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SPINE AND BACK PAIN MANAGEMENT OF INVASIVE minimally-NON-SURGICAL

SPINE AND BACK PAIN MANAGEMENT OF INVASIVE minimally-NON-SURGICAL

LBP
Dr (Maj) Suranga Pankaj N
MBBS, MD, FIP
interventional pain and spine specialist

Back pain is a problem is often met by all the human beings at least once in their life. This pain, if not taken seriously can be transformed into a deadly disease that can put your life at stake

Some important information about back pain

• Back pain is the complaint most common musculo-skeletal, with potentially devastating consequences.

• 90% of patients with acute low back pain do not require no surgery. Most experts agree that the non-surgical treatment should be tried first.

• Surgery as first-line treatment is indicated only in few cases. These are medical emergencies, like a broken neck or if you have symptoms such that weakness in the legs that gets progressively worse and / or bladder and / or fecal incontinence caused by back problems.

• Incidence of LBP is highest between the ages of 35 and 55.

• The disc is not always the culprit. the small joints of the spine are the source of pain in most patients.

• The pain associated with depression and anxiety in the case of places long-term patients at risk of suicide.

• People who work in sedentary occupations are more likely to be injured than those who drive volumes moderate physical labor.

• Up to 85 percent of people with back pain do not remember a specific incident that brought about their pain.

• early intervention treatments in the management of back pain were found to return to work and patients regular activities more quickly than in the past conservative treatment.

• Early intervention reduces chronic pain and unnecessary treatment and long-term disability.

• Heat and massage therapy can not cure the disease. These do not provide not solutions to long-term back problems. They are mainly used for pain management during the recovery period.

Major causes of back pain

The most common causes of lower back pain are:
• Injury or overuse of muscles, ligaments, facet joints, and sacroiliac joints.
• Pressure on nerve roots into the spinal canal. nerve root compression can be caused by:
o A herniated disc, often brought on by repeated vibration or motion (as when operating machinery or sports, or when lifting badly), or by a sudden heavy stress or pressure in the lower back.
o Osteoarthritis (Degeneration of the joints), which usually develops with age. When osteoarthritis affects the small facet joints of the spine spine, it can cause back pain. Osteoarthritis in other joints such as hips, you may limp or change your way of walking. This can also cause back pain.
O Spondylolysis and spondylolisthesis, vertebra defects that can allow a vertebra slide on each other when aggravated by certain activities.
No spinal stenosis, or narrowing of the spinal canal, which develops usually with age.
No fractures of the vertebrae caused by significant force, like a car accident or bicycle, a blow directly to the spine, or compressing the spine by falling onto the buttocks or head.
No deformities of the spine, including problems curvature such as scoliosis or severe kyphosis.
• Compression fractures. Compression fractures are more common in postmenopausal women osteoporosis, or in men or women after long-term corticosteroid use. In someone with osteoporosis, even a small amount of force exerted on the spine, from a sneeze can cause a compression fracture.
Less frequent cord conditions that can cause back pain include:
• Ankylosing spondylitis, a form of joint inflammation (arthritis) which most often affects the spine.
• Bacterial infection. The bacteria are usually performed at the spine in the bloodstream from an infection somewhere else in the body or IV drug use. But bacteria can enter the spine directly during surgery or injection treatments, or following injury. Back pain may be the result of a bone infection (osteomyelitis) in the intervertebral discs, or spinal cord.
• tumors of the spine or growths that develop on bones and ligaments of the spine, spinal cord or nerve roots.
• Paget's disease, which causes abnormal bone growth affecting more often the pelvis, spine, skull, chest and legs.
• Scheuermann's disease, in which one or more bones of the spine (Vertebrae) of wedge-shaped deformities. This causes curvature of the spine (rounding of the back, or kyphosis), most often in the region chest
The latest developments and better understanding in the management of back pain
A wide range of treatment available for pain lower back, depending on what is causing pain and how long it lasts. Most people find that their low back pain improves within a few weeks. Chances are good that your pain disappear soon with some basic self-care.
• If you have recently developed lower back, stay active and consider taking drugs -counter pain relievers.
• Staying active is better for you than bed rest. In fact, stay in bed more than 1 or 2 days can actually worsen your pain and lead other problems such as stiff joints and weak muscles.
• If your back pain has lasted more than three months, you will probably benefit a more intensive treatment.
• You must visit the interventional pain and spine specialist: –
• If you have moderate pain to severe lower back that lasts more than a few days;
• if you have back or leg symptoms that have worsened;
• If your symptoms did not disappear after 2 weeks of home treatment;
• or if improved symptoms erupt again.
• Review physical by a pain specialist and possibly an imaging (x-ray/MRI) test may produce new information on your health and help guide your treatment options.
• Physical Therapy: TENS, ultrasound, heat and cryotherapy:
o These procedures should always be considered as a complement to a program of active treatment in the management of acute low back pain.
o They should never be used as the sole method of treatment.

