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Patient Centered Approach
Our board certified physicians
will work with you to develop a
treatment plan that's right for you.
Our board certified physicians
will work with you to develop a
treatment plan that's right for you.
Low Back Pain (continued)
by Nicole Berardoni M.D, Paul Lynch M.D, and Tory McJunkin M.D
Treatment Options
If your pain has lasted longer than 4 weeks or is severe in nature you should see a pain specialist about the treatment
options that would be beneficial for you. Emerging research is showing that early intervention decreases the chance of
developing chronic pain. Bed rest is contraindicated in most causes of LBP. Staying active and physical therapy are
indicated.
There are many interventions offered by Arizona Pain Specialists for those with severe LBP. Below we list a basic
overview of pain relief options. We are happy to offer these exciting pain managment techniques to the phoenix area.
• Pharmacotherapy - NSAIDs (Ibuprofen like drugs), Acetaminophen (Tylenol), muscle relaxants, and membrane
stabilizing medications are often effective in treating low back pain.
• Epidural Steroid Injections - Epidurals are frequently used for pain syndromes due to common conditions such as
degenerative disc disease. The method involves injecting a steroid into the epidural space of the spinal cord, where the
irritated nerve roots are located. The medicine then spreads to other levels and portions of the spine, reducing
inflammation and irritation.
• Medial Branch Blocks/Denervation - Medial Branch Blocks (MBBs) are a minimally invasive non-surgical treatment that
are used for arthritis related neck and back pain. The injections work by reducing the inflammation and irritation in the
facet joints of the spine that is causing your pain.
• Lysis of Adhesions - Also known as the “Racz Procedure,“ this procedure has proven effective in removing excessive
scar tissue in the epidural space when conservative treatment has failed. A study performed in 2005 said, “a spinal
adhesiolysis with targeted delivery of local anesthetic and steroid is an effective treatment in a significant number of
patients with chronic low back and lower extremity pain without major adverse effects.” This procedure is used in vertebral
body compression fractures, post-laminectomy syndrome, radiculopathy, and disc disease.
• Infusions Techniques- The procedure involves inserting a small catheter through a needle into the epidural space or
directly next to affected nerves. Local anesthetic and other medicines are often given through the catheter for extended
time periods. When the nerves are blocked continuously with an infusion, pain relief can be dramatic and long lasting.
• Spinal Cord Stimulation (SCS) - an implanted electrical device that decreases the perception of pain by confusing the
spinal cord and brain pain processing centers. Initially a trial is done to see if this device will help you long-term. In the
initial trial, your pain physician places a small electrical lead in the epidural space through a needle. Painful signals are
replaced by tingling electrical signals. If you have success in your trial, you may decide to have a permanent SCS device
implanted.
• Peripheral Nerve Stimulation - this method involves tiny electrodes being placed close to the affected nerves. The
electrodes release a small electrical current that inhibits pain transmission and causes pain relief.
• Kyphoplasty and Vertebroplasty - are both minimally invasive procedures that can treat osteoporotic fractures. The
method is to stabilize crushed vertebrae by injecting an acrylic cement into the vertebra. Vertebroplasty is effective in
relieving pain, most likely because of the added support and stability it provides the spine.
• Intrathecal Pump Implants - Implanted pain pumps are also available which can be extremely helpful providing long-term
pain control. The effectiveness of intrathecal therapy in patients suffering from nociceptive pain showed a pain reduction
in 66.7% of patients experiencing pain due to cancer (Becker 2000).
• Percutaneous Discectomy – a needle is inserted through the skin into the affected disc. Disc material is suctioned out
of the bulging disc and pressure is relieved within the disc.
• Disc Denervation – Needles are placed along the vertebral bodies in close proximity to the discs and electrical
stimulation is initiated. When the appropriate nerves are located they are anesthetized and destroyed using electricity.
• Cryotherapy – A probe is placed through a needle near affected painful nerves. Electrical stimulation is done to verify
position and freezing cycles are initiated over the painful nerves.
• Peripheral Nerve Blocks and Ablation – Nerves away from the spinal cord are called peripheral nerves. These nerves
can often be sources of pain and can be blocked with local anesthetic. When pain relief is obtained, ablation or
destruction can be initiated.
• Trigger Point Injections – can be an effective treatment for muscle spasms. The procedure involves injecting a local
anesthetic and steroid into a “Trigger Point.”
• Botox – used in treating neck pain is an exciting new treatment that is widely accepted among modern medicine. In
2005 “Botulinum toxin Type A (BtA) became the first line therapy for the treatment for cervical dystonia.” Although a
single injection of BtA is effective, multiple injection cycles seem to work better for patients (Costa 2005). Botox injections
have also been found to be effective in patients with whiplash injuries. Along with reductions in pain patients were found
to have improved range of motion ((Juan 2004).
