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Back Pain

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Back Pain


Acute Back Pain

The most common and best understood type of pain is acute pain. Acute pain will result when tissue is injured by trauma, surgery, illness, or infection. This type of pain is generally understood and expected. It is typically sharp, shooting, aching, or burning, and it decreases as the tissue heals and the body recovers. This is pain that is “talking to you” and telling you that something is wrong.

The sudden onset of pain in the back can occur after an injury or may appear without a known problem. If the pain is only in the tissues around the spine and does not radiate into the shoulders, arms, or hand, it is less likely to involve pressure on the nerve roots. If the pain is radiating into the limb, then this is more likely to involve pressure on the nerve. The etiology could be strain or tearing of the supporting tissues with intense muscle spasm, a herniation of the disc between the vertebrae, or a fracture of the bony structure of the spine. Initial care will include rest, pain medications, muscle relaxants, and possible epidural steroid injections, with trigger point injections for muscle spasm. The early use of physical therapy is important in many cases.

Chronic Back Pain.

When a particular pain outlasts the normal healing process, it is categorized as chronic pain. Chronic pain symptoms can be caused by a variety of abnormalities in the nervous system. It can be complex, and it is often disabling. Chronic pain can greatly affect a person’s work, personal relationships and self-esteem. The determination of a specific and accurate diagnosis is mandatory for proper treatment.

Chronic back pain is pain experienced longer than 3 to 6 months and might result from the same sources as noted in acute back pain. However, many times the pain may originate from injury to the nerve tissues from chronic degeneration of the spine, or may continue after surgery. Appropriate evaluation might reveal the pain source, and allow specific treatment. The anatomical reasons for pain need to be differentiated from the pain caused by nerve injury which is also known as neuropathic pain.

Lumbar Radiculopathy



Lumbar radiculopathy occurs when a nerve root is irritated in the back and radiates pain into the buttock(s) and or leg(s). When the sciatic nerve is involved it is termed Sciatica. Two nerve roots, one on the right and one on the left, exit in between each bone in the spine (vertebrae) and supply sensation, motor ability, and position sense to a specific area in the body. The nerve roots can become irritated if pressed upon such as when there is a bulging disc pushing against a nerve, narrowing in the spinal cord, or narrowing in the space where the nerve roots exit through the vertebrae. Symptoms typically include back pain that radiates into the leg(s). Pain is described as “pins and needles”, burning, or aching pain that is typically worse when walking. Patients may also complain of numbness or weakness in the legs. Treatment options include physical therapy, non-steroidal anti-inflammatories (NSAIDs), exercise, weight loss, ice, traction, epidural steroid injections, and surgery.

Lumbar Spondylosis



Lumbar Spondylosis is a degenerative condition that occurs with aging and affects the vertebrae and discs. It is a type of arthritis in the back that causes inflammation in the small joints on the side of the vertebrae (called facet joints). When the joints become inflamed or bone spurs (osteophytes) develop, narrowing can occur where the nerve roots exit and pinch the nerves. Symptoms can include back pain that may radiate into the buttock, hip, or leg, weakness or numbness. Treatment options include traction, physical therapy, traction, massage, epidural steroid injections, facet joint injections, medial branch blocks, radiofrequency denervation, and surgery.

Coccydynia



The coccyx is also known as the tailbone that is between the buttocks and the very bottom part of the spine. Pain in this area (Coccydynia) is most often due to inflammation from injury, giving birth, or occurs randomly without any known cause. Symptoms include buttock pain that is worse when sitting and tenderness to the touch. Treatment options include use of a seat cushion when seated, pain medications, non-steroidal anti-inflammatories (NSAIDs), chiropractic adjustments, stretching, physical therapy, and caudal steroid injections.

Degenerative Disc Disease



Degeneration of the intervertebral disc is a condition that results from age-related changes to the discs that serve as cushioning between the vertebrae in the spine. As we get older, the discs become drier, worn down, and thinner which make them provide less support in between the vertebrae. The discs have a tough outer later and a soft inside, similar to a jelly donut, and with age the outer layer can tear (annular tear). The soft material can leak out and irritate the nerve roots. The facet joints can become inflamed and even become loose (subluxation) and bone spurs can develop, causing narrowing in the spinal cord (spinal stenosis). Symptoms can include pain in the neck with possible radiation into the arm or shoulder, neck stiffness, and muscle spasms. Treatment options include exercise, physical therapy, non-steroidal anti-inflammatories (NSAIDs), muscle relaxants, pain medication, heat and ice, epidural steroid injections, and surgery.

