Managing Back Pain: It's Not All In Your Head

Join Dr. Rita Roy, CEO of the Spine Health Foundation, as she sits down with Dr. Jason Savage (Orthopedic Spine Surgeon & LSRS President) and Dr. Sara Davin (Pain Psychologist, Cleveland Clinic) to discuss the real impact of low back pain.

They cover:

-When spine surgery is helpful and when it’s not

-The mental health side of chronic pain

-How programs like Empowered Relief and “Trek for Surgical Success” are changing recovery

-Why whole-person care leads to better outcomes

-Tackling stigma and the opioid crisis in spine treatment

If you or a loved one is dealing with back pain, this conversation offers hope, guidance, and practical tools for navigating the journey.

🧠 Learn more at: https://spinehealth.org
🔔 Subscribe for more expert insights.

 Tune in to learn about the future of spinal health! 

Transcript

SPEAKER_01 0:00

Hello, everyone. I'm Dr. Rita Roy, CEO of the National Spine Health Foundation. Welcome to Spy Talks, where we bring unparalleled access to world-class experts, like the professionals who are joining me on the panel today. I'm here at the Lumbar Spine Research Society meeting, and I'm honored to be joined by Dr. Jace Savage, who happens to be the president this year of this society. And I'm also joined by Dr. Sarah Davin, who is presenting here at this research meeting. The Lumbar Spine Research Society is a gathering of clinicians, scientists, and other providers who are focused for a day and a half on the conditions that affect the low back, the lumbar spine. So we're going to start off our program by asking each of our panelists to introduce themselves. And I'll start with Dr. Dabbin. My name is Dr. Sarah Dabbin. I am a psychologist, a pain psychologist at the Cleveland Clinic and the director of our pain recovery services, which is housed within the Center for Spine and Pain Medicine. So my background is both in clinical psychology and also in public health. And I have a real interest in helping patients optimize their mental wellness and well-being throughout the perioperative pathway. And then for those that have back pain that choose non-surgical management to help them learn to live their best life with pain. Thank you, Dr. Damon. Dr. Savage.

SPEAKER_00 1:40

Yeah, thanks, Rita. It's great to be here with you again. So my name is Jason Savage. I'm an orthopedic spine surgeon at the Cleveland Clinic. I've been in practice for about 13 years now. I'm the fellowship director there. And as Rita said, this year I'm the president of the LSRS. It's been really great for the LSRS to partnership with your society and foundation.

SPEAKER_01 2:00

Thank you, Dr. Savage. So we're going to jump right into this conversation about low back pain. Chronic low back pain, acute low back pain, Patients who need surgery, patients who don't need surgery, and some of the mental health aspects that come along with those conditions. I'm going to start with Dr. Savage talking with us about how we deal with low back pain. And I'll just start off with one stat. The World Health Organization recently issued guidelines around managing back pain chronic low back pain. And the reason why they did that is that musculoskeletal conditions affect more people on the planet than any other disease state. And musculoskeletal conditions are driven primarily from spine and, in particular, low back pain. And so the guidelines that World Health Organization has issued have been to, number one, educate patients about and give patients tools for self-management. So let's dive into this a little bit about when patients show up to see you, Dr. Savage, and they have low back pain. Some are maybe going to have surgery. Some are not. What do you do?

SPEAKER_00 3:17

Yeah, Ria, that's a great question. In your absolute right, the most common reason that someone seeks a doctor's attention or sees a doctor is for the fact that you're more so than the common cold. I'll pardon you, but it's the truth. You know, I think the most important thing to realize is that most people who see A spine care specialist, whether it be a surgeon or a medical spine professionalist or a primary care doctor, see them for an acute episode or for a back pain, which typically is relatively self-limiting or can sometimes get better on its own. But some people have a little bit more of a chronic issue, which is obviously the problem.

SPEAKER_01 3:52

And where does something go from acute to chronic? What's the time point?

