By Dr. Jason Rosenberg

Back pain will affect 80% of all adults during their lifetime. Most pain will abate after 6 to 8 weeks; when it lasts, it is concerning. Patients are often referred for additional diagnosis and treatment when the pain continues.

The treatment options for citizens of the Waccamaw neck and surrounding areas have recently increased for low back pain, with therapies including radio frequency ablation of nerves, transforaminal steroid injections, percutaneous discectomies, and spinal cord stimulators. Once the proper diagnosis is established, the treatments can be very effective.

The initial evaluation is crucial. The history of the pain, attempted therapies (physical therapy, massage therapy, anti-inflammatory medications), and prior surgeries are important factors. A full examination looking for neurological deficits, both obvious and subtle, is paramount. All images of the spine are reviewed. At the conclusion of the examination and evaluation, a treatment algorithm is established.

I frequently see two distinct patterns of back pain. The first usually occurs suddenly, with symptoms including leg and back pain, and is seen after physical maneuvers. This can happen with pressure upon a nerve root, and is usually secondary to pressure from an intervertebral disc. Once properly identified, the treatment can include injections of steroid and numbing medicine around the sleeve containing the affected nerve root. The steroid reduces swelling and inflammation around the nerve root, and hopefully alleviates the symptoms. It is common practices to perform up to three injections in a short period of time. This, combined with physical therapy, can be very effective in returning normal function to patients. Occasionally, patients return to the clinic every quarter for an additional injection.

If the steroids are ineffective in providing lasting relief, some patients might benefit from percutaneous disc decompression. One of the newer options available allows a physician to place a special needle into the disc from the skin, under x-ray guidance, and remove the bulging disc. The needle contains an Archimedes screw, which allows the removal of up to one cubic centimeter of material, without the creation of an incision. This procedure can only be performed in a select group of patients with regard to the location and extent of the disc herniation.

The other type of back pain happens slowly over time. Patients report a long-standing, nagging type of pain that occurs every morning upon awakening and rising from the bed. It has evolved over the years to a chronic, moderate to severe pain. It has elements of arthritis, with worsening in the cold and damp weather. It is much more difficult to straighten up than to bend over. It is worse with activity (felt more on the back 9 of the golf course). Frequently, this pain can be related to the facet joints in the back of the spine. To prove the joints are involved, the physician can block the nerves that supply the joints as a diagnostic test. The test, called a medial branch block, provides instant relief lasting several hours if positive. The pain will return after the block wears off, as this further proves the diagnosis. The therapeutic treatment consists of placing special needles in the identical location, and inserting a radio-frequency probe into the needle to cauterize or 'burn' the nerve. These nerves carry the sensation from the joints to the brain, and, by burning them, the transmission of pain sensation is stopped. The radio frequency procedure reported lasts six months to two years, and may be repeated. Often, the sacroiliac joint has a similar disease simultaneously, and is usually addressed at a later time.

For the minority of patients who still suffer from back pain after completing the proper treatment algorithm, spinal cord stimulation is a viable option. The spinal cord stimulator is a device that can create a vibration type sensation over areas of pain. The vibration is similar to the sensation one creates when rubbing the thumb after it is hit with a hammer. This sensation is usually more pleasant than the sensation of pain. The stimulator consists of one or two wires permanently implanted into the space above the spinal cord, and is attached to a rechargeable battery pack that is also implanted in the body (equal in size to a pacemaker). The device is recharged through the skin, and controlled with a wireless remote control. Before implantation, patients can experience the device with a three to seven day trial. Although not for everyone, the spinal cord stimulator has dramatically improved many patients' lives. In fact, Jerry Lewis, the comedian, has a spinal cord stimulator and lectures around the world for his 'pain pacemaker.'

If the above treatments are ineffective, a referral is made to a competent spinal surgeon.

Jason Charles Rosenberg, MD
Director, Waccamaw Pain Management
Board Certified Neurology and Pain Management

Dr. Jason Rosenberg is double board certified in Neurology and Pain Management. 

Contact Us