What are the basic types of back pain and what are their causes?

     There are many types of back pain and the causes of back pain can often be multi-factorial.There are simple types of back pain which are muscular causes, there are bony causes and disc causes. The muscular causes include muscle strain and sprain most commonly caused by an imbalance where one group of muscles is more developed than another group of muscles.

The bony causes include slippage of one vertebral body, that is, the bones of the back slip upon another - that is called spondylolisthesis.  Discogenic causes are usually referred to as "slipped disc." These discs are cushions between two vertebral bodies, which can rupture or slip. They are structured much like a jelly-filled donut, and are "the shock absorbers of the spine." If the "jelly" comes out, the donut goes flat and it can no longer act as a shock absorber. This may result in severe pain, or what is commonly known as sciatica or nerve impingement.

     This jelly that is inside the disc contains some extremely powerful enzymes that can cause terrible inflammation on the nerves if the nerves come in contact with this. These enzymes can also cause back pain as well as nerve pain. Because of this irritation or inflammation that the disc is causing, we use drugs to stop inflammation. Many times we use orally taken non-steroidal anti-inflammatory medications or steroid medications. These three types of back pain - muscular, bony and disc - comprise the vast majority of back pain.

What is the leading cause of chronic back pain?

Most frequently, it is muscular. This is why physical therapy is such an important adjunct to invasive pain management and oral medication. Physical therapy re-educates the patient and strengthens the muscles in the back so that the patient can be restored towards normalcy and at the very least minimize their pain.

How can I tell when the back pain is due to muscular pain or due to a much more serious condition like discogenic pain?

         If you lifting something too heavy and jerks and suddenly feels a "pop" in your back that is shooting down the leg, this is most likely due to a herniated disc. At this point you should go immediately to a physician with some expertise in spinal treatment and the physician will most likely examine you, perform a straight leg test which will or will not cause pain, obtain a MRI or a CAT scan to actually visualize the discs radio-graphically. All of these things better enable the physician to tell what type of pain the patient is suffering from and what is the etiology of their pain. Once the etiology is accurately obtained, then and only then can the physician form a treatment plan which is proper for that patient.


What is the most common use and when are epidural steroid injections indicated for back pain?

The steroid medication is injected into the epidural space in a wide variety of fashions under fluoroscopic guidance.  The advantage of delivering epidural steroids is that the physician can deliver a high enough concentration in and around the inflamed area much greater than we could have obtained if the medication was given orally. 

What are some things that can be done for the patient that fails injections?

There are patients who do not respond adequately to injection therapy. The treatment after injections is variable depending on the underlying disease. If a patient has discogenic pain with a herniated disc, this patient may very well be a candidate for a nucleoplasty, IDET procedure, a disc decompressor procedure, radiofrequency lesioning or for more invasive surgical procedure.