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Decoding Low Back Pain

Last updated: January 8, 2024

Living with low back pain can feel daunting, but we’re here to help you find the treatment options that best meet your needs.

Dr. Matt Fischer, Anesthesiologist and Director of Pain Management Solutions, ThedaCare

If you’re a low back pain sufferer, you know how disruptive the condition can be. Living with this type of pain can take a toll on both your physical and mental health.

When back pain impacts your day-to-day life and ability to enjoy activities, it’s a good idea to seek care. A specialist can help determine the cause of your pain and guide you through your treatment options.

Low back pain can stem from many causes and present in several ways. Here, we discuss the process of diagnosing low back pain, common conditions, and treatment options.

Low Back Pain Diagnosis

When you’re experiencing low back pain, you may choose to first consult with your primary care physician. They can refer you to a ThedaCare Orthopedic Care specialist. You can also schedule directly through calling (920) 831-5050. Our team can help connect you to care.

“When you come in and see us, we’ll go over your medical history and complete a physical exam,” says Dr. Mac Weninger, a Physical Medicine & Rehabilitation Physician with ThedaCare Orthopedic Care.

Your doctor will ask you several questions that can help pinpoint the cause of your pain. They’ll inquire about where you’re experiencing pain and whether it travels to other parts of your body, such as your buttock, hips, legs, and feet.

They will also evaluate your sensation, strength, reflexes, range of motion, and other maneuvers that may assist in determining the cause of your symptoms. The diagnosis is frequently determined based on the history and physical examination alone.

To further help diagnose your condition, your doctor may order an X-ray. This can show issues such as arthritis, alignment problems, scoliosis, and fractures. Depending on your symptoms, you might also need an MRI or electrodiagnostic testing, also called EMG.

“Your treatment options depend on your diagnosis,” Dr. Weninger says. “For many people, back pain will resolve with time, over-the-counter medications, and physical therapy.

In addition, your doctor may recommend prescription medications, steroid injections, or diagnostic nerve blocks.

“If these measures don’t resolve your pain, my colleagues in Pain Management may be able to offer minimally invasive pain management procedures,” Dr. Weninger says. “Our Mind-Body Therapies program can also help people develop strategies for coping with pain.

Common Low Back Pain Diagnoses

Arthritis

“Arthritis can develop in the facet joints, which are the tiny joints on either side of the spine that help to articulate together each level of the spine,” says Dr. Matt Fischer, an Anesthesiologist and Director of Pain Management Solutions for ThedaCare. “Just like any joint in the body, you can develop arthritis or degeneration here.”

People with facet joint pain will often describe back pain, sometimes with radiation to the buttock or thighs. It’s rare for this to cause sciatica pain that radiates below the knee into the foot, Dr. Fischer says.

If you have facet joint pain, your doctor will often recommend radiofrequency ablation. This procedure uses needles to deliver heat energy to the nerves that carry pain away from the facet joints. The procedure stuns the nerves and “turns them off.” The pain signal cannot be transmitted away from the joint, and the result is pain relief, Dr. Fischer says.

Relief from radiofrequency ablation typically lasts for about nine months, whereas a corticosteroid injection delivers a few weeks to a couple of months of relief, on average. That makes it an excellent treatment option for many patients, Dr. Fischer says. Many patients report less pain with standing, walking, twisting, and other activities.

Myofascial Dysfunction

Myofascial dysfunction — pain coming from the muscles — leads to discomfort that typically stays localized in the back.

“When people come in saying they threw their back out, more often than not, it’s a soft tissue problem or myofascial muscle strain,” Dr. Fischer says. “Here, we can recommend trigger point injections.”

Sometimes you may have pain farther down, in the low back or top of the buttock, where the sacroiliac joint complex is located. Because of its location at the interface between your upper and lower body, the sacroiliac joint complex experiences a lot of shear force. This can lead to degeneration and inflammation. You may experience lower back, upper buttock, or hip pain that worsens with prolonged sitting or other activities.

For sacroiliac joint pain, doctors often start with corticosteroid injections. They’ll inject numbing medicine and/or corticosteroid to try to break the inflammatory cycle and improve the flare of pain. This treatment decreases inflammation and can improve pain for weeks or months at a time.

