Back Pain: Chronic and Acute

Back Pain: A Growing Health Concern

Despite the remarkable progress in medicine—both in understanding diseases and in diagnostics and treatment—certain medical issues remain unresolved and are becoming more prevalent. One such issue is back pain.

Some Key Facts About Back Pain Today:

• Back pain is the leading cause of work-related disability among young people (under 45 years old).
• It is the third most common reason people seek medical help.
• Almost 75-90% of people experience back pain at some point in their lives.
• 20-25% of people suffer from back pain at least once a year.
• 1% of people experience permanent work disability due to back pain.

Understanding Back Pain as a Complex Problem

Back pain is a multifaceted issue—essentially a syndrome that encompasses various causes with similar manifestations. Some of these causes are well understood, while others remain uncertain.

Why Has Back Pain Remained a Common Issue Despite Medical Advances?

The answer lies in the fact that progress has affected not only medicine but every aspect of our lives, significantly altering our daily habits. Advances in technology have made life more sedentary, with tasks becoming more automated and requiring less physical effort:

• Washing and drying machines handle household chores.
• Online communication eliminates the need for physical presence.
• Shopping can be done from home with just a few clicks.
• Widespread car usage has reduced the need for walking and movement.

Are These Modern Comforts Beneficial for Our Health?

Was our body designed for a sedentary lifestyle? Likely not, as health problems associated with inactivity are becoming increasingly common—and back pain is just one example.

Many believe back pain affects only those who perform physically demanding jobs. However, sitting for long periods can be just as harmful to spinal health as improper lifting. For instance, long-haul truck drivers, who spend years in continuous sitting positions, often suffer from chronic back pain. Due to these risks, medical professionals are increasingly referring to prolonged sitting as the "smoking of the 21st century".

What to Do if Back Pain Becomes a Daily Problem?

• Will surgery be necessary?
• Will back pain persist for life?

When dealing with chronic back pain, it's essential to remember that psychosocial factors (such as stress, workplace challenges, and personal struggles) may partially or fully contribute to the condition.

Back Pain Treatment: Is Surgery Necessary?

Fortunately, in most cases, surgery is not required for treating back pain. However, to determine the specific cause of the pain and prescribe appropriate treatment, a medical consultation is necessary.

Below are three common causes of back pain—though they are not the only ones:

1. Muscular Back Pain

Deep back muscles are often responsible for sudden back pain—this may occur due to muscle strain or fiber rupture caused by physical overexertion or trauma.

• Pain is localized, without radiation to other areas.
• Treatment involves medication, and patients typically recover quickly.
• The prognosis is generally good.

2. Facet Joint Pain

Pain from facet (intervertebral) joints is one of the most common causes of back pain—it accounts for about 40% of all cases.

• The direct cause of pain is facet joint degeneration (spondylosis, spondylarthrosis), essentially wear and tear of the intervertebral joints.
• Facet joint pain can be chronic, but may also occur suddenly after physical overexertion.
• It often radiates to the groin, hip, or leg, but never below the knee joint.
• Imaging diagnostics often do not reveal significant abnormalities, apart from spondylosis, which is considered normal after middle age.

In rare cases, facet joint pain may be related to rheumatic diseases, such as rheumatoid arthritis.

Treatment Options:

• Minimally invasive pain relief ("blockades") – facet joint injections under X-ray guidance, delivering long-acting anti-inflammatory and analgesic medication.
• Diagnostic blockades – If pain disappears after the precise injection, it confirms that the facet joints are the source. 
• NSAIDs & Physiotherapy – Once pain relief is achieved, the cornerstone of treatment is long-term physiotherapy focusing on strengthening deep back muscles under a physiotherapist’s supervision.
• Lumbar braces – These stabilize the spine, reduce strain, and speed up recovery, improving patient comfort during treatment.
• Repeated injections – In severe cases, when conservative treatment does not provide sufficient relief, repeat injections may be necessary.
• Radiofrequency denervation ("burning") – An advanced treatment for chronic facet joint pain, interrupting pain signals via radiofrequency ablation.

3. Sacroiliac Joint Pain (Sacroiliitis)
The sacroiliac joint connects the sacrum and pelvis.

• Degenerative changes in this joint (sacroiliitis) are a common cause of lower back pain, but they are often overlooked in diagnoses.
• Pain usually occurs in the lower back, often on one side, though it can be bilateral.
• Pain may radiate to the hip, knee, or leg, even down to the heel.
• X-ray findings are often negative, or do not correspond to symptoms.

