Interventional Treatment Options for Back Pain

Back pain is one of the most common pain complaints that pain management physicians see. 80% of individuals will experience some sort of acute back pain in their lifetime while others may suffer from chronic pain as a result of a condition or injury. Several different factors can attribute to back pain. 

Causes of Back Pain

Congenital Causes

• Skeletal irregularities such as scoliosis, kyphosis, or lordosis, all abnormal curvatures of the spine.  
• Spina bifida, the incomplete development of the spinal cord.

Injury Related Causes

• Traumatic injuries from playing sports, falls, or car accidents.
• Muscle sprains, strains, and spasms. 

Degenerative Causes

• Spondylosis, the degeneration of the spine that occurs as people get older. 
• Arthritis or any inflammatory disease
• Intervertebral disc degeneration where the rubbery-like discs wear down as people age. 

Nerve & Spinal Cord Causes

• Spinal nerve compression
• Narrowing of the spinal column known as spinal stenosis
• Infections
• Osteoporosis
• Herniated discs 

Types of Interventional Treatment Options

A doctor will likely recommend less invasive forms of treatment as the first option for patients experiencing back pain. If conservative treatments such as NSAID’s (Ibuprofen and Acetaminophen) or localized steroid injections do not provide relief a doctor may opt for interventional treatment. Interventional treatments are more invasive than over-the-counter treatment options but have a record for providing significantly more long-term relief. 

Spinal cord stimulation is the most commonly used treatment after nonsurgical treatments have failed for patients. There are two portions to a spinal cord stimulation procedure. First, the patient will have a stimulator trial to see if the stimulator provides them 50% or more pain relief before a permanent spinal cord stimulator is implanted. 

These stimulators consist of electrodes in the form of ultra-thin wires and a generator which is similar to a pacemaker battery pack. During the permanent implantation, doctors will administer local anesthesia and two small incisions will be made. A type of x-ray called fluoroscopy will be used to guide the electrodes to their place along the spine. Placement of the electrodes will be based on where the pain is occurring for the patient. The electrodes will be held in place by sutures and the generator will be implanted permanently. The generator is able to send electrical impulses to the electrodes which interfere with the pain signals sent from the nerves to the brain. 50%-80% of patients experience long-term relief with this procedure. 

Dorsal root ganglion therapy (DRG) is another procedure similar to spinal cord stimulation that sends electrical signals across wires to target and interrupt the nerve fibers that send pain signals. 

Deep brain stimulation (DBS) has proven to be a successful treatment for patients who did not find pain relief from conservative or over-the-counter measures. DBS has been used in pain management since the 1970s. In this procedure, an electrode is placed in the brain that is controlled by a generator that is implanted typically near the collarbone. The generator sends electrical impulses to the electrode in the brain to help regulate abnormal impulses that cause pain. There are three main target sites for DBS electrode implantation, but MRIs will be used to determine where in the brain the surgeon will place the electrodes. This is often done with a high success rate for patients with Parkinson’s disease. 

Vertebroplasty and kyphoplasty are two of the less invasive surgical procedures. Vertebroplasty relies on 3D imaging to guide a fine needle to the vertebral body, the largest portion of vertebrae. A substance is injected into the vertebral body space that quickly hardens and helps both stabilize and strengthen the bone. Kyphoplasty is the same procedure, however, a small balloon is inserted and gently inflated to restore the height of the vertebral structure prior to the hardening substance being injected. 

Nerve blocks are another common treatment for back pain. There are four overarching categories of nerve blocks and three particular types of blocks under those categories. Within these categories, nerve blocks are administered via injections of numbing substances to numb an individual’s pain. Some of the more commonly administered nerve blocks are blocks for trigeminal neuralgia in the face, blocks in the forehead, blocks in the pelvis or abdomen, blocks in the back, and blocks in the jaw. There are three types of nerve blocks that can be administered in the back: cervical, thoracic, and lumbar. 

As science and technology continue to advance, interventional treatments for pain continue to advance as well. There are many options available to those suffering from back pain and relief can be achieved.