Lower Back Pain

General

Eight of every ten people will seek treatment for back pain during their lifetime. It is the most common reason for visits to the doctor except for the common cold and is the single leading cause of disability across the globe. Most back aches will resolve on their own, but you should seek care for any injury to your back or for pain that has persisted for longer than three days without improvement.

Your spine consists of 24 moveable vertebrae with a shock absorbing pad (spinal disc) between each two vertebrae. At the base of the spinal column lies a triangular bone, called the sacrum, which in reality is 5 additional fused vertebrae. Between each two vertebrae a nerve root branches off the spinal cord and passes out of the spinal column to innervate various body parts as well as to receive feedback from these body parts. On the back side of the spine there are two facet joints that connect each two vertebrae together and allow for movement in the back.

The connection between every two vertebrae in the spine is sometimes referred to as a three joint complex. The two facet joints on the back side of the spine and the disc on the front side of the spine are the three joints. Pain or dysfunction that begins in one of the joints often leads to pain or dysfunction in the others.

Symptoms

Lower back pain may present as minor stiffness and discomfort or can be so excruciating that it requires a visit to the emergency room.

Back pain can also be localized or can radiate pain to other body parts. Chronic back pain may cause compensations in gait, posture, mobility and other factors that may eventually lead to pain in other areas of the back, neck or extremities.

Causes

The low back (lumbar spine) bears more body weight than the rest of the spine and is more susceptible to damage to the soft spinal discs as a result. Obesity is a causative factor for low back pain as excessive body weight loads even more pressure onto the lumbar spine structures. Smokers also have a higher incidence of back pain because of diminished blood flow to spinal structures that can prolong healing times.

Wear and tear of the various spinal structures, trauma, or disease can elicit pain in the back. Because spinal movement is complex with many supporting muscles, ligaments and joints there are many potential generators of pain. In fact, there are 6 structures within the spine with pain receptors that may cause pain if irritated or damaged: nerve roots, facet joint capsules, outer layer of spinal discs, spinal ligaments, cartilage, and spinal muscles.

  Click on any of the following painful back conditions to link to more information: Treatments

Novocur takes pride in taking our time to determine the most accurate cause of your back pain and then providing a custom treatment plan based upon your unique back pain problem. As a result of this priority, you will not see a mid-level provider and then be handed off last minute to the pain doctor, but instead you will receive continuity of pain physician care from beginning to end. Novocur’s style of medical practice is becoming a rarity in our shifting healthcare delivery system, however Novocur will strive to continue to provide this superior level of service. This is one reason Novocur was voted one of the top 3 Pain Management Facilities in Arizona for 2014.

The type of treatment you will receive will depend upon your diagnosis, but could include any of the following services.

  • Facet Injection (medial branch block). For pain that originates in the moveable facet joints and injection of a corticosteroid mixed with an anesthetic around the median branch nerve, which innervates the often painful capsule surrounding the facet joint, can quickly reduce or eliminate pain. Facet Injection can act as a treatment as well as a diagnostic tool to help identify the origin of your pain.
  • Radiofrequency Ablation (RFA). When the median branch nerve to the facet joints are identified as a source of your pain, then RFA can provide longer lasting relief than facet injection. The median branch nerve is heated to 90 degrees Celsius for about 90 seconds. This heat lesion created around the nerve prevents transmission of pain signals for 6-12 months on average.
  • Pharmacological Intervention. NSAIDs, muscle relaxers, neuropathic pain medications and opioid pain medications may be utilized to control pain.
  • SIJ Injection. The sacroiliac joint often mimic back pain. A sacroiliac joint injection bathes a mixture of anti-inflammatory and anesthetic medications into the painful joint and upon the nerves that transmit the pain from the joint to your spinal cord and eventually to your brain. This injection rapidly diminishes inflammation in the joint and around nerve tissue. When the pain cycle is broken, your body’s own healing mechanisms can now be more effective. Physical therapy or chiropractic care are often more valuable once the acute pain is managed.
  • Epidural Injection. An injection of a corticosteroid into the epidural space may be utilized to rapidly diminish pain around painful nerve roots and discs. There are 3 ways to administer epidural medication. Your pain doctor will determine the most effective method based upon your symptoms, prior surgeries, scar tissue issues and prior treatment attempts. The three methods of administration are as follows: Interlaminar Epidural Injection, Transforaminal Epidural Injection and Caudal Epidural Injection.
  • Neuromodulation Therapy. As a last resort treatment, an electrical generator with tiny electrode leads may be implanted into the epidural space over the affected area. This spinal cord stimulator tricks your nervous system into feeling a pleasant vibration sensation instead of pain. This treatment is often tried following failed back surgery. It can also be utilized over the sacrum area for difficult sacroiliac pain.

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