What are common causes of back pain?

Approximately 80% of the adult population will develop a significant episode of back pain sometime during their life. Fortunately, many of these will spontaneously resolve. However, approximately 50% will develop into significant chronic/long standing and/or recurrent episodes of back pain. In young population awful life style has been implicated as one of the most important reasons for back pain Wrong postures, long sitting hours, overweight, lack of regular physical exercises, and lack of sports activities are important reasons. In older people age related wear and tear are one of the most important contributing factors in addition to already mentioned factors, such as degenerative arthritis and degenerative disc disease, are some of the most common causes. Low back joint restrictions and/or sacroiliac joint restrictions are also a common cause of acute low back pain. Click on back pain, spinal arthritis, sciatica, slip disc and spine fracture to know in detail.

What is the natural history of low back pain and how we should approach it?

Low back pain improves over a few days to one to two weeks. In fact, 90% of patients report that pain has subsided by two months with physiotherapy and pain killer medicines but without any pain intervention. However, 50% of patients develop significant recurrent symptoms within six months of the initial onset of symptoms. Fortunately, most recurrences are not disabling but may lead to chronic problems with intermittent episodes of exacerbation. And this is the best time to meet any pain management specialist or Interventional Spine & pain specialist. He may advice certain tests like X-rays, CT scan or MRI to find the exact reason for pain. So that it can be cured with minimally-invasive, non-surgical, pinhole techniques, thereby not only get good pain relief but also successfully avoiding surgery. Delay in proper diagnosis and timely treatment always raises the chances of surgery and not so good pain relief ultimately. Approximately 10% to 20% of patients who develop low back pain develop significant chronic low back pain which limits them. Click on back pain, spinal arthritis, sciatica, slip disc and spine fracture to know in detail.

When do most people develop significant low back pain?

The usual age of onset of severe low back pain is between 30 and 50 years of age. The most likely reason is that the wear and tear has begun, and individuals in that age range are still active enough to stress their bodies and place somewhat bulging discs at risk for injury. It is also common in this age group for individuals to be very preoccupied with their life and occupation and in turn not take as good care of themselves as when they were younger. This leads to increased stress on the discs predisposing them to injury. 20 to 30 yrs of age group is the latest victims of back pain and disc related problems because now youngsters don’t learn good body mechanics and neither participate in proper strengthening and conditioning for their spine and overall body. Click on back pain, spinal arthritis, sciatica, slip disc and spine fracture to know in detail.

Is bed rest a good treatment for back pain?

Earlier, bed rest was the recommended treatment for back pain. However, recent studies show that bed rest is counterproductive and often detrimental in treating back pain. Bed rest allows muscles to de-condition and significantly slows the rate of recovery from back pain. The recommended activity modification for patients with back pain is to stop whatever activity causes back pain. Specifically, if bending and lifting cause back pain, then avoid bending and lifting. If a twisting motion, such as playing cricket, causes back pain then stop playing cricket. However, persons with back pain should remain as active as possible as long as they are not having pain. In some cases of severe pain, a very short course of bed rest combined with appropriate medication is found to be beneficial, till the right diagnosis is made and appropriate treatment offered. For a new back pain or short duration back pain, patient should be placed into an aggressive rehabilitation program consisting of physiotherapy, strengthening and joint mobilization as soon as possible. For old pain or chronic pain (pain of more than 6 weeks), detail work up and some tests (x-ray, CT scan, MRI) are important for right diagnosis and treatment. Click on disc treatment for spinal pain, spinal arthritis treatment, radiofrequency ablation, spine fracture treatment, neurotomy, adhesiolysis to know in detail about various treatments.

Does smoking cause spine problems?

Smoking accelerates the wear and tear process of disc and other spinal elements. Smoking has also been linked to increased sensitivity to pain among people who undergo treatment. Because of increased pain, it is associated with increased use of pain medications in trying to control pain and increased dissatisfaction with other treatment of back problems. In patients who undergo surgery, the overall success rate is much lower in smokers when all other factors are equal.

What causes neck pain?

Neck consists of a part of spine and a lot of muscles around it. There are many causes of neck pain. Pain can be divided into many categories: muscular, mechanical (coming from the joint or the disc), radicular (coming from a nerve or nerve root), or neuropathic (coming from the spinal cord). This mechanical pain is called wear and tear disease and is the most common reason for neck pain. Radicular pain is usually sharp, current like pain that goes down the arms. It may be associated with numbness or weakness. It can be precipitated, or relieved by different motions or positions of the head or neck. Neuropathic pain refers to the symptoms from compression of the spinal cord (myelopathy). This type of pain is usually in both arms and can go down into the legs. It is associated with numbness or weakness in the extremities, problems with balance. Click on neck pain / cervical to know in detail.

