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MACS PAIN CLINIC

Tel: 07868118976
Back pain

BACK PAIN

BACK PAIN

Most people get pain in the spine and the lower back and neck the most common areas that develop pain as they are the most mobile part of the spine. Our spine was designed to walk on all four limbs, but once our ancestors started walking on two feet, it puts undue stress on the spine and this leads to painful conditions. Nearly all of us would experience spinal pain sometime in our life and most of them settle down on its own. However, low back pain and neck pain are one of the commonest causes of sickness absenteeism as 1 in 5 people would be experiencing pain for more than three months. It is important that pain is assessed and addressed in a timely manner to prevent undue suffering and disability, but also to rule out sinister conditions.

Differential Diagnosis

Sciatica

Lumbago

Sacroiliac pain/ Sacroiliitis

Piriformis syndrome/Deep gluteal syndrome

Spinal canal Stenosis

Failed Back Surgery Syndrome

Spinal pain

Degenerative disease of spine

Disc prolapse/ Herniated discs

Discogenic pain

Radicular pain

SYMPTOMS & SIGNS

Sometimes spine pain can occur suddenly or it can occur slowly. Spine pain can also occur immediately after an injury or the onset of symptoms can be delayed.

Symptoms may include; a sharp pain, or a stiff back, pain radiating down into the buttock or leg and even into the foot. There might be tingling, numbness, pins and needles and weakness.

Sometimes people can be very unwell if there is a more serious cause like an infection or fracture of the spine.

  • CAUSES OF SPINAL PAIN
  • RISK FACTORS

The back is mechanical in nature and spine pain occurs when there is a disruption in the way the parts of the back fit together and work. These include the spine bones (vertebrae), intervertebral discs between the bones, spinal cord, many complex nerves and surrounding muscles, tendons and ligaments.

The parts of the back all work seamlessly together like components of a complex piece of machinery but if one part is faulty, the whole system can be affected and malfunction.

When back experts make an assessment, a few things need to be considered because pain in the back could be caused by a number of problems in or around the back. A few spine pain causes are:

  • Back Strains and strains of muscles, ligaments, and tendons.
  • Sometimes back muscle pain can be related to myofascial pain syndrome which causes muscle spasms and tenderness. The psoas muscle or any other muscle in your lower back could be in spasm, causing you pain.
  • Back joints
    • The joints in the back are called facet joints. The facet joints can become inflamed and swollen (arthropathy), which can cause stiffness and pain. Sometimes facet joint pain can be debilitating and long-lasting.
  • Muscles around the back are complex and can be a source of pain. These muscles can become weak or go into spasms.
  • Myofascial pain
    • This is pain that occurs because of problems with the surrounding muscles, ligaments and tendons of the back. The muscles may develop discrete little tight knots (taut bands) that are called myo-fascial trigger points. Trigger points are hyperirritable spots in the covering (fascia) surrounding muscle and can be very painful and quite debilitating. When a trigger point is touched or examined, it can cause exquisite pain in and around the area.
  • Lumbar spondylosis (osteoarthritis) is back arthritis
    • An age-related condition that affects the joints, discs and ligaments of the back. This can also occur in the sacroiliac joint.
  • Spondylolisthesis
    • Pronounced spon-di-low-list-thee-sis.
    • Misalignment of spine bones occurs when one vertebra slips over the one below it. It can be caused by problems with the bone or disc degeneration or ligament issues. It usually occurs with spondylosis. Another type of misalignment is when there is a curved spine (scoliosis).
  • Degenerative disc disease
    • When lumbar discs degenerate and change, they can sometimes become painful.
  • Referred pain
    • Referred pain is where pain in one part of the body can be felt in another part of the body that is nearby. This occurs when different parts of the body share the same nerves to send signals to the spine and brain. Back problems like facet joint arthritis or disc prolapses can both contribute to spinal nerves being compressed where they leave the spinal column (pinched nerves). This compression condition is called lumbar foraminal stenosis and can cause radiating pain anywhere down into the buttock, leg or foot.
  • Nerve pain
    • Sometimes neurological problems can cause spine pain. Neurological causes might include shingles (zoster), post herpetic neuralgia, or even some spine conditions like meningitis. When a compression occurs into the spinal column itself, this may be called lumbar spinal stenosis and if the compression is serious it can compress the spinal cord itself, which is called myelopathy. Myelopathy is when the compression of the spinal cord starts causing symptoms, such as weakness or problems with coordination in the arms, hands, legs, or even feet.
  • Sensitisation
    • Sometimes a problem in the nervous system called sensitisation can occur. This is when the pain, usually a nerve pain seems to be spreading up into the body and or down into the arm, or even into the other side of the body. People with sensitisation can even have sensitive skin in the back region and even light touch using a brush can be exquisitely painful.
  • Post-surgical pain
    • After an operation or surgery pain can sometimes persist even after the tissue has had sufficient time to heal. This can occur in up to 25% of all surgeries and sometimes the persistent spine pain can be intolerable and debilitating. Post-surgical pain can be caused by almost any type of operation, and can be caused by many things, including nerve injury or scarring, ongoing inflammation or infection, muscle weakness and stiffness. This is a complex pain condition and should be assessed and managed by pain specialist physicians in conjunction with the operating surgeons. This is called post-laminectomy syndrome or also called Failed Back Surgery Syndrome (FBSS)
  • Elderly people
  • Being obese/overweight
  • Osteoporosis/ osteopenia
  • Sedentary habits/ desk job
  • Poor posturing
  • Unsafe/ untrained moving and handling that involves lifting heavy objects or awkwardly twisting the spine

