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| Arizona Pain Specialists 9787 N. 91st Street, Suite 101 Scottsdale, AZ. 85258 Phone: 480-563-6400 |
Arizona Pain Specialists 2007. All rights reserved
At Arizona Pain Specialists we
practice a balanced approach,
with holistic treatments as well
as cutting-edge pain
managment interventions.
practice a balanced approach,
with holistic treatments as well
as cutting-edge pain
managment interventions.
If you want more Information about
how Arizona Pain Specialists can
help you just Click Here.
how Arizona Pain Specialists can
help you just Click Here.
Typically the symptoms of LBP resolve within four weeks, depending on the pathology associated with the complaint.
However, the pain often returns leading to a high percentage of the American population with a chronic low back pain
condition.
Anatomy of the lower back
Bony structures
Understanding the anatomy and physiological function of the lower back is key in evaluating a person with chronic pain.
The bony spine is positioned so that individual vertebrae (bones of the spine) interconnect with other spine bones above
and below. This provides a flexible support structure while also protecting the spinal cord.
Conditions that can produce chronic pain from the spinal bones include:
• Facet Joint Osteoarthritis
• Spinal Stenosis (narrowing of the spinal canal)
• Vertebral Body Fractures
• Osteoporosis
• Spondylolisthesis
• Neoplasms (Primary vs. metastatic lesions)
• Infections
Facet injections/denervation, Vertebroplasty, SI joint injection/denervation, Lysis of Adhesions, spinal cord stimulation,
intrathecal pumps and other treatments can be extremely affective treatment for many of these conditions.
In fact, a recent study in 2007 concluded that lumbar facet joint nerve blocks with local anesthetic may be effective in the
treatment of chronic low back pain of facet joint origin. Physical therapy, cognitive behavioral therapy, biofeedback, diet and
exercise, along with other alternative techniques have also been helpful (Manchikanti 2007).
Vertebral Discs
Separating adjacent vertebrae are discs that act as cushions to minimize the impact that the spinal column receives. Since
the discs are designed to be soft and provide support, they have a tendency to herniate (bulge) posterior (or backwards)
through the outer ligaments and cause irritation to the adjacent nerves. Disc disease is one of the most common causes of
chronic LBP and accounts for approximately 10% of all low back pain complaints. Disc disease may acutely be from
herniation resulting from trauma or heavy lifting. More commonly chronic back pain is caused by degenerative disc disease.
Degenerative disk disease is due to thinning and degeneration of the discs and can lead to spinal stenosis, nerve
impingement, worsening facet arthritis, or peripheral nerve irritation.
Conditions that can produce chronic pain from the discs:
• Degenerative Disc Disease
• Disc Protrusion
• Disc Herniation
• Disc Extrusion
• Facet Joint Osteoarthritis
• Spinal Stenosis (narrowing of the spinal canal)
• Nerve Root Irritation or Compression (Sciatica)
• Disc Infection
Facet injections/denervation, epidural steroid injections, Lysis of Adhesions, epidural infusions, spinal cord stimulation,
intrathecal pumps and other treatments can be extremely affective treatment for many of these conditions.
Spinal Ligaments and Muscles
There are ligaments that attach to each vertebrae and provide strength and mobility to the spine as well as the many groups
of muscles that are responsible for the movement of the spine. The nerve roots are attached to the spinal cord and exit the
spine to innervate the skin, muscles, and surrounding structures of the back and lower extremities. These muscles and
ligaments have a tendency to become strained and irritated during strenuous lifting and excessive exercise and cause local
nerve irritation. Myofascial (muscle and connective tissue) and ligament injury may account for the majority of low back
pain.
Conditions that can produce chronic pain from ligaments and musculature:
• Myofascial Pain Syndrome
• Muscular Strain
• Torn Muscle
• Ligamentous Strain
• Ligamentous Tear
Trigger point injections widely popularized by Dr Travell are extremely successful in alleviating musculoskeletal pain. An
alternative therapy that specifically targets ligaments is called Prolotherapy. This sort of therapy, also called Regenerative
Injection Therapy has been successful for many chronic pain suffers. Physical therapy, acupuncture, massage, yoga, diet
and exercise have also proven to be affected in treating myofascial pain.
Referred pain
Organs in the abdomen and pelvis can refer pain to the back. Specifically, the kidney, pancreas, spleen, and liver have
been known to refer pain to this region. These organs may cause pain that is due to obstruction, inflammation, infection,
decreased blood supply, enlargement and or cancer. These “activated nerves” cause referred pain by traveling into the
spinal cord at the same level as other structures in the lower back. This can cause a person to experience pain in the back
instead of their organs.
Pathology of LBP
Common causes of LBP consist of Herniated Discs, Spinal Stenosis, Strained Muscles Sciatica, Arthritis (auto-immune vs.
non auto-immune), Fibromyalgia, Vertebral Body Fractures, and Osteoporosis.
