Pictured above: Patient Derik Breidenbach, left, and Salar Deldar, MD
Wielding a heavy chainsaw and bustin’ moves like a breakdancer at the Paris Olympics, Derik Breidenbach was trying to get through a Saturday overtime shift as quickly as possible.
“We were retrofitting a fence,” says Breidenbach, a supervisor for the U.S. Department of Defense. “And I was pushing my body. I was in awkward positions, and my body was telling me, ‘This is uncomfortable,’ but I was so focused on trying to finish.”
Then, it happened: a sharp, searing pain in his lower back that literally floored the 41-year-old.
“I had to physically lay down on the ground,” he says.
As the adrenaline and shock wore off, his back got worse; 12 hours later, he couldn’t walk.
“I’ve been in construction my whole life,” says Breidenbach, now 50. “But this was pain I’ve never felt. You can’t power through it. Coughing, laughing — both a no-go. And it never goes away.”
He Googled pain management and back injury doctors. Up popped Salar Deldar, MD, a Montage Health pain medicine and rehabilitation specialist and founder of Pacific Rehabilitation & Pain in Monterey. Breidenbach hobbled into Deldar’s office.
An MRI revealed devastating news: The discs between his L3 and L4 vertebrae were severely damaged and putting pressure on his spinal nerves, causing numbness and weakness in his leg. If he didn’t act fast, his symptoms might have been permanent.
Translation? Major spine surgery. Through the stomach. With no guarantee of success. But Breidenbach was set on avoiding surgery. He was willing to try anything else, even though it was a major gamble.
Holistic pain management
I attribute my ability to avoid surgery to Dr. Deldar and his willingness to support my journey and let me fix myself.
— Derik Breidenbach, patient
Deldar opened his toolbox of non-surgical options and pulled out an epidural steroid injection paired with physical therapy and, for a brief time, non-opioid medication. He also suggested alternative treatments like yoga, acupuncture, and meditation.
For 18 months, Breidenbach worked hard to avoid surgery. He went to physical therapy even on days when movement felt impossible. He woke up every morning at 4:30 to unroll the yoga mat. He had acupuncture, letting thin needles do the work instead of a scalpel. And when the pain felt as mental as it did physical, mindfulness and meditation helped him turn inward, sit still, and breathe deeply.
There were days when he felt hopeless. But slowly, the routine took hold. Acupuncture started easing the nerve pain. Yoga improved his flexibility. Meditation helped calm the storm in his head. And one day, he realized he wasn’t thinking about pain anymore.
“I attribute my ability to avoid surgery to Dr. Deldar,” Breidenbach says, “and his willingness to support my journey and let me fix myself. Now we’re good friends, I know his wife and kids, and I’m at his house from time to time.”
And when he visits, Breidenbach proudly strides — pretty much pain-free — through the front door.
A safer, smarter approach to pain management
“. . . we prioritize more holistic ways of controlling someone’s pain. And if they do need an opioid, it’s always prescribed at the lowest dose and for the shortest duration.”
— Casey Grover, MD, addiction medicine and emergency medicine, Montage Health
Breidenbach’s story reflects a modern approach to pain care that avoids opioids whenever possible, a philosophy at the heart of Montage Health’s Prescribe Safe program.
Co-founded by Montage Health addiction medicine and emergency medicine specialists Casey Grover, MD, and Reb Close, MD, Prescribe Safe is a countywide collaboration funded by community support through Montage Health Foundation that promotes safe pain management and opioid-prescribing practices, reduces overdoses, and addresses substance misuse through education.
“If you had back pain 15 years ago,” Grover says, “someone might say, ‘Here’s a prescription for an opioid,’ and off you go. We realized that’s not the best medicine. Now we prioritize more holistic ways of controlling someone’s pain. And if they do need an opioid, it’s always prescribed at the lowest dose and for the shortest duration.”
Accessing pain management care
Treatment for pain usually starts with a primary care provider, who can then provide a referral to a specialist for conditions like:
- Back, neck, shoulder, and joint pain (including arthritis)
- Cancer-related pain
- Fibromyalgia
- Migraines and headaches
- Nerve pain
- Pelvic pain
- Post-surgical pain
- Work and sports injuries
“Patients need to make a plan for their pain with their doctor,” Grover says. “People who don’t have a plan end up in the emergency department.”
With a plan and guidance from experts, patients like Breidenbach aren’t just managing pain. They’re getting their lives back.
Explore pain management
Nonsurgical, non-opioid pain management
Acupuncture: Thin needles help stimulate nerves and ease chronic pain, especially in the back, neck, and joints.
Chiropractic care: Hands-on spinal and joint adjustments can reduce pressure and improve mobility.
Cryotherapy and heat therapy: Whether it’s ice or heat, temperature-based treatments can calm inflammation and soothe sore muscles.
Electrical stimulation: Gentle pulses from a TENS (transcutaneous electric nerve stimulation) unit disrupt pain signals before they reach the brain.
Massage therapy: From knots to nagging pain, therapeutic massage eases tension and improves circulation.
Neurofeedback: Shows brain activity in real time to help you learn to control your pain response.
Physical and occupational therapy: Targeted exercises help restore strength, mobility, and the ability to do everyday activities.
When you need something more
Hyaluronic acid injections: Think of it as WD-40 for your joints.
Joint injections: Steroids and anesthetics are delivered right to your knee, hip, spine, or other problem area.
Nerve blocks: Fast-acting relief for acute pain by temporarily “turning off” pain-carrying nerves.
Radiofrequency ablation: Heats nerves to silence their pain signals, providing longer-term relief for chronic conditions.
Spinal or peripheral nerve stimulators: A small device implanted under the skin uses mild electrical pulses to block pain, like noise-canceling headphones for your nervous system.
