Utah Lower Back Pain & Treatment
What causes lower back pain?
Lower back pain (LBP) is a common musculoskeletal complaint in Utah. It can arise from a number of different ailments. Pain will often be produced from damage or irritation to the structures of the lower back including facet joints, vertebrae, vertebral discs, vertebral ligaments, muscles (of the lower back), spinal cord, peripheral nerves, as well as internal organs. Lower back pain will often resolve itself within a month, but will usually return if the underlying problem is not dealt with.
Diagnosing possible conditions and treatment options
It is very important for a doctor to have a thorough knowledge of the anatomy and physiological function of the spine to correctly evaluate a patient with low back pain. The spine is positioned with one vertebra atop another, creating a flexible support structure that also protects the spinal cord. Some of the conditions that produce pain from the spine include facet joint osteoarthritis, infections, neoplasms, spondylolisthesis, spinal stenosis, vertebral body fractures, and osteoporosis. Some of the techniques that are effective in treating lower back pain include physical therapy, cognitive behavioral therapy, diet, exercise, biofeedback, and other alternative therapies.
Between each of the vertebrae is a disc that acts as a cushion to reduce strain due to impact in the spinal column. Because the discs are soft, they have a tendency to herniate posterior (out of the back of the spine) causing irritation to the adjacent nerves. About ten percent of low back pain complaints are caused by disc disease, which may acutely be from herniation due to trauma or excessive lifting. More commonly, though, back pain is caused by degenerative disc disease, which can lead to spinal stenosis, nerve impingement, worsening facet arthritis, or peripheral nerve irritation. Some of the conditions that can potentially produce chronic pain from discs include: degenerative disc disease, disc protrusion, disc infection, nerve root irritation or compression (sciatica), disc herniation, disc extrusion, facet joint osteoarthritis, and spinal stenosis (the narrowing of the spinal canal). Many of these conditions can be greatly improved with: Facet injection/denervation, Lysis of Adhesions, spinal cord stimulation, epidural steroid injections, epidural infusions, intrathecal pumps, as well as other treatments.
Each vertebra of the spine has associated ligaments to provide strength and mobility to the spine and muscle, which are responsible for the spinal movements. The nerve roots are attached to the spinal cord and innervate the skin, muscles, structures of the back, and the lower extremities. Excessive exercise or lifting will often irritate these muscles and ligaments. Conditions that can cause chronic musculoskeletal pain include Myofascial Pain Syndrome, Ligamentous Tear, Torn Muscle, Ligamentous Strain, and Muscular Strain.
Trigger point injections have proved to be very successful in the alleviation of musculoskeletal pain. Prolotherapy, a therapy specifically targeting ligaments (also known as regenerative injection therapy) has had an oustanding success rate. Other activities that can reduce myofascial pain symptoms include acupuncture, physical therapy, yoga, diet, and exercise.
There are also organs, primarily in the pelvis and abdomen, that produce referred pain. This is often mistaken for back pain. The causes of this pain are often due to obstruction, infection, inflammation, decreased blood supply, enlargement, and/or cancer. When pain signals are sent from the organs to the brain, they follow the same path as spinal pain signals. This is why they are often confused with back pain signals.
Common and uncommon pain
Low back pain has a number of common causes, as well as some less common causes. Some of the common causes include arthritis (auto-immune vs. non auto-immune), herniated discs, strained muscles, spinal stenosis, sciatica, fibromyalgia, vertebral body fractures, and osteoporosis. Less common causes include ankylosing spondylitis, infections, psychological causes, and metastic cancer.
Lower back pain can also be considered acute, which typically comes on quickly and occurs during specific activities. It commonly occurs due to overuse by excessive exercise, motor vehicle accidents, lifting heavy objects, or any other trauma involving the lower back. Low back pain is usually a result of irritation of the muscles and ligaments surrounding the spine. Ruptured discs, vertebral body fractures and spinal cord compression can also be seen acutely with pre-existing cancer, spinal stenosis or osteoporosis. NSAIDs are the most common pharmaceutical route taken for acute low back pain. It is important for a doctor to evaluate low back pain in order to rule out other causes, such as kidney stones, kidney infection, and acute pancreatitis. In some cases (usually in emergencies) a pain specialist will order imaging for immediate evaluation. These cases might include: Acute vertebral compression fractures, acute disc herniation, loss of bowel or bladder control, fever/chills, weakness or paralysis, or spinal cord compression.
Diagnosing chronic pain
Lower lumbar back pain is considered chronic if it persists for 3-6 months. The symptoms are gradual and occur over an extended period of time. Chronic pain is experienced in the back and often down the legs. Some causes of chronic low back pain include: Infections, neoplasms, ankylosing spondylitis, spondylolisthesis, osteoporosis, vertebral body fractures, psychological and emotional factors, poor posture, excessive breast size, central sensitization, nerve root irritation or compression (sciatica), facet joint osteoarthritis, disc extrusion, disc herniation, disc protrusion, degenerative disc disease, fibromyalgia, spinal stenosis (narrowing of the spinal canal), sacroiliac joint disease, and arthritis of the facet joint.
Every type of chronic pain has an associated complication called central sensitization. This happens when the peripheral nervous system (PNS) is inflamed or injured and sends stronger signals through the central nervous system (CNS). Sacroiliac Joint (SIJ) Disease is another common contributor to LBP. The Sacroiliac Joint is located between the spine and pelvis and allows the weight of the upper body to be transferred to the legs. SIJ pain can worsen as a result of sitting for extended periods of time. Twisting motions and certain other movements can cause or aggravate SIJ, as well.