What is a spinal disc?

A spinal disc is the ligamentous structure that attaches one vertebra to the next adjacent vertebra in the spine. Many people consider the disc to be a “shock absorber” between the bones of the spine. Another important function of the disc is to allow for motion in the spine. The disc is a very tough ligament that allows the spine to move in multiple directions. A healthy disc has a soft central portion, which is a jelly-like centre. The outer portion of the disc consists of layer of very tough ligaments. It is made of multiple layers crisscrossing as they encompass the jelly-like centre

Why does an injured disc cause pain?

The nerves that are responsible for pain sensation on outer surface of the disc are different than the nerves that pass behind the disc and travel down into the legs. Pain or irritations of the nerves that are on the outer surface of the disc produce back pain if the disc is located in the low back. If the disc is located in the neck, then neck pain is produced. Injury to the disc can cause pain in several ways. First, the age related wear and tear of the disc, causing pain chemicals to be produced. These chemicals can leak out of the disc and further irritate the nerves on the outer surface of the disc. This is a common cause of chronic back pain. Secondly, the injured disc can be painful just by tearing the outer portion of the disc and irritating the nerves that are on the outer surface of the disc. This is called an annular tear. Third, the injured disc is often weakened and does not function properly. Specifically, it does not prevent abnormal motion of one vertebra in relation to the next, causing irritation of the nerves that innervate the surrounding facet joints and supporting tissues. An injured disc can also cause a piece of disc tissue to break off and compress surrounding nerves (pinched nerves | trapped nerves) as they pass to the legs. Pinching of these nerves usually causes leg pain if the pinch is in the low back or arm pain if it is in the neck. Click on back pain, slip disc or sciatica or neck pain/cervical to know in detail.

What is a herniated disc?

A disc is the shock absorber between adjacent vertebrae in back bone. When it deteriorates it may “bulge”, “slip”, “rupture” or “herniate” and press on the spinal cord or nerve roots called pinched nerves or trapped nerves. Herniation means that a piece of disc is trying to get detached from the parent disc. To know the symptoms of herniated disc in detail, click on back pain, slip disc or sciatica or neck pain/cervical.

Are bulging discs normal in an adult?

Bulging discs are extremely common. The incidence of significant disc changes on an MRI scan is almost equal to the age of the patient. For example, if one hundred 40-year old patients underwent MRIs of the cervical spine, approximately 40% of them would show some wear & tear disc changes (at times called normal for age by the doctors). While these changes are technically abnormal, they are extremely common and occur as a consequence of the normal aging process, wrong postures, long sitting hours, overweight, lack of regular physical exercises, and lack of sports activities etc. To know the symptoms of herniated disc in detail, click on back pain, slip disc or sciatica or neck pain/cervical.

What is the difference between a herniated disc and bulging disc?

A normal healthy disc has a usual height and shape. The centre of the disc has high water content and acts as a shock absorber. As a disc begins to have wear & tear changes and lose its normal water content, it loses some of its strength. With this loss of water content, there is usually a loss of disc height. When the disc becomes shorter it causes the surface of the disc to overhang beyond the edges of the bone. This is comparable to letting air out of a car tire. As a car tire loses air, the tire broadens out as it loses height. The same is true for a disc, termed a bulging disc. A bulging disc may pinch a nerve, causing leg / arm pain with back / neck pain.

A disc herniation usually occurs when the outer surface of the disc becomes torn, allowing a portion of the jelly like disc material to express out of the normal margins of the disc itself. If this disc material extends out and pinches one of the nerves passing by as it goes to leg / arm, it often produces radicular pain into that extremity. If disc material that has herniated does not pinch or irritate a nerve going to leg / arm, often there will be no leg / rm symptoms. In fact, there may be just back / neck pain. To know the symptoms of herniated disc in detail, click on back pain, slip disc or sciatica or neck pain/cervical.

What is whiplash?

Whiplash occurs when the neck and head are suddenly forced back and then forward, putting the neck spine through lightning-quick motions and extreme stresses. Most cases of whiplash are caused by car accidents. Other important   causes, can include physical attack, bungee jumping, rollercoaster, football, falls while skiing and other high-impact activities.

Does whiplash cause disc herniations?

A whiplash injury to the neck spine can cause damage to the muscle or ligaments of the spine. If the whiplash does injure the outer surgace of the disc, this can contribute to a herniated disc of the neck. It is not unlikely that a whiplash injury would cause a herniated disc in a previously normal disc. The more common condition is that someone already has undetected disc problem in their spine and is involved in some sort of injury, which aggravate their preexisting symptoms.

