Signs of a Bad Disc In Your Back

Back pain affects 80 percent of Americans at some point in their lives. Whether it’s a twinge in the lower back or pain near the top of your spine, back pain comes in all different shapes and sizes.

One of the more common back injuries stems from a problematic disc. Often referred to as a herniated or slipped disc, painful disc injuries have numerous symptoms, including:

  • Pain in the buttock that travels down the leg while walking or while putting pressure on the sciatic nerve.
  • Tingling or numbness in your lower back, thighs, legs or feet.
  • Weakness in your legs while walking.
  • Pain in the thighs and hips.
  • Significant deep tissue pain.
  • Muscle spasms in your lower body.

Back Disc Pain

Causes of Disc Pain

Disc pain can be triggered by any number of events, but more often than not they occur by three main types of injuries:

Improper lifting – Whether you’re lifting weights or trying to pick up a box while moving into a new house, lifting a heavy object with a poor technique can throw your back out of whack.

Repetitive action – Even if you’re using good form, repetitive action will put excess wear and tear on your back. Repetitive action disc problems often occur in older individuals who have worked physical labor for the majority of their lives.

Age – Even without poor form or repetitive action, over time our bodies start to wear down.

If You’re In Pain

If you’re experiencing disc pain, the first thing you’ll want to do is visit a physical pain medicine physician. Using advanced imaging techniques, your doctor will be able to determine the root cause of your problem and plan a course of action to alleviate the pain. Some common methods to quell bothersome back pain include:

  • Injections
  • Massages
  • Prescription Medication
  • Referral to a chiropractor or physical therapist.

Safety First: Surgical Centers vs. Pain Specialists

Recently there was an article on whether having a procedure done in a surgery center is safe. In the world of pain management, some practitioners only do procedures in these facilities (or hospitals) while others do most of their procedures in the office. Surgery centers can handle more complex procedures, and can typically handle a deeper level of sedation. In pain management, surgery centers can be beneficial for complex procedures such as implants, but often they rarely are necessary. Sedation for a pain management procedure usually does not need to be very deep, and should be able to be done without a surgery center.

Surgery Centers

The safety of a surgery center and a procedure in reality is no better than the quality, skill, and experience of the practitioner. After spending more than 20 years performing complex spinal procedures, as well as teaching courses to other physicians, it is the ability of the physician that really matters. Surgery centers are often profit centers for the physicians working in them. Furthermore, a physician who sedates most patients for procedures is often using the sedation to cover for a technique that may cause pain. A skilled interventionist should be able to do most procedures with a local anesthetic and ensure they are practically painless. The use of sedation for many practitioners is a crutch to reduce the need to talk to the patient and to perform the procedure with the least painful technique.

Pain Medicine Safety

In pain medicine, the most common injections – spinal and joint related procedures – should be able to be done quickly and comfortably. The main issue that most practitioners should be treating is the anxiety of the patient. Light medication to treat the anxiety can often be given orally. For longer procedures, IV medication is sometimes easier to use. Universally, procedures that are painful are most often due to the technique and experience of the provider. Experience often allows the practitioner the knowledge of how to perform a procedure when a patient presents a more complex situation.

In the end, safety of a center is dependent on the practitioners. If the provider does not fully know what they are doing or the best techniques, the patient is more likely to have issues with the procedure. Further, if the patient is significantly sedated, the patient will not react when the practitioner does something wrong, making it more likely that significant damage may occur. The best physicians will always care most about the patient and the problem, not the payment they might receive from doing an intervention. The best physicians have years of experience, are board certified, and have an intense, loyal patient following. Skill and experience help keep a patient safe and make a procedure safe and effective. Errors in pain management procedures are generally rare. Surgical centers and sedation are not important in patient safety; the quality of the practitioner is the most important variable.

