By Qi Zhang, MD
Back pain is among the top five most common reasons people visit their primary care doctors. It costs millions of dollars every year in missed work, medical care, and medication. Back pain is often temporary and resolves in time with rest, physical therapy, and strengthening exercise. However, when the pain is persistent, follow-up with a pain management specialist may help you heal and enable you to resume your normal activities.
What are the most common causes of back pain?
The five most common causes of persistent back pain we treat at the Ithaca Center for Pain Management relate to structures in and adjacent to the spine and include facet joint inflammation, stenosis, herniated disks, spondylolysis, and sacroiliac joint pain.
- The facets are the joints that sit between the vertebrae in the spine and connect them to each other, providing flexibility and smooth movement. If you engage in too much physical work (heavy lifting, active labor, construction work) or too much exaggerated or repetitive motion (as many athletes do when working out), you run the risk of inflaming the facet joints. This can lead to degeneration of the joint and back pain.
- Stenosis is a narrowing of the spinal canal that occurs with aging. It causes pressure on the spinal cord and nerves, leading to inflammation, low back pain, and leg pain.
- Spondylolysis, a condition in which the vertebrae start to slip out of alignment, causes tightening in the canal space and pain.
- Gel-like discs provide a cushion between the vertebrae in the spine. When these discs are damaged, they can bulge out and press on the nerve root, causing pain in the back and numbness in the affected leg.
- The sacroiliac (SI) joint lies at the bottom of the spine, connecting the spine to the pelvis. Inflammation of the SI joint, which is common among women, can cause pain in the back and hip.
How are these types of back pain treated?
Treatment is recommended based on the specific cause of your pain. At the Ithaca Center for Pain Management we use a number of different approaches to treat chronic pain. However, many of the most common causes of back pain respond very well to image-guided injections that allow us to deliver medication directly to the source of the pain. The goal is to reduce inflammation, which allows the condition to resolve.
Doesn’t the injection hurt?
All of the injections we administer are performed under fluoroscopic or ultrasound guidance, which enables us to see all of the anatomy very clearly in real time. Patients typically receive two injections: one to numb the area and another to administer the medication. Most patients tell us that the numbing injection is no worse than getting a flu shot. What they feel during the subsequent steroid injection is some pressure as the healing medication enters the small space of the affected joint, whether it is a facet joint, the SI joint, or a space among the vertebrae. We also administer epidural steroid injections for nerve pain in the leg or back related to spinal stenosis.
What about side effects?
Steroid injections do not have the side effects of oral medications and they work much faster. The treatment is short-term and more cost effective in terms of pain relief and return to normal activity.
What other kinds of pain do you treat in this way?
We treat axial back pain that emanates directly from the spine and is not caused by inflamed muscles or joints. We also treat chronic regional pain syndrome, with is a rare but debilitating nerve pain condition often secondary to minor trauma. We see patients with chronic pain from joint inflammation in shoulders, hip joints, and hip bursa. Patients suffering with nerve pain from neuralgias of various causes can also gain relief from injections. Additionally we will so0n be offering radio frequency ablation to numb chronically irritated nerves.
If you are suffering with chronic pain, consider asking your physician for a referral to a pain management specialist. We know that the notion of an injection intimidates some people and keeps them from seeking help. However, once you undergo it you will realize there is minimal risk and that it can provide significant relief from discomfort in a short period of time,
Dr. Zhang is board certified in anesthesia and specializes in pain management. She serves on the medical staff of Cayuga Medical Center where she divides her time between anesthesia and the Ithaca Center for Pain Management.