FAQ’s on Low Back Pain

Everyone has low back pain at some time during their lives. Low back pain affects around 20% of adults in the United States. This chronic pain is often recurrent, severe, and debilitating. At any age, a person is at risk for back pain but it is most common during the 40s, 50s, and 60s.

What are the components of the spine?

The spine is made of irregular-shaped bones called vertebrae. Each vertebra is stacked on top of the other separated by a cushioning, fibrous disc. The intervertebral discs, ligaments, nerves, and muscles support the vertebrae and compose the spine. The upper portion is called the cervical spine (neck region), whereas the middle section is called the thoracic spine. Most back pain occurs in the lumbar (low back) spine.

What causes low back pain?

As a person ages, so does his/her spine. With age, the bones and discs of the spine weaken from wear-and-tear, and back pain occurs secondary to spinal conditions. Causes of back pain include:

  • Disc tear – Small tears develop in the outer layer of the disc (annulus), which causes fluid loss and spinal bone shifting. Not everyone has pain with these tears, but some patients do.
  • Disc herniation – Also called a slipped disc, a herniated disc occurs when the gel-like center (nucleus) seeps out of the disc. The pressure of the herniation and the irritating proteins cause nerve root problems. Nerve compression and irritation cause back pain.
  • Disc degeneration – Intervertebral discs lose fluid, degenerate, and shrink. This causes vertebrae shifting and nerve impingement.
  • Facet joint syndrome – The tiny joints along the posterior region of the spine lose cartilage and develop arthritis. Called facet joint syndrome, this causes moderate pain for many patients.
  • Spondylolisthesis – With aging and wear-and-tear, the joints and ligaments of the spine shift from proper position. When one vertebra move forward on top of another, this slippage causes pressure on the nerves that branch from the spinal cord.
  • Spinal stenosis – When the space around the spinal cord narrows, it puts pressure on the spinal cord and associated nerves. Collapsing discs and arthritic changes contribute to back pain.

How is back pain diagnosed?

The doctor will seek to find the cause of your low back pain before treating. This involves a physical examination, taking a medical history, and conducting several diagnostic tests. Testing include laboratory blood work, x-rays, magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, bone density tests, bone scans, and nerve conduction studies.

How is low back pain treated?

After diagnosing the cause of the low back pain, treatment is aimed at correcting the problem and alleviating the symptoms. Treatment options include:

  • Medications – Options are nonsteroidal anti-inflammatory drugs (NSAIDs), narcotic analgesics, anticonvulsants, antidepressants, and muscle relaxants.
  • Physical therapy – The therapist uses passive modalities, such as ice, heat therapy, ultrasound, electrical stimulation, and massage. In addition, stretching and strengthening exercises are active therapy for low back pain.
  • Epidural steroid injection (ESI) – The doctor may inject the space around the spinal cord (epidural space) with a long-acting steroid and anesthetic. This helps reduce inflammation and irritation of the affected spinal nerves.
  • Facet joint injection – The doctor can inject the tiny facet joints with a corticosteroid an anesthetic agent. This reduces inflammation and eases pain. In a recent clinical study, this procedure had a 74% positive immediate effect, and a long-term effect for one-third of participants. The researchers found that facet joint blocks had a beneficial effect for many people.
  • Platelet-rich plasma (PRP) – The discs of the spine and other structures may be injected with PRP. This promotes a healing effect because the platelets contain growth factors. Studies show that PRP has an 80-85% success rate.
  • DeKompressor discectomy – To treat herniated discs, the doctor inserts a tiny catheter in the disc and drills away the part of the nucleus that is problematic.
  • Intradiscal electrothermal therapy (IDET) – To shrink and repair tears in the membrane surrounding the discs, the doctor inserts a wire and catheter into the disc. Heat is applied to thicken the collagen, which closes cracks and tears.

Resources

Gorbach C, Schmid MR, Elfering A, et al. (2006). Therapeutic Efficacy of Facet Joint Blocks. American Journal of Roentgenology, 186: 1228-1233. 10.2214/AJR.04.1042

Sampson S, Gerhardt M, & Mandelbaum B (2008). Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskeletal Medicine, 1(3-4), 165-174.