If you suffer from low back pain you are not alone. It is estimated, at any given time approximately 15% of all Americans have recurrent low back pain. By definition acute low back pain is severe, sudden in onset and short term. Chronic low back pain lasts longer than six months. Low back pain can be disabling, by not allowing sufferers to sleep, enjoy recreational activities, to take care of the household or go to work.

Diagnosis

About 90% of all low back pain is because of poor body mechanics. This may contribute to or be a result of arthritis, muscle tears or ligament strains. However, 10% of the time low back pain may indicate a serious underlying medical problem such as an infection or severe inflammatory arthritis. The most important factor in determining the diagnosis is the history and physical. Low back pain coming from a problem with the lumbar spine tends to be sudden in onset, worse during the day when we are weight bearing and relieved when we lay down. The serious medical causes of low back pain tend to be more gradual in onset, develop slowly and are usually worse during the night.

Ninety percent of the time back pain will go away on its own with education, mild pain relievers and a little bit of rest. When back pain is severe and chronic, the diagnostic tests are not always revealing. We are not always sure why the back is hurting despite the use of today’s best technology.

There are four structures in the back that cause pain: nerves, muscles, ligaments and joints. The Pain Management Center uses diagnostic injections to determine the cause of pain. When the physician does an injection, the following may occur: 1.) The patient may get good long-term relief, in which case the problem is identified and solved. 2.) The patient may get short-term relief, in which case a diagnosis is made. 3.) The patient may receive no relief, in which case the next structure is injected. Up to four injections are made into the different structures until a diagnosis can be determined.

Treatment

Is determined by the duration of the back pain and the diagnosis.

• Acute: In the event of acute onset of low back pain, the best therapy is rest for 48 hours
• Onset: along with anti-inflammatory medicine such as Motrin. It is important to note lying or sleeping position and to take pressure off the stained back muscles. Lumbar pillows are beneficial and help keep the back in neutral alignment, thereby relieving pressure. After the 48-hour period, gradually resume normal activities. Some  residual discomfort may persist, but should  subside. Oral medications should only be used for short periods as they can lead to high blood pressure, kidney or liver problems and ulcers in the stomach or small intestine. Usually within four weeks 90% of patients with low back pain will improve to the point where they have minimal or no discomfort. Proper posture and strength training can help reduce further incidence.
• Persistent Discomfort: If you have persistent discomfort, see your doctor. He/She may initiate an examination or diagnostic tests to rule out a medical cause for low back pain.
• Chronic: The pain doctor may inject one of the four structures to determine a diagnosis. Physical therapy may be used concurrently or as a follow-up to help reduce or prevent further pain. Physical therapy focuses on body alignment, mechanics and awareness, as well as flexibility and exercise.

Oral medications should only be used for short periods as they can lead to high blood pressure, kidney or liver problems and ulcers in the stomach or small intestine.

It is important to note lying or sleeping position in order to take pressure off the strained back muscles. Lumbar pillows are beneficial and help keep the back in neutral alignment, thereby relieving pressure.

Prevention

• Note sleep posture
• Consider a lumbar support pillow
• Maintain an ideal body weight
• Maintain proper posture for all daily activities (e.g.) walking, sitting or driving
• Do proper strength training
• Do proper flexibility training
• Avoid smoking
• Reduce stress

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The vertebral column is a series of 24 bones, muscles and ligaments that protect the nerves of spinal cord. Each bone is called a vertebra. The vertebra is about the size of a child’s toy block, only round. Behind this body of the vertebra is the spinal cord followed by a roof of bone called the lamina. The vertebral body and lamina surround and protect the spinal cord from injury (see diagram). As we age, our bones lose calcium and are more prone to fracture. This process of calcium loss is called osteoporosis and is very common in older women. In the presence of osteoporosis, the vertebral bodies can break and collapse, a process known as a compression fracture. Compression fractures most commonly take place in the mid and low back because the weight of the body is carried there. The fracture can be a source of severe pain because the bone is broken and the nerves next to the spinal cord are pinched.

Diagnosis

Patients with compression fractures complain of sudden onsets of mid and low back pain. The pain may be experienced along the course of the nerves next to the compression fracture. If the vertebrae of the lumbar spine are involved, the patient may experience leg pain. In the mid back or thoracic region, the pain may radiate to the front underneath the breast. If the doctor suspects a compression fracture, X-rays of the spine will be ordered. Compression fractures are usually readily apparent on a standard X-ray.