Utah Lower Back Pain Treatment
If pain is severe or persists for longer than 4 weeks, see a pain specialist to learn individualized treatment options. There are several routes that can be taken, and often optimal pain relief will result from a combination of treatments. Some of the options to consider in treating low back pain include:
- Pharmacotherapy- The most effective pharmaceuticals for treating low back pain include NSAIDs (ibuprofen), Acetaminophen (Tylenol), membrane stabilizing drugs, and muscle relaxants.
- Infusion techniques- There are a number of procedures that use infusion techniques. During infusion, a small catheter is inserted through a needle into the epidural space next to the affected nerves. Local anesthetics and other medications are then injected into the epidural space, giving a patient relief that can be dramatic and long lasting.
- Epidural Steroid Injections- As the name implies, ESI involves the injection of steroids into the epidural space inside of the spine. From here, it spreads to other levels and portions of the spine and reduces inflammation and irritation.
- Medial Branch Blocks/Denervation- MBBs are minimally invasive treatments that reduce inflammation and irritation of the facet joint, ultimately relieving pain.
- Lysis of Adhesions- Also known as Racz Procedure, this procedure has been proven effective in the removal of scar tissue in the epidural space of the spine where more conservative options have failed. The procedure is used to treat vertebral body compression fractures, radiculopathy, post-laminectomy syndrome, and disc disease.
- Chiropractic manipulations- A chiropractic adjustment may greatly reduce back pain by correcting nerve transmission. Effectiveness is often increased when chiropractic manipulations are combined with other modalities.
- Massage- A massage can be beneficial in reducing stress and tension that might contribute to pain symptoms. Massage can also help relieve muscle spasm and contractions.
- Nutrition and Exercise- Combined with exercise, a proper diet often reduces the pain associated with sciatica by increasing flexibility and range of motion. This also releases endorphins, which are the body's natural pain reliever.
- Acupuncture- When small needles are inserted into the skin during acupuncture, the body naturally releases endorphins. Acupuncture can also help people relax which decreases tension, stress, and muscle spasms.
- Physical Therapy- Physical therapy can be very helpful by building muscles and reducing pain signals around a degenerated area. Physical therapy works best when combined with other modalities.
- Biofeedback- Biofeedback is a treatment that teaches patients to be more in tune with their body and helps them regulate otherwise involuntary processes (such as heart rate or blood pressure). When a patient is more in tune with their body, it is easier for them to relax which can, in turn, alleviate pain.
- Transcutaneous Electrical Nerve Stimulation (TENS)- TENS works by introducing electrical stimulation through the skin of the affected area. The electrical signals interrupt pain signals, causing a tingling sensation rather than pain.
- Botox- Botox works by paralyzing the nerve ending at the site of injection. Although Botox was originally used for cosmetic purposes, it can also be helpful in pain relief, especially if a patient suffers from whiplash injuries or cervical dystonia. This treatment will reduce pain, and often times increase range of motion within the affected area.
- Trigger Point Injections- These injections are an effective treatment for muscle spasms. The procedure involves the injection of local anesthetic and steroids into a "trigger point," or the origin of the pain.
- Peripheral Nerve Blocks and Ablation- The nerves that are away from the spinal cord are called peripheral nerves. They can often be sources of pain, which can be blocked using local anesthetic. If a block works, an ablation (destruction of nerve endings) is also a possibility for longer-term pain relief.
- Cryotherapy- Similar to an ablation, cryotherapy uses freezing cycles on painful nerves. Electrical stimulation is used to find the correct needle placement.
- Intrathecal Pump implants- An intrathecal pump is implanted into the spine, where it can either continuously deliver medications or be programmed to release a specified amount of medication at specified times. This can produce great relief and reduces side-effects that a patient would experience with oral medications.
- Kyphoplasty and Vertebroplasty- Both of these methods involve injecting acrylic cement into collapsed vertebra, which relieves pain and increases stability of the spine.
- Spinal Cord Stimulation (SCS)- A spinal cord stimulator is an electrical device that is implanted in the body to decrease pain by confusing the spinal cord and brain pain processing centers. A trial SCS will be externally placed in order to test how effective it will be to a particular patient. If pain is relieved during a trial period, a permanent SCS will likely bring great back pain relief.
- Peripheral Nerve Stimulation (PNS)- This treatment is similar to a spinal cord stimulator, Electrodes are placed near affected peripheral nerves instead of directly on the spinal cord.
- Prolotherapy- Also known as Regenerative Injection Therapy, prolotherapy is the technique of injecting irritating substances into painful ligaments or tendons in order to make the body start healing the damaged ligament or tendon.
Surgery is only performed when all conservative treatments are exhausted and little relief has been achieved, or if the exiting nerves of the spine are being severely compressed. Severe compression is characterized by spasticity, loss of sensation, lower extremity weakness, and bowel/bladder incontinence. Invasive, but sometime necessary surgical procedures include: Discectomy, Laminectomy, Spinal Fusion, and Spinal Instrumentation.There are several risks associated with lower back surgery including bleeding, nerve damage, infection, epidural scarring, and prolonged recovery time. Surgery should only be considered after conventional treatments have been tried and have failed.
For more information on how Omega Interventional Pain can help treat your low back pain, please contact us at 801-261-4988 or fill out our contact form.
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