Back / Buttock / Leg pain

ARTHRITIS OF THE LUMBAR SPINE

Lumbar or lumbosacral arthritis is a type of arthritis that affects the lower back and pelvis, resulting in inflammation of the joints, pain, and even loss of motion.

Arthritis of the lumbar spine most commonly affects older adults. However, it is not uncommon for younger patients to be diagnosed with this condition. Those with a higher risk of developing lumbar arthritis include:

• Men and women over 60
• People with obesity
• Individuals who regularly perform heavy labor
• Individuals with previous spinal injuries or spinal surgeries

SYMPTOMS

As with most types of arthritis, the symptoms of lumbar arthritis include joint pain, swelling and stiffness. Pain and other symptoms, however, tend to be centralized in the lower back and pelvic region, with some people also experiencing pain the buttocks and thighs.

Patients with arthritis of the lumbar spine often report more aggravated symptoms in the morning after getting out of bed, with pain and stiffness decreasing over the course of the day. Symptoms also tend to worsen after long periods of inactivity or when performing strenuous activity.

DIAGNOSIS

After reviewing your medical history and examining your spine, your doctor may do a series of tests and procedures in order to diagnose your condition. This can include an X-ray, MRI (magnetic resonance imaging), CT (computed tomography) scan, and even blood tests.

It is important for you to provide your doctor with detailed information about your pain, including:

• What it feels like
• Where it hurts
• How long you have experienced it
• What things make it better or worse

TREATMENT

Individuals with lumbar arthritis should learn how to take care their backs in order to manage pain symptoms and reduce the chance of injuring the spine even further. If you have lumbar arthritis, for example, your doctor might recommend that you avoid certain activities, such as high-impact sports. Certain strengthening exercises can help fortify the muscles around the spine. Meanwhile, proper lifting techniques and stretches can help ensure the spine is protected.

Although there is no cure for arthritis of the lumbar spine, pain and other symptoms can be effectively managed with a variety of treatments, including:

Medication: Anti-inflammatory medications are commonly used in conjunction with other treatments to decrease the amount of inflammation around the joints and provide pain relief. Talk to your doctor if you plan on taking anti-inflammatory drugs, such as Ibuprofen or Naproxen, on a regular basis.

Hot/Cold Therapy: When used in the right combination, hot packs and cold compresses can help reduce inflammation and relieve pain associated with arthritis. Talk to your doctor to determine the best course of treatment for you.

Weight Loss: For patients who are obese or overweight, losing even 10 pounds can significantly lessen the amount of stress placed on the joints.

Physical Therapy: Exercises are used to strengthen and improve the function of the muscles surrounding the lumbar spine so that less burden is placed on the joints.

Epidural Injections: Injections are a more direct way of delivering anti-inflammatory medication, such as cortisone, to a specific area of the body.

Alternative Treatments: Many patients diagnosed with lumbosacral arthritis find pain relief by complementing their doctor-prescribed treatment plan with acupuncture, chiropractic, massage therapy, and/or natural remedies.

FAILED BACK SURGERY / PAIN AFTER SURGERY

Back Pain After Surgery

While many back problems can be addressed with non-surgical treatments, in some cases patients may require back surgery as a result of a progressive spine-related condition (e.g. spinal stenosis, degenerative disc disease or spondylolisthesis), or they may choose to undergo surgery as a last-resort treatment for pain relief. Unfortunately, back surgery does not always achieve its desired results. Sometimes, patients experience chronic pain after a lumbar spine operation. When this happens, it is often referred to as Failed Back Surgery Syndrome, or Post-Laminectomy Syndrome.
Some common causes for back pain after surgery include:

• The formation of scar tissue around a nerve root
• The spinal nerve’s inability to recover from a prior compression/trauma
• The development of structural changes in the spine near the site of a spinal fusion
• A new or recurrent disc herniation
• Spinal or pelvic ligament instability as a result of the surgery

FAILED BACK SURGERY SYMPTOMS

The symptoms associated with a failed back surgery may be similar to those experienced before the operation. However, it is possible that the location and intensity of pain may change, depending on the cause. Patients may feel a sharp or stabbing pain, for example, that moves from the back to the legs, or they may experience a heightened sensitivity to pain (hyperalgesia).
If your pain symptoms continue after back surgery, your doctor will need to re-evaluate you to determine whether the cause of pain was not addressed during surgery or if you have new symptoms caused as a result of the operation. During your examination, be sure to describe your symptoms in detail, mentioning new symptoms, changes in pain, and changes in where your pain originates.

