Back Pain/Spine Pain/Low Back Pain

Back pain is a disease of modern times. Most people have low back pain at some point of time. Mostly people who experience lower back pain for first time get better in 2-6weeks. However chronic back pain or recurrent back pain requires special management.

Reason for Back Pain

1. Wrong posture.
2. Wear & tear of spine called degeneration.
3. Prolonged sitting in one place without movement.
4. Injuries to spine.
5. Picking heavy objects causing a jerk to the spine.

Symptoms of Back Pain

1. Pain in low back.
2. Pain in the buttocks.
3. Pain in the hips.
4. Pain going from back through the buttocks, thigh, and legs to the feet.
5. Tingling numbness in legs.
6. Weakness in the legs.
7. Inability to walk, stand for long duration, sit or turn in bed.
8. Cramps in the calf.
9. Back pain persisting after surgery.

Low back pain is one of the most common causes of patient disability and suffering. The cause of pain depends on the diagnosis of the structure causing the pain (pain generator).

Back Pain can be generated due to –

• Vertebral bodies
• Facet joints
• Spinal Nerves
• Ligaments
• Intervetebral discs
• Muscles
• Fascia
• Spinal cord
• Connective tissue layers

Primary Causes of Back Pain

1. Acute and Chronic Disc protrusion or prolapse with Radiculopathy (disc slipping back onto the nerve & compressing it to cause pain shooting down the leg). It is also called Sciatica.
2. Facet joint pain (Facet joint arthritis).
3. Spondylolysis.
4. Spondylolisthesis (sliding of one vertebra over another vertebra).
5. Lumbar canal stenosis (hard bones and firm ligaments of vertebral canal narrowing onto the soft spinal cord).
6. Sacroiliac joint pain.
7. Failed Back Surgery Syndrome.
8. Sports Injuries- Usually pains from the muscles tendons and ligaments.
9. Any muscular pain in back and lower limb – e.g. Pain from Pyriformis syndrome.

All these conditions produce a tremendous muscle spasm on either side of the spine. Most spine pains are a direct result of this spasm.

Incorrect posture is a major cause of back pain. It puts a lot of load on the spine. The areas particularly stressed are neck, the thoracolumbar junction and the lumbar region, where the load is maximum. Modern lifestyle adds to the problem. Lack of back exercise, prolonged sitting especially people with desk jobs, sitting on soft sofas in front of TV etc aggravates back pain further. Nature has designed our body well. Hence the body tolerates a lot of abuse before it expresses its distress by way of pain. By the time pain is felt considerable damage is done to the spine. This can be reversed in most cases with the help of well-planned exercises, Physical therapy and IMS.

But if there is presence of a disc prolapse (slipped disc) or a small tear in the disc then interventional pain procedures may be necessary to reverse the damage.

Diagnosis of Back Pain

1. Diagnosis of the exact location of back pain is done with help of X rays, CT scans, MRI.
2. Medical history of the patient is studied.
3. Thorough clinical examination.

Lower Back Pain Treatment

We offer a complete rehabilitation package for low back pain. The treatment conpreventive pain management to comprehensive back pain treatment strategies that include correct diagnosis and comprehensive treatment as follows.

1. Medications.

2. Interventional procedures like:
   Transforaminal epidural injection of local anaesthetic (steroid methylprednisolone or triamcinolone). This injection reduces the irritation of the nerve root by the disc.
3. Facet joint injection- To reduce pain coming from facet joints due to arthritis.
4. Radiofrequency ablation of medial branch nerves supplying facet joints for pain coming from facet joints.
5. Sacroiliac joint injections- for Sacroilitis which can cause low back pain.
6. Caudal epidural injections.

3. Intramuscular stimulation (IMS). Whatever may be the pain generator (disc facet etc), muscle spasm is always associated with it. The muscles go into spasm with any insult which is initially painless and later becomes a painful spasm. These spasm can increase the nerve irritation.

IMS of the muscles of back and legs has the potential to completely resolve this problem of paraspinal muscle spasm.

4. Physical therapy: Physiotherapy plays an important role in pain management. It is an essential adjunct to the nerve block and IMS. After pain is relieved, physiotherapy will help in strengthening back muscles to have a long term pain relief.

5. Trigger injections, Botox injections for muscles and targeted physical therapy. If the result of these is not satisfactory then advanced interventions like spinal cord stimulator or intrathecal pump are available.