Back Pain Management

Targeting the muscles is essential in all kinds of back pain.

Back and Radicular pain (sciatica) limits walking, sitting and standing. It can be relieved by treating various pain generators in nerves and muscles. Back pain is a major clinical and socioeconomic problem and is currently ranked as the single leading cause of years lived with disability worldwide. Pain in the back from neck downwards is called axial pain, lumbago if it is in low back, and pain that goes down from buttocks to the ankle and foot is called radicular pain (Sciatica). The pain may come on as a catch suddenly after some unaccustomed activity or lifting a heavy weight or it might be a chronic pain that starts after standing for a while or on sitting for long periods.

Types of Back Pain:

Low back pain may be classified by duration as acute (pain lasting less than 6 weeks), sub-chronic (6 to 12 weeks), or chronic (more than 12 weeks). The actual cause of back pain (eg infection, disc prolapse) can be determined in only about <20% patients. But in the large majority of patients, >80%, the source of pain is unclear, called the ‘non-specific LBP’ or ‘mechanical LBP’. There is no detectable abnormality that can be detected on X-ray, CT scan or MRI but the patient has undeniable back pain.

Sign and Symptoms:

Back pain is a common symptom. It can be aching , squeezing, burning in nature or shock like. Pain can be localized to the lumbar or lumbosacral area.
It can radiate to the lower limbs. This is called sciatica. Back pain can get aggravated with certain activities like standing, sitting, walking depending on the pain generator.
It can be associated with tingling, numbness or weakness or loss of reflexes in the legs. In case of severe narrowing of the spinal space there can be loss of control of bladder and bowel.

Precaution:

Regular exercise is very important for back health.
Intervertebral disc has no blood supply of its own.
Its nutrition comes from the surrounding tissue fluid which enters it when we do exercises that bend the back forwards and backwards.
Walking is also a good exercise since the left and right sides come into action alternately with each step while running is a high impact exercise that can gradually cause degenerative changes
It is important to know what exercise is beneficial to maintaining back health.

Causes Of Back Pain:

There are various pain generators in the back. Prolapsed discs, vertebral fractures, osteoporosis, degenerated facet joints, Sacroiliac joint, degenerated discs.

Slippage of one vertebra over another (spondylolisthesis) causes narrowing of the space between the two vertebrae and lead to pain.
Lumbar canal stenosis is a common cause of back pain radiating to the legs in old age.
Degenerative disc disease is a common cause of back pain in the young. Mental stress can cause back muscle spasm because the mind and muscle are intimately connected.
The deficiency of vitamin D and Vitamin B12 are associated with chronic pains. Vitamin B12 is responsible for forming the insulating sheath around nerves called myelin (rather similar to the insulating plastic sheath on a copper wire.
Its deficiency will increase the nerve irritability due to lack of proper insulation. Vitamin D3 act as a natural anti-inflammatory agent.

Many patients undergo back surgery to get relief from back pain due to causes like a bulging disc.
After back surgery some patients continue to have pain. Causes of such post back surgery pains could be incomplete correction of cause of pain, recurrence of the problem after surgery, or instability and weakness caused due to the surgical trauma itself.

Treatment for Back Pain:

Mechanical Back pain is the commonest cause of back pain. Targeting the muscles is essential in all kinds of back pain. Ultrasound guided dry needling is a unique method to do so. All the muscles of the back and back of legs are targeted using needles of various lengths under the guidance of ultrasound.

Discogenic pain are treated with injection of steroid transforaminally into the epidural space where the nerve comes out of the spine with the help of real time X-ray. This ensures that the steroid goes into the correct spot to reduce the swelling and inflammation around the nerve so that the pain, shocks, tingling and numbness are all reduced. Use of X-ray and dye increase the accuracy and hence the results are good.

Ozone Discectomy (Ozonucleolysis) is another option for treating recalcitrant discogenic pains is injection of Ozone-Oxygen mixture into the disc. This treatment can avoid disc surgery in selected cases.

Pulsed radiofrequency of the dorsal root ganglion is done for patients with sciatica (radicular pains) using the radiofrequency generator. It decreases the pain carrying signals of the nerve root that is compromised due to a disc bulge, without affecting its function

There are paired facet joints on either side of the spine of the vertebra. These can become arthritic and cause muscle spasm pain. This is treated by an injection into the facet joint for temporary relief. But more often a better treatment is a radiofrequency ablation of the nerve that carry the pain sensation. An electrical current produced by a radiofrequency (RF) generator conveyed through a special insulated needle with an open tip to heat up a small area of nerve. The ablated nerve can no longer carry pain signals from facet joint. RF is a safe and very effective treatment that helps patients with chronic (long-lasting) low-back pain to not only become pain free but also return to active life particularly when its effects are augmented by USGDN.

Platelet rich plasma (PRP) is derived from patients own blood taken in the same sitting. The blood sample is processed and injected into the arthritic facet joints. This PRP is rich in growth factors and halts degeneration of the facet joints.

Back pain due to spondylolysis responds to injection of steroid into the fractured segment to heal it and USGDN to address the muscle spasm. When left untreated it can lead to a sliding of one vertebra over the other giving rise to spondylolisthesis.

Summary:

Back pain has a varied nature, cause and presentation. It needs to be correctly evaluated and the pain generator needs to be identified before treatment is commenced. Because of its recalcitrant nature, patients with Chronic back pain come with signs of depression and anxiety. But with timely treatment , it can be reversed and relieved without major surgical interventions.

Back Pain Management

Types of Back Pain:

Low Back Pain

Mechanical Back pain

Facetogenic back pain

Sign and Symptoms:

Precaution:

Causes Of Back Pain:

Treatment for Back Pain:

Summary:

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