The lockdown due to coronavirus created a never before situation where a number of us were unable to pursue our routine physical activities. Some were forced to perform unaccustomed activities like household chores, shifting/lifting heavy objects whereas others had to compromise on their routine exercises or gym visits. Having treated both type of patients with back pain during the lockdown, I can confirm that both situations can initiate and aggravating low back pain.
Low back pain (LBP), in simple words, is any pain in the bottom region of spine, between lower margins of ribs and the gluteal folds (end of buttocks). It is a leading cause of disability with lifetime prevalence estimated at 70–80%. In other words, 70- 80 % of us will be troubled by back pain at some point in our life. The pain may vary in severity from a mild discomfort or distraction to severe pain bringing life to a standstill. Common causes of LBP include muscle or ligament strain, arthritis of the spine, disc bulges/ rupture (slipped disc in common language) and pinched nerves. Other causes include degenerative discs, abnormal curvature or alignment of spine, narrowing of the spinal canal and referred pain from nearby areas. Fortunately, serious causes such as fracture, infection, cancer etc. are not so common. The pain may remain localised to the back or spread to the legs. Pain radiating to the legs accompanied by numbness, tingling and weakness is addressed as sciatica. When dealing with BP pain generators are sometimes tricky to identify. It is better to control this pain sooner than later as persisting untreated pain not only leads to distress/agony but also has harmful effects on most body systems including mental, emotional well-being and quality of life.
Back Pain Secondary Arthritis Of Spinal Joints
One of the causes of back pain is arthritis of the spinal joints. Spine is made up of a number of vertebrae stacked one above the other. The vertebrae join with each other at joints called the facet joints. These joints provide stability while allowing some degree of movement. As one ages, they can become painful and stiff as a result of wear and tear or inflammation. This condition is called facet joint arthritis or simply arthritis of the joints of the spine.
Pain originating from facet joint arthritis generally presents as a dull ache, heaviness sensation accompanied by back stiffness. Some individuals experience difficulty in straightening their back especially in the morning or after a period of rest. It is not uncommon for the pain to travel to the buttocks and thigh. Many bear the pain, accepting it as a part of aging thinking that there is no solution, but is that so? as there are that can provide relief, improving the quality of life. After all, it’s all about quality of life. For someone, quality of life may mean to be able to play a few rounds of golf and for someone else it may to all about attending a work meeting without being distracted by pain. Your goals are your goals and they are important.
Investigations such as x-rays and MRI are often requested to evaluate the source of pain. These may or may not show joint changes. Even if these investigations show wear and tear/arthritis, not every arthritic joint is painful so investigations alone cannot be relied on to diagnose this problem. It required a skilled pain physician to put all findings together (history, examination, Investigations) to identify the source of pain.
This is a common question on everyone’s mind – What can one do to minimise the chances of developing this problem? Prevention involves combining healthy lifestyle with regular exercises to strengthen the core muscles. Healthy lifestyle includes eating healthy, maintaining a healthy weight, good posture, smart lifting using current technique and not smoking.
The fact that surgery or pills cannot resolve all pain issues has been long recognised. Understanding and treating pain is challenging as we all experience and process pain differently. Pain management specialists focus on holistic management, using a combination of modalities such as education, medications, physiotherapy, ergonomics & posture advice, psychology, complementary and alternative therapies and interventions such as injections.
Injections for this pain issue are safe, effective, non-surgical interventions routinely performed as day cases under local anaesthesia. The options include
Facet Joint Injections
Facet joints injections can help to identify the pain source and they generally provide good relief. The procedure revolves placing needles at precise location in the body under x-ray guidance followed by injection of a mixture of medicines to relieve pain.
This procedure can provide prolonged pain relief for back pain originating from spinal joints. It involves placing special needles under x-ray guidance, close to the nerves carrying pain sensation from the affected facet joints. Using specialised equipment, a small area of these nerves is heated using the electric current produced by radio waves. This reduces the pain signals being transmitted by the nerves to the brain resulting in pain relief.
This procedure offers many advantages including no requirement for hospital stay or prolonged rehabilitation and one can return to normal activities soon after the procedure. The pain reduction can help in improving and reducing medication requirements and provide lasting pain relief.