FAQ’s on Back Pain Treatment in Philadelphia- Acute & Chronic

Back pain is not the same for everyone. Some people only have mild pain whereas others have severe back pain. Some patients have severe pain due to chronic, serious conditions. While around 80 percent of all back pain is short-term (acute), some people experience chronic back pain.

How common is back pain?

It is estimated that around 10 percent of all Americans experience back pain during any given year. In addition, back pain is more common among women who are middle aged or older. According to research studies, the direct medical costs for back pain are $24 billion per year.

What symptoms occur along with back pain?

Back pain is associated with:

  • Weakness or numbness in the legs
  • Pain that radiates down one leg
  • Tingling of the extremities

What are the structures of the back?

The back is composed of muscles attached to the spine, which consists of 24 separate irregular-shaped bones (vertebrae). These bones are separated by discs, which act as shock absorbers. The points where two vertebrae join together are called facet joints. The spinal cord runs through a canal formed by the holes in the vertebra. An injury to any of these structures can cause back pain.

What causes back pain?

Anything that puts pressure on the nerves or muscles of the back will result in pain. Back pain is a symptom of arthritis and other conditions. Back pain occurs from a herniated disc, a bulging disc, degenerative disc disease, spinal arthritis, spinal stenosis, or ankylosing spondylitis.

How is back pain diagnosed?

When you come to the doctor, you will be asked certain questions regarding your history. Additionally, the doctor will take a detailed medical history and conduct a physical examination. The doctor will observe your joints and muscles and ask you to move in different positions. Further assessment of your back condition will be done with laboratory and diagnostic tests.

What diagnostic tests are used to diagnose a back condition?

The doctor may order x-rays of the spine and bony structures of the back. This is done to assess for ankylosing spondylitis, spinal arthritis, and other problems. In addition, magnetic resonance imaging (MRI) scans are used to take detailed pictures and images of the spine. With a myelogram, a special dye is injected into the spinal canal, which is used to diagnose spinal cord tumors and spinal stenosis.

What are the available treatments for back pain?

The treatment of back pain depends on the severity of the condition, the exact diagnosis, and the duration of the symptoms. Options are:

  • Physical therapy – The therapist will develop a special exercise program to help you improve posture, strengthen muscles, and increase flexibility of the spine. Water exercise is also used for people with chronic back pain.
  • Medications – To relax tight muscles, the doctor may prescribe a muscle relaxant (Robaxin or Baclofen). Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to relieve inflammation and pain (ibuprofen, ketoprofen, and naproxen).
  • Medial branch block – The doctor injects the facet joints with a long-acting anesthetic, which is done using x-ray guidance. According to a recent clinical study, this procedure has an efficacy rate of around 85%, with the majority of participants reporting pain relief and functional improvement.
  • Radiofrequency ablation (RFA) – With this procedure, the doctor inserts a small needle into the facet joint near the affected nerves and applies radiofrequency energy. To assure correct needle placement, fluoroscopy is used.
  • Epidural steroid injection (ESI) – A corticosteroid is injected into the epidural space, which lies right past the spinal cord and nerves. According to a recent research report, ESI is 90% effective for back pain.
  • Regenerative medicine – With one form of this therapy, stem cells are injected into the damaged tissue and/or structures. Usually, x-ray guidance is used to assure correct needle placement.

Resources

Jacques L, Jensen T, Rollins J, Burton B, Hakim R, & Miller S (2012). Decision memo for transcutaneous electrical nerve stimulation for chronic low back pain (CAG-00429N). tinyurl.com/ decisionmemoTENS

McLain RF, Kapural L, & Mekhail NA (2005). Epidural steroid therapy for back and legpain: mechanism of action and efficacy. Spine Journal, 5:191-201

Riew KD, Park JB, Cho YS, et al. (2006). Nerve root blocks in the treatment of lumbar radicular pain. A minimum five-year follow-up. J Bone Joint Surg Am, 88(8):1722-1725.