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Low-Back Pain Requires Careful Diagnosis for Effective Relief

Orthopedic

Chances are, you’ve seen a doctor for back pain or you know someone who has. In fact, back pain is one of the top reasons people seek professional care. It’s not just a medical problem, either: Work absences, reduced productivity and other factors related to back pain cost billions of dollars every year.

When a person goes to a doctor with chronic, debilitating back pain, however, they’re not thinking about statistics; they just want relief. Often, patients come with a preconceived notion of what they want their doctor to do for them: a certain medication or injection that helped a friend or family member, or a particular treatment they’ve read about online.

The reality is that, since back pain can come from a variety of sources, treatment that works in one situation might have absolutely no effect in another. That’s why the first step toward treating back pain is getting an accurate diagnosis.

The best way for your physician to diagnose your condition is to give you a thorough physical examination and spend time talking with you about your pain. In an era of high-tech medicine, this may sound like a primitive approach. However, pain is very complex, involving not just the physical body, but the mind, emotions and spirit. So although an X-ray or MRI can be useful to confirm a diagnosis, nothing beats a physical examination and conversation to help your physician really understand what’s going on.

While back pain has many causes, there are four common sources, each with a particular approach to diagnosis and treatment.

Low-back arthritis pain. Wear and tear on the spine joints or facets can result in arthritis pain. In addition to the back, you may feel pain in your groin. Low-back arthritis pain typically worsens when you walk or lean back but may not be present when you lean forward—such as when you’re pushing a grocery cart. To confirm this diagnosis, your doctor may do a brief outpatient procedure called a lumbar medial branch block. A common treatment for this condition is radiofrequency ablation, a quick, X-ray-guided outpatient procedure that uses heat to destroy the microscopic nerves that cause joint pain. This procedure typically provides 60- to 70-percent or more relief from pain for six to 12 months and may be repeated, if needed.

Herniated disc/degenerative disc/lumbar stenosis. Whereas arthritis pain comes from outside of the spine, this pain comes from within the spine. It manifests as a deep, dull ache that may travel down the legs, with the pain increasing when you lean forward. Often, a physical exam followed by an MRI will provide the proper diagnosis. The primary interventional treatment is a nerve root steroid injection, which is an outpatient, X-ray guided procedure that uses steroids to reduce inflammation. This procedure typically provides relief for two to three months or longer; repeating the nerve root injection may lengthen the duration of pain relief.

Buttock pain. Commonly caused by inflammation of the sacroiliac joint (SIJ)—the largest joint in the body—this sharp pain occurs below the beltline and may radiate down the legs. This condition often makes it painful to sit and to cross your legs. It is important to have a physical exam to differentiate this type of pain from others, since epidurals aren’t effective with this diagnosis. A steroid injection into the SI joint typically provides 50- to 60-percent or more relief for three to four months or longer.

Hip bursa pain. If the fluid-filled bursa—which cushions the hip joint—becomes inflamed, it can create pain in the mid-glute that may radiate down to the ankles. A physical exam can usually reveal a tender bursa, and an X-ray may be ordered to confirm the diagnosis. A steroid injection in the hip typically provides 50-percent or more relief for three to four months or more.

No matter what type of back pain you experience, you can often extend the period of relief you get from treatment by carefully following your physician’s recommendations. These may include physical therapy to strengthen core muscles and lifestyle modifications such as following a healthy diet, refraining from activities that make your back condition worse, weight loss, exercise and smoking cessation.

Amit Gupta, D.O., is a graduate of the Brigham and Women's Hospital Harvard Medical School Pain Medicine Fellowship. He is an interventional pain management and anesthesiology specialist serving Simi Valley, Westlake Village and Valencia, and he is on the Simi Valley Hospital medical staff.