Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Medication treatment options depend on the precise diagnosis of the low back pain. Your doctor will decide which medication, if any, is best for you based on your medical history, allergies, and other medications you may be taking.
Nonsteroidal anti-inflammatory medications (NSAIDs) are the mainstay of medical treatment for the relief of back pain. Ibuprofen, naproxen, ketoprofen, and many others are available. No particular NSAID has been shown
to be more effective for the control of pain than another. However, your
doctor may switch you from one NSAID to another to find one that works best
COX-2 inhibitors, such as celecoxib (Celebrex), are more selective members of NSAIDs. Although increased cost can be a negative factor, the incidence of costly and potentially fatal bleeding in the gastrointestinal tract is clearly less with COX-2 inhibitors than with traditional NSAIDs. Long-term safety (possible increased risk for heart attack or stroke) is currently
being evaluated for COX-2 inhibitors and NSAIDs.
Acetaminophen is considered effective for treating acute pain as well. NSAIDs do have a number of potential side effects, including gastric irritation
and kidney damage, with long-term use.
Muscle relaxants: Muscle spasm is not
universally accepted as a cause of back pain, and most relaxants have no
effect on muscle spasm. Muscle relaxants may be more effective than a placebo
pill) in treating back pain, but none has been shown to be superior to NSAIDs.
No additional benefit is gained by using muscle relaxants in combination with
NSAIDs over using NSAIDs alone. Muscle relaxants cause drowsiness in up to 30%
of people taking them. Their use is not routinely recommended.
Opioid analgesics: These drugs are considered an option for pain control in acute back pain. The use of these medications is associated with serious side effects, including dependence, sedation, decreased reaction time, nausea, and clouded judgment. One of the most troublesome side effects is constipation. This
occurs in a large percentage of people taking this type of medication for more
than a few days. A few studies support their short-term use for temporary pain
relief. Their use, however, does not speed recovery.
Steroids: Oral steroids can be of benefit in treating acute sciatica. Steroid injections into the epidural space have
not been found to decrease duration of symptoms or improve function and are
not currently recommended for the treatment of acute back pain without
sciatica. Benefit in chronic pain with sciatica remains controversial.
Injections into the posterior joint spaces, the facets, may be beneficial for
people with pain associated with sciatica. Trigger point injections have not
been proven helpful in acute back pain. Trigger point injections with a
steroid and a local anesthetic may be helpful in chronic back pain. Their use remains controversial.