Back Pain : Causes, Diagnosis , Treatment

MRI FOR BACK PAIN
  • Suffering from Back Pain ?
  • Visited a lot of doctors but Back Pain is not relieving  ?
  • Operation advised for Back Pain, Do I really need it ?
  • Want to take  a second opinion before surgery 
Remember scope of surgery for back pain is limited and the condition may worsen if the surgery is done without proper indication. 
Most of the back pain conditions can be treated with medicines or with minimal interventions. 
Back Massage

Back Pain 

Back pain is one of the most common problems for which patients usually visit a pain physician.

while most of the back pain are short lived and heals without treatment or with simple pain killers , some back pains are chronic and amenable to conventional treatment.  some of the back pain can be life threatening and may lead to paralysis of legs.  

Sometimes the pain lasts for long and not responded with usual pain killers. Sometimes back pain may be associated with radiating leg pain, burning sensation in back and legs, tingling, numbness in any specific areas of the legs. 

Back pain needs to be treated properly. 

Causes of Back Pain 

Causes of back pain is complex and sometimes very difficult to find out. 

Reg flags -

Red flag signs in back pain are those conditions that requires aggressive medical and / or surgical treatment. those conditions are 

1.  Suspected fracture

2. Suspected  tumor,

3. suspected malignancy

4. Back pain with progressive weakness of the legs , i

5. Back pain with inability to control bowel and bladder.

An X-Ray of lumber spine needs to be done urgently. and management has to be started immediately.  

Structures responsible for back pain - 

Structures responsible for back pain or in simple terms pain generators are mostly located around neural foramen. 

They are nerve roots, inter-vertebral discs, facet joints , sacroiliac joints, muscles in certain conditions. 

Pain originating from joints may me due to systemic inflammatory diseases like Spondyloarthropathies or it may be degenerative (due to joint wear and tear as a result of ageing) 

Differentiation between  inflammatory and degenerative back pain - 

 

  • Both of these joint pain increases after rest specially in morning and relieves on movement. In inflammatory conditions the pain lasts usually more than one hour. 

  • Degenerative joint involvement usually occurs in older age whereas inflammatory back pain usually occurs in younger age. 

  • Blood investigation markers of inflammation are usually positive in inflammatory pain. 

Common Causes of Back Pain - 

  • Pain from facet joints also called facet joint arthropathy. 

  • sacroiliac Joint arthropathy. 

  • Discogenic pain due to Degenerative Disc Disease or Internal disc disruption. 

  • Lumbosacral radicular Pain or Pain due to slipped disc. also called sciatica..

  • Myofascial Pain Syndrome.

  • Piriformis syndrome

What are the investigations required for diagnosing back pain ? 

To diagnose back pain, your doctor will take your medical history and do a physical exam. Your doctor may order other tests, such as:

  • X rays

  • Magnetic resonance imaging (MRI)

  • Computed tomography (CT) scan

  • Blood tests.

Medical tests may not show the cause of your back pain. Many times, the cause of back pain is never known. In those cases diagnostic pain interventions are done to locate the pain generator (From where the pain starts) and treated accordingly. 

 

Is MRI a mandatory for back pain? 

MRI is not mandatory for back pain but it needs to be performed when a back pain is not responding with medications for more than 1 month.   

What is the treatment for Back Pain ?

Treatment of Back pain depends on the cause of it. Back pain management can be discussed in three major headings 

1. With Medicines.

2. Interventions .

3. Surgery