Low back pain is a very common condition that most people experience at some point in their life. It is one of the most common reasons patients see their doctor or miss days at work. Back pain can range in intensity, onset, duration and course. Many factors influence the onset and course of low back pain. Studies have found the incidence of low back pain is highest in the 3^rd decade of life, and overall prevalence increases with age until the 60-65 year age group and then gradually declines¹.

Anatomy:

The vertebral column (backbone) is made up of 33 vertebrae. These vertebrae are then grouped into divisions based on region: 7 cervical (neck), 12 thoracic (upper back), and 5 lumbar (lower back), 5 fused sacral and 4 fused coccygeal (tailbone). A fibrous disc (intervertebral disc) connects each pair of vertebrae. Each vertebral body is connected to the adjacent level by small joints called “facet” joints. These joints provide mobility and range of motion of the vertebral column; finally, thirty-one pairs of spinal nerves are rooted to the spinal column and travel out of through “neuroforamina” – the spaces between the vertebral bodies.

Causes:

Back pain can be caused by many different pathologies. Often, there are multiple etiologies involved. In general, back pain can be divided into “axial” back pain – pain across the low back, and radicular back pain – back pain with radiation down the leg/foot. Axial back pain can be caused by degenerative disc disease, osteoarthritis of the spine, fracture of the vertebral body or muscle sprain. Radicular back pain is often secondary to a nerve or spinal cord problem, such as disc herniation or spinal canal stenosis (narrowing of the spinal canal).

Diagnosis:

Your physician will often start with a physical exam. Often, an x-ray is obtained initially to evaluate for degenerative changes and rule out any acute fractures. If the pain persists > 6 weeks and/or there are neurological symptoms associated with the back pain, an MRI is then ordered to evaluate the nerves, spinal column and discs.

Treatment:

Most back pain is acute and will resolve with time and conservative management. Initial conservative management includes anti-inflammatories, muscle relaxants or nerve pain medication and a trial of physical therapy. If conservative management fails, advanced interventional treatment options may be recommended. Interventional options include epidural steroid injections, radiofrequency ablation, spinal cord stimulation, or vertebral augmentation for acute fractures. The appropriate interventional option depends on the cause of the pain, and a pain physician can help determine the appropriate steps after a thorough evaluation and review of available imaging.

Valley Pain Consultants physicians have received extensive training in Pain Management, and always stay current with all new and up to date through many educational meetings throughout the year. To schedule an appointment, please call (480) 467-2273.

[1]Hoy D, Brooks P, Blyth F, Buchbinder R. The Epidemiology of low back pain. Best Pract Res Clin Rheumatol. 2010 Dec;24(6):769-81. doi: 10.1016/j.berh.2010.10.002. PMID: 21665125.

The first response to a diagnosis of Ankylosing Spondylitis (AS) is usually, “What in the world is that?” Although it’s strange sounding, there are more than 200,000 US cases per year. Unlike typical back pain which is caused by some type of trauma to the spine, AS is a chronic condition caused by inflammation of the vertebrae.

The inflammatory arthritis affects the spine and large joints making it a form of spinal arthritis. In advanced and more severe cases, abnormal bone growth in the spine may cause the joints to fuse together resulting in an inflexible spine reducing mobility. The good news is that it can be treated by a medical professional.

The condition usually begins in early adulthood, in the late teens, and has been more prevalent in men, but women are susceptible to it just the same. However, AS can still develop at any age. It’s been known to be an inherited disease although not everyone with the gene will ever develop it.

Symptoms always include pain and stiffness from the neck down to the lower back. Spondylitis often starts at the sacrum (the lowest part of the spine). Pain in the back and joints are also common along with intermittent flare-ups of spinal pain. It could be mild or severe, and eventually lead to a hunched over posture. Unfortunately, the disease can also affect other ligaments and tendons, as well as the eyes and intestines. Some patients experience vision problems, and inflammation in the knees, ankles, and beneath the heel. Fever, fatigue, and loss of appetite may also occur.

Typical warning signs of the disease are:

• Unexplained lower back pain for no apparent reason
• Unexplained tightness in the chest, pain in heel, and joints
• Pain comes and goes, but significantly is getting worse up the spine
• Temporary relief from over-the-counter medications
• Family history of AS

Nonetheless, early intervention and treatment can help control pain and stiffness, and may reduce or prevent deformity. A physician cannot give a single test to diagnose AS, but an extremely detailed exam and patient history will help determine the diagnosis. The physician may also order imaging tests such as an MRI, or x-ray. Treatment includes medication, physical therapy, and in rare cases surgery. Remember, it’s always important to not ignore symptoms. Make an appointment to see a physician as soon as any signs exist.

