Back Pain is one of the commonest symptoms with which a person visit a doctor. It is difficult to find a person not suffering from back pain. It is estimated that about 80% of general population suffer from back pain in some part of their whole life. And at a given point about 30% of population suffer from some kind of back pain.
Even in late 1990s it was thought that about 90% of back pain sufferers are suffering from some unknown problem might be related to psychological issues and there is no cure for these problems. Even in 2010 many physicians hold the same views. Whenever they are unable to find something in X-ray, CT-Scan or MRIs, they give a stamp that the back pain is related to psychological issues, so nothing can be done.
But the picture has changed radically over a decade. Now we know that X-ray, CT-Scan or MRIs have some value only, they are not final in diagnosing the reason for back pain. The most important revolution over past one decade in the management of back pain is use of diagnostic interventional procedures. Proper history of patients' sufferings along with these procedures can solve the puzzle in nearly 90% of situations. Once we find out the reason behind the pain treatment or long term management become easy.
Spondylosis is degeneration of spine mostly related to age and found in X-ray of spine in almost everybody. It is not a cause for back pain.
Protocols followed at our clinic:
(for common causes behind back pain)
Facet joint syndrome:
Evaluation -> conservative management with medicines & physical therapy -> diagnostic facet joint inj. -> radio frequency procedure.
Discogenic pain due to Internal Disc Disrruption:
Evaluation => conservative management with medicines & physical therapy -> few shots of caudal epidural steroid inj. -> provocative discogram -> radio frequency procedure -> disc replacement or fixation
Central canal stenosis:
Evaluation -> conservative management with medicines & physical therapy -> caudal epidural steroid inj. -> radio frequency procedure.
Evaluation -> conservative management with medicines & physical therapy -> Transforaminal epidural block -> disc procedures (like Percutaneous disc decompression, ozone nucleolysis etc.) -> endoscopic discectomy procedures.
Sacro-iliac(SI) joint pain:
Evaluation -> conservative management with medicines & physical therapy -> diagnostic SI joint inj. -> radio frequency procedure.
What are the common reasons for Back Pain?
The disease or problems commonly responsible for back pain are arranged from commonest to less common pathology:
There are many more in the list; but cancer is rare.
Above is a X-ray Picture of spine showing facet joints
Below is a picture of Discogram to identify disc pathology