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Dr. Paul Christo, director, Pain Training Program, Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, answered reader questions about lower back pain. Read more below about ergonomic office chairs, pain medicines and sciatica.

Please note that the comments made here are for informational purposes only and do not represent or substitute as medical advice. Patients are advised to consult their own physician or pharmacist for advice, diagnosis and treatment.

More chats: Ask the experts in our daily live health chats, moderated by some of the country's leading health journalists.

 Ask the Expert About Lower Back Pain(12/01/2010) 
10:28
Baltimore Sun Health: 
Hi, we'll be starting the chat at noon, but feel free to send in your questions on lower back pain now so they're ready for when Dr. Paul Christo joins us.
Wednesday December 1, 2010 10:28 Baltimore Sun Health
11:58
Baltimore Sun Health: 
Welcome everyone to our chat on lower back pain. Dr. Christo is with us now, so we're going to get started.
Wednesday December 1, 2010 11:58 Baltimore Sun Health
12:00
Dr. Paul Christo: 
Hello, I'm Dr. Paul Christo, pain specialist from Johns Hopkins. Welcome to web chat. I'm happy to address any questions you have about low back pain.
Wednesday December 1, 2010 12:00 Dr. Paul Christo
12:00
[Comment From LauraLaura: ] 
I'd like to ask Dr. Christo what he thinks of non-conventional office seating, such as kneeling chairs or exercise balls used as chairs. I'm a runner and my lower back is always tight. I'm trying to do more stretching, but I'm wondering if a ball or kneeling chair would also help.
Wednesday December 1, 2010 12:00 Laura
12:03
Dr. Paul Christo: 
If your lower back pain is due to muscular strain, then erconomically correct chairs at the workplace can be helpful. I think that trying a ball or kneeling chair is fine, but if your pain worsens, I would discontinue use. Sometimes the kneeling chairs can worsen back pain, though.
Wednesday December 1, 2010 12:03 Dr. Paul Christo
12:04
[Comment From AbAb: ] 
Is there a known correlation between Parkinson's Disease and severe sciatica? My friend, 5 years post PD dx and age 57, has had 3 epidurals, a microdiscectomy for herniation between L4 & L5, a discectomy 2 weeks later for re-herniation, and is meeting with another surgeon about possible ADR. No one is looking at his Parkinson's as a possible culprit. Could a change in PD meds possibly help the sciatica? He's bouncing around surgeon to surgeon, looking for a "cure" to his debilitating sciatica. (On the floor in fetal position most days, taking way too many pain meds and anti-inflammatories and nerve meds.)
Wednesday December 1, 2010 12:04 Ab
12:08
Dr. Paul Christo: 
I'm unaware of a correlation. Sounds like your friend's pain may now be associated with the spine surgeries. Specific injections called transforaminal epidural steroid injections that target specific nerves may be helpul depending on the location of the pain down the legs. If physical therapy and other medications fail to control his pain, I would consider something called a spinal cord stimulator which can be effective in reducing back and shooting leg pain.
Wednesday December 1, 2010 12:08 Dr. Paul Christo
12:08
[Comment From John MancusoJohn Mancuso: ] 
Is Celebrex the best drug (non narcotic) use for lower back pain and if so is it safe for long term use? I have 3 bulging discs in L3-4; L4 -5 and L-5; S-1.
Wednesday December 1, 2010 12:08 John Mancuso
12:14
Dr. Paul Christo: 
It depends on the source of your low back pain. Guidelines for treating low back pain recommend medications like acetominophen (tylenol), and NSAIDS (celebrex, motrin, naprosyn) initially. The rule of thumb is to take the lowest dose for the shortest period of time. Many of the NSAIDS haven't been studied for long term use, so the data isn't there necessarily. However, if you take an NSAID for a longer period, blood pressure is generally checked at intervals, assessement of any stomach upset (reflux), and even kidney function is checked to ensure that the medication is safe.