Diagnosis & Treatment:

Clinical examination – Diagnosis is based on localized pain during sacroiliac joint palpation, with negative radiological findings.

• Diagnostic injection – X-ray-guided injection can confirm the sacroiliac joint as the source of pain.
• Physiotherapy – Manual joint mobilization and therapeutic exercise help reduce pain.
• Sacroiliac braces – These provide stability, relieving discomfort. 
• NSAIDs & Injections – Long-term treatment often involves repeated injections and anti-inflammatory medication. 
• Radiofrequency Ablation – Final option when conservative treatment does not provide relief—targeted nerve ablation using radiofrequency energy.

General Principles of Back Pain Treatment

For cases where surgery is not indicated, back pain treatment consists of two main approaches:

• Pain Management
• Addressing the Underlying Cause

Pain Management:

1. Medications – NSAIDs (non-steroidal anti-inflammatory drugs) may be prescribed to reduce inflammation caused by joint overload and relieve nerve compression pain.
2. Minimally Invasive Pain Relief ("Blockades") –

• This involves targeted injections of pain-relieving and anti-inflammatory medication near the source of pain.
• Blockades are highly precise—performed under X-ray guidance for optimal accuracy.
• Considered “emergency relief” for severe back pain.

Understanding Epidural Blockades:

The epidural blockade is one of the most commonly used techniques for back pain relief.

• First performed in 1885 by American neurologist James Leonard Corning, this method has been refined for over 100 years.
• Since 1986, high-precision epidural injections have been performed using fluoroscopy.
• Research continues today to optimize safety and effectiveness.

Injection Components:

• Physiological saline (for solution preparation).
• Pain relief medication (for immediate relief).
• Long-acting anti-inflammatory drugs (to reduce inflammation).

Effect Duration:

• Relief may occur immediately or take several days.
• Some patients require repeated injections (every week for three weeks).
• Pain relief lasts between 1 to 6 months, sometimes up to 10 months.

Possible Side Effects:

• Injection site pain
• Temporary increased pain
• Mild sensory disturbances
• Blood pressure fluctuations
• Short-term dizziness or nausea

Complication Risk:

• If performed by an experienced neurosurgeon, serious complications occur in fewer than 0.5% of cases.

Pain Relief and Spinal Orthoses (Braces)

If the doctor performing blockades is highly experienced and professional, and if conditions are appropriate, the risk of complications is less than 0.5%.

It is important to remember that blockades are primarily a symptomatic treatment aimed at reducing inflammation and pain. To address the underlying causes of back problems, it is necessary to focus on potential contributing factors and implement a comprehensive treatment plan—including medications and therapeutic exercise. Blockades should not be seen as a miracle solution for all back problems. Consulting with a specialist is essential to determine the best treatment approach for each individual case.

Spinal Orthoses (Braces)

Spinal orthoses (braces) are used in the treatment of both acute and chronic back pain. Their primary functions include:

• Reducing pain
• Providing additional stabilization for the spine until recovery is complete
• Promoting optimal posture, thereby preventing spinal overload 
• Enhancing comfort and a sense of security during treatment

Just as the spine is divided into cervical, thoracic, and lumbar regions, spinal orthoses are categorized accordingly:

• Cervical orthoses
• Thoracic and thoracolumbar orthoses (TLSO)
• Lumbar and lumbosacral orthoses (LO)
• Sacral (sacroiliac) orthoses (SI orthoses)—used less frequently

When Should You Consult a Specialist?

If you or a loved one are experiencing back pain, a consultation with a back pain specialist—such as a neurosurgeon—is recommended. We are happy to provide expert guidance and offer the best possible solution for your situation.

Our specialists identify the exact cause of your back pain and prescribe appropriate treatment, which may include: 

• Medications
• Physiotherapy
• Minimally invasive pain relief (blockades)
• Surgery, if necessary

When an in-person consultation is not possible, we also offer remote consultations via video call. You can schedule an appointment electronically or contact us via phone or email. Remote consultations should be arranged by reaching out to us directly.

If needed, minimally invasive pain relief procedures ("blockades") and surgeries are performed at the modern and comfortable Aiwa Clinic.