From the July/August Edition of MD News Magazine
Primary care physicians are familiar with diagnosing back pain. But when it comes to discerning the source of the pain and how to treat it, a referral to the physicians at Syracuse Orthopedic Specialists (SOS) and New York Spine & Wellness Center (NYS&WC) is often the next step. The medical groups are in partnership to provide a continuum of care, creating the most complete musculoskeletal group in Central New York and helping patients navigate through their back pain.
Chronic back pain, defined as lasting at least three months, accounts for the most common pain complaint among American adults, according to a 2019 study by the Centers for Disease Control and Prevention, afflicting 39 percent of patients. In 2023, the World Health Organization outlined these key points about low back pain:
- It is the single leading cause of disability worldwide and the condition for which the greatest number of people may benefit from rehabilitation.
- It can be experienced at any age, and most people experience it at least once in their life.
- Prevalence increases with age up to 80 years, while the highest number of low back pain cases occurs at ages 50 to 55, and more prevalently with women.
- Non-specific low back pain is its most common presentation (about 90 percent of cases).
Providers at both SOS and NYS&WC offer initial consultations to patients experiencing back pain. “It’s really important having a trusted partner because there are many sides to pain management,” said Jessica Albanese, MD, a spine surgeon with the SOS Neck and Back Team. “Between our two practices, we offer the full spectrum of interventions. Patients can begin care at either practice and providers will diagnose and navigate patients to the most appropriate specialist to support their treatment and recovery.”
“The best first step for a patient with back pain is to seek treatment and guidance from their primary care provider” shared Dr. Brendan McGinn a specialist in Anesthesiology and Interventional Pain Management at NYS&WC. “By having an initial consultation with their PCP, patients can most effectively take first steps to help manage their pain by trialing a nonsteroidal anti-inflammatory drug (NSAID) or an oral steroid, physical
therapy, and then if it’s indicated, a referral to SOS or NYS&WC”.
Patients are also welcome to contact SOS and NYS&WC directly to request appointments. Both practices accept nearly all insurance types and do not require referrals unless the patient’s insurance company requires it.
Dr. Ryan McConn a specialist in Anesthesiology and Interventional Pain Management at NYS&WC shares, “The benefit of the close partnership between our two organizations is that patients have seamless access to both groups and the services they provide once within our doors. Each practice will consult patients and ensure care is given by the most appropriate provider.”
Upon initial consultation at either organization, patients may meet with a physician assistant, nurse practitioner, or physician. Each clinical team is highly trained, working in tandem to deliver specialized medical care to every patient.
Together, from initial consultation through treatment, clinicians focus on patient education. “A lot of time is spent with our patients, in both practices, educating them and having a discussion about what is going on, the options they have, and the risks and benefits of each option,” Dr. McConn continued. “I refer to it as ‘getting organized’ because when they first come in, they’re in distress, they don’t know exactly why and they’re not sure how this ends for them and they’re nervous.”
After an initial consultation, conservative treatment options are discussed at both practices. Because of the partnership and symbiosis of SOS and NYS&WC, providers can discuss all options from the musculoskeletal perspective to make people feel better. Between the two practices, services include: physical therapy, behavioral therapy, diagnostic and prescriptive services, electrodiagnostic lab, X-ray and MRI Imaging, and ultimately surgery if all conservative measures fail.
Conservative Approach to Spine Care
When pain is reported, figuring out where it hurts is the first step. “We are able to identify the source of the pain using technologies such as X-rays, MRIs and electrodiagnostics to narrow down the diagnosis,” said Dr. Albanese. New York Spine and Wellness Center has the only accredited electrodiagnostic lab in Central New York.
A conservative approach works best, especially with any spinal issue. “We always maximize non-surgical care first,” Dr. Warren Wulff, a spine surgeon with the SOS Neck and Back Team, said. “Only the smallest percentage of patients where that doesn’t work do we consider for surgery. In our toolbox of surgical procedures, we always select the least invasive way that works. We match the procedure to the problem, giving the best chance for a good outcome.”
Still, the first order of business is reducing the pain, and there’s the expertise of Dr. McConn and Dr. McGinn. “Surgery is never the first line treatment for pain unless the patient has neurological deficits.” Dr. McGinn said. “When pain is the issue, there are many interventions along the continuum of care before reaching the surgery option.”
