Back Pain (Frequently Asked Questions)

Back pain can be debilitating as our back supports all everyday movements of our body.

At CPMC, we utilize a multitude of treatments including platelet-rich plasma, physical therapy, therapeutic steroid injections, regenerative medicine through platelet rich plasma injections, epidural steroid injections, facet joint radiofrequency ablations, discograms, neuromodulation with spinal cord stimulators, and if necessary can refer for surgical opinions. Back pain can be debilitating, but we look forward to working with you to be as functional as possible!

Low back pain is one of the most common reasons to see a doctor. It is the leading cause of activity limitation and work absence. Out of 291 diseases surveyed, The Global Burden of Disease Study ranked lower back pain as the greatest contributor to global disability. Back pain can be treated, but identifying the actual cause of pain can be difficult for the untrained physician. Evaluation by a practitioner experienced in accurate diagnosis is the first step in recovery! A comprehensive treatment plan consisting of multiple modalities can provide optimal pain relief.

Accurate diagnosis is paramount in treating lower back pain. Given there are many causes of back pain including muscle strain, herniated disks, arthritis, spondylosis, bone fractures, ligament strains, sacroiliac joint inflammation, and facet joint arthritis, knowing the cause is the first step in treatment and pain relief.

Localized pain in the lower back can be caused by multiple different issues. Muscle strains are the most common. Bulging discs and arthritis can also cause non-radiating pain isolated to the back. The sacroiliac joint that connects the spine to the pelvis is often sprained and can cause significant discomfort while sitting for long periods of time in a car or at work.

Pain radiating down legs frequently caused by a pinched nerve in the lower back from a bulging disc in the spine. It can also be caused by sacroiliac joint sprains and myofascial trigger points. Myofascial trigger points are “knots” of muscle tissue that have lost their normal tissue alignment thereby impinging on local blood vessels causing pain.

Back spasms are frequent in many individuals with chronic back pain and are a source of severe pain and discomfort. They can be a result of pinched nerves or originate from the back muscles. Treating the source and symptoms of back spasms requires a multi-modal approach including medications, physical therapy, neurofeedback, and sometimes injections.

Immediate pain after bending or twisting. This is often termed “throwing your back out” and usually is caused by muscle strains or ligament sprains. The bottom of the neck to the lower back is composed of numerous layers of muscles, fascia, and ligaments. When these tissues become acutely injured substantial pain can be experienced. If pain travels down one or both of the legs, then the issue is more likely to be a disc pinching a nerve.

Pain while bending forward or leaning backwards without pain going down the leg. Pain while bending forward is often indicative of pain caused by bulging discs. As one leans forward pressure is applied to the discs in the lower back causing them to bulge. Nerves surrounding the discs that sense this bulging transmit pain signals that are recognized by the body as pain. Pain when leaning backwards is typical for arthritis of the facet joints that connect the individual vertebrae to each other. This is very common and there are injections that can help reduce pain in this condition.

Myofascial Pain/Ligament Strain
This is often an acute onset cause of lower back pain and can occur after bending and lifting heavy objects or twisting. It can be associated with muscle spasms. Chronic muscle pain in the back is also common and usually caused by myofascial trigger points. These are local areas of mal-aligned muscle fibers causing local irritation that can cause traveling pain.

Sacroiliac Joint Pain
Sacroiliac joint pain is located in the lowest part of the back on right, left, or on both sides. It can be made worse by sitting for long periods. There is an extensive system of ligaments surrounding this joint that are often sprained causing pain. Arthritis of this joint is also a source of discomfort. Pelvic imbalances can lead to pain at the sacroiliac joint.

Arthritis
Arthritis can be located in numerous joints of the spine. Most commonly it occurs between the vertebrae at the site of disc degeneration. This can lead to local lower back pain or radiating pain down the leg. Arthritis in the facet joints causes local back pain while leaning backwards. This can be treated with facet joint radiofrequency ablations, which has been used in the medical community for years and can provide significant long term relief!

Bulging Disc
A bulging disc can cause local pain in the lower back, but most often radiating pain down the legs. Depending on location, it can also cause impingement on spinal cord and neurological deficits requiring emergent medical attention. We can provide symptomatic relief with epidural steroid injections and other modalities that can get you back to your desired activities!

Abnormalities on MRI imaging of the lower back are always the cause of pain symptoms.

Multiple scientific studies have shown that MRI imaging can identify numerous pathological changes in normal people who are pain free. There are also many patients with substantial pain that have relatively normal MRI imaging. Accurate diagnosis by your pain physician is important so that MRI imaging can be analyzed in conjunction with pain symptoms

Platelet Rich Plasma (PRP)
Platelet rich plasma (PRP) can treat many causes of low back pain. Sacroiliac joint pain can respond well to regenerative techniques. Facet joint arthritis is also commonly treated with PRP.

Physical Therapy
Physical therapy is a mainstay of most treatments for lower back pain. It is used in conjunction with all other treatments and helps stabilize the back and strengthen your core muscles. Proper stretching and health maintenance is key in reducing recurrences of back pain.

Physical Modalities
Physical modalities such as heating pads and ice packs are part of the integrative care for back pain. Other treatments include ultrasound, transcutaneous electrical stimulations (TENS) units, and chiropractic care.

Topical Medications
Topical medications (eg creams, gels, ointments) can help reduce muscle and nerve pain.

Oral Medications
Oral medications can be part of initial treatment in the form of short course anti-inflammatories such as ibuprofen and muscle relaxers. Neuropathic back pain caused by pinched nerves can also be treated with medication such as gabapentin. Opioid medications are avoided and have not been shown to have long term benefit.