If you have lower back pain, you are not alone. Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. 85% of Americans will experience low back pain sometime in their lifetime and accounts for 25% of lost workdays. Fortunately, most occurrences of low back pain go away within a few days. 95% of the patients will recover in the first 12 weeks of the onset of the low back pain. Some causes of back pain can become more serious if left untreated. The long-lasting back pain or chronic back pain is measured by duration — pain that persists for more than 3 months is considered chronic. Chronic low back pain can be more difficult to cure, especially if adhesions develop.
Chronic causes of back pain are related to 3 areas of the spine. The front part of the spine contains the disc, disc space, and body of the vertebra. The middle portion of the spine contains the spinal canal, spinal nerves, and spinal fluid. The back part of the spine contains the facet joints, ligaments, and muscle. Any one of these elements or combination of these elements can cause back pain in patients. The facet joints are a pair of small joints in the back part of the spine. They are responsible for most of the motion of the spine and a significant amount of the arthritis that occurs in the spine. They are usually the safest site in the spine to reduce or eliminate the source of the pain generation. These joints are the most common area of the body that can be made numb for pain relief. Each facet joint is connected to two medial branch nerves that carry signals, including pain signals, away from the spine to the brain. The sacroiliac joints are located at the lowest part of the spine, between the sacrum and ilium in the pelvis, and are also connected to nerves that carry signals to the brain. The pain signal from these joints can be interrupted to the brain and eliminating the perception of pain by destruction of the nerves. The facet joints and sacroiliac joint nerves are responsible for sensation to these joints and are not involved in walking, bladder/bowel function, or sexual function. The nerves can be destroyed by simple techniques, however world wide the most common method is radiofrequency ablation. Radiofrequency ablation (RFA) of the facet joint nerves is also known as rhizotomy or “burning” / “zapping” of the facet joint nerves. In this non-surgical procedure, radiofrequency waves are delivered by simple needles causing the surrounding tissue to heat up with the goal of interrupting pain signals to the brain. RFA typically targets pain from in the neck or lower back, and the sacroiliac joints, which can contribute to chronic spine pain. Treatment options start with the less aggressive therapies such as anti-inflammatory medications, physical therapy, manual therapy, pain medications, oral steroids, and staying mobile with activities of daily living. If the less aggressive therapies are ineffective, then the RFA can be considered. After the RFA, the recovery period is minimal. Since the technique is performed through needles at times with sedation, there are no incisions that require healing. Patients often return to work the next day or the following day if they have not experienced a temporary flare-up of pain. The facet joint and sacroiliac joint nerves are peripheral nerves which can grow back anywhere between 4 months to 2-1/2 years later with an average around 12 months. For some patient’s, the RFA offers permanent pain relief. If the pain were to return, the RFA can be safely repeated. RFA can offer significant pain relief in patients without pinched nerves or unstable spines.
Arch Advanced Pain Management
James Sturm DO DABA FIPP
830 Waterbury Falls Suite 202
O’Fallon, Missouri 63368