Interventions: Non-invasive surgical procedures for the management of back pain

For back pain sufferers, intervention techniques for pain management may be particularly useful. In addition to a complete medical history and physical examination, intervention Physician pain have a wide range of treatments that can be used, including the following:

Epidural injections (in all areas of the spine):

The use of anesthetic drugs and anti-inflammatory injection in space epidural for pain relief or to diagnose a particular condition.

Nerve root blocks and medial branch:

Injections done to determine if a specific nerve root cord is the source of pain. Blocks can also be used to reduce inflammation and pain.

Facet joint injections:

An injection used to determine if the facet joints are the source of pain. These injections can also relieve pain.

Discography:

An "inside" look on the disks to determine if they are the source of the pain of a patient. This procedure involves using a dye that is injected in a disk, and then examined using X-ray or CT scan.

Pulsed radiofrequency neurotomy (PRFN):

A minimally invasive procedure that disables and spinal nerves from sending pain signals to the brain.

Rhizotomy:

A procedure in which pain signals are "hijacked" by the use of heated electrodes which are applied at specific nerves that carry pain signals to the brain.

S Pinal marrow stimulation:

The use of pulses power that are used to block pain from being perceived in the brain.

intrathecal pumps:

A surgically implanted pump that delivers pain medication against the precise location in the spine where the pain is located.

Percutaneous discectomy / Nucleoplasty:

A minimally invasive day care in which the fabric is removed from the disk with the help of decompression through a hole very minute to decompress and relieve pressure on spinal nerves.

or Ozone discectomy Ozoneucleolysis:

Has emerged as an affordable, least invasive approach and cost 2 / 3 the price the conventional surgery. Ozone injected into the affected intervertebral disc under the direction c-arm, causes shrinkage of the disc and thus reduce volume and decrease pressure on the nerves.

Intradiscal Electrothermoplasty (IDET)
This procedure involves inserting a needle in the affected disc in the direction of an X-ray machine. A wire is then threaded through the needle into the disc until it located along the inner wall of the ring. The wire is then heated which destroys the small nerve fibers that grew in the cracks and have invaded the degenerating disc.

These techniques are interesting. They offer the possibility of treating back pain and sciatica to trauma and far fewer risks than surgery.

Quick tips back to better health

• After a period of prolonged inactivity, begin a program of regular low-impact exercises.
• Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscular strength and flexibility.
• Yoga can also help stretch and strengthen muscles and improve posture
• Always stretch before exercise or strenuous physical activity.
• Do not slouch when standing or sitting. When standing, keep your weight balanced your feet. Your back supports weight most easily when curvature is reduced.
• At home or at work, make sure your work surface is at a comfortable height.
• Sit on a chair with lumbar support and proper position and height of the task. Keep your shoulders back. Change position often and regularly sitting around the office or gently stretch muscles to relieve tension. A pillow or rolled towel placed behind the lower back can provide some lumbar support. If you must sit for an extended period of time, rest your feet on a low stool or a stack of books.
• Wear comfortable shoes with low heels.
• Sleeping on your side to reduce any curve in your spine. Always sleep on a surface farm.
• Ask for help transferring a family member ill or injured from a reclining to a sitting position or when moving the patient from one chair to a bed.
• Do not attempt to lift objects too heavy for you. Lift with your knees, pull in the muscles of stomach and keep your head down and in line with your back straight. Keep the object close to your body. Do not twist when lifting.
• Maintain Good nutrition and diet to reduce and prevent excessive weight, especially weight around the waist as taxes under the back muscles.
• If you smoke, stop. Smoking reduces blood flow to the lower back and causes the spinal discs to degenerate.

About the Author

dr pankaj nsurange is an Interventional Anesthesiologist and practicing interventional pain management.
special interest in spine interventions and chronic pain management

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