面试官: 在考虑手术治疗背痛之前, 你可能要先考虑其他的选择. Dr. 安德鲁·乔伊斯是 物理医学和康复专科T，专注于非手术治疗各种肌肉和脊柱问题. 这是一个场景. A patient has been told by another provider that their 背部疼痛 might benefit from surgery. They come to you for a second opinion or just wanting to know if there's something that they can do before surgery. 第一个问题是?
不用手术就能治疗背痛
Dr. 乔伊斯: 肯定. 在绝大多数情况下, there's something that we can offer to at least try to ameliorate the pain before jumping to surgery. 大发娱乐研究了各种各样的治疗方法, 无论是药物治疗, 治疗方法, 模式, 或者是大发娱乐人们控制疼痛的程序.
面试官: And does that happen often that you end up talking to a patient that has been told surgery is what is going to help with their 背部疼痛 并且没有被告知其他的选择?
Dr. 乔伊斯: 是的. 我会说, 你知道, we're fortunate here at the university because most of the way our referrals are sent in, they get sent to us first to evaluate for non-operative treatments before we decide whether or not the patient would really benefit from surgery. 但在社区中，情况并非总是如此. And so it's not uncommon for patients to have 背部疼痛 or pain originating from their back and sciatica, 谁会去看另一个为他们大发娱乐提供手术的医生, 然后再来找大发娱乐征求第二意见，看看大发娱乐还能做些什么.
讨论选项时应该期待什么
面试官: 大发娱乐来谈谈一些可能的选择. 你从哪里开始这个对话?
物理考试 & 病史
Dr. 乔伊斯: The first thing we do is we try to get a comprehensive physical and history from the patient. And what we're looking for is to try to identify what the exact source of the pain is. 所以大发娱乐会和你们一起复习, 你知道, 你痛苦的历史, 它的确切位置在哪里, 大发娱乐来看看成像, and we'll look at different other medical conditions which may factor into our decision. 一旦大发娱乐看了所有这些, 大发娱乐将讨论在不同的过程中可以使用的不同选项. 这取决于大发娱乐认为你的诊断是什么.
治疗背痛的方法
面试官: And I think a lot of times patients think these non-surgical options tend to be like some sort of like a cortisone injection or something like that, 这绝对是一种选择, 但也有其他选择. 给我介绍一下这些选择，以及它们如何应用于病人.
类固醇注射
Dr. 乔伊斯: 所以最常见的注射和人们称之为, 你知道, 可的松注射基本上就是类固醇注射. 重要的并不一定是你注射了类固醇, 重要的是你在哪里注射类固醇. So we use these steroid injections in various parts of the body depending on where we think your pain is coming from. 所以如果你的疼痛是由 椎间盘突出 压迫神经, 然后大发娱乐会做硬膜外类固醇注射, where we place steroid in and around the epidural space to bathe that nerve and calm down any inflammation and irritation that's happening to the nerve. 另一方面, 如果你感到疼痛，大发娱乐认为是来自骶髂关节, 哪个是脊椎底部的大关节, then we would inject the steroid into the sacroiliac joint and use that to calm down inflammation and irritation to the area.
面试官: 然后除了注射, what are some of the other options that you can offer a patient and what situation with those apply?
医疗分院 & 射频消融（RFA）
Dr. 乔伊斯: Some of the more common things when people have arthritis related pain in their back, we do a series of procedures where we do test blocks to help determine if the arthritis is truly the source of the pain. 这些被称为内侧分支阻滞. 如果病人在这些测试块之后确实感觉好多了, 还有一种手术叫做射频消融, where we actually burn those little tiny branches of nerves that go to the joints and help relieve the pain. 这些实际上非常耐用. 它们通常可以持续六个月到一年半, 这样大发娱乐就可以重复，得到类似的疼痛缓解.
电刺激
面试官: 我还听说过电刺激. 这是另一种选择吗？?
Dr. 乔伊斯: 是的，这是一种新兴技术. 脊髓刺激本身实际上已经存在了50多年. But in the past 10 to 15 years, there's been huge advances in the technology that we can use for it. 这几乎从来不是大发娱乐使用的第一线治疗方法. 但对于那些背部疼痛严重且没有好转的人来说, 大发娱乐可以用电来大发娱乐调节疼痛信号. And so that involves putting electrical leads either in the epidural space behind the spinal cord or even more superficially, 在腰部的神经周围大发娱乐阻断疼痛信号.