TREATMENT

After a diagnosis is made, your doctor will determine the best treatment plan to address your symptoms. There are treatment options besides surgery that can help alleviate pain symptoms. These include physical therapy, anti-inflammatory medications, epidural injections, medial nerve branch blocks, spinal cord stimulation, and more.
At Paradigm Pain and Spine, we develop customized treatment plans to alleviate and manage pain after surgery. Contact us today to make an appointment with one of our double or triple board-certified pain experts.

HERNIATED DISC

Spinal or intervertebral discs are pillow-like cushions that separate the bones that make up your spine. They are made up of a tougher outer layer (annulus), which surrounds a softer, gel-like substance (nucleus pulposus). When the outer fibers become damaged, the inner layer can start to leak out. This is referred to as a herniated disc. A herniated disc can occur in the lumbar spine (lower back) or cervical spine (neck), though it is most common in the lower back.

Many people with a herniated disc do not experience symptoms. However, others may experience pain, muscle weakness and/or numbness as a result of the herniated disc putting pressure on the spine or affecting nearby nerves. If the herniated disc is in your lumbar spine, your pain will likely be centered on your buttocks and leg. If it is in your neck, your symptoms will be most intense around your shoulder and arm. Symptoms may worsen when coughing or sneezing.

Herniated discs are common, especially in people between 35 and 55 years old. The following groups have a higher risk of developing a herniated disc:

• People with jobs that involve heavy lifting or repetitive bending
• People who are overweight (extra weight puts extra stress on the discs)
• People with pre-existing back injuries

DIAGNOSING A HERNIATED DISC

A physical exam and a review of your medical history may be sufficient for your doctor to make a diagnosis, though in some cases he or she may also order diagnostic tests. During your visit, be sure to tell the doctor where your pain is located, what it feels like, and how long it has been going on.

HERNIATED DISC TREATMENT

There is no cure for a herniated disc, and in most cases they heal on their own. Your doctor may recommend getting rest and reducing physical activity for some time to give the disc time to heal. Non-steroidal anti-inflammatory drugs may be taken during this time to help reduce inflammation around the joints and improve pain symptoms. Physical therapy may also be prescribed. In the event that conservative therapy does not alleviate symptoms, other options are available.

An epidural steroid injection may may help you feel more comfortable while you recover from a herniated disc, by reducing pain symptoms. Epidural injections are delivered directly at the source of your pain. Some patients feel improvement within minutes of getting an epidural injection, while others may start to feel better after a few days.

In other cases, mimimally invasive procedures such as disc decompression, disc biacuplasty, hydrocision or endoscopic decompression of the disc may be offered as a therapeutic modality.These therapies may eliminate the pain of the disc disease while minimizing time away from life activities or work.

If you think you might be suffering from a bulging, ruptured or herniated disc, you should see a doctor as soon as possible. To make an appointment with one of our triple board-certified spine and pain experts, call (859) 282-2024 today.

