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What Is the Role of Interventional Pain Medicine in Treating Lower Back Pain?

Published in Pain Management, For the Health of It Author: Ryan Finn,MD

It is estimated that 80% of individuals will experience lower back pain at some point in their lives. However, most people do not develop chronic pain. Rest is often employed in the most acute period of pain and inflammation. After this, moving the right muscles and restoring proper biomechanics is important to prevent hyper reactive and disordered muscle responses. Sometimes the muscles react this way because of deeper inflammation related to spinal joints, bones, discs, or nerves. During periods of inflammation, the muscles around the spine have a propensity to spasm or contract in order to protect and stabilize the spine; unfortunately, this muscle response can cause additional pain.

When our biomechanics fail to correct, and repetitive stress is placed on our spine, chronic low back pain can develop. Sometimes this is from recurring stress signals coming from the tissues, other times it is from repetitive stress signals in the spinal cord. This can create an imbalance between the pain neurotransmitters in the spinal cord. If this imbalance continues for too long, the threshold to trigger pain changes. This makes typical activities more painful and chronic pain can develop. 

In order to prevent this cycle, it is important to address pain before a persistent neurotransmitter imbalance develops. Most of the time, restoring biomechanics with physical therapy and exercise accomplishes this. Anti-inflammatory medications, ice, topical medications, play a role in reducing tissue inflammation as well. Other classes of medications can restore balance between pain neurotransmitters as well. Sometimes we utilize psychological strategies such as biofeedback to block pain signals from reaching the brain. When pain continues despite conservative measures, advanced imaging is often warranted as well as referral to a pain specialist. Based on a thorough history, examination, and imaging results, we are able to recommend more targeted treatments to address pain.

Understanding the source of lower back pain can be crucial for effective treatment. Often we find abnormalities related to the spine that are asymptomatic. Our job as pain specialists is often connecting symptoms and image findings to potential solutions. Identifying the specific source of pain is key to tailoring an appropriate treatment plan for lasting relief.

Depending on the cause of back pain, treatments such as trigger point injections, epidural steroid injections, radiofrequency ablation, spinal cord stimulation as well as other interventions are used to target the source of pain. Our goal is to reduce pain, improve function, and enhance the patient's quality of life. Depending on the severity of symptoms or if there is concern that the nerves are being permanently damaged, surgical intervention may be necessary. Part of the pain specialist’s role is directing patients along the path of conservative care and interventional care in the safest way possible.

When pain is severe enough to interfere with daily activities, and other treatment types have not been successful in reducing pain, we’ll try other treatment options. Call CentraCare Neurosciences Pain Center at 320-240-7859 to make an appointment.