Quick relief for a common cause of back pain
Adam Brown, DO, unravels mysteries every day.
As the pain specialist at the Falmouth Hospital Pain Center, he works with patients who have debilitating pain to try to find the cause and arrive at the best treatment. His tools are the patient’s history, a physical exam, MRIs, CT scans, lab tests and even electrical tests if there is evidence of nerve damage or injury.
Those suffering from back pain or any other pain should seek treatment sooner rather than later, Dr. Brown said. One of the first things he does is to find out whether the pain is acute or chronic. Chronic pain is any pain that lasts for more than three months.
“It seems brief in the big span of things, but unfortunately chronic pain behaves vastly differently than acute pain or something that is brand new,” Dr. Brown said. “Our bodies respond differently to each, and with chronic pain, our brains and spinal cord actually change.”
Chronic pain includes a phase called neuroplasticity, where patients have demonstrable changes in their brain and spinal cord that can be seen with MRIs and also in autopsies when people die and donate their bodies to science.
“Our bodies respond very quickly and poorly to chronic pain, where in some ways pain becomes the disease itself,” he said. “At some point there’s no cause anymore other than the brain and spinal cord and disease itself.”
Dr. Brown sees a lot of chronic back pain. With the age of the population on Cape Cod, it’s not surprising that arthritis is often a culprit.
Symptoms include pain that improves when you rest and gets worse when you’re active, or pain that gets much worse when you extend backwards. If an MRI shows that the facet joints of the spine are in bad shape, Dr. Brown often uses a medial branch block to help diagnose the arthritis as a cause of pain.
“It’s almost ridiculous in its simplicity,” he said. The idea is to gauge the pain before the procedure and after. If the patient feels better after an initial test treatment, he knows it is most likely arthritis and will likely respond well to the full treatment.
For a medial branch block, patients are usually put in a facedown position and Dr. Brown uses a special type of X-ray called a fluoroscopy. He then guides a needle to touch a point in the bone where the nerve resides and injects a small amount of a local anesthetic to numb the problem nerve.
The nerve remains numb for about five hours and Dr. Brown encourages his patients to be active during that time. If the back feels considerably better afterwards, Dr. Brown knows the pain is most likely caused by arthritis in that joint.
The treatment is almost identical to the test, only instead of putting a numbing agent through the needle, he uses heat to cauterize those nerves.
“It’s called a radiofrequency ablation because you are intentionally trying to cauterize that medial branch nerve,” he says. “It works very well.”
The results from the ablation last from six months to two years, with the average time being eight to 12 months. Most people find relief with yearly treatments.
Another type of back pain that responds well to treatment is a narrowing of the spine, which is called spinal stenosis, Dr. Brown explained. In that case he does an epidural steroid injection, which he says works very well, with one drawback: The treatment doesn’t last long.
“The positive is that it really provides dramatic pain improvement and the negative is that it’s something we need to repeat,” he says. “Typically we would do between two and four per year on most patients that I see with chronic pain issues.”
He has seen steroid injections work for longer periods of time or even cure a problem, but those are usually with younger people who have acute pain that is more inflammatory in nature. Older people with issues that are more degenerative and chronic need frequent treatment.
“In those cases steroid injections are meant to provide pain management – not a cure, which it definitely doesn’t,” he said. “But if it were me or my family, I would much rather have a steroid shot every four or five months than take a pill.”