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Spine & Sports Medical Group

Patient Education

Causes of Neck & Back Pain

Causes The spinal column is complex. The spine consists of the vertebra, the discs, and the spinal cords and its nerves. In addition to the primary structures, the spine is held together by a complex structure of ligaments, tendons, and muscles. Injury or irritation of any of the primary components of the spine has the potential to cause spinal pain. The supporting structures (muscles, ligaments, tendons) in turn may go into spasm creating additional pain. In some patients the situation is complicated by stress and depression, which frequently accompany pain and can make pain worse.

Physicians can generally make a fairly accurate guess of where the source of pain based on the patient’s, physical examination, Xray, MRI, and EMG/NCS . However, in some cases, the source of pain is not obvious. The above tools cannot see the patient’s pain. MRI scans frequently are not helpful in these patients, as they may show only the normal age related changes that occur in most people, whether they have pain or not. The nerve supply to the spine is diffuse and overlapping, so a particular pain could have one of several possible causes. While diagnosing the exact source of pain may be difficult, if your doctor knows the source of your pain he or she may be able to treat you more effectively. This is particularly true if surgery is being considered.

Diagnosis of Pain

An alternative to relying only on the clinical evaluation and x-ray studies to diagnose the source of pain is diagnostic injections. These may be useful both in patients with nerve root pain and in patients with back or neck pain. At the time of a diagnostic injection we selectively inject individual structures of your spine with contrast dye and/or local anesthetic, and observe the effect this has on your pain. If you experience reproduction of your typical symptoms during an injection, that may be an indication that the structure being injected is the source of your pain. If your pain goes away, even for a short period of time, after we inject a specific structure with local anesthetic, that may also be an indication that the structure injected is the source of your pain.

Because the degree of pain relief that you experience immediately after a diagnostic injection is so important, following the injection you may be asked to perform certain maneuvers that usually increase your pain, to determine if that has changed. In addition to contrast dye and/or local anesthetic we often include a small amount of cortisone with diagnostic injections. The cortisone used may provide prolonged pain relief beginning one to two weeks after the injection. If you have such pain relief following a cortisone injection, that also may be important diagnostically. Examples of diagnostic injections include disc, facet, sacroiliac, sympathetic, and selective epidural or nerve root injections. Using injections, in conjunction with clinical information and imaging studies, we are able to diagnose the source of pain in approximately 75% of patients.

Treatment of Pain

In general there are four treatment options for patients with chronic spinal pain. Physical therapy can be effective for many people, particularly physical therapy that emphasizes activity and return to function. For patients that have pain despite physical therapy surgery can sometimes be effective. The success of surgery is highly dependent on an accurate diagnosis as to the source of pain. Another option for patients is to simply live with their pain as best as they can, sometimes with the assistance of pain medications or other methods such as acupuncture.

Another alternative for treating spinal pain is injections. If your doctor knows where your pain is coming from he or she may recommend a therapeutic injection. Therapeutic injections differ from diagnostic injections in that they are intended to treat pain, rather than diagnose its cause. Most therapeutic injections use local anesthetic and cortisone medications, although sometimes other substances or even heat can be applied. Examples of therapeutic injections include epidural, facet, sacroiliac, sympathetic injections, facet rhizotomy, and intradiscal electrothermal therapy.

Therapeutic injections have two potential benefits. The first is they may provide long term pain relief. The likelihood of significant, lasting pain relief after a therapeutic injection will vary according to the source of pain and the specific injection, but typically is in the 50%-60% range. The second potential benefit of a therapeutic injection is that even though it only provides short term relief of pain (e.g. 2-3 weeks), during that time other treatments such as physical therapy will be much more effective. The combination of the injection and additional treatments (as ordered by your doctor) may then lead to long term pain relief.

Risks, Side Effects, and Possible Complications

When done properly, spinal injection procedures are very safe. All of our procedures are done under x-ray guidance, both for safety reasons and to provide the greatest likelihood of success. However, with any medical procedure or treatment there are possible risks. Any time a needle is placed into the body there is a risk of bleeding. Usually, any bleeding that does occur after an injection is very minor. However, in rare circumstances bleeding can lead to a serious complication. To minimize this risk, we ask you to stop anti-inflammatories for 3 days prior to your procedure — aspirin for 7 days prior — and to notify us if you take blood thinning medications. Another complication that can occur with needle procedures is infection. The chance of getting a significant infection after any needle procedure is very low. However, with certain procedures involving disc injections (including discograms and intradiscal electrothermoplasty) if an infection did occur it could lead to a serious complication. For that reason, if you are having a disc injection antibiotics will be administered to you both intravenously and directly into the disc at the time of the procedure.

All of our procedures are performed using local anesthesia. Intravenous sedation may be required. It is possible to have allergic or other reactions to the medications used during the procedure, including the injection of contrast material or "dye" to make the x-ray image better and to make sure the injected medication will go to the right place. Most such reactions that do occur are minor, although serious complications are possible. For that reason it is important that you notify us of any medication allergies prior to the procedure.

Minor side effects are common after injection procedures. The sedative medications that are used may impair your coordination, so you should not drive or do other activities requiring coordination for at least 12 hours after the procedure. The local anesthetic injected into the spine may cause regional numbness or weakness for up to 6 hours after the procedure, which is another reason to limit your activity the day of the injection. You may have local soreness at the injection site for one or two days, which usually responds to ice packs. Some patients, especially those having discograms, may have an increase in their usual pain for up to 10 days following an injection. If you experience this try rest and your regular pain medication, and call us if your pain persists. If you received cortisone in your injection you may notice an improvement in your usual pain within 2-3 days, although it may take as long as 10-14 days for the medication to fully take effect. Although most patients do not have any side effects from cortisone, the following side effects are possible: sweating, flushing, palpitations, increased heart rate, insomnia, anxiety, hiccoughs, headache, menstrual changes, upset stomach, frequent urination, and slight fever with flu-like symptoms. If any of these side effects become significant or persists longer than three days please contact us.

Although serious complications are rare, they can occur. Possible serious complications include: increased pain, headache, temporary or permanent nerve damage, hip (bone) damage caused by steroids, seizures, difficulty breathing, collapsed lung, death, paralysis. It is possible that serious complications, especially those related to bleeding and infection, could occur in the recovery period at home, after you have left the clinic. For that reason, if you develop fever, progressive weakness or numbness, loss of bowel or bladder control or any other symptoms which you find concerning please notify us immediately.