An Introduction to Back Pain: Part 2

This is the second in a 3-part series

Part 1 | Part 2 | Part 3

Written by Michael J. Musacchio, Jr., M.D.

We hope you read last week’s post about low back pain in which we covered myofascial pain. There are several causes of back pain and this week we look at another cause.

Low back pain is an exceptionally common condition in which an estimated half to three-quarters of the adult population will experience at least one memorable episode of back pain per year and up to 1 in 10 will develop chronic back pain. Acute back pain, which resolves within weeks, is typically attributed to the soft connective tissues. Once pain goes beyond three months, it is considered chronic and the physiology of this pain can become quite complex. Chronic back pain is typically attributed to traumatic or degenerative conditions, and may include a variety of physiologic, psychological, and social influences. Most patients with chronic back pain will respond to conservative treatments as anti-inflammatory medications, physical therapies, and therapeutic injections become more widespread and better understood. Others won’t, and in some cases surgical options exist and have become more common due to the popularization of minimally invasive techniques.

There are several potential sources of low back pain which can generally be categorized into one of three categories:

  1. Myofascial pain is that which is attributable to a primarily muscular of ligamentous origin.
  2. Facetogenic pain is mediated by the facet joints of the spine.
  3. Discogenic pain emanates from the intervertebral discs.

Facetogenic Pain

Facetogenic pain is attributed to pain associated with degeneration and arthritis of the spinal joints. Facet-joint pain commonly occurs with leaning back or twisting and may stay central or radiate into the legs. Classically, the pain is described as an ache or stiffness across the low back that can be stabbing or shooting with rotation or extension. The pain will commonly radiate through the buttocks and hips and down the thighs, but typically stops at the knees and there is no associated numbness or tingling.

Like any other joint, the accumulation of repetitive trauma leads to inflamed and worn joint surfaces which generate pain signals in response to stress. Here again, the root cause is typically poor conditioning, poor posture, and poor spinal mechanics.

Besides anti-inflammatory medications and physical therapies, there may be very positive and sustainable responses to facet steroid injections and/or facet rhizotomy procedures which can give more long term pain relief in select patients by disrupting the nerve fibers that transmit pain from the joints.

Look for part 3 of our series about “Introduction to Back Pain.” Hope this info is helpful!

Michael J. Musacchio, Jr., M.D. is a Center for Spine Care minimally invasive neurosurgeon specializing in the spine.
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To learn more about Center for Spine Care, visit our website!

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One Response to An Introduction to Back Pain: Part 2

  1. Rose Mills says:

    Very interesting and knowledgable article. Learned a lot.
    Rose Mills

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