Chronic back pain constitutes a major chunk of patients visiting a pain clinic. First and foremost the need is to locate the exact cause of the pain generator in the back. This is derived from the facts based on the history and the symptoms given by the patient and a thorough clinical examination. Imaging modalities like MRI or CT scans may or may not be required. The important rule of thumb here is to co-relate the findings on MRI with a physician’s clinical findings; otherwise, an MRI can be misleading in many cases.

I am suffering from back pain even after the correction of my posture and physiotherapy. What to do?

First of all, we will have to understand the causes of back pain. Back pain may be caused by a pain generator located at the level of the disc (jelly-like cushion present in between two vertebrae), nerve root, facet joints (small spinal joints in between two vertebrae), muscles of the back region, sacroiliac joint, etc.

In the majority of patients with younger age, the problem is located with their disc which can be a disc disruption or else disc prolapsed leading to leg pain also in addition to pain in the back. In older age groups, most of the causes of back pain are due to degenerative changes in the facets joints or may be due to narrowing of the central canal region which presents as tingling, numbness, and heaviness in the foot region on walking (claudication).

Once the pain generator is localized based on history and physical examination, a diagnostic block may be required in a few cases to confirm the source of pain generation. Further course of treatment is then decided.

Do I have to live with these pain killers lifelong?

We at Impact Pain Clinic always discourage patients to be dependent on over-the-counter pain relief medications for longer periods of time in view of the side effects profile of these medications with regards to heart and kidney systems. Our line of treatment is based on targeted pain interventions aimed at treating the root cause of pain. The first step is always the use of neuropathic medications (NOT pain killers) which help in healing the sensitized nerves in the areas of chronic pains.

A few subsets of patients may require Minimally Invasive Pain & Spine Interventions (MIPSI) for the treatment of their pain generators. These interventions include Epidural injections, Radiofrequency and laser procedures, etc wherein the irritated nerves which are damaged because of the chronic pain are blocked to provide long-lasting pain relief to the patients.

I have been advised surgery for my condition as the last resort. What to do?

The good news is latest research studies have confirmed that the majority of back pain cases can be managed conservatively either with medication or MIPSIs. Surgery is to consider in cases where there is a red flag or a dangerous sign including bowel and bladder problems/ muscle weakness or progressing sensory damage.