Low Back Pain
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90% of people suffer from low back pain at some point in their life. The old myth was that 90% of the time low back pain resolves in 6 weeks. The truth is that 25-65% of back pain relapses one year after the initial episode.
The biggest mystery is how to diagnose the cause of back pain; i.e., what is the structure that in causing the pain? Most surgeons rely very heavily on MRIs and x-rays to diagnose the cause of neck pain. Clearly, this is clearly not a reliable way of determining the underlying cause of a patient's low back pain. Studies show that most people who have no back pain at all have abnormalities on their MRI. Physicians and surgeons often falsely presume that the abnormalities, often stated as degenerative disk disease or disk herniations or disk protrusions, are the cause of a patient's neck pain. The only way to reliably determine the cause of a patient's low back pain is to perform an interventional diagnostic workup in conjunction with taking a patient's history, performing a physical exam, and using MRIs or x-rays, if available.
What do I mean by the cause of a patient's neck pain? There are several structures in almost every individual’s back that can cause chronic pain. To keep things simple, most back pain is caused by one of four structures: the discs (which are the “cushions” of the spine), the joints of the spine, the soft tissues (the ligaments, tendons, or the muscles around the spine), or the nerves of the back.
The discs are the cushions in between the bones in your back. These can bulge and can be the cause of a patient's pain. However, many disc bulges do not cause pain. Many patients are scared when they hear that they have degenerative disc disease, disc herniations, or disc protrusions. Patients should not be alarmed if the term disc disease is used. Degenerative disk disease is present in the majority of patients who have NO back pain!
The joints in your back can also cause neck pain. These joints are called facet joints. Most painful facet joints are due to osteoarthritis, also called wear and tear arthritis, or trauma, like car accidents or falls.
Last, but not least, soft tissues like muscles, tendons, and ligaments can cause chronic back pain and neck pain. This is a much underappreciated cause of a patient's pain and the definitive treatment for these "myofascial" pains is Prolotherapy.
Depending upon what is causing a patient's pain, the treatment varies. We, at MIPA, offer many new minimally invasive procedures for painful discs. If our testing process reveals that a patient’s neck pain is coming from the joints in their neck, we offer the latest minimally invasive radiofrequency and/or joint stabilization treatments. Soft tissue pain, also called myofascial pain, is often permanently treated by Prolotherapy. Prolotherapy is primarily used to treat chronic back pain that stems from injured or worn ligaments, tendons, or muscles. Prolotherapy works by healing a patient’s injured tendons by causing a controlled inflammatory cascade that stimulates the body to repair the injured tissues. A patient’s pain can be permanently improved by strengthening the structures around the spine and injured discs.
At Minnesota Interventional Pain Associates (MIPA) we rarely offer any treatments that do not provide long-term or permanent pain relief. Older, outdated treatments like epidural steroid injections are not routinely performed since most studies have shown these treatments are not overly helpful. Epidural steroid injections usually do not get to the root cause of the problem.
Prolotherapy is the main treatment for soft tissue pain and works by naturally restoring stability to an injured back. Radiofrequency or facet stabilization are treatment options for facet joint mediated back pain. Back pain from painful discs is treated by minimally invasive disc procedures. To determine the best treatment for you, we first have to identify the cause of your back pain. MIPA is one of the few pain centers in the country that offers both this approach and this variety of treatments.
About the Author
Mark A. Janiga ,M.D., Diplomate of the American Board of Pain Medicine, Diplomate of the American Board of Anesthesiology, is a graduate of the Nevada School of Medicine in Reno, Nevada. He currently practices in Blaine, Minnesota, at Minnesota Interventional Pain Associates. Dr. Janiga completed his Anesthesiology residency at the University of Wisconsin in Madison, Wisconsin, and completed his Interventional Pain Management fellowship at the University of Michigan. He is committed to providing patients the latest in diagnostic and therapeutic pain-relieving treatments. Prolotherapy is one of Dr. Janiga's most relied upon and favorite pain-relieving therapies for soft tissue/ligamentous/tendon problems. Sacro-iliac (SI) joint, low back, upper cervical (neck) pain, and sports related musculoskeletal pain are his special areas of interest.
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