Most people suffer from backache during their lifetime.
The Common Causes of Back Pain are:
• Facet joint arthropathy
• Sacroiliac joint pains
• Disc pain originating from intervertebral disc (slip disc and internal disc disorders)
• Myofacial pain syndrome
• Back injuries
• No cause is identifiable in some patients
Facet Joint Arthopathy
The facet joints are the only true joints of the vertebral column which allows movement of two adjacent vertebrae. Patient suffering from low backache may have facet joint affection and present as low back pain with non radicular referral pattern. The pain is usually describe as unilateral or bilateral paraspinal pain which occasionally radiates to buttocks and thigh region. Generally no neurological deficit is present. These patients experience less pain on spinal flexion and the greatest pain is produced during the combined movement of extension, side bending and rotation. Pain is usually least in the morning and worsens as the day progresses. Physical examination may reveal paraspinal muscle spasm and tenderness.
X Ray, CT scan, MRI scan may or may not be useful for conforming the diagnosis for Facet joint arthropathy. Diagnostic facet joint block can confirm the diagnosis.
Treatment Methods Includes
• Facet joint injections comprising local anaestheic & steroid
• Median branch block
• Radiofrequency neuro ablation of median branch
Fibromyalgia is a complex chronic condition which cause widespread pain and fatigue as well as a variety of other symptoms. It was only in 1990 that diagnostic criteria for fibromyalgia were established by the American College Of Rheumatology. It can be diagnosed by the presence of chronic widespread musculoskeletal pain lasting longer then three months in all four quadrants of the body. Here “Widespread pain” was defined as the pain above and below the waist on both sides of the body. In addition axial skeletal pain (in the cervical spine, anterior chest, thoracic spine, lower back) must be present. There are eighteen tender points that the doctors looks for in making fibromyalgia diagnosis. The patient must have eleven or more of the eighteen points to be diagnosed with fibromyalgia. Approximately four kilograms of pressure must be applied to the tender points and the patient must indicates that the tender points locations are painful.
If trigger points develops secondary to other known conditions, then that condition must be treated adequately.
• Neutralization or inactivation of trigger points with local anaesthetic drugs and steroids or even by dry kneadling can be done with very gud results. This can also be done with lasers as well.
• Medicines acting on central sensitization for example:
• antidepressant (amitryptlin, duloxetine etc.) and anticonvulsants (gabapentine, pregabalin etc.)
• Muscle relaxants
• Different forms of physiotherapy
Myofacial Pain Syndrome
Myofacial pain syndrome is manifested as localized muscle spasm and pain with the presence of trigger points in certain areas. It may develop from a muscle lesion or excessive strain on a particular muscle group or ligament or tendon. The lesions or the strains prompts the development of trigger points which in turn causes pain. Trigger points are usually associated with a taut band (a ropey thickening of the muscle tissue). Trigger points may develop due to:
• Sudden trauma to musculoskeletal tissues (muscle, tendons, ligaments)
• Injury to intervertebrial discs
• Repetitive motions (excessive exercises or muscle strain due to overactivity)
• Systemic conditions like MI, appendicitis etc
• Lack of activity, nutritional defeciencies, hormonal changes
• Nervous tensions or stress
• Chilling of areas of the body for e.g. sitting under th A.C.
• Medicines such as NSAID’s, muscle relaxants are useful
• Various Physiotherapy modalities
• Injections of local anaesthetic and steroid or even dry kneadling can be very useful