Wednesday December 1, 2010 12:14 Dr. Paul Christo
12:16
[Comment From ClaudiaClaudia: ] 
I never experienced lower back pain before pregnancy - I engaged in lots of activity, ballet classes, yoga. After childbirth, all I could continue with was the yoga, my back has never felt the same. Carrying my daughter in a baby bjoirn for 6 months didn't help. I do lots of abdominal strengthening exercises to try and approach the problem from a "weakness" standpoint, but after a year, nothing has helped. Is this just a new way of life for me since having my child?
Wednesday December 1, 2010 12:16 Claudia
12:19
Baltimore Sun Health: 
We're getting lots of great questions coming in. Please be patient as we sort through them.
Wednesday December 1, 2010 12:19 Baltimore Sun Health
12:21
Dr. Paul Christo: 
I think you could add a course of physical therapy to the abdominal strenghening. Physical therapy will focus on stretching and strengthening your low back muscles, working on your core muscles, and provide heat therapy as well. After childbirth, the muscles and ligaments of the spine can be strained or sprained thus causing back pain. You might consider an evaluation with your primary care doctor and then a pain specialist for more specific assessment and management given that it's been a year.
Wednesday December 1, 2010 12:21 Dr. Paul Christo
12:22
[Comment From j.l. harrisj.l. harris: ] 
I've been doing exercises prescribed several years ago after knee arthroscopy for a torn meniscus. I now have back pain in the process of diagnosis. Should I discontinue the old exercises (leg lifts with weights, piriformis stretch,...) until I resolve the back issue?
Wednesday December 1, 2010 12:22 j.l. harris
12:26
Dr. Paul Christo: 
I would be careful with anything that adds pressure to spine (loading) until your evaluation is complete. Generally, stretching can be helpful for low back pain. Weights might be add some strain to the back. If these maneuvers worsen your pain, I would wait until you have a diagnosis
Wednesday December 1, 2010 12:26 Dr. Paul Christo
12:27
[Comment From Jon S.Jon S.: ] 
How many back injuries have nonspecific origins? I had a herniated disk about nine years ago and to this day have no idea what caused it. Also, at the time, I was age 20 or so. Was it as uncommon as I thought it seemed for that age?
Wednesday December 1, 2010 12:27 Jon S.
12:31
Dr. Paul Christo: 
Most low back pain is considered non-specific (mechanical) and can be due to musculoligamentous strain or sprain. Other things like disk bulges or arthritis can cause mechanical low back pain. Generally, young adults don't suffer form low back pain, but traumatic injuries (sports, accidents) or alignment disorders (scoliosis) can cause pain in young people.
Wednesday December 1, 2010 12:31 Dr. Paul Christo
12:31
[Comment From JohnJohn: ] 
I see guys at the gym wearing big leather belts to "protect their back" while working out. Do these actually work or do they make things worse?
Wednesday December 1, 2010 12:31 John
12:35
Dr. Paul Christo: 
These belts are designed to provide support of the lumbar spine (low back). The key is to be mindful that downward pressure on the spine (loading) can cause strain, or sprain of muscles, ligaments and can change the position of discs leading to spine related pain. The belts are supportive, but not necessary protective.
Wednesday December 1, 2010 12:35 Dr. Paul Christo
12:36
[Comment From DebbieDebbie: ] 
Hi. I have lower back pain and I"m sure it's from my bad posture. I'm tall. After 43 years, how do I stop doing that (bad posture) and do you have any pain remedies that I can do at night. Thank ou.
Wednesday December 1, 2010 12:36 Debbie
12:40
Dr. Paul Christo: 
Physical therapy can be very helpful. The therapists can guide you on proper positioning and re-training your muscles: stretching, strenghthening. Awareness of the back posture can lead to behavior that will "correct" it. Your pain may have another source, so consider an evaluation from a physician.