• Transcutaneous Electrical Nerve Stimulation (TENS) - is a technique that relieves pain by applying mild electric current
to the skin at the site of the pain. The electric impulses interfere with normal pain sensations and alter perceptions that
were previously painful.
• Biofeedback - is a treatment that teaches a patient to become aware of processes that are normally thought to be
involuntary inside of the body (such as blood pressure, temperature and heart rate control). This method enables you to
gain some conscious control of these processes, which can influence and improve your level of pain. A better awareness
of ones body teaches one to effectively relax and this can help to relieve pain.
• Physical therapy - In order to decrease or prevent functional limitations, physical therapy and occupational therapy are
recommended as well as medical treatments,
• Acupuncture – Small needles are inserted into the skin. These needle cause your body to release hormones called
“endorphins“, which are your body’s natural pain reliever. Acupuncture can also help you relax; decreasing stress,
tension, and muscular spasm.
• Nutrition and Exercise - Exercise improves the pain of sciatica by increasing flexibility and range of motion. Another
benefit is the releases hormones called “endorphins,“ which are your body’s natural pain reliever. Nutrition and healthy
eating may be powerful treatments to combat nutritional deficits.
• Massage - Gentle focal rubbing of the tender areas may help relieve muscle spasms or contractions and improve the
discomfort associated with it. Massage can also help you relax, decreasing stress and tension.
• Chiropractic Manipulations – targeted “adjustments” especially combined with other modalities may significantly reduce
back pain. Manipulations are undertaken in order to allow correct nerve transmission.
• Prolotherapy – also known as Regenerative Injection Therapy is a technique of injecting irritating substances into
painful ligaments and tendons. The procedure is used to initiate the bodies healing of a damaged ligament or tendon.
Surgery
Surgical procedures are typically done when all conservative managements are unsuccessful in reducing pain or when
the spinal cord or exiting nerves are being severely compressed. Serious compressions are characterized by bladder
and/or bowel incontinence, lower extremity weakness, spasticity, and/or loss of sensation.
Invasive Surgical Procedures Include:• Discectomy
• Laminectomy
• Spinal Fusion
• Spinal Instrumentation
Long-term, surgical fusion or discectomy may not provide relief. In addition, surgical options for LBP were found to be
associated with a significant risk of complications, including bleeding, nerve damage, epidural scarring, and prolonged
recovery times. Surgical procedures are typically done when conservative management by pain specialists have been
exhausted, life-threatening complications have ensued, or neurological symptoms like weakness, bowel or bladder
changes, and/or loss of sensation. The evidence at the present time does not support routine surgical fusion or surgery
for the treatment of chronic pain alone.
Journal Articles
Early intervention for the management of acute low back pain: a single-blind randomized controlled trial of
biopsychosocial education, manual therapy, and exercise. PMID: 15507794. Spine. 2004 Nov 1;29(21):2350-6.
Surgical management of neck and low back pain. PMID: 17445741 Neurol Clin. 2007 May;25(2):507-22.
Clinical Trials:
2007;10;425-440. Evaluation of Lumbar Facet Joint Nerve Blocks in the Management of Chronic Low Back Pain:
Preliminary Report of a Randomized, Double-Blind Controlled Trial: Clinical Trial NCT00355914 Laxmaiah
Manchikanti, MD, Kavita N. Manchikanti, BA, Rajeev Manchukonda, BDS, Kimberly A. Cash, RT, Kim S. Damron, RN,
Vidyasagar Pampati, MSc, and Carla D. McManus, RN, BSN
Surgical versus non-surgical treatment of chronic low back pain: a meta-analysis of randomised trials. PMID:
17119962 Int Orthop. 2006 Nov 21
Physiotherapist-Directed Exercise, Advice, or Both for Subacute Low Back Pain: A Randomized Trial Liset H.M.
Pengel, Kathryn M. Refshauge, Christopher G. Maher, Michael K. Nicholas, Robert D. Herbert, and Peter McNair
Abstract for study: http://www.annals.org/cgi/content/abstract/146/11/787
"Meta-Analysis: Acupuncture for Low Back Pain." 19 April 2005 issue of Annals of Internal Medicine (volume 142,
pages 651-663). E. Manheimer, A. White, B. Berman, K. Forys, and E. Ernst
Summary of study: http://www.annals.org/cgi/content/summary/142/8/651
A randomized, controlled trial of spinal endoscopic adhesiolysis in chronic refractory low back and lower extremity
pain [ISRCTN 16558617] Laxmaiah Manchikanti1 BMC Anesthesiology 2005, 5:10 doi:10.1186/1471-2253-5-10
Effect of periarticular and intraarticular lidocaine injections for sacroiliac joint pain: prospective comparative study.
Murakami E, Tanaka Y, Aizawa T, Ishizuka M, Kokubun S. J Orthop Sci. 2007 May;12(3):274-80. Epub 2007 May 31
PMID: 17530380
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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.
Information about how
Arizona Pain Specialists can
help you just Click Here.
