Back pain is a major issue in our society, impacting a large portion of individuals. The Centers for Disease Control and Prevention (CDC) reports that in 2019, approximately 39% of adults were living with some form of back pain. How can these individuals find the relief they need?
Dr. Mohammad Issa, pain management specialist at Riverside Healthcare, offers helpful information surrounding back pain—including the different types of pain, potential causes, and treatment options.
What Causes Back Pain?
One common condition that causes back pain is osteoarthritis of the spine. This could appear in the joints of the spine, as well as in the discs of the spine. Another cause might be inflammation of the SI joint, which connects the spine to the hip. Any injury to the spine, such as a compression fracture or disc herniation, will instigate pain as well.
Spinal stenosis involves wear and tear and narrowing of the spinal canal, which can arise from thickening of the ligaments in the spine. “It can be caused by arthritis of the joints in the spine, disc herniations, or the combination of all of that together,” states Dr. Issa.
Finally, sciatica occurs when a pinched nerve in the spine results in severe pain that shoots down the leg. “That can be really debilitating,” he adds.
Pain Intervention Strategies
In some cases, back pain resolves with rest, physical therapy, anti-inflammatories, muscle relaxers, and oral steroids. If those strategies don’t provide relief, Dr. Issa considers an interventional procedure such as a medicated injection.
“The most common type of injection I perform is lumbar epidural steroid injection. Not to be confused with the epidural that pregnant ladies get,” he explains. “The goal of is to place medicine in an area where we have a disc bulge that's pushing or irritating a nerve. That's used for sciatica type of pain, or what we call pinched nerve in the back.”
A second type of injection addresses the joints in the spine, which are called facets. These joints can also be treated with a procedure called radiofrequency ablation (RFA). This procedure targets the nerves that live in the joints and “deadens” the pain signal coming from them.
SI joint injections are a third option. “This can help with SI joint pain, mainly in that buttock area to lower back area. Sometimes, it radiates down the legs, so it can mimic sciatica. So, that's another type of injection we can perform, obviously after evaluating the patient and confirming the pain is coming from the SI joint. There are some maneuvers in specific we do in clinic during our visit to confirm the presence of SI joint dysfunction,” notes Dr. Issa.
Additional interventions include a nerve block and spinal cord stimulation. With the latter, Dr. Issa places a wired device into the spine to mask the pain—first with a temporary device to see if the patient achieves pain relief and then a more permanent implant if they respond well.
“We use this in patients who are either not good candidates for spine surgery or patients who have had spine surgery but still have severe pain in the lower back or down their legs.”
What Can Patients Expect?
A patient’s timeline for relief depends on what type of pain they’re experiencing and which intervention is employed. For example, injections that involve a steroid may take a few days to take hold—after the initial pain relief realized from the numbing medication used during the injection procedure.
“Sometimes what patients can experience is an immediate improvement in that pain level. Then, shortly after, eight hours later or so, they would have an increase in the level of pain again. But, the cortisone kicks in within a couple of days or so, and then they get that longer lasting relief,” shares Dr. Issa. “That's our hope, always.”
If you’re living with back pain and conservative treatments have proven ineffective, it’s a smart next step to book an appointment with a specialist like Dr. Issa. Contact your primary care provider or an orthopedic physician to get a referral if needed. Click here for more information about orthopedic care at Riverside.