Introduction:
Spinal pain particularly low back pain is a common & complex problem affecting about 40% to 80% of general population in life time. Also at a particular point of time 14 to 20% suffer from back pain. About one fourth of U.S. adults report low back pain in the past 3 months.
Diagnosis:
Diagnosis is always a problem in neck pain, back pain with or without leg and knee pain. Before availability of diagnostic pain management procedures etiology remained unclear in most situations (85-90%) even with CT/MRI. Diagnostic procedures are major breakthroughs in management of neck or back pain. In diagnostic interventional procedures small amount of local anaesthetic drug is injected at the suspected area of pain and amount of pain relief is noticed. If pain relief is more than 50% then the source of pain is confirmed.
In one prospective evaluation, consecutive adult patients with intractable low back pain (who had failed conservative therapy) of undetermined etiology (by medical history, physical examination, x-ray, CT, MRI, EMG/NCV) had pain from facet joint(s) in 24%, combined lumbar nerve root and facet disease in 24%, combined facet(s) and sacroiliac joint(s) in 4%, lumbar nerve root irritation in 20%, internal disc disorder in 7%, sacroiliac joint in 6%, and sympathetic dystrophy in 2%. No cause was identified in 13% of patients. In another similar study, 40% of the patients were shown to have facet joint pain, 26% discogenic pain, 2% sacroiliac joint pain, 13% segmental dural/ nerve root pain and no cause was identified in 19% of the patients.
Thus diagnostic IPM procedures like facet joint block, provocative discography, epidurogram, selective nerve root block, SI joint block etc. can unmask diagnosis in most situations.
Treatment:
Treatment is normally started with conventional medicines except in some situations. Again in certain conditions operative procedures are suggested directly. But most situations can be handled with medicines and interventional pain management (IPM) procedures.
If conventional therapies are failed, therapeutic IPM procedures are tried. The following are common IPM procedures like: facet joint interventions (intra-articular injections, medial branch blocks, and medial branch neurotomy); sacroiliac joint interventions (including sacroiliac joint blocks, and radiofrequency neurotomy); epidural injections (caudal epidural injections, interlaminar epidural injections, and transforaminal epidural injections); epidural adhesiolysis (percutaneous adhesiolysis, and spinal endoscopic adhesiolysis); intradiscal therapies (percutaneous discectomy, disc decompression, nucleolysis, biacuplasty) and implantable therapies (spinal cord stimulation and intrathecal drug administration systems) give permanent/long-term relief.
Spinal pain particularly low back pain is a common & complex problem affecting about 40% to 80% of general population in life time. Also at a particular point of time 14 to 20% suffer from back pain. About one fourth of U.S. adults report low back pain in the past 3 months.
Diagnosis:
Diagnosis is always a problem in neck pain, back pain with or without leg and knee pain. Before availability of diagnostic pain management procedures etiology remained unclear in most situations (85-90%) even with CT/MRI. Diagnostic procedures are major breakthroughs in management of neck or back pain. In diagnostic interventional procedures small amount of local anaesthetic drug is injected at the suspected area of pain and amount of pain relief is noticed. If pain relief is more than 50% then the source of pain is confirmed.
In one prospective evaluation, consecutive adult patients with intractable low back pain (who had failed conservative therapy) of undetermined etiology (by medical history, physical examination, x-ray, CT, MRI, EMG/NCV) had pain from facet joint(s) in 24%, combined lumbar nerve root and facet disease in 24%, combined facet(s) and sacroiliac joint(s) in 4%, lumbar nerve root irritation in 20%, internal disc disorder in 7%, sacroiliac joint in 6%, and sympathetic dystrophy in 2%. No cause was identified in 13% of patients. In another similar study, 40% of the patients were shown to have facet joint pain, 26% discogenic pain, 2% sacroiliac joint pain, 13% segmental dural/ nerve root pain and no cause was identified in 19% of the patients.
Thus diagnostic IPM procedures like facet joint block, provocative discography, epidurogram, selective nerve root block, SI joint block etc. can unmask diagnosis in most situations.
Thus diagnosis in neck and back pain is done by following methods:
- History of pain
- Clinical examination of the patient
- Investigations: Blood/ X-ray/ CT-scan/ MRI/ EMG & NCV etc.
- Diagnostic Pain Procedures (Injection of Local anaesthetic)
Treatment:
Treatment is normally started with conventional medicines except in some situations. Again in certain conditions operative procedures are suggested directly. But most situations can be handled with medicines and interventional pain management (IPM) procedures.
If conventional therapies are failed, therapeutic IPM procedures are tried. The following are common IPM procedures like: facet joint interventions (intra-articular injections, medial branch blocks, and medial branch neurotomy); sacroiliac joint interventions (including sacroiliac joint blocks, and radiofrequency neurotomy); epidural injections (caudal epidural injections, interlaminar epidural injections, and transforaminal epidural injections); epidural adhesiolysis (percutaneous adhesiolysis, and spinal endoscopic adhesiolysis); intradiscal therapies (percutaneous discectomy, disc decompression, nucleolysis, biacuplasty) and implantable therapies (spinal cord stimulation and intrathecal drug administration systems) give permanent/long-term relief.
If you are a patient of Daradia and suffering from neck or back pain you may report your condition at comments section. You can mention your improvement, deterioration or cure. Don't forget to mention the way we started treatment like: medicines or injections, name of medicines or injection procedure, its doses and other relevant details:
