Low back pain doesn’t always come from the back. Physical diagnosis techniques exist to help differentiate back pain originating from other than the lumbar spine.
The etiologies of chronic low back pain are many, and sometimes diverse. While herniated disc, spinal stenosis, spondylosis, and facet arthropathy are often considered along with myofascial origins, myofascial trigger points have been shown as coexisting with the other commonly accepted causes. Therefore, myofascial trigger point injections are considered a significant treatment adjunct to low back pain. Additionally, prolotherapy, ultrasound guided injection or C-arm guided injection can be considered.
Diagnostic and Therapeutic Spinal Injections
Selective spinal injections are being performed with increasing frequency in the management of acute and chronic pain syndromes. A few of the most common indications for these diagnostic and therapeutic spinal procedures are noted as follows:
- Spinal nerve radiculopathy
- Spinal stenosis
- Discogenic pain (i.e., symptomatic, internal disc disruption)
- Contained, disc bulge, or protrusion vs. extruded or sequestered herniated disc
- Multilevel degenerative disc disease
- Facet joint arthropathy or associated facet joint nerve pain
- Sacroiliac joint pain dysfunction
- Failed back surgery syndrome (FBSS)
- Epidural and/or perineural fibrosis/granulation with associated symptomatic pain
- Complex regional pain syndrome (CRPS) (formerly known as reflex sympathetic dystrophy, RSD).
Although numerous interventional procedures are used to treat spinal-related pain conditions, a few of the most common types of diagnostic and therapeutic spinal injections are noted as follows:
- Epidural steroid injections (translaminar, transforaminal, caudal)
- Facet joint nerve blocks and facet joint intra-articular injections
- Radiofrequency (RF) nerve ablation procedures
- Sacroiliac joint and other intra-articular joint injections
- Sympathetic ganglion nerve blocks
- Diagnostic discographic injections
- Epiduroscopic laser decompression