Spine Pain Management: Basic and Complex Diagnoses

Pain is a complex and multifactorial manifestation of spinal dysfuction and its treatment best depends on making an accurate diagnosis.  The spine institute has a network of pain management specialists who manage severe exacerbations of pain originating and radiating from the spine, and engage our patients in treatment of pain as well as pre and post operative rehabilitation. The initial evaluation of spinal pain is geared toward making the correct diagnosis, and this is indeed critical to prognosis and recovery. 

These very common conditions can all manifest themselves as "back pain" but they require different treatment modalities:

Herniated Nucleus Pulposus (Slipped Disc) - Commonly occurs in the lumbar spine, followed by the cervical spine and the thoracic spine. The inner nucleus pulposes slips past the fibrous outer layer and in its new location causes severe epidural inflammation resulting in pain, numbness, tingling or weakness in your arms or legs.

Spinal Stenosis - Narrowing of the bony spinal canal causes pressure on the spinal cord and spinal nerve roots. Patients usually have pain, with numbness, tingling or weakness that
worsens with walking.

Degenerative Disc Disease - the flexible disc shrinks and degenerates as a normal part of aging. It is accelerated repetitive stress in the area and arthritis. Limited range of motion of the spine and back or neck pain are common. The disc itself may also be directly responsible for the pain.

Spondylolisthesis - Spondylolisthesis is the forward slippage of one vertebra on an adjacent vertebra that most commonly occurs in the lumbar area. This condition results in lower back and leg pain that worsens with activity. The pain is due to narrowing of the spinal canal where the spinal cord resides and the foramen where the spinal nerves exit.

Facet Syndrome - a form of arthritis of the joints at the back of the spinal column (facet joints). The degenerated joint can directly cause pain as well as cause narrowing of the canal where the spinal nerves exit.

Scoliosis/Kyphosis - conditions where the natural curves of the spine are altered. The altered anatomy may result in neck pain, upper and lower back pain and numbness and weakness of arms and/or legs.


Sequalae of chronic back pain:

As one of the most common presenting complaints and a major source of disability, back pain does not only cause incapacitation of the body, but at times it becomes a major inhibitor of our mental function and causes serious debilitation by causing emotional problems as well.

Depression is by far the most common emotion associated with chronic back pain. The type of depression that often accompanies chronic pain is referred to as major depression or clinical depression. This type of depression goes beyond what would be considered normal sadness or feeling "down for a few days".

The symptoms of a major depression occur daily for at least two weeks and include at least 5 of the following (DSM-IV, 1994):

  • A predominant mood that is depressed, sad, blue, hopeless, low, or irritable, which may include periodic crying spells
  • Poor appetite or significant weight loss or increased appetite or weight gain
  • Sleep problem of either too much (hypersomnia) or too little (hyposomnia) sleep
  • Feeling agitated (restless) or sluggish (low energy or fatigue)
  • Loss of interest or pleasure in usual activities
  • Decreased sex drive
  • Feeling of worthlessness and/or guilt
  • Problems with concentration or memory