SPEAKER_00 3:57

Yeah, that's a good question. I would argue... I would argue probably if you're having that pain for more than three to six months after some kind of initial care, I would start to say that that's a medical management problem. The exact definition of chronicity, I'm not sure if we want to answer

SPEAKER_01 4:13

that. Yeah, probably not a switch that gets slipped. But you know when it's been going on for a little too long that it's no longer just chronic. I threw my bag out taking the trash out kind of situation. Is that right?

SPEAKER_00 4:26

Yeah, that's exactly right. And I think, you know, most people, the time we get to someone like me, have had symptoms for a bit. They tried some kind of non-operative things, and now we're trying to say, okay, what else is there?

SPEAKER_01 4:40

Dr. Savage, one of the things that you've talked about with me and with others before and talking about here at the society meeting, sharing the evidence, science around it, is that a lot of times, Low back pain, whether it's acute or chronic, doesn't need a surgery. Can you talk with us about that?

SPEAKER_00 5:00

Yeah, sure. And I think that's a really important point for people to understand, though. The vast majority of people who have low back pain, regardless if it's one month of duration or five years of duration, typically don't benefit from surgery when mentioned. It's a very small subset of people. Typically, they have surgery for their you know, what we call your oxalic low back pain, discomfort without nerve symptoms. And the vast majority of people are treated non-operatively with things like lifestyle modifications, weight loss, smoking cessation, exercise programs, injections. That's typically the standard care for treatment of low back

SPEAKER_01 5:37

pain. So one of the things that Dr. Savage does so exceptionally well in his practice is is approach these problems in a multidisciplinary way. And so we're really delighted to have Dr. Davin here today to talk about her role on the care team with Dr. Savage and his team. So Dr. Davin, tell us, when do patients who are seeing Dr. Savage get to meet you? Yes, that could be at various time points, depending upon the patient, their particular needs, if they're opting for non-surgical management or surgical management. But I think the important piece here is recognizing that if somebody has had pain for three, four, five, six plus months, understandably, they're going to be experiencing some frustration, probably anxiety, maybe fear. And their day-to-day functioning has been limited. So of course they are going to be distressed. And that's where the team management, I think, really comes into play. And I think an important piece of working collaboratively with behavioral medicine and physicians, surgeons, fine specialists is normalizing these experiences or the person that it's experiencing. It is understandable that they're anxious. It's understandable that they have fear. But we want to help them with that so that they can be able to have confidence that they can face this condition and ultimately get through it without the worst case scenario that they might be playing out in their head. So interestingly enough, there's been some really good research out there coming out of Stanford University that shows that these self-management classes and programs, one in particular called Empowered Relief, can even benefit individuals that are having acute pain flares. And it encompasses really pain education, so talking a bit about the neurobiology of pain. We want patients to be informed. And then teaching them three to four basic skills that they can use. They can kind of put in their toolbox to prepare themselves. them for managing pain and or if they are going to opt for surgery, they can utilize these tools as well. And we use this at the Cleveland Clinic. Dr. Sabanich and I work together more in the surgical realm, but we also use it for all of our chronic pain patients who are not going through surgery. And we found that they really embrace the information. And it's We really want them to understand that there's no stigma behind this. I think the biggest challenge that I have is as a psychologist by background, they might assume that they're seeing me because it's really bad or because the doctor thinks that I'm depressed or this is in my head. And it's really not that. It's actually best practice now to integrate behavioral strategies and self-management for every patient with pain. And I truly believe that even acute pain patients can benefit from this. brief, small interventions to help them get through and not sort of continue to circle through the doors of the physician's office because of fear and anxiety. It's so interesting. Having been a patient myself, I had a spinal fusion eight years ago. And when you have that kind of shooting pain down your leg, like I had nerve pain, it's indescribable. It's truly indescribable. As you said, Dr. Savage, you know, axial pain, muscle pain, you can kind of get through that. It takes some non-steroidal anti-inflammatories. You can subside the pain. But nerve pain, it's indescribable. And, you know, oftentimes people feel like they can't describe it. And nobody understands what I'm saying. And am I crazy? What's going on? Like, I can't even... describe this tape. Dr. Savage, what are some of the scenarios that you see when patients come in to see you and they've got this intractable pain, arm, leg, and how does it work in your practice where you can help them get to the kinds of tools that Sarah can offer? Explain that journey to us.

