Agree totally, but here’s the challenge…these are the type of people who we actually want to see back…active old people with jacked spines that may benefit from intervention over time. I don’t personally have the luxury where I live to tell people that they are old as **** and they have exceeded their life expectancy, even though I want to say it everyday all the time.
So picklers are valuable to me despite their idiocy
I agree regarding the ones with facet pain that benefit from RFA, or that have moderate symptomatic stenosis.
However, I see quite a few of these with diffuse DDD, no focal modic changes, and no consistent radiculopathy. Beyond PT, weight loss, and abstaining from pickleball, there are no treatments for them.
At least once a month I will see an elderly patient who doesn’t play pickleball but will tell me either of these two histories.
1- their back really hurts for the first 20 minutes of the day, but otherwise they are fine all day and all night, (and they have an updated mattress, have tried sleeping with body pillow)
2- they will have significant axial only spine pain for a day, then they’re fine for 2 weeks, then hurt for 1-2 days, then fine for two weeks. (And they can’t remember or describe doing any particular new or different activity the day before they hurt significantly for those 1-2 days
Those patients I do tell (politely) that they are just old, end of story, and this is normal life in someone’s 80s or 90s.
Sometimes the most important things we can do as physicians are to
1 reassure patients when they have nothing seriously wrong, and
2- politely hint they should “buck up” when they are just being whiny.
pubmed.ncbi.nlm.nih.gov
