Back pain is a very common complaint. According to research most people will have lower back pain at least once in their lives. Even though back pain can affect people of any age, it is significantly more common among adults aged between 35 and 55 years of age. Pain in the back, from neck to lower back may be linked to the bony lumbar spine, the joints between the vertebrae, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, lower back muscles, abdomen and pelvic internal organs, and the skin In most cases the pain settles with conservative management, but comes back if the underlying problem is not addressed. Earlier the only options for treatment of back pain were either conservative or surgery, with the advent of Pain Management now various interventions can be performed to tackle the pain.
Spinal cord is encased in a bony tube formed by bone blocks 9 vertebra with interspersed discs. The nerves to legs & arms leave the spinal cord at regular intervals through the spaces in vertebral column. These nerves can be trapped by inflamed or degenerative joints or discs, either in front, back or sides. The area of problem is determined & is targeted for therapy using ultrasound or fluoroscopy guidance
Back Pain can be due to following reasons:
• Failed back surgery
• Facet Joints
• Nerve Root
• Sciatic Nerve
• Sacro-iliac Joint
There are certain warning signs or Red Flags which one needs to watch out for and must contact the doctor:
• Night pain
• Younger or Older age group
• Weight loss or Bowel symptoms
• History of TB or Cancer
• Requiring regular pain killers
• Weakness or pins and needles
Pelvic pain may be a symptom of infection or may arise from pain in the pelvic bone or in non-reproductive internal organs, such as the bladder or colon. In women, however, pelvic pain can very well be an indication that there may be a problem with one of the reproductive organs in the pelvic area (uterus, ovaries, fallopian tubes, cervix, or vagina). Pelvic pain may often become chronic, i.e. persistence of pain even after treating the involved organ. In such situation the pain itself becomes the disease. The cause of this pain needs to be diagnosed .
Various treatment options are available:
• Ganglion Impar block – cluster of nerves giving rise to pain
• Ultrasound guided intra-articular-if the pain is from joint
• Ultrasound guided nerve blocks-individual nerves can be targeted if found responsible or sympathetic chain which carries all the pain
fibers can be blocked so they are unable to transmit pain
• Percutaneous external neuro-modulation for remodeling the nerves so they don’t carry pain
• TENS have proven to be of benefit to patients
• Ultrasound guided treatment for the nerve involved can help in case of facial pain
• Percutaneous external Neuromodulation
• Percutaneous neuromodulation
• Ultrasound guided blocks
Post-surgical or Injury Refractory Pain
Post-surgical pain is a complex response to tissue trauma during surgery that stimulates hypersensitivity of the central nervous system. The result is pain in areas not directly affected by the surgical procedure. Post-operative pain may be experienced by an inpatient or outpatient. It can be felt after any surgical procedure, whether it is minor dental surgery or a bypass heart operation.
Cancer Pain Treatment
This is the generalized pain in body associated with fatigue, sleep disorder, joint stiffness & cognitive dysfunction among other symptoms. It is estimated to affect 2% – 4% of the population. Earlier thought to be associated with psychiatric conditions, it is now recognized as a diagnosable disorder. The treatment is the specific medical management, trigger point injections, which improves the quality of life.