It is estimated that 80% of American adults will experience some form of back pain in their lives. For most, this is a transient phenomenon associated with full recovery without significant medical attention. However, a significant portion of patients will have symptoms severe enough to require medical intervention.
Back pain is usually a symptom of disease or injury to the structural components of the back, but it can also be a sign of disease or injury in other parts of the body, sometimes described as referred pain. We can differentiate the cause of back pain based on the anatomic component involved.
Musculoskeletal pain refers to pain originating from the muscles and the skeletons around the spine. Examples of this kind of pain include most athletic injuries and such syndromes as fibromyalgia and myofascial pain.
Skeletal pain can be as a result of noninfectious inflammation of the spine (spondylitis), infections of the spine (osteomyelitis), fractures of the spine such as vertebral compression fractures and/or tumors of the skeletal system.
Back pain can also be generated by the discs. With age, spinal discs lose moisture and get thinner (degenerative disk disease). This can result in herniation or bulging of the discs. The discs can be the primary pain generator, but they can also cause pain by impinging on the spinal cord or nerve roots. Classic sciatica (shooting pain down the back of the legs) is an example of a nerve root impingement syndrome. Degeneration in the spinal discs and joints can cause narrowing of the spinal canal, or spinal stenosis, which can result in pain, weakness or numbness down the legs with standing or walking.
Occasionally spinal stenosis can cause severe impingement of the nerve roots, causing an acute cauda equina syndrome, sometimes associated with loss of bowel/bladder control or severe numbness, weakness, or tingling of the legs. This requires immediate medical attention.
As previously mentioned, referred pain occurs as a result of abnormalities outside the structural components of the back. Common causes include kidney stones and infections and bladder and pelvic infections, and intra-abdominal causes such as pancreatitis, gallstones or vascular aneurysms.
A thorough history and physical is an essential first step to diagnosing back pain. This will often lead to further testing, depending on what your doctor suspects is the cause of your pain. Imaging with MRI and/or CT scanning offers the most detailed imaging. A CT-myelogram is a study in which dye is injected into a spinal canal and a subsequent CT scan is performed – this study details both the skeletal and neural (spinal cord and nerve roots) elements of the spine. However, a CT-myelogram is more invasive than an MRI, and usually only contained when a patient cannot obtain an MRI, or an MRI has too much distortion to provide adequate information. Nerve conduction studies may help to assess nerve involvement and injury.
Treatment of back pain is often conservative and limited to anti-inflammatory medication and physical therapy. Persistent back pain, or back pain associated with weakness or radiating pain, may require further intervention. Surgical intervention is often beneficial, but it is necessary in certain conditions only. Dallas Neurosurgical & Spine employs a conservative approach to all back pain patients. Physical therapy, along with anti-inflammatory medications, muscle relaxants and medicines that reduce nerve irritation are mainstays of treatment plans. They are tailored specifically to a patient’s condition. Once the more conservative treatment modalities have been tried and/or the severity of the symptoms requires further intervention, some of the following pain treatments may be appropriate.
Non-Surgical Interventional Treatments
Lumbar epidural steroid injections
Lumbar epidural steroid injections are employed to treat generalized severe back pain. These may provide transient relief of severe back pain but may also provide prolonged relief depending on the condition being treated.
Nerve root blocks
Nerve root blocks can be used for both therapeutic and diagnostic purposes. These involve injection of medication around nerve roots that have been identified as probable causes of pain.
Facet blocks are often used again for both diagnostic and therapeutic purposes. Facet joints are located within the spine and are often a site of pain as a result of degeneration and injury.