Interventional pain management clinic can be of value in cases of Low Back pain, Abdominal and Pelvic Pains ,Back Pain, Headache, Migraine and Facial Pains Heel Pain Knee Pain Neck Pain Neuropathic Pain or Neuralgias Upper Limb Pains in Shoulder Elbow & Hand Sports Injuries ,Pains after Stroke, Phantom Pains ,Abnormal Pain after any Surgery and causalgias

Low backache is one of the most common causes of patient disability and suffering. The cause of pain depends the diagnosis of the pain generator or the structure causing the pain. The tissues that make up the back are, the bony cage comprised of vertebrae with paired facet joints at each level, intervertebral disc in between covered by ligaments and muscles. The spinal cord travels in the center of canal formed by vertebra and nerves emerge at each level. Out of all these structures any tissue can be a cause of backpain. After talking and examining the patient we can decide on the pain generator which can further be confirmed by X-Ray, CT scanning and MRI scanning depending on the need.

Some of the most understood causes are

1-Acute and Chronic Disc Protrusion-Slipped disc, It causes backpain +_Leg pain going to thigh, gluteal area, calf or foot depending on nerve involved. This pain is addressed as sciatica in common language.

2-Facet joint pain- Pain on prolong standing, mostly on sides of spine and pain increases with change of posture

3-Sponylosis- Centre back pain, Early Morning stiffness

4-Spondylolistesis- Pain increases on getting up after lying down

5-Lumbar canal Stenosis- Pain after walking

6-Muscular pain syndromes- Localized back pain with stiffness

Whatever the pain generator, all these conditions produce a tremendous spasm of the muscles on either side of the spine. Mostly back pains are a result of this spasm. When man evolved from a quadruped to a biped posture, the weight that was well distributed between 4 legs became transferred to just 2 legs. In addition, the center of gravity shifted upwards making constant muscular effort essential to maintain stability. In addition, the upper extremities pivot on the lumbothoracic junctional area for all movements. All this puts a lot of load on the back. The areas particularly stressed are neck, the thoracolumbar junction and the lumbar region where the load is maximum. It is well to remember that back is not a stable fixed structure but is supported by the 2 legs which are themselves mobile. So the way the feet are placed on the ground, and the tensioning of the muscles around the ankle and knee can determine whether the back is tilted forward or backward. Thus, the equilibrium of back in health is extremely complex even at rest. When dynamics of body movement, and of the upper and lower limbs are added to the situation it becomes well-nigh unpredictable and incomprehensible. Little wonder then, that the incidence of back pain is what it is. Modern lifestyle adds to the problem because of the lack of exercise to the back, prolonged sitting especially working at the computer, slouching on soft sofas in front of TV etc. Nature however, has designed our body well. So, the body tolerates a lot of abuse before it expresses its distress by way of pain. By the time pain is felt considerable damage would be done to the back. This can be reversed in most people with well-planned exercises, and giving proper healing to affected tissue. However if the result of the negligence has already caused a disc to prolapse or even a small tear in the disc then interventional procedures may be necessary to reverse the damage and restore normalcy.

Treatment:
Medigram offers a complete rehabilitation package for low backache, from preventive pain management to comprehensive treatment strategies that includes a correct diagnosis of the pain generator and a specific target treatment for the pain generators.

We perform a transforaminal epidural injection of steroid to reduce the irritation of the nerve root by the disc, Facet joint injection, trigger point injection, Disc fix, RF Ablation of Median branch etc. It is our experience that whatever the pain generator (disc facet etc.), the pain is invariably expressed through the muscles. Pain killers offers temporary solution in all types of backpain but combining it with injections reduces dependency on pain killers, helps in going back to normal life early, early mobilization and many times it has been seen operations can be deferred by using these pain relief measures early.

Writer - Dr Varsha Agarwal