Valley Pain Consultant physicians have received extensive training in Pain Management, and stay current with new and up to date procedures throughout the year. To schedule an appointment, please call (480) 467-2273 or complete the contact form.

There is often confusion when diagnosing neck or back pain since many refer to their discomfort as being a pinched nerve or a herniated disc. The diagnosis is often correct because the two conditions are the most common problem of the pain, but they are both different issues that just happen to occur at the same time.

Typically, a herniated disc occurs in the cervical spine (neck) and the lumbar spine (back). Disc pain tends to most often take place in the lower back (disc herniation lumbar) where most weight-bearing and movement in the spine occurs. A pinched nerve is caused by a herniated disc protrusion pressing against the nerve. In most cases, a herniated disc is not painful, it’s the leaking gel substance which it contains that pinches, inflames, and irritates the nearby nerve.

A spine is made of twenty-four bones called vertebrae, but the lumbar (lower back) bears most of the weight of the body. In between each of the five lumbar vertebrae (bones) is a disc which acts like a tough fibrous shock-absorbing pad which prevents the vertebrae from rubbing together. A disc is filled with a gel-like center and if the disc ruptures or bulges (bulging disc), the gel substance escapes and causes irritation to the spinal nerves resulting in inflammation, pressure, and pain. Some may also experience leg pain, numbness, and tingling.

The spine contains many nerves, which branch out and travel to various parts of the body. If a bulging disc herniates, it usually presses on the spinal cord or spinal nerves. These nerves pass through small areas between the vertebrae and the discs, so if a herniated disc presses into the area, it can compress (“pinch”) the nerve which results in the pain associated with the herniated disc.

What Causes A Herniated Disc?

A herniation may develop instantly or gradually over weeks or months. Many factors increase the risk such as lifestyle choices, aging, and poor posture. Obesity, inadequate nutrition and lack of regular exercise, as well as tobacco use, contribute to the condition. As the body ages, biochemical changes can cause the discs to dry out and be less capable to absorb shock from movement. Additionally, body mechanics such as incorrect lifting and twisting combined with daily wear and tear stress the lumbar spine. Rheumatoid arthritis and genetics may also contribute if a family has a history of the problem.

When to seek medical attention for a herniated disc?

It’s important to seek medical attention if one is experiencing numbness, weakness, tingling, and extreme burning, or pain. While an x-ray may be able to rule out acute fractures, usually advanced imaging techniques such as a CT or MRI scan are usually needed to determine the presence, location an extent of disc herniation. Sometimes a myelogram (injection of dye) is needed so the physician can view the problem area with more ease.

How Is Disc Herniation Treated?

Disc herniation is most often initially treated with conservative management including a trial of medication and physical therapy. Medications include anti-inflammatories, muscle relaxants or nerve pain medications. If this fails, a trial of spinal injections can be offered. “Cortisone epidural” injections are the most common injection utilized for disc herniation. This is usually performed by a trained pain physician and is done in the outpatient setting. Epidural cortisone injections include deposition of a combination of steroid with a local anesthetic under x-ray guidance into/near the area of disc herniation. Sometimes, a series of 3 injections must be performed to achieve maximal benefits.

Often and over time, the herniation will shrink, and the pain will subside and perhaps eventually disappear entirely. If patients fail to respond to conservative management and/or cortisone injections, referral to a spine surgeon may be recommended. Patients who continue to have symptoms and are not surgical candidate may be offered advanced interventional pain therapies such as spinal cord stimulation.

Valley Pain Consultant physicians have received extensive training in Pain Management, and stay current with new and up to date procedures throughout the year. To schedule an appointment, please call (480) 467-2273 or complete the contact form.

The spinal column has open spaces that create passageways for the spinal cord and the spinal nerves. However, a serious condition occurs when the spinal column narrows thus putting pressure on the spinal column and nerves. This painful compression of the nerves is known as spinal stenosis.

The pressure that occurs can cause pain, weakness and numbness, and is most common in the cervical and lumbar regions of the spine since the spinal column can narrow at any point from the head to the tailbone, including the center of the spine.

The cause of spinal stenosis is commonly caused by excess growth of the bone around the spinal nerves which is the result of osteoarthritis. It can also result from a dislocation or a fracture of the vertebral bone, or by soft tissue intruding into the spine’s open spaces. Other culprits are herniated discs, tumors, and thickened spinal ligaments which press against the spinal nerves.

