Back pain affects as many as 4 out of 5 Americans, and relief can be elusive. That’s because it may be caused by multiple overlapping factors that cannot always be visualized on a scan. On the flipside, the scan of a healthy individual may be riddled with spinal abnormalities, none of which require treatment.
Patricia Zheng, MD, helps direct the UCSF Non-Operative Spine Program, which provides first-line care for adults and teens 16 and over with spinal pain. The program helps to triage patients, including those who need surgical consultations. For others, the objective is to find the least invasive way to manage their pain.
Q: How do you reduce your risks for back pain at work?
A: When I’m not in clinic, I sit for long periods. So, I like to remind myself to get up and grab a cup of water every hour or so because prolonged sitting puts pressure on the spinal discs. On clinic days, I’ll make sure that the room computer is set up appropriately for my height to promote good posture.
Q: Do you use a height-adjustable sit-stand desk at work?
A: I do use them, but I haven’t seen any rigorous studies that have proven they help. Large, randomized studies comparing back pain in people who use a sit-stand desk with those who don’t are very difficult to do because everyone’s back pain is unique.
I think you could have the best possible ergonomic set-up in the office, but you can still get back pain due to stress on certain discs if you aren’t moving for prolonged periods. I tell my patients with desk jobs to take frequent breaks, stretch, and go for a walk. And to engage in physical activity when they can.
Q: Does exercise help back pain?
A: I think it’s important to stay active. I can’t emphasize that enough. But I’m not someone who hits the gym first thing every morning. I try to do a Pilates/light lifting or aerobics class five days a week, switching it up so I can work my muscles in different ways. But I’m not perfect; when life gets busy, I slack off.
Q: Can exercise worsen back pain?
A: If a patient is having lots of pain, exercising aggressively won’t help. There’s a 1995 study at divided patients with chronic back pain into groups. One was assigned to bedrest, the second was instructed to do intensive exercises every other waking hour, and the third to continue their regular daily activities as tolerated. It was this third group that listened to their bodies that made the most rapid recovery.
Q: What if a patient’s back pain is due to an injury?
A: I may play a more active role in encouraging my patients to move if they are reporting prolonged pain after an injury has healed and they are afraid to resume regular activities. The problem is, if you don’t move, you get deconditioned. That can make you more susceptible to future injuries.
I team up with a physical therapist to understand a patient’s pain experience. We ease the patient into exercises that will improve their flexibility and range of motion, based on their tolerance level. We will work with massage therapists, acupuncturists, and chiropractors if that’s something the patient requests.
Q: Some studies show that eating an anti-inflammatory diet eases chronic pain. Is that something you’ve tried?
A: I’ve had patients who have reported that eliminating certain foods and beverages has eased back pain and some preliminary research suggests that an anti-inflammatory diet can help with pain in general. That means cutting out the fun stuff: red meat, sweets, alcohol. I try to eat a balanced diet, but for me personally, I love sweets. I’m not going to pass on the dessert!
Q: Are there any surprising causes of back pain?
A: In a 2024 study, we identified smoking, alcohol, obesity, sleep disturbance, and depression as risk factors for chronic back pain. I think some patients are surprised that depression, which may be associated with sleep disturbances, is linked to back pain. I try to be consistent with my own sleep schedule and aim for about 7 ½ hours’ sleep. My phone warns me when it’s my bedtime.
Pain may be amplified in patients with depression, so I often recommend that patients seek out a psychologist if they are persistently feeling down. Talk therapy and antidepressants can be helpful for people with sensitized pain. Studies show that the neurotransmitters that play a role in depression and anxiety are also involved in the way we process pain, so taking an antidepressant may dampen the nervous system’s overreaction to pain.
Q: What should patients consider before electing to have surgery?
A: Unless there’s a nerve injury or instability requiring urgent surgery, at UCSF, we try non-operative options first. We provide a stepwise approach starting with lifestyle modifications and physical therapy.
Patients with conditions like sciatica may benefit from steroid injections, which can provide relief for weeks or months. Nerve-burning procedures can address pain in the facet joints that connect the vertebrae to each other. There’s also a newer procedure called Intracept that targets nerves deep within the vertebrae to help with pain from inflammation around discs. By burning these small nerves, pain signals to the brain are disrupted.