SPEAKER_00 9:58

Yeah, that's a great question. And I think Sarah made a great point before where initially patients see this almost as a like a stigma right or a failure and then find like well why do I need to do this and so fortunately over the past three years four years we've really made this standard of care so this is standard of care you know at the clinic we're very lucky we have CRT available to work with us and I tell patients that I said listen you know there's a physical component of pain There was a mental amount of pain. And what we want to do is really treat both of those things. You know, as a surgeon, you got to do a little bit better of a job of treating the physical component.

SPEAKER_01 10:36

Yeah.

SPEAKER_00 10:37

But Sarah does a much better job of treating the physical component. Together, we can really optimize health.

SPEAKER_01 10:42

And what I think is so beautiful about this moment where we have these world-leading experts talking about a very tough topic, um, It's that it's the compassionate care that comes through in talking with both of you because we do know that there are sadly many cases where people are suffering with chronic low back pain and they feel that their life is ending. They feel that their life should end and they've given up hope. And that is something that the surgeon sees and doesn't have a solution for, but having that standard of care where you can provide the continuum of care to get over to Sarah's team to address that is so critical. And I'm just, I'm so honored to be talking about this because it's a really tough topic and it's something that is a level of care that oftentimes people don't attribute to surgery. That a surgeon is only going to You know, cut on knee and that's it. But really, in a well-organized, surgical practice like you have at your center and many other centers do across the country, patients should look for that continuum of care because there's not a sick letter. These are real topics affecting real people. And there are real solutions and there's real hope. Sarah, you mentioned something at the very beginning of this panel about educating people how to live with chronic pain. That's fascinating to me. I don't know anything about that. I know a little bit about that, but tell us more about that. Sure. Yeah, it's one of my most favorite things that I do as a clinician. I think giving patients choices and options of ways in which different pathways that they might choose to manage their pain non-surgically. So we look at some lifestyle factors. We talk about movement, things like physical therapy, stretching. We want to help them understand that movement doesn't necessarily mean they're going to re-injure themselves or do harm. In fact, we talk about the benefits of movement and regaining strength and also just improving your mood and feeling capable. Because as humans, we just want to feel like we can accomplish things. And that's a hard conversation. Sorry to interrupt, but that's a hard conversation because you're talking to people who are in pain and they don't want to move because it hurts. And it's a little bit counterintuitive to say, we can get you moving. Some of that pain is going to subside. How do you do that, Sarah? Well, I think, again, ideally, this is a message that we're reinforcing across the team. So it's not just Dr. Savage. It's myself. It's also a great physical or occupational therapist. And we're all speaking the same language. We can talk about it. We can actually talk about movement as fear, just like we would talk about getting on a plane as a phobia or I fear. You know, how can we start to gradually face this fear and see that you can accomplish things and do things without that catastrophic outcome that you're predicting? We also work on things like sleep, which most people that are having pain, of course, it makes it really hard. And if we're not sleeping, our body is not recovering. Our mind isn't working right. It just doesn't. a whole host of other problems and sets