Treatment

The initial treatment for compression fractures is bed rest and pain medications. This gives the fracture time to heal, unfortunately however, the bone will heal in the collapsed position. Once the bone heals, it stops hurting but the nerves remain pinched, causing chronic pain. If chronic pain develops, the patient may need moderate doses of appropriate narcotic medications such as Tylenol #3, Darvocet or Vicodin. Excessive use of these drugs must be avoided because of the long-term toxic effects to the kidneys or liver. If, despite the use of appropriate medications, the patient is still experiencing significant discomfort, nerve block techniques may be able to resolve the pain. Traditionally, epidural injections are given. With this technique, powerful anti-inflammatory drugs are injected along side the nerves where they are pinched. This helps relieve swelling and inflammation, thereby resulting in pain relief. Nerve block techniques have to be used cautiously because the medication is an anti- inflammatory steroid, cortisone-type drug. Long-term use of cortisone can actually lead to osteoporosis and cause more compression fractures. The injections are usually given as a series of two or three over a period of weeks. In the event of a compression fracture, no more than two or three series should be given in the course of any one year. In addition to injections, braces can be used to help stabilize the joints. Although this may prevent further fractures, it cannot alleviate the compression of the old fracture. Compression fractures are a serious problem that can be difficult to treat. Ultimately, patients will need a combination of injections, medications and bracing to achieve a significant level of comfort.

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A headache is the most common pain complaint in our society. Tens of millions of people suffer from headaches every year. Chronic headaches can be divided into three categories:

• Migraine Headaches – are believed to originate in the blood vessels that supply the head.
• Muscle Tension Headaches – are caused from chronic contraction of the head muscles.
• Cervicogenic Headaches – are usually due to arthritis of the spine. The arthritis originates in the small joints of the neck or upper (cervical) spine called the cervical facet joints.  This type of Headache is usually seen in older patients who suffer from arthritis, but may also be present in patients who have suffered neck trauma such as whiplash.

Arthritis is a deterioration of the joint caused by low-grade inflammation. This inflammation can spread to the nerves of the neck. The occipital nerves are formed in the upper levels of the neck and ascend to the back of the head where they provide sensation. When the joints of the neck are inflamed, it spreads to the occipital nerves and the pain is experienced in the back of the head.

Diagnosis

Patients with cervicogenic headaches will have pain in the back of the head, although some patients will also experience the pain behind the eyeballs. Usually there is a history of trauma and X-rays of the neck may reveal the presence of arthritis. When the doctor examines the patient, he or she may discover the neck muscles are tender and in spasm. The only way to absolutely document the presence of cervicogenic headaches is with a diagnostic injection of the joints under X-ray. During this procedure, a specialist in joint injections can put an anti-inflammatory drug into the joint, causing reduction in the inflammation. If the headache disappears after this procedure, the doctor can be relatively certain the headache is coming from the neck, and thus diagnosed as a cervicogenic headache.

Treatment

In the event of acute flare-ups, cervicogenic headaches can be treated with a combination of ice application to the neck, oral anti-inflammatory drugs such as aspirin or Motrin, and immobilization of the neck with a neck brace or soft collar. In most cases the headache will resolve with this treatment in relatively short time. If the headache fails to improve, the patient can be prescribed physical therapy. The physical therapist will apply ice, mobilize the soft tissue and also apply gentle traction to the head and neck to relieve the pressure on the joints. If this strategy fails to improve the patient, injections of the joints with anti-inflammatory drugs can be done. These injections are the same injections that are given for diagnosis, except they may be given as a short series of two to three injections over a period of months and can lead to long term relief.

Prevention

• Sleep with your head in a neutral position.
• Use a relatively firm, non-feather pillow that keeps your neck in good alignment with the rest of your spine when you sleep on your side.
• If you sleep on your back, use a relatively narrow pillow so that your head is not thrust too far forward.
• If you pay careful attention to your sleep posture, avoid sudden neck movements and take appropriate prescribed anti-inflammatory medications, most cervicogenic headaches can be prevented or controlled.

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