Low back pain is a common condition that affects most people at some time of their lives. It can be short lived and resolves on its own, or with simple pain killers and physiotherapy. Sometimes low back pain can become longer lasting
The back is a very complicated area and is made up of many different anatomical structures from which pain can come. Sometimes low back pain can come from mainly one single structure or type of structure. On other occasions low back pain can come from many different structures. Some, such as sacroiliac joints and facet joints, can be injected with local anaesthetic and steroid to give pain relief and allow rehabilitation. Others, such as the muscles around the back, are usually best treated by physiotherapy or other physical therapies including pilates.
Neck Pain (Cervical Pain) can, like low back pain, come from more than one type of anatomical structure. Typically in younger patients (less than fifty years of age) seen in pain clinics neck pain can predominantly be muscular in origin. The trapezius muscle is a large muscle that spreads over the back, across the shoulders and up to the neck forming a kite shape. The upper part of the trapezius muscle can be responsible for much muscular neck and shoulder pains. Typically the muscles are in spasm and tender to firm touch. Muscular neck pain can be treated with physiotherapy (including advice on posture), pain killers, and injections into the muscles that are causing pain (these are called trigger point injections). Muscular neck pains can often be brought on and perpetuated by the things that people do on a day to day basis. For this reason ensuring workstations are set up correctly (workstation ergonomics) is important for those who spend their working lives using computers.
In older patients neck pain is more likely to come from boney structures of the neck. The source of pain can be the small joints between vertebrae called the facet joints. These joints can be injected to give pain relief and aid rehabilitation.
Pains in arms and legs can be caused by nerves to the arms and legs being
squeezed or squashed. The most common place for nerves to get squeezed or squashed
in the spine is the neck (for arm pains) and in the low back (for leg pains).
Nerves in the spine can either be squeezed or squashed by a vertebral disc that
is protruding, or by boney structures. Disc protrusions can retreat over time
(but not always) whereas boney pressure on nerves unlikely to reverse without
surgery. Pressure on nerves causes pain as a result of both the physical force
on nerves and also the inflammatory processes in nerves that this provokes.
Steroid epidural injections and nerve root blocks aim to treat spinal nerve entrapment
pains.
Nerve entrapment can happen in many places other than the spine, for example
after inguinal (groin) hernia surgery nerve entrapment pains can occur.
Chronic Regional Pain Syndrome (formerly known as reflex sympathetic dystrophy)
The official definition includes pain, heightened skin sensations, swelling and
changes in skin colour. It can be a cause of persistent pain after trauma or
surgery. This is a very easy self diagnosis to make wrongly. Very many different
pains can, on the face of it fit, the criteria for Chronic Regional Pain Syndrome.
Some websites can be particularly dispiriting about the prospects for patients
with this condition. Bearing these facts in mind, it is advisable not to reach
this as a self diagnosis. Pain management consultants can give a balanced view
of this as a possible diagnosis, its implications, and the best management strategies.
The key to improving this condition is to restore movement and function to the
affected limb. This is achieved with physiotherapy and pain killers of varying
types. Occasionally injections can be helpful for this condition. Injections
used include stellate ganglion blocks (for arms), lumbar sympathectomies (for
legs), and guanethidine blocks (for arms and legs).
Pain as a result of lack of blood supply to a leg (claudication) is initially best seen and treated by a vascular surgeon. If there are no surgical options available (because the disease has progressed too far) vascular surgeons may refer to a pain management consultant to carry out a lumber phenol sympathectomy to try to improve blood supply and decrease pain in the affected leg.
It is impossible to give an exhaustive complete list of all of the different pains seen in a pain clinic. However, others pains regularly seen include
Hip, knee, and shoulder pains
Persistent pain after surgery
Persistent pain after trauma
Myofascial pain and fibromyalgia
Neuropathic pains secondary to medical diseases
Neuropathic pains secondary to medical treatments
Facial pain including trigeminal neuralgia
Cancer pains