Musculoskeletal pain

In case of musculoskeletal pain pathologies they can be varied. The most common are:

1. Sciatica
2. Facet joint degeneration
3. Myofascial pain
4. Spondylolisthesis
5. Spinal stenosis

1. Sciatica

   It is usually caused by disc degeneration or a bulging disc. In these cases the resulting protrusion or hernia produces an inflammatory phenomenon in the nerve root, which is manifested as back pain and sometimes radiating pain to the affected limb. In many cases the pain is severe and disabling.

   

   Herniated disc affecting nerve root

   The diagnosis is made by physical examination and radiological tests. MRI is usually the best option to show evidence of the injury.

   

   Pain distribution in sciatica. Lumbar MRI with a herniated disc

   The treatment is initiated with with analgesics, anti-inflammatories, muscle relaxants and is complemented by physiotherapy. If there is no improvement, the Pain Unit can help by performing injections that relieve pain in the acute phase and may last for several months. These injections can be repeated if the pain returns.

   The injections that we do in these cases are:

   1. Epidural injection with corticosteroids and local anesthetic:

      this treatment is performed under local anesthesia on an outpatient basis. It usually takes 5 to 10 minutes to complete and then the patient remains under observation for a reasonable time (15-20 minutes) before going home on their own feet.

      You need to take some precautions, such as fasting for 6 hours and not driving after the injection. If you take medications, the doctor will tell you which may be taken and which should be discontinued, such as anticoagulants (Sintrom, Pradaxa, Xarelto, Eliquis, Clexane, Hibor, Fragmin) or antiplatelet therapy (Plavix, Iscover, Ticlopidine, Disgren).

      

   2. Selective nerve block of the root affected:

      It is performed under local anesthesia and as almost all treatments on an outpatient basis. In this case, the medication (corticosteroid and local anesthetic) is placed in the area of ​​nerve root irritation, with the help of x-rays, the zone is located to be treated. The relief in these cases is usually immediate and may need to be repeated after a time if back pain returns.

      

   Spinal surgery should not be the first option, as there is up to 30-40% of cases where the patient does not improve. Studies show that it is advisable when there is a motor involvement, ie, significant weakness to move a hand or foot, for example. Surgery it is also indicated in cases where there is no improvement with injections / blocks / other conservative therapies.

   In those cases where surgery does not bring improvement, the remaining symptoms are very similar to the initial pain. It is called postlaminectomy syndrome or failed back surgery syndrome.

   The treatments in these cases are often more complex: medication, physiotherapy, rehabilitation and nerve blocks that may improve pain. If they don´t, there are other treatments such as epidurolysis (lysis of epidural adhesions) or epiduroscopy that can help. In cases where there this not improvement with the previous therapies, we recommend the placement of spinal cord stimulation electrodes.

   

   Lumbar arthrodesis

   

   Intradiscal prosthesis

2. Facet joint degeneration

   Another cause of back or neck pain is facet joint degeneration. Facet joints are there to ensemble two adjacent vertebrae. With age, they suffer a degenerative process like any other joint, and in cases of overweight or trauma. Facet pain is usually located at the lumbar level and sometimes radiates to buttocks or thighs. A cervical level, is located in the neck and shoulders and radiates in other cases at dorsal area.

   

   Areas of pain in patients with lumbar facet degeneration

   For this type of pain, blockade of the facet joint affected produce a significant improvement. This block is performed on an outpatient basis, with radiological control, and local anesthesia.

   

   Myofascial trigger points ate lumbar and cervical areas

3. Myofascial pain

   In cases of muscle pain and muscle spasms, also called myofascial pain, we do injections with local anesthetic of so-called “trigger points” that are very effective, without being painful. Another treatment that can be effective is the application of TENS.

   

   Placement of TENS electrodes for back pain

4. Spondylolisthesis

   Spondylolisthesis is another cause of back pain. It consists of a slippage of one vertebra over another. There are two types according to slide forward ( “anterolisthesis”) or backward ( “retrolisthesis”), and is classified into four grades according to the degree of displacement.

   

   Spondylolisthesis

5. Spinal stenosis

   Spinal stenosis is caused by a narrowing of the spinal canal. It is most often located at the lumbar level, L4-5 and L3-4, and can also affect the cervical spine. It is presented usually in older people who often have other associated diseases.

   The main symptom is pain and weakness in the legs when walking, which requires the person to stop and rest ((is called intermittent pseudo-claudication). The pain is also relieved by sitting or leaning forward, because in this position decreases compression.

   

   Lumbar spinal stenosis | Cervical spinal stenosis

   It is diagnosed by clinical symptoms and physical examination and with the help of MRI and CT scan.
   Conservative treatment is the main objective. Only when pain is not controlled with medications, physiotherapy or treatments in the Pain Unit, you might consider surgery.

   

   Lumbar spinal stenosis: narrowing of the spinal canal