Chronic Back Pain

Back pain is considered chronic if it has been present for more than 3 months. Chronic back pain can be experienced from the neck to lower spine and it can either be localised or radiates into the lower limbs.

• A deep, aching, dull or burning pain in one area of the back or travelling down the legs.
• Numbness, burning or pins and needles sensation in the legs.
• Difficulty in performing regular daily activities.
• Lasts a long time, and is not relieved by standard types of medical management.
  

There can be many causes of chronic back pain. The pain can come from the bones joints, muscles, nerves or organs. It may result from a previous injury since healed, or it may have an ongoing cause, such as nerve damage or arthritis. In some cases, the exact cause of pain cannot be identified.

As chronic back pain may be caused by many factors, your doctor will conduct a thorough medical history and physical examination. Imaging tests may be ordered to rule out conditions such as infection, cancer or fractures. Some of the tests ordered are:

X-rays. To check for fractures or other problems in the bone.

MRI. MRI’s can be used to detect conditions including slipped discs, nerve root compression, infections of the bone or spinal canal, fractures or tumours.

CT Scan. Similar function as x-ray but shows greater details.

Nerve Conduction Study / Electromyogram. Also known as NCS and EMG, this is a nerve test that can help to determine the presence of nerve abnormality. The test will help to distinguish between nerve root and muscle disease.

Medication. Medication is prescribed to relieve pain, reduce inflammation, decrease muscle spasm and soothe nerve pain. Non-steroidal anti-inflammatory medications (NSAIDs) are commonly used. Cox-2 inhibitors, which may be safer for the stomach can also be prescribed for inflammatory conditions. Tricyclic antidepressants, anti-convulsants and serotonin – noradrenaline reuptake inhibitors are also commonly prescribed for neuropathic pain.

Physiotherapy. For many patients, a programme of supervised physiotherapy will help to reduce back pain. Treatment normally begins with traction and heat therapy, followed by exercise programmes to improve the strength and stamina of spinal muscles.

Surgery

Most people do not need surgery for chronic back pain. But if conservative treatment is ineffective, surgery may be considered. The appropriate surgery depends on the specific pathology.

Pain Management

Pain management procedures may be of benefit if you are not suitable for or do not wish to undergo surgery. Some of the options include:

Radiofrequency ablation. The objective of this procedure is to reduce chronic back pain by generating heat around a nerve and destroying its ability to transmit pain. It is normally used for patients with degenerative joint disease like arthritis.

Spinal cord stimulation. An implantable device that offers pain relief by stimulating the spinal cord electrically to block the transmission of pain. It does not eliminate the source of pain but the electrical currents interrupt the pain signals from reaching your brain.

Spinal injections. There are various types of spinal injections, they include:

• Epidural injections for back pain normally consists of a corticosteroid and anaesthetic to reduce pain by reducing inflammation of the affected areas.
• Nerve blocks are injections of medication near the nerves. They help to reduce nerve and joint inflammation, reducing the excessive triggering of injured nerves. They are also used for diagnostic purposes to determine the extent of damage to the nerves as well as the source of pain.