THREE DIFFERENT TYPES OF BACK PAIN…

1. Acute Pain

Acute Pain is a pain that lasts less than 3 to 6 months, or pain directly related to tissue damage. This is the type of pain caused by a paper cut or needle prick. Other examples of acute pain are like labour pains, the pain is acute and identifiable.

Acute low back pain is defined as a pain present for up to six weeks. It could feel like an aching, stabbing, burning, or dull pain. The actual intensity of this type of low back pain could range from mild to severe and could fluctuate or move to other areas of your body like your hip or thigh area.

2. Chronic Pain

Chronic pain describes pain that lasts more than three to six months, or beyond the point of tissue healing. Chronic pain is usually less directly related to identifiable tissue damage and structural problems. Chronic back pain without a clearly determined cause, failed back surgery syndrome (continued pain after the surgery has completely healed), and fibromyalgia are all examples of chronic pain. Chronic pain is much less well understood than acute pain.

Chronic pain can take many forms, but is often described as a pain with an identifiable cause, such as an injury. Certain structural spine conditions, including degenerative disc disease, spinal stenosis, and spondylolisthesis, can cause ongoing pain until they are successfully treated.

3. Neuropathic Pain

Neuropathic pain could be placed in the chronic pain category, but it has a different feel than chronic musculoskeletal pain. The pain is often described as severe, sharp, lightning-like, stabbing, burning, or cold. The individual may also experience ongoing numbness, tingling, or weakness. Pain may be felt along the nerve path from the spine down to the arms/hands or legs/feet.

It is thought that the pain is caused by damage or disease affecting the somatosensory nervous system. Neuropathic pain may be associated with abnormal sensations called dysesthesia or pain from normally non-painful stimuli (allodynia). It may have continuous and/or episodic (paroxysmal) components.

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MYOFASCIAL PAIN -v- DISC PAIN…

As most of my readers know I suffer from chronic back pain after four previous spinal fusion surgeries only alleviated the pain for a matter of years before it came back.

Nowadays spinal fusion is not used as the first choice for prolapsed discs with pain management being the first treatment and only if nerves are compressed is it used as another option.

The problem with spinal fusion especially if you have more than one surgery is the pressure it puts on the disc below and above your fusion.

Another condition which you can also suffer from after any type of surgery is Myofascial Pain Syndrome which is a chronic painful muscle disorder and is common if you have experienced a muscle injury. Over time these myofascial restrictions can lead to poor biomechanics, altered structural alignment, compromised blood supply and pain. Other causes of myofascial pain are injuries to an intervertebral disc, general fatigue, repetitive motions, and some medical conditions.

It is characterised by the myofascial trigger points and the symptoms include persistent or worsening pain, deep and aching muscle pain, tender knots located in the muscles and pain after exercise or sporting activity.

Myofascial Pain Syndrome (MPS) is the name given to pain caused by trigger points and fascia (connective tissue) adhesions in the body, usually in muscle tissue, and inflammation in the body’s soft tissues.

Myo = muscle
Fascia = the main connective tissue in the body
Release = to let go, ease pressure

Treatments include anti-inflammatory medication, pain killers, physical therapy, stretching, massage therapy and trigger point injections.

A trigger point injection is either a cortisone injection or dry needling. Pain relief is quick and helps in continuing physical therapy. Trigger point injections can also be used for people suffering from degenerative disc disease.

Understanding the cause of your pain is an important step to finding an effective solution. It may involve a series of sessions and an at home program to keep the area strong.

Disc pain can come from a disc bulge or prolapse but you can also get myofascial pain which could be treated conservatively instead of surgery. Fibromyalgia patients can also suffer from myofascial pain. According to history, Sir William Gowers introduced the term fibrositis for a common, but idiopathic, localized form of muscular rheumatism that is now recognised as myofascial pain syndrome in 1904. And, despite the intervening years, it still constitutes the largest group of unrecognised and undertreated acute and chronic pain problems. Some people (like myself) have also been told they could have Fibromyalgia, previously named ‘fibrositis’.

My neck and arm pain have been giving me a lot of problems since last summer and after extensive tests, MRI’s, ct scans and more it was decided that a nerve block would help with the pain. There is never any guarantee with any injection but they hope to give the patient a few months of pain relief.

Nerve block injections into your neck for a disc bulge can be quite dangerous as they are quite tricky to do and they go through the front of your neck. I had this injection about six weeks ago. It’s not a very nice injection (if any are) but I knew the pain consultant had hit the spot and soon felt total relief. Unfortunately, it was short lived and only gave me pain relief for a few weeks. Not all the pain has come back but most of it as did the pins and needles.