DIAGNOSIS & TREATMENT FOR SPINAL PAIN

Most of the spinal pain people experience are in the lower back and neck.  These are discussed in detail in our pages for low back pain & sciatica and neck pain.  Pain in the middle of the spine is not that common, but persistent pain there should be investigated.  The diagnosis of spinal pain is mainly on history and clinical examination and if required, it would be confirmed with appropriate investigations.  These include X-rays, MRI/CT scans, Bone scan/DEXA scan and blood tests.

ACUTE SPINE PAIN TREATMENT

  • Simple treatments like hot or cold packs, physical activity and exercise and physical therapy.
  • Pain medications like anti-inflammatories and anti-spasm medications to provide you pain relief.

If pain is long lasting (chronic pain), debilitating and has not been responding to treatments an assessment should be made by a pain management specialist, who can assess and treat most types of chronic pain.

CHRONIC SPINE PAIN TREATMENT

Through years of experience, we’ve figured out that good and long-lasting chronic spine pain relief doesn’t work unless all bases are covered.

The best spine pain management combines pain-reducing treatments with selected therapies like physical and psychological rehabilitation treatment.

TYPES OF TREATMENT

  • Medications to reduce to pain
  • These may be simple over the counter medications or can be pain medications prescribed by your pain specialist. Medications might include muscle relaxants or nerve pain medications (neuropathic pain medications). Sometimes analgesic compound creams are used to ease pain.
  • Pain interventions
    • Injection therapies can be used to target, diagnose and manage chronic pain caused by muscle, joint and nerve pain.
    • It includes interventional therapies like nerve blocks (medial branch nerve, lumbar nerve roots, cluneal nerves, gluteal nerves, sciatic nerve, lumbar plexus), radiofrequency ablation (RFA), pulsed radiofrequency (PRF) and epidural and nerve root injections. Sympathetic nerve blocks can also be performed. Some of these therapies can be focused on various structures that might be causing or making the pain worse like the lumbar facet joints, the spinal nerve roots and other nerves around the back. Platelet-rich plasma can also be used in some locations around this area.
  • Nerve stimulation or neuromodulation techniques
    • Advanced pain reduction strategies may include spinal cord stimulation for severe spine pain. Some forms of spinal cord stimulation are high frequency stimulation (HF10), tonic stimulation, multi-waveform stimulation, BurstDR stimulation and even Dorsal Root Ganglion (DRG) stimulation.
  • Surgery
    • Generally recommended when tests show structural changes, which need corrective surgery. When other therapies fail, surgery may be considered an option to relieve pain caused by serious musculoskeletal injuries or nerve compression. These are typically performed by a neurosurgeon or a spinal surgeon. Types of surgery might include, decompression surgery (laminotomy, laminectomy, discectomy) and or stabilisation surgery (fusion)
  • Rehabilitation

Most types of chronic pain treatment should be managed alongside some form of specialist rehabilitation. This is when the best results occur.