Less common causes include infections, Ankylosing Spondylitis, Psychological causes and Metastatic Cancer. Risk factors
for malignancy include an age greater than 50, pain not relieved by lying down, symptoms worse at night, and pain for longer
than one month.
Acute LBP
Acute LBP typically comes on abruptly and occurs during a specific activity. Acute lower back injury is more commonly due
to overuse by excessive exercise, lifting of heavy objects, motor vehicle accidents, or any trauma involving the lower back.
The anatomy typically involved in acute LBP is the muscles and surrounding ligaments. Vertebral body fractures, ruptured
discs and spinal cord compressions can also be seen acutely with pre-existing osteoporosis, cancer, or spinal stenosis.
Acute pain due to ligament and muscle injury typically responds to activity and NSAIDs (Ibuprofen like drugs). Acute back
pain should be evaluated by a physician to rule out other causes like: kidney stones, kidney infection, and acute
pancreatitis.
In some cases of acute back pain a specialists and proper imaging is required for immediate evaluation (Emergency Room,
Pain Specialists, Spine Surgeon).
These cases might include:
• Acute Vertebral Compression Fractures
• Acute Disc Herniation
• Fever/Chills
• Weakness or Paralysis
• Loss of Bowel or Bladder Control
• Spinal Cord Compression
Chronic LBP
Chronic low back pain is defined as pain over 3-6months in duration. Typically the symptoms are more gradual and occur
over an extended period of time. With chronic LBP a person may experience pain in their back as well as down either leg.
Causes of chronic LBP are numerous and include:
• Arthritis, Facet Joint
• Sacroiliac Joint Disease
• Spinal Stenosis (narrowing of the spinal canal)
• Fibromyalgia
• Degenerative Disc Disease
• Disc Protrusion
• Disc Herniation
• Disc Extrusion
• Facet Joint Osteoarthritis
• Nerve Root Irritation or Compression (Sciatica)
• Central Sensitization
• Excessive Breast Size
• Poor Posture
• Psychological and Emotional Factors
• Vertebral Body Fractures
• Osteoporosis
• Spondylolisthesis
• Ankylosing Spondylitis
• Neoplasms
• Infections
Central Sensitization is a common complication associated with chronic pain of all kinds. This is a development involving both
the peripheral nervous system (PNS) and the central nervous system (CNS). Local tissue injury and inflammation activate
the PNS, which sends signals through the spinal cord to the brain. Central sensitization occurs when there is an increase in
the excitability of neurons within the CNS at the level of the spinal cord and higher. Eventually normal inputs from the PNS
begin to produce abnormal responses. Low-threshold sensory fibers activated by very light touch of the skin activate
neurons in the spinal cord that normally only respond to painful stimuli. As a result, an input that would normally produce a
harmless sensation now produces significant pain.
Sacroiliac Joint (SIJ) Disease is another major cause of LBP. The SIJ is located at the junction between the spine and the
pelvis. Many muscles and ligaments support the SIJ. This joint allows the weight of the spine and upper body to be
transmitted into the pelvis and finally into the legs. The SIJ is richly innervated by free nerve endings and spinal nerve roots,
explaining the severe pain caused by inflammation in the SIJ. Pain associated with SIJ can worsen with sitting for long
periods of time, or twisting motions and certain movements. Often the pain begins spontaneously, while others recognize a
specific traumatic event that triggered the occurrence of the pain. While conservative treatment, such as NSAIDs and
physical therapy may be effective, Murakami and Tanaka reported in 2007 that the effect of periarticular lidocaine injection
into the SIJ was 96% effective in pain improvement in patients with SIJ complaints with minimal complications (2007
Murakami). Arizona Pain Specialists now offer SIJ injections and longer lasting denervation procedures when warranted.
Diagnosis of LBP
Diagnosis of LBP can be difficult and the Pain Physicians at Arizona Pain Specialists have received extra training to examine
and diagnose your painful condition. The physician may perform a physical exam demonstrating tenderness over certain
areas of the spine as well as assessing the various limitations in movement. The physician may also order radiological
imaging such as x-ray, CT scan, MRI, or bone scan depending on his clinical suspicion and the history obtained.
Low Back Pain
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Low back pain is one of the most frequent musculoskeletal
complaints. Pain may arise from damage or irritation to
structures of the lower back including the vertebrae (bony spine),
facet joints, discs between the vertebrae, vertebral ligaments,
muscles of the lower back, spinal cord and peripheral nerves, as
well as internal organs of the pelvis and abdomen (spleen,
kidney, pancreas, liver).
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Low back pain is one of the most frequent musculoskeletal
complaints. Pain may arise from damage or irritation to
structures of the lower back including the vertebrae (bony spine),
facet joints, discs between the vertebrae, vertebral ligaments,
muscles of the lower back, spinal cord and peripheral nerves, as
well as internal organs of the pelvis and abdomen (spleen,
kidney, pancreas, liver).
At Arizona Pain Specialists we've
incorporated alternative treatments like
Acupuncture with excellent results.
incorporated alternative treatments like
Acupuncture with excellent results.