Some patients ask for a cortisone shot, thinking that will solve the problem. “But that injection is intended to be more of a bridge toward a faster recovery as the body heals and gets stronger with exercise,” Dr. McGinn added. “It’s supposed to allow for improved functionality and to get patients moving again above all. An injection is part of a multi-modal approach to recovery that can also include chiropractic care, acupuncture, physical therapy, and surgical intervention.”
Importance and Impact of Physical Therapy
Physical therapy is one of the most common treatment choices. “Motion is what makes people feel better, and we typically start treatment with PT,” Dr. Albanese said, “and having patients relearn how to move. They may have some mechanical dysfunction, so they work with the therapy team on strength and mobility.”
Physical therapy includes therapist-guided strengthening, stabilization, and stretching, re-training functional movements, hands-on joint and tissue mobilization, and patient education. At SOS, the therapists pride themselves on individualized, personalized care. SOS offers Orthopedic & Sports Therapy at 5 locations surrounding Central New York, as well as offering remote physical therapy (RTM). RTM is offered to patients living outside the area, to those with limited access to transportation, as well as to patients who prefer online care.
One of the greatest benefits of the Orthopedic & Sports Therapy department within SOS is the close relationship built with the physicians. This direct connection enhances communication amongst the entire care team to expedite patient recovery.
On average, SOS patients achieve superior outcomes with fewer visits and shorter treatment durations compared to national averages. This is consistently shown through the outcomes and patient satisfaction data measured by FOTO Inc. (Focus on Therapeutic Outcomes, Inc.). FOTO has 26 million patients, which is the largest database of outpatient orthopedic therapy patients to compare and the greatest participation by therapy providers.
Non-Operative Interventions
If pain persists, other interventions remain, which is a huge benefit to starting with conservative treatments. “That’s where New York Spine & Wellness Comes in. They can prescribe medications that may be appropriate and perform minimally invasive procedures – options that are still non-surgical,” Dr. Albanese said.
“While we specialize in spine pain and back disorders, we treat all types of acute and chronic pain” said Dr. McGinn. “Some of our interventions can help patients avoid surgery by working through injuries and healing while others can be used as maintenance therapy for chronic arthritic or disc-based pain in the spine for which there is no real surgical option. Other procedures can involve temporary or permanent implants that can treat debilitating nerve pain that may be severely affecting quality of life. We also perform minimally invasive surgeries in patients with spinal stenosis who may be poor candidates for more invasive surgery due to their age or medical comorbidities.”
Surgical Innovation
“Given enough time and attention, many painful spinal conditions will resolve with non-surgical measures only.” shared Dr. Warren Wulff. In instances when surgical intervention is recommended, we use the latest technology and newest techniques such as neuromodulation and minimally invasive surgery at our orthopedic focused surgery center”.
Neuromodulation, through the use of a spinal cord stimulator, is a recent trend in pain management, and Wulff is expert in the procedure. The International Neuromodulation Society defines it as “the alteration of nerve activity through targeted delivery of a stimulus, such as electrical stimulation or chemical agents, to specific neurological sites in the body.” The goal is to re-establish normal function of the nervous system.
Neuromodulation itself is nothing new. Cardiologists have been using the technology for more than 90 years. “People whose hearts don’t beat regularly, most often get a pacemaker, which is a neuromodulator,” said Wulff. “Similar systems are being investigated to treat tremors, epilepsy, limb ischemia, obesity and eating disorders, and even depression—stimulating the brain with painless magnetic pulses.”
Again, that approach begins conservatively. “We can attach an external version of the neurostimulator for a week,” Wulff said. “If the patient has a good reaction, a permanent device is implanted. This is a 1-2 hour procedure that requires an overnight stay. The benefits can be lifelong.”
“These patients may have been highly medicated for years, taking higher doses of opioids with all the negative consequences,” Wulff continued. “Once you get patients off opioids, they feel better and think clearer. It also leads to reduced need for spinal procedures, and medications, which results in long term savings to the healthcare system.”
Reducing a patient’s pain is the ultimate goal, and both practices advocate for attempting the least invasive, most conservative treatments first. “With everybody being unique,” said Dr. McConn, “there is no one modality that is going to relieve symptoms long-term. It’s actually a combination of all these modalities. I tell patients I don’t know what’s going to work for you but we have the access to all options and we’re going to find a combination that’s going to make the pain more manageable and enhance your quality of life.”
