An estimated 80 percent of American adults will miss work at some point in their careers because of back pain. For the majority, the pain is neither permanent nor serious – approximately 95 percent of backaches go away within six weeks without a specific treatment.
Unless you are totally immobilized from a back injury — your doctor will test your range of motion and nerve function and touch your body to locate the area of discomfort.
Importantly if you suffer from pain that doesn’t subside – or becomes worse – there are three levels of back pain treatment you should explore.
The most common, and least invasive, treatments for back pain include physical therapy, bracing, medication, oral steroids, massage therapy, acupuncture, and chiropractic support.
Using imaging (x-ray) guidance for needle placements, these injections are performed by specialized physicians. Your doctor may recommend one of several types of steroid injections, depending on the location and level of pain you experience.
Epidural Steroid Injections (ESIs) – ESIs are a minimally invasive outpatient procedure performed by injecting a mixture of a steroid and long-acting anesthetic into the epidural space (a space containing nerves and nerve roots). ESIs are typically performed for central (axial) back or neck pain. Some indications for ESIs include back pain from degenerative, bulging, or herniated discs, spinal stenosis, and spinal nerve root inflammation (such as shingles). If successful at relieving pain, an ESI can be performed three times in a 6-month period.
Selective Nerve Root Block (SNRB) – SNRBs are a minimally invasive outpatient procedure performed by injecting a mixture of a steroid and long-acting anesthetic into a specific nerve root sleeve. The main indication for a SNRB is a patient with peripheral (arm or leg) pain, which is felt to be secondary to compression or inflammation of a specific nerve root (s).
Medial Branch (Facet Joint) Blocks – The facet joints in our back and neck have cartilage that allows our back and neck to bend, twist, and flex. As we age, these joints can become degenerative or arthritic. The cartilage loses fluid and height, which can lead to a bone-on-bone condition often resulting in bone spur formation and chronic neck or lower back pain. Facet joint arthritis is one of the most common causes of chronic neck or lower back pain. Medial branch (facet) blocks are performed by injecting a mixture of a steroid and long-anesthetic into the medial branch nerves going to the facet joints.
Medial Branch (Facet Joint ) Denervations – If a medial branch (facet) block results in pain relief for the patient but the pain recurs, the patient may then be a candidate for a medial branch (facet) denervation. Using a radiofrequency (RF) device is recommended to perform the denervation. A RF denervation is a minimally invasive, outpatient procedure performed by placing a needle electrode adjacent to medial branch nerve (s) and then ablating (burning) the nerves with RF heat energy. If successful, the RF denervation procedure can result in longer-lasting pain relief, from 6 months to 2 years.
Sacro-iliac (SI) Joint Injections – Degenerative arthritis and inflammation of the SI joints is a common cause of chronic low back and buttock pain. Patients often complain of chronic low back pain, groin pain, and sitting intolerance without associated leg pain. SI joint injections are minimally invasive, outpatient procedures performed by injecting a mixture of a steroid and long-acting anesthetic into the SI joint.
Kyphoplasty – This procedure is for patients with acute painful compression fractures of the spine. These fractures typically cause severe pain and may lead to the patients being wheelchair bound or bedridden, with severely limited daily activities. The most common reason for these fractures is the presence of osteoporosis; other less common causes are trauma and cancer. Kyphoplasty is a minimally invasive, non-surgical, outpatient treatment performed through one or two needle holes for each spine fracture. The needles are inserted using the latest in high resolution imaging technology. Balloons are inserted through the needles to re-expand the bone; the resultant cavity is filled with a bone cement to internally cast the broken bone. Kyphoplasty procedures typically result in greater than 90 percent of patients experiencing near-complete or complete pain relief. Patients with spinal compression fractures have a higher risk for additional fractures; these fractures can also be treated with kyphoplasty.
When patients with intolerable pain have exhausted all conservative therapies and injection treatments, the remaining option is surgery.