By: Melissa Brady
Lower back pain, or lumbar pain, is one of the most common pain conditions that people experience. Because of it being, “invisible,” lower back pain is sometimes difficult to diagnose and treat.
In this day and age where opioids are so readily prescribed, often times physicians are encouraged to prescribe medications to treat the symptoms rather than getting to the root of the problem. Whether you are suffering from chronic or acute lumbar pain, finding treatment can be frustrating.
To avoid the tedious medication “trial and error period,” a more beneficial course of treatment may be found by using interventional pain management.
What is Interventional Pain Management?
Interventional pain management is provided by a healthcare specialist with the goal of reducing or relieving a person’s pain. This allows that person to manage his or her condition, resulting in an improved quality of life.
Interventional pain management relies upon minimally invasive procedures, which help treat and/or diagnose painful conditions so individuals can return to acts of daily living (ADLs) without having to rely upon heavy duty narcotic medications or surgical intervention.
With this type of treatment, there’s less downtime than surgery, and the benefits often far outweigh the risks when considering a less-invasive, outpatient procedure versus a more invasive, inpatient surgery.
Lumbar Conditions and Interventional Pain Management
Lumbar pain is one of the most popular complaints that physicians or physiatrists hear from patients. Once you have been properly diagnosed by means of diagnostic imaging and a physical exam, your physician can then recommend the best course of action for treatment.
Usually combined with NSAIDs, heat/ice and physical therapy, interventional procedures can help with the management of acute or chronic pain. Types of lumbar conditions that can be treated with interventional pain management include:
- Muscle Spasms- most commonly caused by a sprain or strain to the surrounding tissues and muscles, thus resulting in painful “spasms.”
- Sacroiliitis- the sacroiliac joint is the joint connecting your hip to your spine. When this joint becomes inflamed from either arthritis or trauma, it produces pain.
- Facet Arthropathy- the facet joints are the joints connected to the spine that provide stability and movement. When they start to age (degeneration) or become arthritic (arthropathy), the joints become painful.
- Facet Hypertrophy- a condition in which the facet joint becomes enlarged, causing the lining to become inflamed, swollen and painful.
- Ankylosing Spondylitis- a form of arthritis affecting the spine and joints, most commonly the facet joints and sacroiliac joints. This form of arthritis causes inflammation, stiffness and pain at the affected area. In severe cases, it can cause the bones to naturally fuse together, making the affected area immobile.
- Lumbar DDD- “DDD” is the abbreviation for degenerative disc disease. This is the degenerative process in which the cushioning discs between the vertebrae lose hydration, resulting in stiffness and pain.
- Lumbar Herniated Disc(s)- There are discs in between each vertebrae of the spine that provide cushioning. Within these discs is a gel-like substance. When the disc becomes injured or ruptured, that substance can leak from a tear into the disc annulus (disc wall). Once this happens, the internal disc fluid causes spinal nerve irritation and inflammation, resulting in pain.
- Lumbar Stenosis- stenosis is the narrowing of the spinal canal, either from trauma or degeneration. This narrowing can cause back pain, stiffness, lower extremity pain, including paresthesias (numbness and tingling) and weakness.
- Lumbar Spondylosis- spondylosis is a fancy word for degeneration or osteoarthritis. This condition can affect the spine, vertebral joints or discs in the back, causing discomfort. In some cases of degenerative change, bone spurs (a bone outgrowth which forms along the edge of a bone or joint) can form, resulting in pain and a decreased range of motion.
- Lumbar spondylolisthesis- is a condition in which the vertebrae slips forward or backward from the vertebrae below it. This “slipping” causes a narrowing of the spinal canal and in some cases, causes narrowing around the exiting nerve roots. Spondylolisthesis can cause low back pain and stiffness, and also lower extremity pain, paresthesias and weakness.
Types of Interventional Treatment for Lumbar Pain
Once you have been properly diagnosed, your medical care provider will discuss different treatment options for which you are eligible. One option is injections. Most (but not all) injections are cortisone based.
Cortisone is a basically a strong, synthetic based injectable medication with antiinflammatory properties. When cortisone is injected into the affected area it decreases inflammation and, in turn, decreases pain. Different interventional pain procedures for people suffering from lumbar pain are:
- Trigger point injections- intramuscular injections given to decrease inflammation in the tissue and affected muscles in order to provide relief from pain and muscle spasms.
- SIJ injections: therapeutic injection in which cortisone is injected directly into the sacroiliac joint.
- Lumbar Facet Injections: therapeutic injections in which cortisone is injected directly into the multi-level facet joints.
- Lumbar Medial Branch Blocks: diagnostic procedure in which Lidocaine (and sometimes cortisone) is injected around the affected facet joints nerve endings to see if one responds with pain relief. When used for diagnostic purposes, if the patient experiences relief, this tells the physician the correct nerves were targeted, therefore rendering them a candidate for a Radiofrequency Ablation. When done for therapeutic purposes, if the cortisone provides lasting relief, the more invasive Radiofrequency Ablation may not be required.
- Radiofrequency Ablation or RFA: therapeutic procedure in which the affected nerves that were diagnosed by the Medial Branch Blocks are cauterized for longer lasting relief.
- Lumbar Epidural Steroid Injection: Epidural Steroid Injections are therapeutic injections in which cortisone is injected around the affected disc and nerve endings for pain relief. Usually beneficial for those suffering from herniated discs or with stenosis or spondylolisthesis.
- Stem Cell Injections: a newer treatment option that is widely becoming popular is stem cell therapy. Stem cells are formed at birth, and have the unique ability to change into other types of cells found throughout the body. Once the stem cells have been harvested from the body, these cells can then regenerate and help the other cells that work to produce tendons, ligaments, bones and joints. Once injected into the injured disc(s) or joint(s) and their surrounding tissues, stem cells enhance the natural repair of the affected area, thus providing pain relief.
- Intrathecal Pain Pump: is an implanted device that provides targeted drug delivery to relieve chronic pain. Cerebrospinal fluid flows through the intrathecal space (the area surrounding the spinal cord), and provides protection for the spine. The intrathecal pain pump uses a catheter that has been implanted into this space that delivers small amounts of opioid medication or a muscle relaxer directly into the spinal fluid, therefore providing pain relief.
- Spinal Cord Stimulator: is a small device implanted underneath the skin. Electrical leads are threaded through the epidural space that provide stimulation to block the pain waves traveling to the brain, which tell the brain that the body is in pain. A small handheld device allows the patient to turn the stimulator off/on, and also adjust the setting of the internal device, depending on the severity of pain.
Where to Get Help for Lower Back Pain
Consult with a pain management physician or psychiatrist (a physician specializing in physical medication and rehabilitation) to discuss treatment options for lower back pain. These doctors are specially trained to use science to evaluate, diagnose, treat and hopefully prevent pain from reoccurring. Using a combination of interventional injection treatment, physical therapy and medications, their goal is to improve the patient’s quality of life, while also trying to prevent surgical intervention.
Lumbar pain is one of the most common disorders affecting old and young alike. Whether from an injury or degeneration as we age, there are a variety of treatment options available for managing your individual needs. For more information, ask your doctor about the benefits of interventional pain management and how it can help with your acute or chronic condition.