Our spines take a lot of wear and tear from our everyday lives. According to the 2010 National Health Interview Survey, within the past 3 months “17% of adults had experienced a migraine or severe headache, 15% had experienced pain in the neck area, [and] 29% had experienced pain in the lower back.” If you are among this number, and you need an answer on what’s causing it and options to help, that’s where I come in.
I’m Forrest Monroe, MD – Interventional pain management specialist at Shasta Orthopaedics. I’d like to start by telling you about some of the most common causes of spine pain I see in my clinic, because there’s a good chance you’ll recognize your own symptoms on this list (of course with the usual caveat that this is not intended to provide individual medical advice, but rather to educate. This information is not a substitute for being evaluated by a doctor). In future posts, I’ll go over these conditions in more detail.
A Disc herniation is when the soft inner part of the disc leaks out onto the nerve, causing inflammation of the spinal nerves it touches. It is a sudden onset, severe pain described as burning, numb, tingling, shooting, that radiates from the neck down the arm or from the low back down the leg. An MRI is usually required to confirm the diagnosis. Depending on the severity of the pain or accompanying symptoms, this condition may be managed with conservative care (medications and physical therapy), injections (typically an epidural steroid injection), or surgery.
Facet arthropathy is a common form of arthritis of the spine. The pain is typically aching, spreads out sideways from the spine, and is worse with bending back and twisting. In the neck, it may cause a headache or spread down across the shoulder blades. In the low back, the pain commonly spreads into the buttocks and upper legs. An x-ray is often enough to make the diagnosis. For some people it is mild – the expected aches of aging – and can be managed with conservative measures. However, when the pain is more disruptive it can be treated with steroid injections into the joints, or radiofrequency ablation (cauterization of nerves to the painful joints). Surgery is not reliable for facet arthropathy, and is generally saved as a last resort if offered at all.
Vertebral Compression Fracture
A Vertebral compression fracture is a collapse of the vertebral body (the large cylinders of bone that stack together to make the spinal column), usually due to osteoporosis (thinning of the bones) and/or trauma. The pain is typically sharp and aching, and worse with bending forward or lifting. Like a fracture anywhere else in the body, the bone will eventually heal back together. It can be managed with a back brace, rest, and medications. For most people, it will improve on its own within a few weeks to months. The most important thing is to treat the underlying cause by getting a bone density test and likely taking medication to treat osteoporosis. If the pain is severe and debilitating though, a kyphoplasty may help. An MRI is needed first to confirm that the fracture is the source of the pain, by looking for inflammation in the bone. Kyphoplasty involves injecting orthopedic cement into the site of the fracture, and often results in almost immediate resolution of the pain.
Sacroiliitis is a commonly missed cause of low back pain. Some studies estimate about 20% of low back pain may be due to the Sacroiliac (SI) joints – the joints where the pelvis meets the spine. The pain is low in the low back, often wraps around into the hip, and is usually worse with sitting and crossing one leg over the other. It is more common in women, and in people who have had a surgical fusion of their lower back. There are a wide variety of treatment options for the SI joints. In addition to conservative care, steroid injections, radio frequency ablation (cauterization of nerves that go to the joint, to block pain signals), regenerative medicine, and even surgical fusion are an option.
Back Pain Treatment
If you are dealing with pain, whether it started this morning or decades ago, you deserve answers. I am an interventional pain management specialist, double board certified in Anesthesiology and Pain Medicine. I specialize in evaluation and non-opioid treatment of pain. To see a pain specialist, you may think you need an MRI, physical therapy, and even a visit to a surgeon, but at Shasta Orthopaedics we have everything under one roof and can take care of all of that and more for you. Successful treatment starts with the correct diagnosis, so it makes sense to start with an expert who can point you in the right direction. Depending on your insurance, you may not even need a referral from your primary care provider, though it’s always a good idea to keep them in the loop – just call us or use the form below to ask for an appointment. If you have pain and want answers, we will work together to get imaging, make a diagnosis, and lay out a treatment plan.