REFLEX SYMPATHETIC DYSTROPHY / COMPLEX REGIONAL PAIN SYNDROME

Complex regional pain syndrome (CRPS) is a chronic pain condition characterized by severe pain, swelling, and changes in the skin, such as the pigmentation and/or texture. Previously known as reflex sympathetic dystrophy (RSD), CRPS most commonly develops in an arm or a leg, typically after surgery or as a result of an injury (i.e. a broken bone or sprain); and it may subsequently spread throughout the body.
Other events or conditions that can trigger CRPS include: brain diseases, such as stroke; degenerative arthritis of the neck; and heart disease. Though more uncommon, patients may also experience CRPS without being able to identify the event or injury that triggered it.
There are two types of complex regional pain syndrome:

• Type 1: Without nerve injury. Most patients are diagnosed with this type.
• Type 2 (formerly known as causalgia): With nerve injury. This type of CRPS tends to be more painful and is characterized by burning pain.

SYMPTOMS OF CRPS/RSD

The pain associated with complex regional pain syndrome is often more severe than what is customary for the initial injury. Symptoms can start out mild or moderate and get worse over time, either gradually or quickly, depending on the patient. The first signs of CRPS are usually pain in the affected arm or leg, redness, swelling, and sensitivity to touch and cold.
Other symptoms of complex regional pain syndrome include:

• Burning or throbbing pain in the limbs
• Changes in skin temperature, alternating between sweaty and cold
• Changes in skin texture (shiny or dry) and/or color (white, blotchy, red or blue)
• Stiffness in the joints
• Muscle spasms, weakness, and muscle loss
• Loss of movement in the affected arm or leg

Symptoms may last for a few months to several years – and they can get progressively worse.

DIAGNOSIS & TREATMENT

Your doctor will diagnose complex regional pain syndrome based on a physical exam and medical history. The following tests and procedures may also be used to help make a CRPS diagnosis: bone scan to help detect changes in bone density; X-ray to check for loss of minerals in the bones; magnetic resonance imaging (MRI) to identify tissues changes; thermography to measure skin temperature and blood flow; and other sympathetic nervous system tests.
It is possible to recover fully from CRPS if you start treatment early (within months of your first symptoms). At Paradigm Pain and Spine, we tailor treatment plans to meet the individual needs of each patient. Treatment options may include:

• Pain relievers (over-the-counter and/or opioid)
• Topical analgesics
• Physical therapy
• Spinal cord stimulation
• Sympathetic block
• Stellate ganglion block
• Intrathecal drug pumps
• Transcutaneous electrical nerve stimulation
• Other medication (corticosteroids, alpha-blocking drugs, calcium channel blockers)

If you think you might have complex regional pain syndrome (reflex sympathetic dystrophy), contact us to make an appointment with a pain specialist. The earlier you start treatment the more likely it is to be effective.

SCIATICA & LOW BACK PAIN

The sciatic nerve starts at the back of the pelvis and extends down to the feet, running through the buttocks and the back of the leg on its way down. It is the longest nerve in the body and is a major source of pain for some individuals.
When the sciatic nerve gets compressed, irritated or pinched, resulting in pain and other symptoms, this is referred to as sciatica. It may be caused by things such as a bone spur, bulging disc, or herniated disc.
Other causes may include:

• Degenerative disc disease
• Spondylolisthesis
• Lumbar spinal stenosis
• Pregnancy
• Injury (e.g. muscle strain)

Sciatic pain usually starts in the lower back and can radiate from the lumbar region to the buttocks, through the hips, down the back of each leg, and all the way down to the toes.
Symptoms associated with sciatica include inflammation, pain (it can range from a mild ache to a burning sensation), tingling and numbness. Symptoms can be mild or severe, depending on what is causing the pain, and the pain can be non-stop or intermittent.
Standing or sitting for too long may make symptoms worse. Lying down or changing positions may provide temporary relief.
Sciatica typically only affects one side of the body, but in rare cases it can affect both sides. This is called bilateral sciatica.

