Low Back Pain & Sciatica

Low Back Pain & Sciatica

Low back pain is one of the leading causes of disability globally. About 80% of adults experience low back pain at some point during their lifetimes. Symptoms range from a dull ache to a stabbing or shooting sensation. It can be due to various reasons ranging from muscle strain to prolapsed intervertebral discs. If a bulging disc presses on the nerve, pain may run from the buttock down one leg. This is called sciatica.

Low back pain is managed by a multidisciplinary approach which includes posture precautions, medications, exercises, physiotherapy and some minimally invasive interventions which include:

Neck and Arm Pain

Neck pain is a common problem with two-thirds of the population having neck pain at some point in their lives. Neck pain may arise due to muscular tightness in both the neck and upper back, or pinching of the nerves exiting near the cervical vertebrae. Facet joints in the neck may also be the source of pain.

Neck Pain is managed by a multidisciplinary approach which includes posture precautions, medications, exercises, physiotherapy and some minimally invasive interventions which include:

Thoracic Spine & Chest wall Pain

Chronic thoracic and chest wall pain can originate from any of the structures of the chest wall including bones, joints, muscles and nerves. It is managed by a multidisciplinary approach which includes posture precautions, medications, exercises and minimally invasive interventions which include:

Coccyx Pain

Coccyx Pain, also known as coccydynia, is pain over the region of the tailbone, particularly aggravated on sitting. It can be managed by simple conservative measures like the use of a doughnut pillow and sitz bath. A course of NSAIDs is usually required. If pain persists, minimally invasive interventions in the form of local injections or ganglion impar block may be offered.

Knee Pain

Osteoarthritis is the commonest degenerative disorder causing knee pain. The management of knee pain due to OA requires knee exercises and precautions. If swelling or joint effusion is evident, intraarticular injections may be required. Grade 1 or 2 OA patients may benefit from Platelet rich Plasma injections. In patients with more advanced OA, Genicular nerve Radiofrequency ablation may be done for pain relief. Definitive treatment includes surgery (Total Knee replacement)

Neuropathic Pain

Pain arising from damage or improper functioning of nerves is termed as neuropathic pain. It may present as burning, shooting or electric shock like pain. This pain is usually managed by anti neuropathic medications. Sometimes nerve blocks may be required to relieve the pain.

Abdominal and Pelvic Pain

There may be cases when all radiological investigations of the abdomen or the pelvis are normal, but the patients still continue to feel the pain in these regions. These pains may either be arising from the abdominal wall, or may be a result of nerve entrapments in this region. These pains are complex to diagnose and manage, and usually require USG guided injections and nerve blocks.

Post Herpetic Neuralgia

Pain persisting in the region of rashes of Herpes Zoster. It is generally burning, shooting, throbbing or electric shock like pain, and is most commonly observed in chest wall region or the face around the eyes. Management includes judicious use of antineuropathic medications, topical ointments and nerve blocks.

Complex regional pain syndrome (CRPS)

CRPS is a chronic pain condition that most often affects one limb (arm, leg, hand or foot) usually after an injury. It is believed to be caused by damage to, or malfunction of the peripheral or central nervous systems. Rehabilitation, physiotherapy and psychotherapy are important for managing CRPS. Sympathetic nerve blocks like stellate ganglion block or lumbar sympathetic plexus block may be required.

Cancer Pain and Palliative Care

Pain is one of the most common symptoms in cancer patients. It can be caused by cancer, treatment for cancer, or a combination of factors. Cancer pain is managed as per the WHO ladder for pain, escalating to opioid drugs like morphine and sometimes requiring neurolytic blocks such as celiac plexus block for abdominal pain. In addition to managing cancer, a whole new spectrum is applicable to end of life and palliative care which is care of the dying.

Fibromyalgia and Widespread Pain

Fibromyalgia is a common cause of widespread pain in the body. It may be accompanied by other symptoms including fatigue, non refreshing sleep, impaired concentration, memory issues and mood disturbances. The management of fibromyalgia is multidisciplinary, including medications, physiotherapy and dietary counselling.

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Dr. Saipriya Tewari

MBBS, MD, PDCC (Pain Management), Fellow of Interventional Pain Practice (FIPP) (WIP USA)

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