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Back Pain

Back pain is one of the leading reasons that people visit their doctor.  It is also one of the most common causes of chronic pain in Singapore.  The peak incidence is usually in between 45 to 60 years of age.  Up to 75-90% of the population will seek treatment for acute low back pain at some points in their lives. 

What causes back pain?

Causes of mechanical back pain can be varied and includes:

  1. Internal disc disruption
  2. Disc herniation/ prolapse
  3. Facet joints disease
  4. Sacro-iliac joints disease
  5. Spinal stenosis

It can also be caused by serious conditions such as cancer (multiple myeloma / metastatic spinal disease), infection (discitis / osteomyelitis) and fracture. 

Back pain can also be caused by pathology in the pelvic or abdominal organs, as a form of referred pain.

What can patients do to relieve back pain?

Exercise is one of the best ways to treat patients with benign back pain.  Exercise can help to strengthen the weak muscles that may be the cause of back pain.  In addition, exercise can help with weight loss and can stimulate the release of endorphins in the body.  Endorphins are a natural pain killer and a natural stress reliever.

What can be done for back pain in the clinic?

Medications are often employed when exercise alone is not enough to control the back pain.  Over-the-counter medications can usually be used for treating mild back pain.  Stronger medications can be prescribed in the clinic to aid in the control of moderate to severe back pain.  In the event that pain is caused by impingement of nerves, anti-neuropathic medications (nerve stabilizers) would be prescribed to best manage the symptoms of nerve pain.

Rehabilitative therapies would help to minimize pain symptoms and improve function. These include modalities such as heat, ice, ultra-sound, stretching, cardiovascular exercise, work conditioning and strength training, depending on the progress of individual patients.

Acupuncture can be integrated into the care of patients with back pain.  This form of treatment has the advantage of aiding the relief of back pain and leg pain with minimal side-effects and risk.  This is an effective form of treatment in itself and it also complements the efficacy of the medications, rehabilitative therapies and interventional pain procedure used.

Can Minimal Invasive Pain Procedures be performed for back pain?

Interventional pain procedure can be performed for patient who had failure conservative treatment of the back pain.  These are procedures which are minimally invasive and it has both diagnostic and therapeutic applications in the treatment of patients with complicated back pain problems. 

Many patients may not be aware that these treatment modalities can help to manage the pain and thus reduce the need for surgery as a solution for the back pain.

List of interventional therapy includes

  1. Epidural steroid injection
  2. Nerve root sleeve injection
  3. Facet joint block
  4. Sacro-iliac joint block
  5. Facet joint radiofrequency rhizotomy
  6. Sacro-iliac joint radiofrequency rhizotomy
  7. Intra-discal injection and therapy, such as nucleoplasty
  8. Neurolysis

What is the outcome (prognosis) for patients with back pain?

Although there is widespread opinion that 75-90% of patients with low back pain recover within about 6 weeks, pain may persist in up to 72% and disability in up to 12% of patients 1 year after the onset of low back pain.  It has also been cited as the most common cause of job-related disability and a leading contributor to missed work.

Thus it is important to seek early assessment of your back pain so that the most appropriate treatment can be instituted to best optimize the outcome.