23 Feb 2014

An Effective Middle-Ground for Back Pain

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Medications, physical therapy, spinal manipulation, acupuncture, spine surgery — sorting through the treatment options for back pain can be overwhelming!  Many people believe that when conservative non-invasive options have failed, surgery is their only option.  In many cases, this is not true.  For many causes of back pain, interventional therapies offer the opportunity to direct treatment to the source of pain, without the risks of invasive surgery.

Interventional Therapy for Back Pain

All treatments come with some risk, and it makes sense to start treatment of back pain with the least invasive options.  Exercise, physical therapy, and other non-invasive options are very safe and often effective.  But for some patients these options do not work.  For others, back pain is so severe that they are unable to fully take participate in these treatments.  Many of these people stop looking for treatment options, believing that the only remaining choice is an invasive back surgery.  A large part of my work is to find options that identify and treat a specific pain generator in the back.  Using medical imaging technology like fluoroscopy and ultrasound, I am able to target that pain generator without the need for surgical incisions or general anesthesia.

Step One: Identify the Back Pain Generator

“Low Back Pain” is not a diagnosis on its own!  As I have discussed previously, there are many structures in the back that can cause pain.  As a specialist in back pain, I employ three tools every day to find the underlying cause of my patients’ back pain.

History: Specific details about how your back pain started, what it feels like, and associated symptoms can reveal much about the underlying cause.  I schedule a full hour for each initial consultation so that such key details are not missed when we discuss your back pain.

Physical Examination: A detailed musculoskeletal and neurological examination can pick up subtle findings that point to specific pain generators.

Medical Imaging:  Ultimately, studies like X-rays and MRI’s help me confirm my diagnosis and aid in planning for particular interventional procedures.  It is important not to over-rely on imaging alone: many findings on imaging like small disc herniations do not match with one’s specific pain, and can distract doctors from identifying and targeting the true source of back pain.

Step Two: Target Therapy to the Source

Once a pain generator is identified, it is possible to direct treatment to that area.  The exact treatment depends on the kind of pain being treated.  For example, sciatica pain from a compressed nerve root often gets better when steroid medication is injected at the area of compression, using live X-ray guide a thin needle to the area where the medication will be most effective.  A painful facet joint, however, responds much longer when treated with radiofrequency neurotomy.

In some cases, diagnostic nerve blocks are necessary to confirm the source of pain before treatment.

Step Three: An Integrated Back Pain Treatment Plan

One limitation of interventional treatments for pain is that they may wear off with time.  Although they can be safely repeated every several months, the best use of these therapies is in conjunction with other treatments.  For example, patients who are unable to attend physical therapy due to pain are often able to fully participate after a therapeutic injection.  The best outcomes are achieved when interventions are used to complement other forms of treatment, especially physiotherapy and exercise.  As a comprehensive pain specialist, I can help coordinate a specific multidisciplinary plan to supplement interventions.

 

Image by BruceBlaus (Own work) [CC-BY-3.0 (http://creativecommons.org/licenses/by/3.0)], via Wikimedia Commons
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About Leo Lombardo, M.D.

Leo Lombardo, M.D. is a dual-board-certified pain physician and founder of Ventura Pain and Spine Physicians, a medical practice serving Ventura, Oxnard, Camarillo, and all of Ventura County.

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