LOWER BACK PAIN

What are the common causes?

Lower back pain can have various causes. It often results from muscle or ligament strain, but can also be due to a slipped disc, back disc problems, or issues with the lumbar spine. Other factors include poor posture, overexertion, and conditions such as arthritis or osteoporosis. Specific situations, like pregnancy, can also lead to pregnancy back pain due to the extra stress on the spine.

what Investigations you may require?

To diagnose the cause of lower back pain, a back pain specialist may order imaging tests such as X-rays, MRIs, or CT scans. These can help identify issues like slipped discs or other structural problems. Other assessments might include physical examinations or nerve studies.

How do we manage such kind of pain?

Back pain treatment usually involves a combination of methods for back pain relief. Initial treatments might include over-the counter pain relievers, heat/ice therapy, and rest. Physical therapy, including exercises to strengthen the back muscles, can offer lower back pain relief. For persistent pain, treatments like transcutaneous electrical nerve stimulation (TENS) or injections may be recommended. Surgery is generally considered only when other treatments have failed and if there’s a specific condition (like a severely slipped disc) causing the pain.

Lifestyle adjustments, such as improving posture and engaging in regular low-impact exercises, can also serve as a preventive cure for back pain. In some cases, alternative therapies like acupuncture or chiropractic care can provide relief. It's crucial to consult a healthcare provider or a back pain specialist to identify the best treatment plan for your specific situation.

Radiofrequency ablation (RFA) is a minimally invasive procedure used to reduce pain, including different types of low back pain, by disrupting nerve function responsible for transmitting pain signals to the brain. The procedure involves the use of electrical current produced by a radio wave to heat a small area of nerve tissue, thereby decreasing pain signals from that specific area. For low back pain, RFA can be applied in several specific contexts, each targeting different sources of pain. Here are the main types of radiofrequency ablations done for various kinds of low back pain:

Lumbar Facet Joint Ablation

This procedure targets the nerves supplying the facet joints in the lumbar spine. Facet joint pain can arise due to arthritis, degeneration, or injury, leading to chronic low back pain. By performing RFA on the medial branch nerves that innervate the facet joints, the transmission of pain can be effectively reduced.

Sacroiliac Joint Ablation

The sacroiliac joints, located at the junction between the spine and the pelvis, can also be a source of low back pain when they become inflamed or dysfunctional. RFA can target the nerves supplying these joints, reducing pain and improving function.

Dorsal Root Ganglion Ablation

For conditions affecting the lumbar spinal nerves directly, such as nerve root irritation or compression (radiculopathy), targeting the dorsal root ganglion (DRG) can be effective. The DRG is a cluster of nerve cells located just outside the spinal cord that plays a critical role in the transmission of pain signals. Ablating these ganglia can significantly reduce pain signals originating from the affected nerve roots.

Discogenic Pain Ablation

Some individuals suffer from pain originating from the intervertebral discs themselves, known as discogenic pain. This type of pain can result from disc degeneration, herniation, or tears in the outer ring of the disc (annulus fibrosus). RFA can be used to target and disable nerve fibers within the affected disc, thereby reducing pain. This is called as Biacuplasty/ Bipolar Intra-Discal cooled RFA.

Each of these procedures requires precise imaging guidance (usually fluoroscopy or CT) to accurately target the nerves responsible for transmitting pain signals from the affected area of the lower back. The choice of RFA procedure depends on the underlying cause of the low back pain, the specific anatomy of the patient, and the presence of any contraindications or risks associated with the procedure.