Wednesday December 1, 2010 12:40 Dr. Paul Christo
12:40
[Comment From MonaMona: ] 
I fell from my horse a week ago, landed on my back. Used heat and ice, much less pain this week, but still hurts when walking uphill, when laying and coughing at the same time, and sitting back on my tailbone. No swelling or bruising, no tenderness. Since it's getting better, what might I have injured?
Wednesday December 1, 2010 12:40 Mona
12:42
Dr. Paul Christo: 
I'm glad to hear that it's improving. Given your symptoms, I would seek an evaluation from the primary care doctor to rule out things like trauma to the disc, joints, or nerves of the spine that could be causing your pain.
Wednesday December 1, 2010 12:42 Dr. Paul Christo
12:43
[Comment From CathyCathy: ] 
I am 58 and have been diagnosed with spinal stenosis. I work in the health care field which involves assisting people with their ADLs. Rather than constantly take pain relievers, is there any kind of excercise, etc to relieve the pain/
Wednesday December 1, 2010 12:43 Cathy
12:47
Dr. Paul Christo: 
Spinal stenosis can cause back pain, shooting leg pain, or even no pain depending on the severity. Core strengthening exercises in the abdomen as well as specific stretches for the low back muscles can be helpful to stabilize the spine and reduce pain. Nerve blocks (injections) of local anesthetic and steroid can also provide relief depending on your symptoms and the nature of the stenosis.
Wednesday December 1, 2010 12:47 Dr. Paul Christo
12:47
[Comment From ErinErin: ] 
I'm a runner and being treated by a chiropractor for slipped discs in the lower back. I tried to start running again last week after weeks of doing well with the elliptical and stationary bike and after getting the go-ahead for (short) jogs from my chiropractor. The first jog went fine but the second turned out to be a mistake, and I'm back in pain. Are there any signs I should watch for before I try again (it won't be until spring)?
Wednesday December 1, 2010 12:47 Erin
12:52
Dr. Paul Christo: 
The major signs to be aware of consist of progressive weakenss/numbness in your legs or loss of bowel or bladder function. This can mean that a disc has herniated significantly against the spinal cord and merits a visit with your primary care doctor and spine surgeon. Loading the spine (downward pressure) from jogging, running, weigh lifting may worsen spine problems and should be performed cautiously.
Wednesday December 1, 2010 12:52 Dr. Paul Christo
12:54
[Comment From MattMatt: ] 
Pain meds seem to be the only way I can get relief from back pain [L3/4 & L5/S1 herniations and L1 compression fracture] but Vicodin is constipating & Darvon is being pulled off shelves for causing heart problems. Additionally, they dont work when I have the occasional slipped disc which causes extreme sciatica though it usually only lasts 2-3 days max. Motrin 600 is ineffective. I'm kind of reluctant to use oxycontin / oxycodone because of all the horror stories surrounding them although Vicodin seem to have it's own stories too. What med/s or treatment would you reccommend?
Wednesday December 1, 2010 12:54 Matt
12:57
Dr. Paul Christo: 
Nerve blocks (injections with local anesthetic and steroid) can be helpul. Non-opioids such as gabapentin (neurontin), pregabalin (lyrica), and a group of medications called tricyclic antidepressants (nortriptyline) can help ease shooting leg pain (sciatica). Surgery may be option as well. Finally, a device called a spinal cord stimulator has been shown to be effective in controlling sciatica like pain.
Wednesday December 1, 2010 12:57 Dr. Paul Christo
12:59
Baltimore Sun Health: 
Thanks for all of your great questions. This all the time we have for today. We'll be back in two weeks to discuss another pain topic.
Wednesday December 1, 2010 12:59 Baltimore Sun Health
12:59
Dr. Paul Christo: 
Thank you for your questions. I'll be back in 2 weeks to address another topic on pain. I hope that this was helpful.
Wednesday December 1, 2010 12:59 Dr. Paul Christo
1:03
 

 
 
 
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