. While all of these surgeries are important for long-term health and healing, very rarely are they particularly urgent.

No one likes to be kept waiting, particularly for something as high-stakes as surgery. But delaying your procedure until things have returned to normal will allow hospital staff to reserve supplies for COVID-19 patients. And if you yourself are in a high-risk group for COVID-19 – which includes demographics like the elderly, the immunocompromised, and those with kidney, lung or liver conditions –  it’s better to avoid hospitals altogether if at all possible. 

Tier 3 procedures are at the other end of the spectrum: high-acuity procedures so urgent that it’s worth the risk of being exposed to COVID-19. Traumatic injuries fall under this category, as do organ transplants and any surgeries that combat cancer. The CMS placed neurosurgery in the 3a category: Even if a patient is otherwise healthy, neurosurgery cannot and should not be delayed because of COVID-19. The only possible exception is if the condition is longstanding or congenital, in which case a delay of a few months may not make a big difference.

Tier 2 cases fall somewhere in the middle: In some instances, the procedure can be postponed, but in other instances, it’s best to act as quickly as possible. There is a large gray area where a surgeon must use his or her best judgment to assess whether or not it’s best to postpone surgery. The CMS put spinal surgeries in this category – which means that many Americans struggling with back pain will need to do some long, hard thinking about their next step. 

SHOULD YOU STILL GET SPINE SURGERY DURING COVID19?

“According to the Centers for Medicare and Medicaid Services (CMS), spine surgeries are considered a Tier 2 level of urgency. Meaning that it is really up to the guidance of your neurosurgeon on how to proceed based on your condition and levels of pain.”

BEYOND TIERS: TELLTALE SIGNS THAT IT’S TIME TO ACT

Approximately 1.62 million spinal surgeries are performed each year in the United States. Patients seek spinal surgery for a wide variety of conditions and reasons, ranging from a herniated disc that puts unnecessary pressure on the spine to a spinal fracture resulting from a traumatic injury. How to know which of these conditions merits immediate attention, even in the middle of a pandemic, and which can safely defer treatment until the pandemic is over?

Spine patients generally experience a number of symptoms: pain, numbness and functional weakness. While none of these are desirable, functional weakness is the biggest red flag. If a patient’s spine is so compromised that they exhibit signs of physical weakness, surgery cannot and should not be postponed.

If, on the other hand, the patient experiences pain and numbness, but shows no signs of weakness, the surgery can probably wait until the pandemic has passed. These symptoms, while not pleasant, can generally be managed until hospitals have more supplies and fewer patients to care for.

Ultimately, however, any decision to undergo or postpone surgery should be made in consultation with your neurosurgeon. He or she is ultimately the best judge of your condition and will guide you to the decision that supports your long-term health and well-being. Give your surgeon a call to ask their opinion. And when you do, be sure to inform them of any possible COVID-19-related factors, including any instances of potential exposure to the infection. You want to receive the best advice possible and getting a sound opinion means providing your information with any and all relevant details.

IS IT TIME FOR SPINE SURGERY?

“Your neurosurgeon will have the best understanding of when you should commit yourself to a spinal surgery based on your symptoms and visualization of your spine. If you haven’t seen anyone concerning your back pain and are experiencing any of the symptoms above, especially weakness, consult your doctor.”

MANAGING BACK PAIN IN THE MIDDLE OF A PANDEMIC

Unfortunately, the realities of the pandemic have the potential to exacerbate back pain. Working from home means many of us lack the ergonomic chairs, keyboards and monitors designed to support good posture. We slump over our laptops at the kitchen table, on the sofa, or even in bed. This puts strain on our neck and back that we’re not built to bear for months on end.

Like most aspects of COVID-19, this is bad news for everyone – but it’s particularly bad news for the elderly and spinal patients with pre-existing back conditions. We don’t know how long we’ll be practicing social distancing, but it could go on for weeks, if not months. Spinal patients who find themselves waiting for surgery must start taking steps now if they want to maximize their health and comfort over the uncertain months ahead.

Fortunately, there are effective, natural ways to combat back pain that don't require large amount of medicine.

One key thing patients can do is recreate the spine-friendly setting of the office at home. Ask your office if they’d be willing to allow you to quickly return to the office and take your monitor, office chair, keyboard and mouse home with you – or, if that’s too risky, ask them to reimburse you for one at home. Employers have a duty to ensure the health and safety of their employees, and if you are suffering from a serious spinal condition, your company is obligated to support you, even if you’re working from home.