in. So we work on sleep hygiene, sometimes refer to some more intensive cognitive behavioral therapy for insomnia. We want to help them in that specific area as well. The third component would be nutrition. and just sort of general diet and self-care. So we want to provide them with education on the relationship between nutrition and pain. And we actually have a class that's co-led by a psychologist and a physician where folks can learn about anti-inflammatory diets and those kinds of things. And then the other piece is really managing stress and helping patients understand how the brain perceives stress. pain as stress, just like any other threat, and how that in and of itself can wire up the nervous system and make us more attuned and more sensitive to stress. And that can actually increase our pain. It's not that we're so anxious and we have an anxiety disorder or depressive disorder and that's why we have pain. It's actually understandable intuitions. It could be anxiety. It could be anger. It could be frustration. That can actually amplify pain. And we've helped to educate folks on ways in which they can actually dial that down. I'd say that was our design. It's like which came first, the pain and then... You know, the anxiety and mental health components or the mental health components driving the pain are, they're so closely intertwined. They're completely comorbid. And some can come first, some can come after, but they're tied together in a very understandable way. And I want to normalize that so much. I mean, how could you not be afraid if your pain is going away? Or how could you not feel it? Yeah. So it's more about, okay, we're humans. We have these understandable emotional reactions. We tend to sometimes go down that worst-paced scenario train of thinking. How can we recognize when those things are happening and in the moment? Choose an alternative pathway. Maybe choose a way to reassure yourself just through self-talk. maybe engage in a relaxation exercise or a meditation, maybe build in some fun distractions in your life. So it's really a menu, a face that, and we want patients to feel like they have all of these choices. And some of them might work a little bit more than others, but all together, that's where we can get the best results. And Dr. Devon, I would imagine that part of that counseling is letting patients know they don't have to be perfect at all of that. And you don't have to get 100% to get a benefit, right? Small things can lead to big changes in how you feel. For sure. And because if they're expecting an instantaneous change or they're trying to do too much too soon, they will become disappointed and they'll give up. So we talk about sort of rewiring the brain to respond to pain differently. And this is a process that unfolds over time. It absolutely cannot happen in a week's time. And it requires time. consistency and persistence. But within our team, we also want our patients to know that this is a place where we really were passionate about helping people that have pain. And so we're here for you along the journey. Right. Let's talk a little bit in detail about the surgical patient. So a patient comes to see you, Dr. Savage, has a structural problem with their spine that you do your study, your preoperative assessment, and you said, you know what? We can do this procedure and it's going to fix that power. So a patient has an expectation that they're going to get fixed and they're going to get better. It has been described to me by some that, you know, we have to send an appropriate expectation for each patient. And, you know, Can you ever alleviate 100% of the pain? Sometimes. We don't know how that's going to go, but we set expectations with the patient. And there's a whole field of study in spine about how to set expectations for patients. And some of that research is being presented here at this meeting. Can you share with us a little bit about your approach to setting expectations with patients for how they're going to feel after surgery?