Should I have an MRI for my pain?

The decision to have a MRI scan should be made by your doctor after a careful history and physical examination. The majority of patients with arm/leg or neck/back pain will improve with time (maximum within 4 – 6 weeks) by themselves without having any sort of treatment or testing. Unless there is proof of a major neurological symptoms, waiting for few weeks is desirable prior to obtaining a MRI scan. If you are, however, suffering significant weakness, problems walking, persisting pain, tingling & numbness or any trouble with your bladder, an MRI is essential.

What is degenerative disc disease (DDD)?

Degenerative disc disease is basically arthritis of the disc. The disc serves as a cushion between the bones of the spine. With age, stress and strain disc can become arthritic and “wear out.” In this situation, these discs are termed degenerative. All should learn how to prevent placing great amounts of stress on the back and how to lift properly to protect the back.

What is spinal instability?

Spinal instability occurs when the supporting ligaments, discs and joints of the spine are damaged to the point they can no longer hold the bones together. As the vertebrae move out of alignment, they can pinch nerves and cause leg pain and weakness. The abnormal motion is very minute and can be measured on standing & bending x-rays.

What is spinal stenosis?

Spinal stenosis is a condition that mostly affects the elderly. In this condition the spinal canal is narrowed to an extant where the spinal cord or nerve roots may be trapped, enlargement of the facet joints and thickening of a ligament (ligamentum flavum). The resulting combination of symptoms of pain, numbness, and weakness is called neurogenic claudication. These symptoms are more spread out than slip disc due to the involvement of many nerve roots. The symptoms are aggravated by standing and walking, which increase the curve of the lumbar spine. Sitting relieves symptoms by straightening the spine and stretching the ligament to open the spinal canal.

What can I do to avoid surgery?

It is important to realize that neck and back pain related to disc problem is often a non-surgical condition that may resolve with rest, medication, and sometimes physiotherapy initially (maximum 3 – 4 weeks). If you are suffering from neck or back pain related to disc problem, it would be best to be evaluated by a spine specialist. Then, after other potentially more serious conditions have been excluded, one can plan for non-surgical, minimally-invasive, pinhole treatments. This is followed by home & workplace evaluation to maximize ergonomics and change in sleep and rest habits.

Will losing weight decrease the chance i will need back surgery?

While degenerative disc disease and spine disease has a large genetic component, there are activities you can adopt to prevent or decrease, developing back pain and further surgery. Timely intervention in the form of non-surgical, minimally-invasive, pinhole treatments is most important in avoiding surgery. Excess weight speed up degenerative forces in the spine, as well as in the hips and knees. Losing weight can help protect your spine, and at the same time benefit your overall health and well-being. Shedding extra kilos can decrease the amount of stress that is put on a herniated or slipped disc and may protect it for years to come.

What non-surgical, minimally-invasive, pinhole treatments (= minimally-invasive, pinhole interventions = MIPI) are for back and neck pain?

MIPI is a super specialty treatments of the medical science, devoted to the use of minimally-invasive techniques such as neurotomy, radiofrequency ablation, percutaneous disc procedures, vertebral augmentation, pain relief implants (including spinal cord stimulation and peripheral nerve stimulation), and implantable drug delivery systems. With the help of these treatments either we try to remove the root cause of pain or if not possible, interrupt the flow of pain signals to brain along specific pain nerves in the spine or outside the spine.

Special medical training is necessary to evaluate, diagnose and safely treat patients suffering from spinal or joints pain and to respond to squeal of treatment should they arise.

Many complex interventional pain procedures are done using the advanced imaging techniques (e.g. Fluoroscopy, digital subtraction angiography, computerized tomography and others) to accurately guide needle like instruments to the proper location, evaluate potentially beneficial treatments and to prevent unwanted effects of medications and techniques. And assist in the implantation of drug devices near source of pain. Image-guided spine intervention is used primarily for its precise pinpointing capabilities.

Fluoroscopic (x-rays) imaging either alone or in combination with digital subtraction angiography is a vital imaging technique used to assist interventional spine & pain physicians in the diagnosis and treatment of pain. A clear understanding of how to obtain and interpret fluoroscopic images is critical to obtaining successful outcomes and avoiding side effects

What is interventional pain management?

The goal of interventional pain management is not only relief in pain but also to increase work capacity, improve quality of life and reduce one’s sense of suffering.

