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Low Back Pain?

Causes and Cures Can be IdentIfIed

The medical community has long upheld the notion that low back pain is mysterious and can’t be diagnosed. This belief can be traced to a 1966 paper published by two British general practitioners. The source of chronic low back pain can be identified, however, in 90 percent of those affected. Over the last 46 years, the advent of advanced imaging and development of x-ray guided, diagnostic spine injections has allowed us to determine more accurately the source of painful symptoms in order to treat them.

The most common cause of chronic low back pain is a degenerated intervertebral disc. These discs develop an internal tear that does not heal completely. The body’s attempt to heal the tear incites inflammatory reactions and leads to degeneration of the disc marked by loss of cells. The tear itself becomes innervated, or supplied with nerves, and then the native inflammation sensitizes the exposed nerve endings. As we engage in daily activities, our discs bear loads from these activities and the muscles activating around them. These activities can trigger low back pain symptoms reducing level of function and quality of life.

Rather than a disc, certain joints serve as the source of low back pain in older adults. A painful facet joint (small joints positioned behind and toward the sides of the discs) or sacroiliac joint (larger joint on both sides of the backside of the pelvis) becomes more common in those over age 55 to 60. As it turns out, women tend to have painful joints more often than men. We’re not entirely sure if this is due partially to the anatomical differences between genders or changes to the pelvis because of endocrinologic differences.

Once the specific source of low back pain is identified, we can then prescribe definitive treatments. Sometimes epidural steroid injections can help a painful disc. The objective here is to use a target-specific injection technique to place the steroid around the back of the disc where the inflamed tears reside. Similarly, injecting steroids into painful sacroiliac joints can reduce symptoms. Sometimes, anywhere from two to four of these injections can be successful at reducing the individual’s low back pain, allowing him or her to progress further in physical therapy. Currently, we can treat painful facet joints by burning the nerves that supply the affected joint. This technique is called a neurotomy and is highly effective in well-selected patients. The key to matching the proper candidate to a procedure is the use of precision, x-ray guided diagnostic spine injections.

New technologies are being investigated to help stimulate repair of an injured and degenerated disc in instances where injections are not effective. These experimental treatments may become available over the next three to five years. Investigators are evaluating the effects of injecting protein growth factors, stem cells, and tissue scaffolds into degenerative discs. These investigations are FDA-regulated trials not currently available on the market.

Over the past 45 years, we have learned how to diagnose more accurately the source of chronic low back pain. We have also learned to refine treatment options for low back pain sufferers. The horizon holds promise in the form of reparative medications that may be able to regenerate certain spine tissues when injected into them. If you are suffering from chronic low back pain, odds are a specialist can figure out why you’re hurting and offer reasonable treatments to reduce your symptoms.

Michael DePalma, MD, is president and medical director of iSpine Physicians where he practices interventional spine care.
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