SPEAKER_00 18:48

Yes, I think that's a great point, Vivek. But to answer your question from a surgical standpoint, I think it's just having very, very honest conversations with patients about what the problem is, what the treatment options are. If we think surgery is going to be a good treatment option for that problem, and if it is, what are the expecting outcomes? We're doing ranges of expected.

SPEAKER_01 19:07

Ranges, right.

SPEAKER_00 19:08

Based on data we have. Yeah. And so

SPEAKER_01 19:26

patients can decide what that level of improvement

SPEAKER_00 19:30

is.

SPEAKER_01 19:31

they're willing to undergo, right? Like, even if I only get a 25% improvement over this pain, I'm willing to do that or, you know, understanding where that's going to be. And so setting those expectations do involve education. And let's talk about where Dr. Davin's team comes in, in that preoperative patient education expectation setting scenario. So patients getting ready to have surgery, And we're setting the expectation that you think you're going to do great. You know, there might be some 10% pay, right? There might be, we're not going to make you, we're not going to take a 50-year-old and make them 25 again, right? We're going to get you to a place where you're better. What do those conversations say? Yeah. So, you know, again, we made a standard of care that they're all going to see me or my colleagues. It is in more of a group setting where we're teaching them some of these coping skills. And I think, you know, patients come to me with a lot of apprehension about what's going to happen after surgery, you know, what it... How quick am I going to get better? And how am I going to feel? And how am I going to manage the pain? So there's a lot of discussion around how can we give you as many tools as we possibly can to help you feel prepared to handle that period where you are post-operative and it might be uncomfortable and you might be a little more anxious and there's some uncertainty. And if we can do that really well, and if you can utilize these tools, then it's going to make your recovery even better. And the other thing that I've been thinking about as we've been talking is I think a lot of this boils down to trust in relationships. It's such a good point. You know, I know Dr. Savage is so compassionate and his patients love him and to have a surgeon that they can trust and then come to a class where they're talking about surgery and to be able to know that we're working together as a team, right? They come to my class because they trust Dr. Savage and his recommendations. And so I also try to remind patients that we work together, Dr. Savage and I, or whatever surgeon it is, are, we really want to help you. We want you to recover as quickly as possible and to be as reassured as you possibly can that we're going to do everything we can to help you. And so I think, you know, patients ultimately, when they're feeling understandably scared and anxious, especially right before surgery, and a lot of times we're seeing that they need more support after surgery, it's those relationships that helps them believe that it's going to be okay. And I do, I'm supported by a team of people that work together as opposed to, you know, different people in different settings that never talk. Yeah. And if people go into that surgery with an expectation of, what the recovery is going to be like. It might be uncomfortable for a few days. I'm going to be okay. Do we see that they generally do better? I think for the most part, yes. Of course, there's all sorts of things that can happen after surgery and things that we would never be able to predict. But the important thing that we want our patients to know is that if the there are struggles after surgery, we can help with that. Our entire team has a lot of different things that we can offer to the patient if things are going as expected. So it's going to be okay. So that's fantastic. Yeah. Let's talk a little bit about another topic that's difficult to talk about, and that is the opioid crisis in the United States. The United States of America represents 4% of the world's population. but we represent 80% of the world's opioid consumption. We definitely know we have an opioid crisis in the U.S., and it's not getting better. It's persisting. And opioid prescriptions are written for low back pain more often than any other reason. So we have a scenario where low back pain is harshly a driver, potentially, of an opioid use scenario. problem in our country. And I think that's something that is a unique challenge for spine surgeons who are addressing pain, both acute and chronic pain. But I'd like to talk with you, Dr. Daman, about appropriate use of opioid medications for spine patients. Yeah. I mean, I think that certainly opioids have gotten a bad rap. Yeah. And a light reason. Yes. And yes, for good reason. Although I think what I see is how patients feel kind of unsure about what they're supposed to do then. And they also, if they are even asking a question about a pain medication, they feel unfairly judged and labeled. Or if they're taking those medications, they feel judged and labeled. So they are not never appropriate, right? For short-term use, they can offer benefits. But I think the thing to know is that when we're talking more about a pain that is persisting, particularly a pain that's going beyond three to six months, what we know from the data is that the longer that they're on them, actually the outcomes get worse and they become less functional. And we actually see higher rates of depression in individuals that are using long-term opioids. So their pain, they might be thinking that, well, it's kind of making it seem like I can get through the day. But when we've looked at really longitudinal studies in chronic pain patients, we see that actually the pain isn't the same. It's just the function and the mood that is worse. So I think first and foremost, we have to approach every patient without judgment, and we have to help them feel safe to be able to ask for what they think they need, ask to ask questions, and for us to be able to educate them on the appropriate and appropriate use of opioids or other medications. And the neuropharmacology around pain management has really exploded in terms of what we know about how our brain perceives pain and and how different medications can help in managing pain and I think that's it's just so important to stay on top of that that science and you know to your point no judgment around what is needed each person's perception of pain is different. Right. And there's a lot of other options than opioids. You know, there's many different interventional medication options alongside all of the lifestyle and behavioral management stuff that we discussed. Yeah. Dr. Savage, when it comes to opioid medications, what changes have you seen in your practice or the practice of spine surgery in how opioids are used as a component of the care.

SPEAKER_00 26:37

I think from a surgical standpoint, what I explain to patients is like, look, you're going to have pain after surgery. Surgery causes pain. We're going to give you pain medications to help manage that acute kind of insults, for lack of a better term, to your pain. But then we're going to try to get you off of your pain medications as quickly as we can after surgery. I tend to try to set some guidelines just to kind of have... a little bit of an expectation in our patients. And so the bigger the surgery, the longer they're going to be on steroids. After surgery, we had a good discussion about what are our goals here. We can get out this medication. It's two weeks after surgery, six weeks after surgery, or three months after surgery. I think some of the hardest, longest conversations I have with patients, I think, is about how they need to kind of decrease the amount of opioids they're on before they get to surgery. A four-speed forcer. For that exact reason that Sarah said, I explain to patients, I say, look, I know it's hard to leave, But promise you to count down your pain medications. Your pain's not going to worsen. We're just talking about the side effects of all that medication for that long. And then we know with data that it's better control on lower noses and A, but it's a quick stop.

SPEAKER_01 27:47

That is fascinating. Dr. Savage, we are seeing a lot of evidence and some of it's being presented here at this meeting around a term that's being used more and more, enhanced surgical recovery. And that's a protocol. that surgeons are employing to help patients get better faster, if you will. Can you talk to us about what that looks like for you and in your practice?

SPEAKER_00 28:13

Yeah, absolutely. We're actually having a symposium about that today. And Sarah is a part of, so it's a perfect part for that. Preoperative opioid reduction and management, I think that's part of it. I think part of it is kind of UNC protocols. I think part of it is local kind of protocols. the K-E management options that we can be around the time of surgery. Now, opioid medications that we're using around the time of surgery helps people with the recovery.

SPEAKER_01 28:38

That's interesting. Dr. Davin, talk to me and the audience about what you are seeing with these enhanced surgical recovery programs that you have. Yeah. So our class called Track for Surgical Success, Justin and I have been working on this for quite some time. So smile as I talk about it because I'm all about it. So I'm really proud that we've made this class a standard of care. We're the only large hospital system in the U.S. that has made the standard of care this particular class. It's just like any other thing in the perioperative pathway. We ask them to do it course we don't force them to do it but it is something that we think is in their best interest. We offer classes that are done virtually but they are given with a live instructor and there's anywhere between we have really large group sessions that are up to 50 patients then we have some smaller ones that are well about a time and we're teaching skills to prepare the patients for surgery to prepare them for pain after surgery so yes if you are going to have pain and these are some other strategies that you can use that from the standpoint of your brain which is the perceiver of pain we can dial down the tone of that right we want to be able to sort of dial down that harm alarm in the brain um so family members are more than welcome to attend this class as well And it's really taken off. Patients are very, very grateful for it. They want more. We've surveyed our patients, and they are asking for more in the post-surgical period. And actually, all the evidence around behavioral interventions looking at pre or post is actually saying that the post-op period is probably the optimal time, but not to only do it in the preoperative or only do it in the quick stop. I think patients are just a bit more vulnerable, right, in that period of time. So we're looking at really trying to expand this in a variety of different ways, including using digital technology so patients can have this while they're inpatient at the bedside. You also have an inpatient pain psychologist that could go to the patient's bedside during the hospital stay to be able to talk to them and to reinforce these skills. And so I have a question about access to that program. How does that work? Does Dr. Savage write a prescription for a patient to come to your program? Or is it part of the journey for the patient in your program? How does that work?

SPEAKER_00 31:16

It's part of their journey, honestly. I think that's a perfect way to put it. And so I tell every patient that I'm going to do surgery out, look, this is part of your perioperative optimization process. It's just like getting own help optimized before surgery. It's just like getting... You know, your medical, your heart, lungs, optimums.

