|The Pain Management Center of South Texas offers questions and
answers to help you.
What are the basic
types of back pain and what are their causes?
There are many types of back pain and the causes of back pain
can often be multi-factorial.There are simple types of back pain
which are muscular causes, there are bony causes and disc
causes. The muscular causes include muscle strain and sprain
most commonly caused by an imbalance where one group of muscles
is more developed than another group of muscles. The bony causes
include slippage of one vertebral body, that is, the bones of
the back slip upon another. This is called spondylolisthesis, a
malady is when the bones are actually misaligned. Discogenic
causes are usually referred to as “slipped disc.” These discs
are cushions between two vertebral bodies, which can rupture or
slip. They are structured much like a jelly-filled donut, and
are “the shock absorbers of the spine.” If the “jelly” comes
out, the donut goes flat and it can no longer act as a shock
absorber. This may result in severe pain, or what is commonly
known as sciatica or nerve impingement. This jelly that is
inside the disc contains some extremely powerful enzymes that
can cause terrible inflammation on the nerves if the nerves come
in contact with this. These enzymes can also cause back pain as
well as nerve pain. Because of this irritation or inflammation
that the disc is causing, we use drugs to stop inflammation.
Many times we use orally taken non-steroidal anti-inflammatory
medications or steroid medications. These three types of back
pain - muscular, bony and disc - comprise the vast majority of
What is the leading
cause of chronic back pain?
Most frequently, it is muscular. This is why physical therapy is
such an important adjunct to invasive pain management and oral
medication. Physical therapy re-educates the patient and
strengthens the muscles in the back so that the patient can be
restored towards normalcy and at the very least minimize their
How can a patient
tell when the back pain is due to muscular pain or due to a much
more serious condition like discogenic
If the patient is lifting something too heavy and jerks and
suddenly feels a “pop” in his back that is shooting down the
leg, this is most likely due to a herniated disc, This patient
should go immediately to a physician with some expertise in
spinal treatment and the physician will most likely examine the
patient, perform a straight leg test which will or will not
cause pain, obtain a MRI or a CAT scan to actually visualize the
discs radiographically, or the physician may perform a
electromyogram. This is usually a test performed by a
neurologist or a physiatrist that can delineate whether there is
an electroconduction problem down the nerve. All of these things
- the history, the physical, the MRI testing and the EMG testing
- better enable the physician to tell what type of pain the
patient is suffering from and what is the etiology of their
pain. Once the etiology is accurately obtained, then and only
then can the physician form a treatment plan which is proper for
What is the
most common use and when are epidural
steroid injections indicated for back pain?
Steroids are anti-inflammatory drugs, so they are only
indicated where there are conditions of inflammation.
The steroid medication is injected percutaneously into
the epidural space in a wide variety of fashions under
fluoroscopic guidance. This is a fancy X-ray machine in
an operating room where the medication can be placed
exactly where the inflammation is believed to be. This
fluoroscope also minimizes any of the complications that
can occur by placing the needle blindly into the spine.
The advantage of delivering epidural steroids is that
the physician can deliver a high enough concentration in
and around the inflamed area much greater than we could
have obtained if the medication was given orally.
Epidural steroid injections have been in use since the
early 1960’s and have been well studied and well
published in the medical literature. They have been
proven effective since that time.
Is there a limit to
the number of injections you can have
in a lifetime or in a year?
The number of injections is deliberately limited based on the
experience of the medical profession since the 1960’s. Generally
speaking, if we don’t get very good relief in two to three weeks
with two to three injections, the patient will most likely not
get substantial relief just from epidural injections. There are
occasions however where we can vary the type of injection which
is given and we will go to a fourth or fifth injection.
Generally speaking it is the total dose of steroid a patient
receives that actually limits the number of injections the
patient can receive. When steroids are delivered to the body, we
can develop some side effects from the steroids. This is a
complex problem of endocrinology which can cause increased blood
sugar or retention of fluids to name a few.
What are some things
that can be done for the patient that fails
The vast majority of patients that present to the Bergen Pain
Management center do respond to injection therapy alone. However
there are patients who do not respond adequately to injection
therapy. The treatment after injections is variable depending on
the underlying disease. If a patient has discogenic pain with a
herniated disc, this patient may very well be a candidate for a
nucleoplasty, IDET procedure, a disc decompressor procedure, or
a radio frequency lesioning. It is a rare event that the patient
proceeds to a more invasive surgical procedure.
||Do you have foreign language staff?
||Who schedules my procedure?
||What do I need to bring with me the
day of my appointment?
Do you have foreign
I ask that you bring a interpreter with you if this is not
possible I have staff that speak multiple languages and if you
inform us ahead of time we will attempt to provide someone.
Who schedules my
Your procedure will be scheduled by my office staff with the
surgery center. Someone will confirm date and time prior to
What do I need to
bring with me the day of my appointment?
If you are being referred by another doctor that office will
forward all records, insurance information and MRI’s to us. If
you are not being referred please bring your insurance
information and any MRI’s- X-rays of the affected area. You
should arrive 15 minutes before your appointment to complete