Interventional pain management is the branch of medicine involving multiple specialities to offer relief of pain and improvement in the quality of life of those living with chronic pain. Due to the complexities involved in the treatment of chronic pain, pain medicine is recognized as a separate medical super specialty as interventional pain management or interventional spine & pain management. Not everyone is able or willing to take pain medication every day, and not everyone can or should have surgery for painful conditions.

Pain relief doesn’t always come in a bottle of pills. Pain can take many forms and relief is not a one-size fits all persons. Interventional pain management explores beyond the boundaries of standard medical treatments (medications and surgery) and describes the many other approaches that are available for pain relief. It is to be understood very clearly that physiotherapy, exercises & other related methods are primarily for prevention of back, neck & joints pain. They have no role what so ever in the treatment of slip disc, sciatica, spinal arthritis, pinched nerves in the spine, cervical (neck pain), spinal fracture, spondylitis, herniated disc. Though it’s always better to continue physiotherapy & exercises under supervision to further slow down the underlying disease process.

Pain relief without medications or surgery leads to the latest technology of variety of non-drug/non-surgical, minimally-invasive, pinhole treatments and their applications to a number of common types of pain ie interventional pain management.

In chronic pain cases interventional pain management treatment should be explored before considering painkiller medications and narcotic medications, which come with inherent risks, side effects, physical dependency and the potential for abuse.

What are the benefits of non-surgical, minimally-invasive, pinhole techniques?

These latest techniques, in mostly cases, improve the pain rather than masking it with medications. For a very small percentage of patients pain medication may be the best solution, but the majority of pain sufferers will benefit from non-surgical, minimally-invasive, pinhole techniques. Through a combination of, interventional pain management and judicious use of medications/physical therapy patients can resume their everyday activities instead of being limited by pain.

Patients deserve superior alternatives to painful surgical treatment options that requires a long recovery time. These new techniques provide equally good results with exceptionally low risk, while avoiding the downside of surgery. Non-surgical treatments are superior to surgical treatment options in many areas including:

  • Pain: Interventional pain management procedures involve no significant pain. Our treatments require, at most, a topical numbing cream or a small prick of local anesthesia before starting the treatment.
  • Recovery time: After the procedure, mostly patients can go home the same day and back to work the next day. A few of the most extensive treatments may require one or two days of resting period. This is in contrast to surgery, which can require weeks or months of recovery before normal activities can be resumed.
  • Common risks: All of the standard risks of surgery, such as serious infection, bleeding, risk related with general anaesthesia and other complications are reduced to a greater extent.
  • Procedure time: These procedures usually take about thirty to sixty minutes to perform (and only local anesthesia is required) and do not require lengthy preparation time. Surgical procedures can mean taking days out of your busy schedule.
  • Cost: Interventional pain management procedures are designed to be accessible to all the patients. Affordable healthcare is a policy. In general cost is one third of the cost of surgical treatment for the same problem.

By use of minimally-invasive, pinhole techniques, a patient may require only a band-aid at the site of treatment, rather than multiple stitches or staples to close a large cut or incision in surgery. This usually results in less infection, a quicker recovery time and shorter hospital stays, or allows treatment on outpatient basis.

Will I have irreversible damage if I delay treatment?

If pressure on a nerve or the spinal cord lasts for a long period of time, it is possible that the changes in the nerve or spinal cord can become permanent. This would generally be the case in someone who had significant weakness as symptoms of spinal problems. For patients who primarily have pain, there is probably less chance of permanent damage if treatment is delayed. Of course, patients with cancer, infections, fractures, or instability involving the spine may need much more urgent attention, if not surgery. In general, if the longer nerve compression or spinal cord compression persists, the chance of complete recovery becomes less and less.

When do I need spinal surgery?

If pain is progressive, severe, and disabling, non-surgical, minimally-invasive, pinhole treatments are strongly recommended. Numbness, tingling, and mild weakness are all possible signs of nerve compression and may indicate a need for such treatments before nerve damage becomes permanent. If these treatments are not helpful or you are developing limb weakness or loss of control of passing urine or stool then surgery becomes imminent. Pressure directly on the spinal cord can be very dangerous and may require surgery. Surgery may also be needed if there is significant deformity of the spine.

What are my surgical risks if I undergo surgery?

The risks of any surgery include: bleeding, infection, and the risk of general anaesthesia. Surgery from the front of the spine in the neck requires cutting through important vital structures like food pipe, wind pipe, major blood vessels. Any of these structures could potentially be injured by the surgical approach. In spine surgery, work is done next to the spinal cord and nerve roots. These structures could be injured and may cause weakness or numbness in the arms, as well as potential as loss of control over passing urine or stools or sexual dysfunction. The main vertebral artery is close by and can also be injured during resulting in a life threatening stroke.


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