If for whatever reason, employer support isn’t a possibility, there are other strategies you can use to support good posture at this time. Create a makeshift laptop stand so the monitor is level with the top of your eyes, or use an HDMI cord and treat the TV as your laptop. Take breaks every half hour to move, stretch occasionally throughout the day and use phone calls as an opportunity to stretch your legs. Though sitting on the sofa might seem comfortable in the short-term, it will do only do damage to your back in the long term.

AVOID THE “QUARANTINE FIFTEEN” BY EATING CLEAN

Of course, if healing back pain were just a matter of moving around more or having the right chair, you wouldn’t be seeking out spinal surgery. Most of the time, managing back pain requires other, more concrete steps.

You might consider taking a look at your diet. These days, many of us are loading up on take-out and delivery to help support our local businesses. And while that’s a great thing to do, take-out meals are often high in trans fats, sugar and processed ingredients that can cause inflammation and makes your back pain worse.

Use the extra time that quarantine gives to refine your cooking skills, building meals out of healthy fats, lean meat and fruits and vegetables. It’s also a good idea to concentrate on foods high in Vitamin D, such as egg yolks and fish, and Calcium, such as milk and yogurt, as these nutrients will keep your bones strong and healthy. You’ll not only feel better, but you may lose a few pounds, which would in turn decrease strain on your spine.

STILLNESS IN THE STORM: MAKING MINDFULNESS A HABIT

Over the past few years, the popularity of practices like yoga and meditation has skyrocketed. According to the National Institutes of Health (NIH), only 4.1% of U.S. adults practiced mindfulness in 2012 – but by 2017, that number had jumped to 14.2%.

The isolation of quarantine can make back pain seem as though it’s the only real thing in the world. Mindfulness can help manage that pain by giving you the tools to refocus your attention. One study found that 43.6% of patients with chronic back pain who underwent an eight-week course in mindfulness training said they felt better 26 weeks later, as opposed to 26.6% who continued with their standard care plan without mindfulness training.

This is good news on its own, but even more promisingly, the eight-week course was partly comprised of mindfulness training that patients could do in their own homes on a CD-ROM. This speaks to the effectiveness of digital tools to manage pain. Talk to your doctor to see if this solution could help bridge the gap during social distancing and ask him or her to recommend an app or program that teaches the skills of mindfulness.

TAKE IT ONLINE: THE POSSIBILITIES OF TELEHEALTH VISITS

While physically going to a hospital or a doctor’s office to have a consultation with your neurosurgeon may not be prudent during this season, technology has allowed remote visits to be a very real possibility.

In the past, remote visits have been used by rural patients who live far away from medical offices. But COVID-19 has driven many physicians online, empowering them to offer virtual visits so that their patients are still able to get professional medical advice and direction from the safety of their own home.

Though some of the hands-on aspects of a consultation will inevitably be lost, neurosurgeons can still look at your MRI, talk through your symptoms, recommend approaches to dealing with pain and talk through steps moving forward over a video call. This empowers you as a patient to find solutions to your back pain without endangering your health or the health of those around you.

Atlantic Brain and Spine has implemented telehealth visits for patients, if you’re interested in scheduling a remote appointment, contact us.

MEDICATION FOR MITIGATION

For those patients who were a few days or weeks away from surgery, the prospect of having to wait a few more months is overwhelming. Some have tried everything else – eating well, improving workspaces, physical therapy and mindfulness – and still find the pain too much to bear.

If this sounds like you, don’t be afraid to reach out to your doctor and ask if medication is a possibility. There are a number of different options available to you, ranging from anti-inflammatory drugs and muscle relaxants to analgesics and even anti-depressants. Opioids aren’t a good long-term solution, but they may help you manage the pain for a short period of time.

STAYING STRONG AND DEALING WITH DISTANCE

Perhaps the most difficult aspect of COVID-19 is the uncertainty it brings. No one knows when this period will end and what the world will look like on the other side. Such uncertainty makes managing chronic pain all the more difficult – especially if you had a surgery that promised relief on the horizon.

There’s no denying that this is a difficult season. But difficult does not mean impossible. Taking a thoughtful look at your lifestyle, being willing to revise habits or pick up new ones, and having an honest conversation with your doctor can empower you to get through these next few weeks as painlessly and easily as possible.