DIAGNOSIS

If your symptoms are severe or last for more than six weeks, see a doctor. At Paradigm Pain and Spine, we can diagnose the cause of your pain and help treat any underlying conditions.
To diagnose sciatica, a physician will review your medical history and perform a physical examination. During the exam, the doctor may apply pressure to specific areas of your lower back and/or spine to pinpoint the source of your pain.
You may also be asked to perform a straight leg raise test. To do this, you will need to lie flat on your back. The doctor will then raise one leg at a time, making sure your knee does not bend, in order to stretch the sciatic nerve. If you feel pain in the back of the leg when it is raised above a 30% angle, it is likely that you have sciatica.
Diagnostic tests, such as an MRI scan or X-ray, may be used to determine the exact cause of your sciatica before a treatment is decided upon. If your doctor suspects an infection, blood tests may also be ordered.

SCIATICA TREATMENT

For some patients, sciatica symptoms may go away on their own. If your pain does not improve with time and symptoms worsen, a spine specialist can help.
Initial treatment may include taking acetaminophen (Tylenol) or nonsteroidal anti-inflammatory medication, such as ibuprofen (Advil). Your doctor may recommend using a heating pad or ice pack for 10-15 minutes every few hours, in addition to certain exercises to help relieve pain.
Depending on what is causing irritation of the sciatic nerve, you may require stronger medication, physical therapy, a minimally invasive procedure, or even surgery. Epidural injections, for example, are used to treat sciatica-related pain in cases where a herniated disc is the problem.
To learn more about epidural injection procedures or other treatment options for sciatica, call 859-282-2024 today to schedule a consultation with a spine and pain expert.

VERTEBRAL COMPRESSION FRACTURE (VCF)

The bones that make up your spine are called vertebrae. These bones protect your spinal cord, allow flexibility, and work to give your body structure and support. Over time, bone mass and density throughout the body can diminish and bone minerals can be lost. This is referred to as osteoporosis. Osteoporosis results in thinner, frailer bones, which means that there is a greater chance that they might fracture or break. When the problem affects the bones in the spine, a vertebral compression fracture can occur.

Vertebral compression fracture (VCF) is one of the most prevalent causes of back pain. Fractures can be caused by stress placed on the bones as a result of an injury (e.g. a car accident or a fall); however, osteoporosis tends to be the main cause. According to the American Association of Neurological Surgeons, approximately 750,000 people with osteoporosis will get a vertebral compression fracture each year.

VCF SYMPTOMS

When a bone in the spine compresses or breaks, it can be painful. Different people, however, exhibit different symptoms. Some people experience severe pain when a fracture occurs, while others may only feel pain when performing certain movements, such as lifting, bending or twisting. It is also possible for a VCF to occur without a patient experiencing any pain or discomfort.

In addition to pain, other symptoms of VCF include kyphosis (having a humpback); loss of balance; loss of height over time; and neurological symptoms, such as numbness, tingling and weakness.

If you feel a nagging pain in your mid to lower back, you should see a specialist, especially if the symptoms started suddenly. A doctor will be able to determine whether a vertebral compression fracture is the cause of your pain.

DIAGNOSIS & TREATMENT

To diagnose your back problem, our expertly trained physicians will conduct a comprehensive medical history and perform a physical exam, paying special attention to your symptoms. If a diagnosis is inconclusive based on this exam, diagnostic imaging may be necessary. An X-ray can be used to see if bones in the spine are compressed, broken or fractured. Meanwhile, a bone scan can be used to determine if you have osteoporosis.

If a vertebral compression fracture is diagnosed, a treatment plan will be tailored to treat your individual symptoms. For mild fractures, treatment options may include wearing a back brace to limit spine movement while the fracture heals; taking pain medication; getting rest and slowly incorporating doctor-approved exercises; and taking calcium or other supplements to help strengthen the bones.

For more severe cases, a minimally invasive procedure may be necessary. Two of the most common minimally invasive procedures for VCF include vertebroplasty and kyphoplasty. With both procedures bone cement is injected into the fractured vertebrae to provide stability, the main difference being that kyphoplasty requires injecting a balloon into the vertebrae to create a cavity for the cement.

Our pain and spine specialists with discuss all treatment options with you so that you understand the benefits and risk. Call (859) 282-2024 for a consultation with one of our double or triple-board certified physicians.