FAQs on Back Pain and Treatment in Nashville

If you have back pain, you are not all alone. Most all people experience back pain at least once during their lifetime. Actually, back pain is a common cause of missed work and trips to the doctor. According to statistics, chronic low back pain (LBP) affects around 10% of the general adult population. In addition, LBP is the second most common cause of disability among Americans.

What are the symptoms associated with back pain?

Back pain is described as dull and achy, sharp and shooting, intermittent or continuous, and short-term and long-standing. Symptoms associated with back pain include:

  • Muscle spasms and aches
  • Pain that radiates into the buttock and down the leg
  • Inability to stand upright
  • Limited range of motion and flexibility of the back

What causes back pain?

Back pain often occurs without a specific cause that the doctor can identify with an imaging study or diagnostic test. Conditions linked to back pain are:

  • Back strain – This occurs due to repeated heavy lifting or sudden, awkward movements that strain the back muscles and ligaments. People in poor physical condition often experience muscles spasms from constant back strain.
  • Spinal arthritis – Arthritis affects the lower back due to spinal stenosis, where narrowing of the space around the spinal cord occurs.
  • Bulging disc(s) – Discs act as cushions between the individual vertebrae of the spine. When the inner soft disc material bulges out of place or ruptures, it causes irritation and compression of the nerves.
  • Scoliosis – Skeletal irregularities cause back pain when the spine curves in an abnormal way.
  • Osteoporosis – Vertebral spinal fractures (VCFs) can occur due to porous and brittle vertebrae bones, which occurs from osteoporosis.

How is back pain treated?

Back pain is treated based on the individual characteristics of the pain, the underlying condition, and the patient’s medical history.

Treatment options include:

  • Medications – Depending on your history and condition, the doctor may order medications for your back pain. Tylenol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) are two affective therapies. In addition, muscle relaxants are prescribed for patients who experience muscle spasms. Narcotic analgesics are used for a short time, under the close supervision of the doctor. Many antidepressants are useful in the relief of chronic back pain.

 

  • Physical therapy – The cornerstone of back pain treatment is physical therapy. The therapist uses heat, electrical stimulation, ultrasound, and muscle-release techniques to alleviate pain. In addition, the patient learns exercises to strengthen back and abdominal muscles and improve flexibility and posture. A 2012 review of several clinical studies found evidence supporting the use of physical therapy for treating back pain.

 

  • Epidural steroid injection (ESI) – The doctor injects a numbing medication and corticosteroid into the epidural space of the spinal cord, near the irritated nerve roots. The medicines will spread to the other levels and portions of the spine, reducing inflammation.

 

  • Medial branch block (MMB) (with or without denervation) – MMBs are a minimally invasive treatment used for back pain. After numbing the skin and soft tissues and under x-ray guidance, the doctor inserts small needles into the facet joint spaces of the spine, which are near the spinal cord. The doctor will instill a long-acting anesthetic, and in some cases, destroy the nerve fibers using either a neurolytic agent (phenol or alcohol) or with radiofrequency energy. Success rates for MBB procedures vary from patient to patient, but most all patients feel some level of pain relief within 5-10 hours. In a clinical study of lumbar MBB, an 84% efficacy rate was noted, and most study participants claimed the pain relief lasted for 2 years.

 

  • Trigger point injection (TPI) – Trigger points are painful areas on the back and shoulders. With TPI, the doctor injects each trigger point with an anesthetic, corticosteroid, and/or sterile water. In a recent study, TPI effectiveness was reported at 90%.

 

  • Transcutaneous electrical nerve stimulation (TENS) – This is a technique that relieves back pain by applying mild electrical current to the skin near the site of discomfort. The electric impulses work by interfering with pain sensations and altering perceptions that were once painful. In a 2012 clinical study, TENS was found to be effective in approximately 90% of patients.

Resources

Dhadwal, N, Hangan, MF, Dyo, FM, Zeman, R, & Li, J (2013). Tolerability and efficacy of long-term lidocaine trigger point injections in patients with chronic myofascial pain. International Journal of Physical Medicine and Rehabilitation.

Jacques L, Jensen T, Rollins J, Burton B, Bakim R, & Miller S (2012) Decision memo for transcutaneous electrical nerve stimulation for chronic low back pain (CAG-00429N). tinyurl.com/ decisionmemoTENS

Kuczynski JJ, Schwieterman B, Columber K, et al. (2012). Effectiveness of physical therapist administered spinal manipulation for the treatment of low back pain: a systematic review of the literature. Int J Sports Phys Ther, 7(6): 647–662.

Ricci JA, Stewart WF, Chee E, et al. (2006). Back pain exacerbations and lost productive time costs in United States workers. Spine, 31 (26) 3052- 3060.

Shim JK, Moon JC, Yoon KB, Kim WO, & Yoon DM (2006). Ultrasound-guided lumbar medial-branch block: a clinical study with fluoroscopy control. Reg Anesth Pain Med, 31:451-454.

Stewart WF, Ricci JA, Chee E, Morganstein D, & Lipton R (2003). Lost productive time and cost due to common pain conditions in the US workforce. JAMA, 290 (18) 2443- 2454.

Veizi E & Hayek S (2014). Interventional therapies for chronic low back pain. Neuromodulation, 17(2), 31-45.