If corticosteroids don’t work, your doctor may explore other options, including radiofrequency ablation or peripheral nerve stimulation.

With peripheral nerve stimulation, a doctor will use ultrasound or X-ray guidance to place a tiny needle to the target nerve. A small wire is threaded through the needle. Through this treatment, stimulation is applied to the nerve to overwhelm pain as it’s happening. It also reorganizes the nerve inputs to the brain to attempt to retrain or “hit the reset button” on abnormal pathways. Thus, the goal is to try to achieve longer-term pain relief, Dr. Fischer says.

Some stimulators stay in place for 60 days. Others are designed to be implanted for longer. Some patients report pain relief lasting years from this technique.

Sciatica

Sciatica results in pain that radiates from the back and down the legs. Many causes can lead to this condition. These can include disc displacement or herniation stemming from an injury, stenosis or “pinching” of nerves in the low back, and failed back surgery syndrome (a term used to describe ongoing pain even after back surgery).

For disc displacement or herniation, doctors often recommend an epidural corticosteroid injection. This can decrease inflammation and “turn down the volume” on inflamed nerves.

Stenosis

Stenosis results from arthritis that leads to pinching of nerves. The condition can cause symptoms in the back radiating to the buttocks or down the legs.

Stenosis pains tend to worsen when you’re in an upright position — standing or walking. This upright posture is called lumbar extension, and it worsens any pinching or stenosis that already exists.        

“People will say they can’t do even little things like walking around the block, or standing to cook a meal, without having to stop and take a break,” Dr. Fischer says. “But if they take a break and sit down, or if they’re in the grocery store and can lean forward on a shopping cart, they can make it around without a problem.”

That’s because when a person sits down or leans forward, they position their spine in flexion posture. That small movement is enough to minimize the degree of pinching and improve symptoms, Dr. Fischer says.

Two minimally invasive procedures are available for stenosis.

A needle-based procedure called mild® (minimally invasive lumbar decompression) involves placing a needle down to the levels of the spine where stenosis or “nerve pinching” is occurring. Through the needle, the physician uses small tools to thin or “debulk” the ligament that is contributing to stenosis. This is all done through an incision smaller than your pinky fingernail, Dr. Fischer says.

With the Vertiflex™ interspinous spacer implant, a doctor places a small device between the spinous processes — the little bumps you can feel along the back of your spine. Once it’s in place, most people can stand and walk more easily without the same degree of back and radiating leg pain. That’s because the implant prevents stenosis or “pinching” from worsening with these activities.

Some people have already had back surgery. Due to re-accumulation of stenosis or scar tissue, or other factors, they still experience back pain or pain that radiates down the leg. This condition is called failed back surgery syndrome.

Spinal Cord stimulation

Doctors may recommend spinal cord stimulation for people with ongoing back and leg pain even with a history of back surgery. This condition is sometimes called failed back surgery syndrome. Individuals with diabetic peripheral neuropathy or complex regional pain syndrome may also benefit.

Stimulation is delivered by a neurostimulator — a device similar to a pacemaker — implanted under the skin. The impulses travel from the device to the spine over thin, insulated wires called leads. The leads deliver mild electrical impulses to an area near the spine. By interrupting pain signals between the spinal cord and the brain, the stimulator can help relieve pain.

“One of the best parts of this treatment is that you get to try it before you have the implantation surgery,” Dr. Fischer says.

Using needles only, a doctor can navigate the trial stimulator leads into the space behind your backbones. They then remove the needles and leave the ends of the electrodes to protrude through the skin. The ends attach to a temporary battery that’s taped to the back.

You can try the technology for up to a week. The doctor then removes the temporary system, and you can decide where to go from there. If you experienced pain relief during the trial, you may choose to proceed with the implantation. Otherwise your doctor can work with you to explore other options, Dr. Fischer says.

“Living with low back pain can feel daunting, but we’re here to help you find the treatment options that best meet your needs,” he says.

You don’t have to live your life in pain. Call (920) 831-5050 to schedule today.

Tags: disc displacement disc herniation EMG facet joint arthritis failed back surgery syndrome Lower back pain myofascial dysfunction Pain Management Physical Medicine & Rehabilitation sciatica stenosis

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