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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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