Facet Joint Syndrome



Facet joints are a pair of joints on the back of the spine and are prone to arthritis. This is one of the most common causes of back pain. Just as arthritis in a person’s hand can cause enlargement of the joints, the same occurs in the back. When the facet joints enlarge, they can narrow the opening where the nerve roots leave the spinal cord and go out to the body. Symptoms can include neck pain without associated arm pain. The pain is typically described as an ache and centrally located. Treatment options include physical therapy, chiropractic adjustments, medial branch blocks, facet joint injections, and radiofrequency denervation.

Piriformis Syndrome



The piriformis is a muscle in the buttocks that helps with balance, walking, and movement of the hips. Occasionally, the muscle traps the sciatic nerve as it passes through the muscle and down the leg. This typically occurs when the piriformis is frequently stressed which is most common in athletes, specifically runners. Symptoms of this syndrome include pain, “pins and needles,” and/or numbness in the buttocks that may go down the back side of the thigh, typically not extending passed the knee. The pain typically worsens with extended periods of sitting as well as with hip flexion as when walking up stairs. Conservative treatments consist of ice, stretching, anti-inflammatory medications, muscle relaxants, and physical therapy. Steroid injections into the muscle may also provide relief.

Post Laminectomy Syndrome Spinal Stenosis



Post laminectomy syndrome (also known as Failed Back syndrome) is continued neck and or arm pain even after surgery. The cause for the continued pain is varied and could be due to injury to the nerve root during surgery, scar formation after the surgery, changes above or below fusion, and delayed surgery causing significant damage to the nerve root before surgery. Symptoms include neck pain with or without associated arm pain. Treatment options include physical therapy, pain medications, tricyclic anti-depressants, anti-seizure medications, epidural steroid injections, and spinal cord stimulation.

Sacroiliac Joint Pain

The SI joints are where the bottom portion of the spine, the sacrum, connects to two of the bones that make up the pelvis, iliac bones, which lie on each side of the spine.  The SI joints are relatively immobile being held in place by ligaments and support the majority of the weight of the spine so they are frequently stressed.  Chronic stress can lead to arthritis of the SI joints which in turn, causes pain.  The SI joints can also be painful during pregnancy when added stress is applied to them due to the relaxation of the ligaments that help hold the SI joints stable as the body prepares for childbirth as well as the added weight incurred during pregnancy.  Unequal leg lengths may also place added stress on the SI joints causing pain.  Symptoms typically include low back pain that is worsened with standing or walking and may or may not include pain into the thighs or groin.  Treatment includes NSAIDs, physical therapy, chiropractic adjustments, exercise such as yoga or pilates, and steroid injections into the joint. 

Sacroilitis

Sacroilitis is inflammation of either one or both SI joints.  The inflammation can occur due to injury, infection, pregnancy, or arthritis.  The most common cause is arthritis.  Symptoms include low back pain that may radiate into the buttocks, groin, or thigh.  The pain is typically worse after extended periods of standing or going up stairs.  Treatments include ice/heat, pain medication, NSAIDs, muscle relaxants, physical therapy, steroid injections into the SI joint(s), as well as radiofrequency denervation.

Cervical Spinal Stenosis



Spinal stenosis is narrowing in the spine that can be in the central canal, where the spinal cord is located, or where the nerve roots exit from the spinal cord, the neuroforamen. This is most commonly due to degenerative changes such as disc bulges or enlargement of the facet joints from arthritis, bone spurs, thickened ligamentum flavum (ligament that runs in between the vertebrae and spinal cord providing strength to the spine). Symptoms can include pain and/or numbness in the neck with possible radiation into the arms, weakness, numbness, and if severe enough, can cause bladder and bowel difficulty. The pain is worse with activity such as working with the upper extremities, driving, or working over a desk or computer. Treatment options include oral steroids, anti-inflammatory medications like Ibuprofen or Naproxen, anti-seizure medications, pain medications, physical therapy, and epidural steroid injections. In some patients, surgery to open the space is necessary or indicated.

Spondylolisthesis



Spondylolisthesis is when one vertebra is not in correct alignment with the vertebrae either above or below it. When the vertebra is moved forward, it is called anterolisthesis, and retrolisthesis is when the vertebrae moves backwards in comparison to the other vertebrae. This can occur due to injury, a defect in the bone that can be due to a tumor or a disorder you are born with, but is most typically caused by arthritis. Symptoms of spondylolisthesis include low back pain, stiffness of the low back, and possible numbness or weakness in the legs if it causes spinal stenosis. Treatments include non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, epidural steroid injection if it causes spinal stenosis, and possible surgery.