SPINAL PAIN
Spinal pain is the most frequently
occurring disorder treated
at our pain clinic. It seems to
occur in virtually everyone's
lives at some point but becomes
chronic and intractable in
only about 10% of all cases. This
section will describe general
types of spinal pain. Other
possibilities exist as this listing will not
be complete or exhaustive.
It will apply to all regions of
the spine, cervical, thoracic,
lumbar, sacral. Backs hurt
for many reasons. Below is a listing
of common "physical" causes.
This listing does not address
other causes of back pain
such as stress or genetic malformations,
therefore it is a very limited
list.
Sciatica and brachialgia are
terms referring to pain in the
low back and lower extremities
or neck and upper extremities,
respectively. When there is nerve
root irritation or compression
in the C4 to T1 regions there
may be pain in the neck, shoulder
and arm regions. When there is
nerve root irritation or compression
in the L1 to S1 regions of the
low back there may be pain in
the buttock and leg regions.
More rare are T2 to T12 nerve
root irritation/compression causing
chest and abdomen pain.
 Simple
Sprain
Usually a superficial area of
the spine such as a joint, ligament
or muscle is hyper- extended
or twisted causing inflammation.
Severe
Sprain
More extensive and prolonged
often resulting in sensitization
of the spinal cord (dorsal horn)
thus even minor amounts of stimulation
are magnified by in the spine
creating muscle spasms and a
cycle of persistent pain.
Postural
Pain
Imbalances in body position can
result in painful muscles, ligaments,
tendons and joints that receive
increased pressure/strain as
a result. Osteopathic doctors
say that the sum of the inward
curves of the spine (cervical
and lumbar lordosis) should equal
the sum of the outward curves
of the spine (thoracic and pelvic
kyphosis). If they are not equal,
then posture may be out of alignment
with resulting pain. Certainly,
posture with regard to sitting,
standing, bending, lifting, etc.
all become significant for the
development of persistent pain
problems.
Mechanical
Imbalance
Some minor differences exist
between our left and right leg
lengths normally. When these
differences are large they can
result in our pelvis tilting
toward the shorter leg. Compensation
occurs in our spinal structures
(usually altered spinal curves)
from lumbar through cervical
regions setting up painful muscle
and other pain.
Spinal
Ligament Pain
Sometimes occurs as a result
of disc degeneration or spondylolisthesis.
In the former, loss of disc height
results in increased tension
on the lumbar-pelvic ligament.
In the latter, there is tension
on the iliolumbar ligament at
the base of the spine. Both can
produce back pain.
Facet
Joint Pain
In the small spinal joints on
the sides of the vertebrae inflammation
or articulation problems can
occur resulting in back pain.
Most common in older persons
with history of injury or other
inflammatory disorders such as
lupus or ankylosing sodalities.
Spinal
Nerve Root Pain
Irritation or compression of
a spinal nerve root sometimes
resulting in pain, tingling,
numbness, and/or weakness. Most
commonly, when inside the spine
the disorders are:
- disc herniation or prolapse.
- annular tear in wall
of the disc
- spinal stenosis or narrowing
of spinal canal
- foramina stenosis or
narrowing of nerve exit
holes
- spondilolysthesis or
slipped vertebra usually
in low back
- epidural adhesions occasionally
because of infections
after surgery
- spinal tumors which are
rare.
Back pain sometimes results from
dysfunctions outside the spine.
They can include:
- thoracic outlet syndrome
with cervical nerve compression
bya rib or scalene muscle
spasm in the neck.
- piriformis syndrome is
sciatic nerve compression
because the piriformis
muscle in buttock is
in spasm
- rarely tumors outside
the spine
Finally, referred pain is pain
in an area distant from where
the physical disorder is located.
The example is leg pain when
the trouble is really in the
low back or arm pain when the
trouble is really in the neck.
Failed
Back Surgery Pain
The surgical process of correcting
spinal disorders can itself create
residual pain. This can come
from several sources including
scar tissue formation, infection,
blood vessel and nerve damage.
Osteoporosis
Bone thinning can result in vertebral
fractures resulting in episodes
of back pain. Most often in the
elderly and frequently in the
mid and upper spine regions.
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