I then had another appointment at the pain clinic and after looking at my MRI’s etc I was given a quick check where my pain consultant felt that the pain I now have could well be myofascial and not from the bulging disc so he has booked me in for a series of steroid injections in my shoulders.

I guess with any spinal pain after you have had all the tests it’s then worth trying alternative treatments well before you resort to surgery which is something I have always said I would avoid having.

 

MY CERVICAL NERVE BLOCK INJECTION…

Yesterday I went in hospital for a nerve block injection into my cervical spine where I have been having lots of problems since last June. Surgery had been talked about but then an injection was a preferred choice which is also used to diagnose the source of the pain. A cervical nerve block injection is where a steroid and local anaesthetic are injected into the nerve root. The medication can decrease inflammation in the nerve root and will often, but not always then reduce the pain.

The consultant uses a live X-ray image (fluoroscopy) to very carefully insert and guide the needle to the spinal nerve then a contrast dye is used to confirm the needle placement. Next, the medication is slowly injected, and the needle removed.

In 2001 I had a cervical trigger point injection done in a side room at the hospital and not in the X-Ray department. Unfortunately it went very wrong and I collapsed and had to be resuscitated. The memory lasted a long time and I did say I would never have one in my spine again.

Since then I have had many different types of injections from epidurals, trigger points and facet joint injections in my spine, but all in my lumber spine. I have to admit I was a little nervous before having this second cervical injection as I have never had a nerve block before.

I explained my fears to all who were looking after me yesterday and they could not have be more sympathetic and kind. But, my consultant did explain to me that he felt the injection should be placed in at the C8 level and not C6/7 as requested as he could clearly see from the CT and MRI scan that C6/7 was where my other metal work and fusions were. Trying to inject around the metal work would not work nor relieve the pain.

I must admit it did throw me at first but it all made complete sense as I have had two cervical fusions so the last one had to be at that level and C8 had to be where the disc was giving me all the problems. The minute I told him my symptoms he was certain it was that disc but he did explain to me it was not an easy one to access. It also carried quite high risks with it but he understood that I really did not want surgery which probably had higher risks involved with that also.

He really took his time and explained every detail along the way. I cannot say it was not uncomfortable because even with a local anaesthetic once the medication started hitting the nerve boy did I know about it.

Today I’m ‘extremely perky’ as my sister put it after a great sleep last night, no pins and needles, no pain when I did simple tasks like cleaning my teeth and drying my hair. As the day has gone on the pain has got easier and easier and it’s just ‘amazing .’

Before the consultant left me yesterday I asked him if the injection was a success how many could I have in a year. ‘None, as far as I’m concerned ‘, he said ‘It’s to tricky a procedure .’

I felt a bit despondent about his reply so when I got home I had a quick look on Google about the area I ‘d had the injection and soon realised why he said it. An article from Inside Radiology wrote ‘Accurate needle placement, high-resolution image guidance and skilled specialist doctors are essential to avoid the major complications that arise as a result of poor quality imaging.

Luckily this time I had the treatment done in the right environment with a great consultant.

TUESDAY TIPS FROM #backpainbloguk…

Check out my #tuesdaytips on how to look after your back.

Stay flexible, if you are desk bound, move around every 30 minutes.

Stay strong, go swimming and walking regularly or as often as you can.

Steer clear of the driving range. Unfortunately golf swings are of no help to people with back problems.

Try to sit on a stability ball for 15 minutes a day.

I think we all know that excess weight can cause a number of health problems but it can be a big contributor to back pain.

Don’t sleep on a hard bed. Believe or not these can really irritate back problems. If your staying in a Hotel ask if the bed is firm. Before now I have been known to buy a bed quilt and fold it to lie on as the bed was too hard, it just takes the pressure off your back.

Have a deep tissue massage – this can help back pain a great deal but make sure whoever gives it to you is fully qualified.

Stay hydrated.

Try not to pound the streets when you walk, make sure your shoes have a good cushioning.

Feel the pain sometimes rather than reaching straight out for the medication as it could be masking something.

Always, always, always bend the knees when picking up anything or bending down.

And for the women, don’t carry your life around in your handbag.

And for the men, don’t carry too much in your computer bag.

Another one for the women, don’t wear high heels all the time. The long term effect can not only effect your back but also your feet.

Get an accurate clinical diagnosis if your pain does not settle down after a few weeks.

Don’t smoke, it has been proven that people who smoke are more likely to have lower back pain.

Never twist and bend at the same time.