Frequently Asked Questions

Q: What are the side-effects of injections?

A:

Each injection can have different side-effects. Please refer to appropriate injections information leaflet in the section of treatments.

Q: How can injections help in pain management?

A:

In situations where the pain is disabling severe and not allowing you to do the day-to-day chores, medications have proven inadequate to reduce the pain; injections are targeted to be given either under x-ray guidance or ultrasound guidance at the presumed sources of pain. Injections mainly consist of local anaesthetic with or without steroid. This works as anti-inflammatory at the source of pain.

Injections are not a permanent cure. Injections help by reducing the intensity of pain. The aim is to reduce pain and break the cycle of pain, allow you to carry out rigourous physiotherapy and help and healing. We may have to repeat injections in order to achieve the goals.

There are other injections available when nerves can be ablated (burnt) or we can apply what is called a radio-frequency lesioning at lower temperatures. These treatments have intermediate to long-term benefits and also work to reduce inflammation. These can be offered if the initial injection does not last long enough to follow on with strengthening Physiotherapy. These injections are not operations or permanent treatments. They are used to improve your condition of pain in order for you to carry out rehabilitative strengthening physiotherapy and come out of the vicious cycle of pain.

Q: What can I do if I do not want medications for my pain control or medications have not helped, or I get too many side-effects from medications?

A:

We can offer you Non-injection interventions such as acupuncture. We can introduce you to other means of self management of pain such as using a TENS machine . We have a modalities to offer at our clinic for example Medical yoga therapy, deep electrical muscle stimulation, TENS treatment. If the pain is unbearable, not responding to medications, or you do not want to try the non-invasive modalities ; we could offer you injection therapies.

Q: What will happen then ?

A:

You will have a detailed consultation, examination and then be given information and advice about your condition. We may also organise investigations. We may be able to prescribe you medication and give you details about how to manage pain and other interventional options can be discussed.

Q: Who will be seeing me?

A:

You will be reviewed only by MACS clinic senior Pain Consultants for your condition.

Q: If I am unable to get a GP appointment or don’t want to wait for any appointments how can I get in touch with you?

A:

You could phone us On (020) 7078 4378 or 07868118976; from 9 am to 6 pm; to book an appointment. You could also email us on info@macsclinic.co.uk or you could also get in touch with us on our website www.macsclinic.co.uk

Q: I am concerned about my pain. What should I do?

A:

If your pain is very severe, not responding to over-the-counter painkillers you should contact your GP and get an appointment for review. If you are in severe disabling pain, unable to carry out any routine tasks, you could book an emergency appointment with your GP or go to the local A&E for a review.

RED FLAGS – SINISTER CAUSES OF SPINAL PAIN

These are not very common, but it is important to rule them out if there is suspicion of a serious underlying condition.  These include   some instances, pain can indicate more serious back problems. These problems might include cancer, fractures, infection, severe nerve compression (pinched nerve) and ankylosis spondylitis.

  • Metastatic cancer
  • Fractures – this could be traumatic or spontaneous (osteoporosis/pathological fracture)
  • Infection/Inflammation – Osteomyelitis, Discitis, TB, Meningitis, Arachnoiditis
  • Spinal cord/ Nerve compression causing weakness or bowel/bladder dysfunction
  • Sero-positive arthritis – Rheumatoid arthritis, Ankylosing spondylitis

Seek urgent and specialist medical advice if you have:

  • Sudden onset persisting pain
  • H/o trauma or fall
  • Fever and stiffness
  • Weakness of
  • Weakness in arms and or legs
  • Problems with bladder or bowel function
  • Stiffness is worsening
  • Pain does not settle by itself after a few days or weeks

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