哪种治疗方案适合我?
面试官: 然后是大发娱乐讨论过的治疗方法, 大发娱乐讲过注射, 大发娱乐已经讨论过刺激神经, 大发娱乐已经讨论过电刺激, 这是真的吗？, 这取决于患者的疼痛类型? Or are those options suitable for all types of pain and you just kind of cycle through one after another? 我是说，有没有什么程序是你想要的?
疼痛严重程度 & 原因
Dr. 乔伊斯: No. 是的, it 肯定 depends on the type of pain and where the source of the pain is. So, 你知道, if your pain is coming from purely the arthritis in your back and I do an epidural steroid injection, 我不指望你的痛苦能得到实质性的缓解. 所以这取决于疼痛在哪里. And where this becomes more complicated is when patients have more than one thing going on, right? 患者背部有关节炎并不罕见, 这会对神经造成一定的压力. 所以他们有不止一件事要做. 然后呢, 在这些情况下, 大发娱乐将使用不止一种手术来缓解他们的疼痛. 但实际上，这取决于他们疼痛的来源.
我什么时候能感觉好一点?
面试官: And I'm kind of getting the feeling that 背部疼痛 can be kind of a complicated thing. 我的意思是, it sounds like you have to know 是什么引起的？ and then what treatments are the most effective for that type of pain, 取决于是什么样的痛, 是什么引起的？, 的位置. 几次就诊后病人多久会有缓解, versus you've kind of got to look a little bit further in the cases where patients might have multiple things going on?
Dr. 乔伊斯: 这取决于病人的情况. 我会说, 你知道, 对很多急症患者来说, 疼痛持续了6到12周的病人, 这些病人倾向于, 平均, 做得更好, because they haven't had the pain for quite so long and oftentimes it's less complex. 但肯定, 当事情变得更复杂的时候, 有时，这确实需要一些尝试和错误，以及一些搜索. 有时候这些注射实际上是有大发娱乐的, 都是治疗性地大发娱乐人们缓解疼痛, but also diagnostically to help us determine the exact source of pain and help us get a better treatment program put together.
面试官: 在这种情况下，你必须解开一个谜.
Dr. 乔伊斯: 完全.
面试官: 是的. 那么在什么情况下你会推荐某人做手术呢?
何时建议进行背部疼痛手术
Dr. 乔伊斯: Most common reasons that I will have someone be seen by surgery is 背部疼痛 or neck pain going down their arms or their legs, 伴随麻木感, 刺痛, 尤其是弱点. 当人们出现症状时, 你知道, 客观的调查结果，当他们客观上是薄弱的, 这是最需要手术的时候. And that's oftentimes when I will send them to surgeons earlier rather than later because we don't want patients to be left with any sort of neurological problems long term. And surgery is the only way to decompress nerves and help prevent that from happening.
如果你感到虚弱 & 刺痛
面试官: Is weakness generally always a sign you're going to be sending somebody to surgery or not always?
Dr. 乔伊斯: So it depends a little bit on having objective weakness, but also on the pattern of weakness. 大发娱乐知道身体的某些神经与某些肌肉相连. 所以大发娱乐可以预料如果神经受到压迫导致虚弱, 它会影响到它所支配的肌肉. And so what we look for is to try to see if the pattern of weakness matches the nerve being pinched. 如果是这样的话，手术可能是必要的.
和专家谈谈你的症状
面试官: 一次又一次, it just really sounds like coming to a specialist like you is really just a great step just to make sure.
Dr. 乔伊斯: 是的. 我认为在那一点上, 如果有人担心你有弱点, 或者你有神经学上的发现却不知道该怎么做, 肯定 看专家就像大发娱乐一样，我认为这很有意义.
面试官: 你所描述的, 你知道, 选择正确的注射部位, 你想用的注射方式听起来真的, 很复杂的. What do you recommend a patient look for in a provider that's doing that type of work?
Dr. 乔伊斯: You want to make sure that the person who is doing your injection has done hundreds of these types of injections and is well versed with it before you go in with them.
面试官: 无论是通过他们所做的奖学金, 医学院毕业后专门研究这个的那一年, 或者他们在职业生涯中做过很多手术.
Dr. 乔伊斯: 同意. 是的.
