Replay of Back Pain Chat with Dr. Michael Regan

Central Maine Medical:
Good evening everyone. Welcome to CMMC’s online chat. My name is Tessa and I will be the moderator for tonight’s chat. Questions will not appear until they are approved and they will be posted in the order they are received. This chat is scheduled for one hour so let’s begin.
5:00

Central Maine Medical:
Tonight orthopaedic surgeon Michael Regan, M.D. of Central Maine Orthopaedics will answer questions about back and neck pain, diagnosis and treatment.
5:00

Central Maine Medical:
First, I would like to introduce Dr. Michael Regan. Dr. Regan earned his doctorate from the University of Massachusetts Medical School at Worcester, in Worcester, Massachusetts. He has completed multiple residencies including General surgery at Maine Medical Center, Portland, Maine; Orthopedic surgery at Eastern Virginia Graduate School of Medicine, Norfolk, Va., and the University of Pittsburgh School of Medicine, Pittsburgh He is certified by the American Board of Orthopaedic Surgery. Welcome Dr. Regan.
5:01

Central Maine Medical:
Please send in your questions
5:02

Comment From Guest
what is the treatment for cervical disk disease in your neck?
5:03

Dr. Michael Regan:
Treatment usually begins with over the counter medications, activity modifications, and often times some physical therapy. Usually, this combination of treatments will improve pain in more than 90% of the patients.
5:04

Comment From Frederick Bonhomme
I have recurrent back problems. In particular, I get spasms that can literally knock me off my feet. Some people say I need surgery. But I think it’s muscular. How do you tell the difference?
5:06

Dr. Michael Regan:
Usually, a comprehensive evaluation at a regional spine center will help sort out these issues, using a combination of your complaints, your examination, and reviewing all your imaging studies. After review of all of these, a decision can then be made as to the most appropriate form of treatment.
5:08

Comment From Guest
I have a lumbar tear at L5 S1. What is the treatment for that? I also have bulging disk at C5, C6, and C7. How do I get a proper diagonsis?
5:12

Dr. Michael Regan:
Multiple studies in the literature have conclusively documented that bulging discs and tears of the disc are extremely common and a normal age related phenomenon – like getting gray hair as one gets older. Generally speaking, unless the disc is causing nerve compression, no specific treatment is needed. Of course, some patients do require treatment. A full review of their complaints, exam, and imaging studies would be necessary prior to recommending any treatment.
5:12

Comment From Kevin Ryan III
Often when my back hurts I feel pain in my legs. Sometimes when back pain subsides, the leg pain lingers. Is this a back problem or a leg problem?
5:14

Dr. Michael Regan:
Your complaints certainly suggest more of a back issue than a leg issue, but ultimately, the diagnosis cannot be made without a review of your examination and imaging studies. Often times, age is an important variable as to whether the symptoms are back related.
5:15

Comment From Guest
what happens when the neck gets a crawling feeling under the skin is that nerve related?
5:16

Dr. Michael Regan:
Usually nerve problems in the neck cause arm symptoms of numbness, tingling, or pain. If the crawling feeling is limited to the neck, it is less likely that any nerves are being compressed.
5:19

Comment From Guest
what do you know about thoracic outlet syndrome? Also I have heard very good things about Maine SpineCare. I have never been there but I do know there is good doctors over there.
5:24

Dr. Michael Regan:
Thoracic outlet syndrome is an uncommon diagnosis that is often times difficult to prove. Additionally, treatments are limited. That being said, the syndrome does occur and requires careful diagnostic testing. I believe the physiatrist, Dr. Pavlak at Maine Spinecare would be an excellent choice and an excellent setting to have your complaints evaluated. To schedule an appointment with Dr. Pavlak, please call Stephanie McQuade, Maine Spinecare scheduling coordinator at 207-376-3340.
5:24

Comment From Iosef Dzhughashvili
I had surgery on back outside America long time ago. It didn’t seem to help much and now am in much pain. Can surgery happen again.
5:25

Dr. Michael Regan:
Depending on your complaints, surgery could be an option. Although, usually conservative treatment such as activity modification, and physical modalities, are more appropriate initially.
5:31

Comment From Gary Elmer
I had an x-ray of my lower back a few years ago and the doctor said it showed normal wear and tear. Is it likely that normal wear and tear would make my back get so sore and stiff that it is actually hard and lumpy to the touch?
5:31

Dr. Michael Regan:
No. It is unlikely that normal wear and tear would cause lumpiness in the skin. Perhaps a re-evaluation by your primary care physician would be appropriate at this time.
5:34

Comment From April Fulk
Is it possible that I hurt my back during childbirth? I’m 38 and have had six babies. Since the last one I’ve had back pain that seems to never go away.
5:37

Dr. Michael Regan:
Although carrying a child in the third trimester of pregnancy can cause increasing back pain at times, usually the pain will resolve after child birth. Any ongoing pain beyond that is usually treated by an exercise program and simple over the counter medications. If these simple treatments are not effective, an evaluation by your primary care physician would be your next step. Maine Spinecare offers a free remedy book for neck and back pain with various exercises one can do in their home. To receive a copy, call Stephanie McQuade at 207-376-3340.
5:39

Comment From Guest
what can you tell me about a interscalene nerve block in the neck?When is it given?
5:40

Dr. Michael Regan:
Usually, these are used for two purposes; First, in the operating room, they may be used for post-operative pain management for 12-24 hours after shoulder surgery. Second, they are occasionally used for diagnostic purposes by pain management specialists.
5:40

Comment From Guest
Can having a intersclane nerve block cause RSD? Even if you had it before? Thank you for answering my questions.
5:43

Dr. Michael Regan:
Usually it does not cause the RSD, but is used to help diagnose the problem.
5:43

Comment From Nicholas Braun
I work as a mason and do landscaping. I’m only 28 and have no back problems now, but my father and girlfriend are always telling me that I’m going to ruin my back. Doing this kind of work, how do I prevent damage to my spine?
5:45

Dr. Michael Regan:
Provided you use appropriate ergonomic methods while laboring, I don’t believe you put yourself at increase risk of long term problems. Appropriate ergonomic lifting could be taught by a physical therapist or other similar health care providers. That being said, other measures that are critical to maintaining good back health include discontinuing all smoking, regular daily exercise focusing on core strengthening, and maintaining appropriate body weight.
5:46

Comment From Guest
How many doctors are at Maine Spinecare? I really want to Thank You for answering my questions tonight! You really are a nice doctor.
5:51

Dr. Michael Regan:
I’m happy to help. Currently, there are three non-surgical providers, Drs. Pavlak, Guernelli, and Owen. I am a surgeon. Additionally, we have support with multiple physical therapy centers including CMMC, Rumford, Bridgton, and other practices that have worked together to provide the latest and most appropriate treatment for chronic neck and back disorders.
5:53

Comment From Idella Maloney
What innovations can we expect in spinal surgery in the next 10 years or so?
5:56

Dr. Michael Regan:
I would expect that similar procedures would be done as today, but through smaller incisions, with less recovery, on an outpatient basis, with equivalent or better results. Additionally, spinal fusion for chronic low back pain will likely not be considered appropriate treatment due to the cost and less than optimal outcome associated with the procedure.
5:58

Central Maine Medical:
Thank you everyone for participating and thank you Dr. Regan. For more information about Central Maine Orthopaedics visit their website at http://www.cmogroup.org and for more information on the Orthopaedic Institute of Central Maine visit http://www.oicm.cmmc.org