Questions Worth Asking

By Ann E. Butenas

Dr. C. Lan Fotopoulos reveals the critical questions patients forget to ask about back pain, and provides the answers that could change everything.

We’ve all been there: you leave the doctor’s office and suddenly remember the question you really wanted to ask. Dr. C. Lan Fotopoulos, an interventional physiatrist with Kansas City Orthopedic Alliance, shares the most important questions patients often forget to ask about back and neck pain, along with answers that might change how you approach your own pain management.

How do I know if my back pain is actually serious?

Dr. Fotopoulos emphasizes this should be the first question every patient asks. His years in emergency medicine from 1994 to 2003 taught him to recognize red flags quickly. Patients should seek immediate care for sudden loss of bowel or bladder control, progressive leg weakness, numbness in the saddle region, or pain accompanied by fever and unexplained weight loss. Anyone with a cancer history who develops new back pain should also call their doctor right away.

Severe pain following a fall or accident deserves attention too, especially in older adults with osteoporosis, as it could indicate a compression fracture. Fortunately, what once required weeks of bed rest can now be treated in a 30-minute outpatient procedure through vertebroplasty or kyphoplasty, if indicated for the patient and the issue.

What should I actually try before considering procedures?

Dr. Fotopoulos advocates strongly for a treatment ladder approach. For most mechanical back pain, he recommends starting with physical therapy, appropriate exercises, and anti-inflammatory medications when tolerated. Heat, ice, and maintaining activity, not just bed rest, prove most beneficial. Conservative treatment deserves a fair trial, usually six to eight weeks, before moving to interventional options.

That said, some conditions may warrant earlier intervention. Take sacroiliac joint dysfunction, for example, which affects roughly 30% of lower back pain sufferers. When conservative measures aren’t providing lasting relief, but diagnostic injections temporarily help, it may be time for advanced options like percutaneous sacroiliac fusion or procedures like Intracept, a basivertebral nerve ablation that addresses tiny sensory nerves causing chronic pain.

Will this procedure actually fix my problem or just mask the pain?

This question reveals a common misconception about interventional pain management. The answer depends entirely on the underlying condition. Procedures like vertebroplasty and kyphoplasty for compression fractures actually stabilize the bone structure, fixing the problem rather than masking symptoms. This becomes crucial when considering that patients with one osteoporotic fracture face a five-fold risk of developing another within a year.

For other conditions, the goal centers on interrupting the pain cycle. Traditional radiofrequency ablation disrupts pain signals from arthritic joints, typically providing relief for a year or longer. For painful diabetic neuropathy, spinal cord stimulation interrupts pain signals, with studies showing that at 12 months, 86% of participants report pain relief greater than 50%.

Why does my shoulder hurt when the problem is my neck?

Referred pain patterns confuse many patients. The neck contains nerve roots that travel into the shoulder, arm, and hand. Compression of these nerves in the cervical spine can cause pain anywhere along that pathway. Drawing on his experience as team physician for the Kansas City Royals and as a boxing and mixed martial arts physician, Dr. Fotopoulos notes this diagnostic challenge requires investigating the source of pain rather than just addressing its location.

What questions should I ask before agreeing to any procedure?

Patients should ask about success rates for their specific condition, not just procedures in general. They should understand what happens if the treatment doesn’t work and clarify recovery timelines before moving forward. Asking about a provider’s experience proves equally important, as it’s a fair question that deserves a confident answer.

The Bottom Line

Dr. Fotopoulos believes the best question patients can ask is simply why. His diverse background, from Navy service during Operation Noble Anvil to his current work with the Claycomo Police Department, has reinforced that effective communication matters.

Why am I having this pain? Why this treatment? Why now? When patients understand the reasoning behind recommendations, they make better decisions and maintain more realistic expectations.

For more information on back pain, or to set an appointment with Dr. Fotopoulos please call or visit:

913-319-7678 ext 3109 KCORTHOALLIANCE.COM