Chronic pain is a common problem. 70 to 85% of the population experiences back pain at some point in their lives and it costs the United States an estimated 100-200 billion dollars a year.
For pain to be chronic, it lasts for longer than 3 months and usually follows a known injury or cause. Chronic pain is a disease in itself and can have physical, psychological, social and economic effects.
Chronic back pain can be nociceptive, which arises from a tissue injury like arthritis or post surgical pain. Pain can also be neuropathic, which is a primary lesion in the nervous system, described by a burning, tingling, shooting and electric feeling. Examples of neuropathic pain are diabetic neuropathy, complex regional pain syndrome and post herpetic neuralgia.
Some known chronic back pain conditions are disc protrusion or herniation, facet joint syndrome, Sacroiliac joint syndrome, discogenic pain syndrome, spinal stenosis, musculoskeletal and failed back syndrome.
Therapeutic treatments include exercise, meditation and relaxation, over-the-counter or adjuvant drugs, acupuncture, physical and aquatic therapy, cognitive & behavioral therapies as well as pain interventions.
Here are a few examples of interventional pain treatments:
- Epidural Steroid Injections (ESI) treats herniated discs, lower back radiculopathy (compressed nerves), lower back spinal stenosis and post laminectomy syndrome. Steroid injections may be repeated as needed in conjunction with physical therapy and medications.
- Lower back or cervical facet blocks and radiofrequency ablation (RFA) treat arthritis of the facet joints when dealing with low back pain and neck pain.
- Sacroiliac Joint injection: for buttock pain related to sacroiliac joint dysfunction
- Spinal cord stimulation manages failed back syndrome, complex regional pain syndrome (CRPS) and other neuropathic conditions. This is used when conservative medical management and blocks fail.
- Kyphoplasty treats vertebral compression fractures, which is common with osteoporotic patients who have taken a fall. The goal of kyphoplasty is to restore vertebral height and immediate improvement of the pain.
- Botox injections can treat migraine headaches, cervical dystonia and muscle spasms.
When thinking about a long-term cure for chronic back pain, the new consensus is to minimize the use opioid medications. Opioid medications are not the answer and can lead to addiction and tolerance. Opioid medications should be used for short-term use after surgery, for malignant cases and for short-term in conjunction with physical therapy, interventions and conditioning. Non-opioid strategies such as injections, physical therapy, neuromodulating medications, anti-inflammatory medications and muscle relaxants are tried first.
If you are suffering from any of these conditions, make an appointment with a pain management physician to find out what treatment is best for you.