Chronic back pain is an all too 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 considered chronic, it typically persists for more than 3 months and usually follows a known injury or cause. Chronic pain is a disease 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 treatment of back pain should be centered around physical exercise, as well as physical and aquatic therapy. Treatment can be supplemented with other options such as over-the-counter or adjuvant pain medications, meditation and relaxation, acupuncture, cognitive & behavioral therapies, as well as pain interventions.
Here are a few examples of interventional pain treatments:
- Epidural Steroid Injection (ESI) treats herniated discs, lower back radiculopathy (compressed nerves), lower back spinal stenosis. 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 other interventions fail.
- Kyphoplasty treats vertebral compression fractures, which are common with osteoporotic patients who have taken a fall. The goal of kyphoplasty is to restore vertebral height and provide immediate improvement of the pain to help restore mobility and function.
- Botox injections can treat migraine headaches, cervical dystonia and muscle spasms.
When thinking about a long-term treatment for chronic back pain, the new consensus is to minimize the use of opioid medications. Opioid medications are not the answer for chronic pain and can lead to addiction and tolerance. Opioid medications should be used for short-term use after surgery, for pain related to cancer, and for short-term relief in conjunction with physical therapy, interventions and exercise. Non-opioid strategies such as injections, physical therapy, neuromodulating medications, anti-inflammatory medications and muscle relaxants should be utilized first.