Spinal Disc Imaging and Discograms for Back Pain Problems

Back Pain treatment central minnesotaThe spine has discs between each vertebral body in the cervical, thoracic, and lumbar spine. These discs are dynamic spacers between the bones and facilitate the motion between segments. The structure of the disc varies between the cervical, thoracic and lumbar levels. The differences in structure lead to different stabilization patterns in each area of the spine. The strongest discs are in the lumbar region and the weakest are in the neck, with the thoracic discs being of moderate strength.

The discs have two components, the outer anulous fibrosus, and inner nucleous pulposus. The outer ring is made of interlaced collagen fibers. The nucleous is a loose fibrous network with a gelatinous acidic mucoprotein. The combination of the outer core and inner gel is to provide the ability to absorb forces between the bones as the body moves. Extreme forces and sudden movements as well as age can damage the disc integrity. The strength and weave of the fibers is the strongest in the lumbar region and the weakest in the cervical region. Lifting and twisting heavy objects is main primary reason a person suffers a low back injury, while whiplash injuries account for the majority of neck problems. Repetitive activities and age can also damage the discs throughout the spine. Damaged discs can bulge, crack and leak, and herniate. The discs injuries can be very painful, and treatment should not be ignored.

Diagnosing Disc Injuries

Studying the spine is done in multiple ways. The simplest is by an X-ray; They can give basic information on the integrity and alignment of the bones, the height of discs, and the presence of degenerative changes. In a young person, X-rays are usually normal, but in the older person they tend to show age related changes. The problem with an X-ray is that it often can identify the area of pain, but it gives very little information about a cause of pain. CT-scans are sophisticated computer enhanced X-rays that give significantly more information about the bony structure of the spine and some limited information about the discs and spinal nerves. An MRI scan can give significant information about the discs, spinal nerves and cord, joints and bones of the spine. Electromyography can map whether the nerves of the spine are functioning properly. Discograms pressurize the disc with contrast and then they are viewed under X-ray or CT scan to determine the integrity of the disc and whether they are painful. Your doctor will determine which method is best for identifying your issue.

Discograms & MRI Scans

Discograms can tell valuable information in the lumbar region, however, in the thoracic and cervical region the data is of questionable value. In the lumbar region, a discogram can help identify whether a disc has internal disruption and if it is painful. If only one disc is painful, a doctor may be able to preform routine surgery to address the problemed disc. That said, multiple painful lumbar discs do poorly with surgical management. Often, MRI scans can give sufficient information such that a discogram is not necessary. In the thoracic region, a discogram would not clarify surgical options since the MRI can provide sufficient information along with physical exam. The nature of the discs in the cervical region makes discograms vary unreliable for useful information.

I typically suggest that a patient undergoes an MRI if they are experiencing back pain, as it provides a comprehensive look into the inner workings of the back. If you are plagued by constant low back, spine or neck pain, stop in for an assessment. We’ll work with you to find a solution to your pain.

What Types of Patients Do Pain Doctors Treat?

MN Pain Doctor patientsFinding the right care for each individual patient who is dealing with chronic pain can be difficult. If a patient has ongoing difficulties with pain symptoms, additional medical expertise is often helpful with symptom management. The comprehensive Pain Care program at CDI is designed to help manage these complex and difficult problems.

Pain Management at CDI

The Pain Care program at CDI will see any patient who has ongoing problems with pain. The program is run by a Board Certified Physical Medicine and Rehabilitation specialists with subspecialty training in Pain. We are available to help evaluate and diagnose medical problems that are causing ongoing pain symptoms in any region of the body. Common problems that we usually see include patients with:

  • neck pain
  • headaches
  • joint pain
  • neuropathy
  • low back pain
  • mid back pain
  • multilevel pain problems.

The goal is to develop an individualized comprehensive treatment plan to better control symptoms on a conservative basis. Early management of pain problems often leads to solutions that completely solve the issues.

