Understandably, patients have many questions when it comes to pain and treatment options. I wanted to take a moment to address some of the most common questions we get asked about back pain every day.
Q: Why does my back hurt?
A: The spine is a massive weight-bearing structure made of bone, discs, muscles, ligaments, and joints that provide structural support for the body and protection for the nerves. As one may imagine, with all of these structures working together any one of them can lead to back pain, and more commonly there is a combination of these factors at play. Back pain may result from a known injury or from normal wear and tear. As a result of aging and normal wear and tear, the spine structures may begin to degenerate and become more susceptible to injury.
Q: How can I have so much pain, but my MRI and X-ray is normal?
A: There are two general types of back pain that most conditions may be classified as: structural back pain and mechanical back pain.
Structural back pain results from conditions, like herniated discs, that impinge upon nerves, or stress fractures in the spine that lead to instability. These entities are often seen on the MRI and may correlate to back pain. However, many patients may have these findings on their MRI but they do not necessarily correlate to the back pain. We consider these to be clinically silent.
The other type of pain is mechanical pain, and this is the most common type of pain. Mechanical pain may result from muscle strains or inflammation in the spine that isn’t seen on an MRI or X-ray. I often tell patients that pain itself does not show up on an MRI, so a detailed history and physical exam is the greatest diagnostic tool to determining the most likely cause of pain.
Q: Do injections really work or are they just masking my pain?
A: We utilize steroid injections for various ailments of the spine for two main reasons: treatment and diagnostics. There are many conditions that cause back pain that respond very well to steroid injections, such as inflamed nerves and aggravated arthritis. Steroids may not always cure a problem, but they often offer sustainable relief for chronic conditions. In addition, steroids can help us confirm a diagnosis, such as whether a particular pinched nerve is causing the patient’s pain, or whether the pain is coming from a joint or a nerve. So, yes, steroid injections do work and have many different uses in the treatment of back pain.
Q: So, there is hope for me?
A: Absolutely, there is hope for all sufferers of back pain. Every back pain has a cause and a potential treatment. Some problems are surgical and some are not. Not all back problems can be cured, but all problems can potentially be treated.Written by Michael Musacchio, Jr., M.D., a Center for Spine Care neurosurgeon specializing in minimally invasive spine surgery. .
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