BACK PAIN


Low back pain is a very common occurrence in the general population. It may originate from disease, injury or stress to many different structures, including bones, muscles, ligaments, joints, nerves or the spinal cord. It is considered to be chronic if it has been presented for greater than 3 months.

SIGNS & SYMPTOMS

The clinician will obtain the following information from the patient:
1.    A description of location, timing, frequency, character or quality, severity, referral pattern, aggravating and alleviating factors, and associated symptoms.
2.    A pain diagram can be visually helpful in demonstrating the location, and quality of the patient’s complaints.  While “Red Flags” which can indicate more serious medical conditions that require prompt medical workup.  The “red flags” include: change in bowel, bladder, or sexual function; bilateral perineal numbness or sciatic type pain, night pain that awakens the patient from sleep, previous history of cancer, unexplained weight loss, failure of bed rest to relieve pain and fever.
3.    Previous consultations, impressions, diagnostic testing, treatments, medications (tried, successful, side effects), and interventional procedures.  It is important to document what has been tried and failed, why that intervention failed, and which interventions have been successful.
4.    Psychosocial history

DIAGNOSIS & INVESTIGATIONS

1.    Plain Radiographs (X-rays)
Plain radiographs are not routinely necessary for most episodes of acute low back pain. It can be useful in selected patients in identifying underlying structural abnormalities, or vertebral compression fractures in higher risk populations.

2.    Bone Scan
Bone Scans can be useful when the history and physical examination suggest tumor, infection, or fracture. Positive bone scan findings should generally be followed by confirmatory imaging such as MRI or computed tomography.

3.    Magnetic resonance imaging (MRI)
It is recommended in patients with symptoms suggestive of “red flags” and for those patients likely to undergo invasive interventions such as epidural injections, selected nerve blocks or possible surgery and when physical examination and electrodiagnostic examination is inconclusive.

4.    Computer Tomography Scan (CT)
CT is generally used to evaluate the boney architecture, or in those patients who cannot undergo MRI.

5.    Electrodiagnostics (Nerve conduction studies, Electromyography and Somatosensory evoked potentials)
These studies are helpful in the evaluation of patients with limb pain in whom the diagnosis remains unclear and to rule out other causes of sensory and motor disturbances. These tests can differentiate radiculopathy from peripheral neuropathy, and help to quantify age and degree of nerve damage.

6.    Myelography
Myleography is done as a preoperative test, often in conjunction with a CT scan. It is used in cases where the clinical picture supports a progressive neurologic deficit and the MRI and EMG are nondiagnostic.

7.    Diskography
Diskography is done in patients who have not responded to a well coordinated rehabilitation program or who have normal or equivocal MRI findings. It is most often used prior to contemplating surgical fusion for unremitting pain.

8.    Diagnostic Selective Neural blockade
It is indicated in patients with radicular symptoms who have not responded to a previously employed comprehensive rehabilitation program or in determining a symptomatic nerve root when other studies (e.g. EMG) have been equivocal, and in determining whether therapeutic nerve root injections might be helpful.

MANAGEMENT

1.    Ice packs or cryotherapy
It is applied over an area for 15-20 minutes, 3-4 times per day initially and then on an as needed basis.

2.    Superficial Heat
Heat packs are commonly used in combination with electrical stimulation therapy. This should be used as an adjunct to facilitate an active exercise program.

3.    Bed rest and exercise
Remaining active is more effective than bed rest for patients with back pain. The patient should be instructed to avoid positions such as sitting, bending, and lifting. In subacute back pain, an intensive interdisciplinary rehabilitation program has been shown to be moderately effective.  And in patients with chronic low back pain, programs that incorporate individual tailoring, supervision, stretching, and strengthening are associated with the best outcomes.

4.    Medications
Medications such as acetaminophen, nonsteroidal anti-inflammatory drugs, muscle relaxants, opioid analgesics, oral steroids, colchicine, and anti-depressant medications can also be used to control pain and allow for improvement in daily function. All these medications have different side effect profiles and interactions, and therefore, should be carefully monitored by a physician.

5.    Physical therapy and other modalities
Physical Therapy includes a variety of education principles, stretching and strengthening exercises, manual therapies, as well as modalities (ice, heat, TENS, ultrasound etc.) to treat pain. Active therapies, which the patient can continue on his/her own, such as exercise and strengthening, usually have the most permanent and long lasting effects.

Traction, Lumbar bracing and spinal manipulation- These are not better than other marginal therapies in reducing low back.

TENS (Transcutaneous electrical nerve stimulation)- It is generally used in chronic pain conditions and not indicated in the initial management of acute low back pain.

Ultrasound- a deep heating modality that has been shown to improve segmental limitations in range of motion by facilitating soft tissue mobilization and stretching. It is contraindicated in acute inflammatory conditions and over a previous laminectomy site.

6.    Therapeutic Injections
When more conservative measures fail, these injections may be considered depending on the patient’s signs and symptoms, and physician’s decision.
-Trigger Point Injections.
-Epidural Steroid Injections.
-Facet Injections.
-Sacroiliac Joint Injections.
Typically many of these injections have been performed with steroids (cortisone), but we offer options including ozone, regenerative treatments, etc.

7.    Psychological Counseling.
In patients with chronic pain, cognitive behavioral therapy is an effective component in management. However, it needs to be combined with other therapeutic components, such as physical therapy to deal with physical deconditioning issues.

8.    Interventional procedures
-Prolotherapy
Prolotherapy involves the injection of solution to promote healing of loose tissue, ligaments, tendons, and joint capsules.

-Neuromodulations/Spinal Cord Stimulation (SCS)
Spinal cord stimulation refers to an implantable device used primarily to treat failed back surgery syndrome, complex regional pain syndromes, and chronic back pain.

9.    Alternative medicine treatments
Alternative medicine such as acupuncture, dry needling, nutrition, magnets and many others may be very helpful in the treatment of chronic pain. It is important for the patients to discuss these treatments with their physician to ensure they are not harmful to the patient and that they won’t interfere with any of the other treatments being prescribed.

Ozone and Prolozone® Therapy

   

The YANN TRUST

IN LOVING MEMORY OF YASMIN ALGARIN

Yasmin was, and always will be, a shining example of a how a person can achieve anything with hard work and a life-affirming attitude. She gave more than she took, she loved more than she feared, and she nurtured her family and friends at every opportunity. We will always remember Yasmin as a woman of strength, courage and compassion. 

Due to her untimely passing from brain cancer, we have set up a trust fund for her two children, Niles and Nylah. Please make your checks payable to: The YANN Trust (Yasmin Algarin Niles Nylah), 197 Ridgedale Ave., Suite 210, Cedar Knolls, NJ 07927.

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DISCLAIMER

The pages on this website contain general guidelines and information based on acceptable standards and should not be construed as medical advice. 

Please consult your own physician for appropriate management about your medical condition.