Treating Pain Problems

A typical low back pain patient may have muscles strains, disc issues, nerve irritation, lumbar facet joint pain, or even pelvic problems. A comprehensive evaluation and examination often leads to an appropriate diagnosis and a number of treatment options. A Physiatrist can work with a patient to complete further testing, and if necessary, assist with physical therapy, medication, and interventions to overcome the medical problems causing low back pain. Muscle strains for instance may only need physical therapy and appropriate short-term medications. Lumbar facet joint problems cause axial low back pain and may benefit from a combination of injections, radio-frequency neurolysis/lesioning, and physical therapy. Depending on the diagnosis, a comprehensive treatment plan with the available options for management can be discussed and implemented with the patient.

Neck pain issues often cause headaches and can be treated with a number of conservative interventions. The Pain Care team can help diagnose and develop a comprehensive management strategy. One common problem causing headaches is irritation of the cervical facets, and this often occurs after trauma, especially motor vehicle accidents. This pain is often known as a whiplash injury. It often resolves with conservative physical therapy and short-term medication, but about 10% of cases require more intense intervention. These patients are often helped with injections and sometimes radio-frequency lesioning of nerves in the neck. Successful management often cures the problems for a prolonged time.

Pain is a complex problems, and every patient is unique with their own set of important issues. If all the answers were obvious, there would be no need for our services. Unfortunately, pain is the most common problem bringing a patient to the doctor’s office. When it does not resolve in short period of time, having the skills of a specialist is often extremely beneficial. There is not one solution, one medication, one shot, or one specific intervention that is right for every patient.  Pain Care is designed to integrate and coordinate our skills into the community to treat these challenging patients with their current care team.

Pain management is not a new field.  At CDI we have recognized the need to provide a more comprehensive service to help with the management of these complex and difficult patients. With a comprehensive approach to the evaluation and management of these patients by a Physiatrist, we hope to bring a successful approach to resolving these difficult problems within the community. At CDI we hope to partner with a community of physicians to better serve these patients and their providers.

Discograms – What are they & When are they Useful?

discogramA discogram is a special x-ray study of the intervertebral discs in the spine.  The test is used to determine the structural integrity of the disc and whether the disc is painful when pressurized.

The Procedure

During the study, a needle is placed in the disc and dye is injected into the disc.  The study is done under real-time fluoroscopy. Normal discs are not painful.  Abnormal discs may or may not be painful.  Tears in the outer layers of the disc and whether the disc actually leaks contents can be determined with a Discogram.  Any disc in the spine can be examined in this way but it is most useful in the lumbar region.

When Discograms are Useful

Discograms are not common tests. They are used when other tests are inconclusive and surgery is being considered.  MRI scans can give a physician a wealth of information about the structural integrity of a disc, but it cannot determine if it is causing pain.  It can show a herniated disc that is pressing on a spinal nerve root and from that it may be inferred whether it is causing damage.  Combining the information from a MRI scan with other studies, like an EMG that can determine whether a specific nerve is damaged, can limit the need for a Discogram.

Today, discograms are used mostly to identify abnormal and painful discs in the lumbar region prior to surgery when other studies are not providing adequate information, and conservative care has failed.  Performing discograms in the thoracic region and cervical region is often considered very questionable, since the disc structure is different and the information provided may not be accurate.  The most useful information provided from a Discogram is that only a single abnormal disc is present and that it is causing symptoms perceived by the patient.  When multiple abnormal discs are present, surgery is usually a poor option since pain is likely to be generated from multiple sources and will not be improved with intervention.

The Future of Discograms

In the future, abnormal discs that have cracks and bulges, but are not herniated and causing pressure, may be able to be treated without surgery.  The center of the discs contain acid, when cracks develop as they age and are stressed, the acid can leak out and cause a chemical irritation to nerves.  At this time, researchers are developing compounds known as bio-sealants to seal cracks and prevent this leaks that are causing pain.  Discograms will be useful in the future if these materials being studied actually work.

An experienced interventionalist – either a radiologist or pain physician, should perform a Discogram.  Discograms are very painful studies for most patients, and sedation can be used to control the pain.  They do have risks, especially for serious infection if not performed properly.