SPEAKER_01 31:33

Right. Your body and mind. Right. Your mind, optimums, fortunes. Yeah. That's amazing. And, you know, I think what's so beautiful about that program is that, and I'm sure you can attest to this, Dr. Savage, we've talked about this, people want to do the right thing. People want to be successful. They've come to you seeking answers. They've come to you seeking relief and hope. And they want to And oftentimes they just don't know what to do. And so you've created this journey for them so that they can have a pathway. They can take ownership of it. They can advocate for themselves. They can do the self-care in a supported environment. And I think that's absolutely awesome. I'm so thrilled to be talking about that. What about patients who are not in the Cleveland area? Can they find programs like this? Can they access your program? How can we extend what you're doing in the most awesome way possible? So in terms of our patients who are not in the Cleveland area, but they're being treated within our system, we do have the ability to see patients out of state. And also, again, with some of the digital technology, they can do it wherever they're at. So we do have that option. Empowered Relief, which is part of Stanford and Dr. Beth Darnell developed that class, a component of our Track for Surgery Success Class uses Empowered Relief, and that is available across the globe now. So actually, if you go to the Empowered Relief website, you can find certified instructors. There's a lot of hospital systems now that are using it. It's being used in the VA as well now. And I know at Stanford, they're also using it in their orthopedic trauma patients. They're receiving it during surgery. That's wonderful. We will link to that information in this program as well. So thank you for sharing that. That's awesome. How do we make these programs more fully embraced by patients and providers across the world? we have to get a lot of players on board, not just the patients and the families, but literally every single type of clinician that is in their care path. So the physicians, the nurses, people that are at the bedside, even the people that schedule the appointments because they're sending a message to these patients. And culture change is not quick and easy. So I think we've learned, Dr. Savage and I have learned with the time that we've put into this, that persistence is key. And also being able to take breaths and to share the experiences that really, really are informing us. I mean, I can't argue with the patient comments that we get about how, you know, my gosh, this relaxation exercise, I felt like your voice was with me at the bedside. I mean, that's just so powerful. Patients are embracing these skills, they are really feeling supported and it's making a difference. Well, and getting the results can help drive that cultural shift. The results are undeniable. Yes. I think that can go a long way. And so that's part of what we're doing at the National Spine Health Foundation and partnering with you today is to get the word out that there's good news out there and that that can be found and patients can ask for these things and can identify sources to help them get through. And so all of us working together can make that cultural change happen that we were doing such a phenomenal job. Yeah, I hope so. This has been a fascinating discussion about treating people who suffer with chronic and short-term low back pain. You've covered lots of topics from surgery to non-surgical interventions to pain and pain management, living with pain and being able to eliminate the pain. As we close out our discussion today, I'd like to ask our panels to give us maybe one sort of closing pearl face up.

SPEAKER_00 36:07

Yeah, I think from my standpoint, the education, the counseling about patients is the most important thing. Regardless of whether or not they would benefit from surgery or not benefit from surgery, really what patients need to know and want to know is, what can I do to be better? A lot of times with low back pain, as we talked about before, it's incredibly common. It's not going anywhere, unfortunately. They will continue to be a big problem. Most of the time, they can be successfully treated without surgery. It's just us educating the patients about how we can treat them, what the options are from a physical standpoint, from a mental standpoint, kind of empowering them.

SPEAKER_01 36:43

Empowerment is so important. I would say... Listen to the patients, you know, really stop and listen to their story and what they're saying, because you can learn quite a lot from that. And just that, you know, pain is a whole person problem. It's not just my back hurts. It affects a lot of areas of one's life. And so I think as much as we can do to continue to move the needle towards looking at every person when pain as needing a person approach, the better off our patients are going to be. Yeah. That's beautiful. I love that. I'm so grateful to Dr. Davin and Dr. Savage for joining us on the panel today to talk about this complicated problem of back pain and dealing with pain, managing pain. potentially living the pain. The National Spine Health Foundation is here to empower you with tools and resources to learn more about your journey. And as professionals have told us today, every person's journey is unique and there's no cookie cutter approach. So you've got to find out what is the right treatment and the right journey for you. And we're here to provide those tools for you. So I want to thank Dr. Savage. I want to thank Dr. Davin. I want to thank the Lombard Spine Research Society for supporting this initiative, and we invite you to explore our resources at spineyouth.org. Thank you for watching.