Symptoms vary depending on the location and severity. Pain can radiate down the back, arms, and legs, indicating that there is a problem. The development of spinal stenosis can affect a person’s involuntary and voluntary functions, such as breathing, walking, and even bladder and bowel control.

Treatment options may include anti-inflammatory pain relievers, such as ibuprofen and aspirin, muscle relaxants, or other pain relief medications. Physical therapy may also be recommended as stretching and adjusting posture may alleviate some pain and help patients get relief from the discomfort associated with spinal stenosis. However, if these methods are not helping relieve your pain, medical procedures are available from your physician, such as:

• Steroid injections
• Anesthetic nerve blocks
• Vertiflex implant

Surgical options can include decompression surgery (laminectomy) or laminoplasty. These procedures can be helpful for some people with severe pain. Both create more space between the bones which helps reduce inflammation and pain. There are other surgical interventions which may be less aggressive, but not all patients are good candidates.

If you believe you may have spinal stenosis now and are experiencing pain, you should see your physician and get help. In the meantime, you can apply ice the area to reduce inflammation or heat to soothe stiff joints and relax muscles

Valley Pain Consultant physicians have received extensive training in Pain Management, and stay current with new and up to date procedures throughout the year. To schedule an appointment, please call (480) 467-2273 or complete the contact form.

When to seek a pain management physician to relieve the pain.

A common complaint that affects people of all ages is knee pain. Knee pain can be the result of various diseases or injury, or most often the result of normal wear and tear which occurs with aging (this is usually called Osteoarthritis). Osteoarthritis of the knee is one of the leading causes of disability in the United States. It develops slowly and the pain it causes worsens over time. 

The bones that make up your knee usually have a cap of cartilage on their ends. This cartilage helps make sure that your bones move smoothly against each other. The normal knee joint also contains a small amount of fluid called synovial fluid, which is a thick, gel-like substance that cushions the joint and provides lubrication to reduce friction. In osteoarthritis, the surface layer of the cartilage breaks down and wears away, and the synovial fluid loses its ability to lubricate the joint. This combination causes pain and stiffness, limitation of joint motion, and some inflammation in your knees.

Many types of minor knee pain may respond well to self-care measures such as icing, wearing a knee brace, and elevating legs at the end of the day. However, if the pain is preventing you from doing your work or your daily activities, you may require pain management intervention to relieve the pain. Your pain physician will evaluate your knee, may order some x-rays and some blood work to determine what is going on and what is the best treatment for you.

After knowing the cause, there are multiple treatment options:

• Medications: such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy: to strengthen the muscles around the knee joint and decrease the friction.
• Steroid injection: this procedure will decrease the inflammation and make physical therapy and activity easier.
• Visco-supplementation: in this procedure a gel-like fluid called hyaluronic acid will be injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding the joint’s cartilages.
• Genicular nerve block: in this procedure the physician will inject medications near the nerves that transmit the pain signals from your knee and interrupt and block these signals. If you experienced effective pain relief following a nerve block, your physician may recommend genicular nerve ablation.

Our physicians at Valley Pain Consultants will help you and offer a fast, safe and effective treatment. To schedule an appointment, please call (480) 467-2273 or complete the contact form.

Sciatica (sigh-at-eh-kah) is a term used to describe the symptoms of pain such as tingling, numbness, or weakness in the leg. The pain typically begins in the lower back and travels down the buttock and then down the large sciatic nerve in the back of each leg. Although sciatica is not a medical diagnosis, it is a symptom of an underlying medical condition.

Common lower back problems such as a herniated disc, degenerative disc disease, spondylolisthesis, or spinal stenosis often cause sciatica symptoms. Physicians may diagnose a patient with sciatica if they have one or more of the following symptoms:

• Leg pain that is often described as burning, tingling, or numb
• Difficulty moving the leg, foot, and/or toes
• Sharp pain which makes it difficult to stand or walk
• Constant pain on one side of the buttock or leg
• Radiating pain down the leg and possibly into the foot
• Lower back pain

Sciatic pain can vary from infrequent and annoying to constant and debilitating. The sciatic nerve is the largest single nerve in the body and is made up of individual nerve roots which start in the lower back. Symptoms occur when the large nerve is compressed or irritated at or near its point of origin.

The condition will need to be treated if it is severe with ongoing flare-ups of sciatic nerve pain, so it does not worsen over time. It’s best to share all your symptoms with your physician so the best approach can be made to design a treatment program.

Valley Pain Consultant physicians have received extensive training in Pain Management, and stay current with new and up to date procedures throughout the year. To schedule an appointment, please call (480) 467-2273 or complete the contact form.