Do you have back pain? Does back pain interfere with your ability to work, play, travel or enjoy your retirement? Have you been told that there is nothing that can be done about it and that you need to learn to live with it? I am here to tell you what the common causes of back pain are and what you can do to improve or eliminate it so that you can return to a better quality of life.

The spine is composed of bones, discs and soft tissue that protect the spinal cord and nerves and provide a foundation that allows us to walk, run and do all the activities that we enjoy. There are a number of structures within the spine that are prone to injury or deterioration that can result in pain. The most common sources of pain are the facet joints, which is where most of the movement in the spine occurs. They are weight-bearing joints like knees and hips and they develop osteoarthritis due to cartilage damage. This can result in pain and restricted movement in the back or the neck.

Discs are located in the front of the spine and deteriorate as we get older. They become thinner which is why people get shorter as they get older. The sacroiliac joints are in the pelvis and are another common source of low back pain.

Diagnostic imaging studies such as CT scans and MRI scans can show damage to the discs and the facet joints which can help in localizing the origin of a person’s pain. Diagnostic blocks means that a doctor injects local anesthetic to freeze the nerves to different joints, which can identify the source of a person’s pain. The injections should be performed under X-ray guidance so that you are certain where the local anesthetic is being injected.

Freezing the nerves that innervates the joint provides instant pain relief. The pain could be coming from one joint or from multiple joints in the spine. Each joint has two nerves that supply the joint which are called medial branch nerves. Both nerves need to be frozen to relieve the pain from the joint. Injecting local anesthetic or cortisone into the joint is not an adequate test. If it relieves the pain, it implies that it is the source of the pain. If it does not relieve the pain, it does not mean that the joint is not the source of the pain because the nerves that carry the pain signal have not been anesthetized.

Injections need to be done when the person is in pain or they will not provide information on where the pain is coming from. The local anesthetic works immediately but only lasts for a couple of hours. Ideally, each joint should be tested individually. The two nerves to a joint should be injected with local anesthetic and the person should be allowed to get up and walk, bend, twist or do activities that would normally increase their pain. If their pain is gone, then it means that the joint that was anesthetized is probably the source of the pain. If their pain is not relieved, then the procedure can be repeated and the nerves to the next joint should be frozen and the person reassessed after in regards to their pain.

The procedure can take up to an hour depending on how many joints are injected in order to identify the source of the person’s pain. Many places inject one or two joints and provide a pain diary for people to log their pain experience. They often have the person return several times for repeated injections. However, if the pain is coming from more than one site, this approach may never completely relieve the pain.

Figure 1: Osteoarthritis in facet joints is a common source of back pain

The sacroiliac joints are located in the pelvis between the sacrum and the ileum. These joints are supported by a number of ligaments. Damage to the ligaments or arthritis within the joint can result in pain. The best way to determine if the sacroiliac (SI) joint is the source of a person’s pain is to inject local anesthetic into the joint at a time when the person is in pain. If the SI joint is the source of their pain the pain should be relieved by the injection.

Figure 2: The sacroiliac joints are in the pelvis between the sacrum and the ileum. The pelvis supports the spine. The Sacroiliac joints are a common source of low back pain or posterior hip pain. 

Intervertebral discs can also be the source of back pain, but from my experience it is less common than the facet joints or the sacroiliac joints. Disc degeneration is common and can be seen on CT and MRI scans. A procedure called provocative discography can be performed to determine if back pain is arising from one or more of the discs. This procedure involves inserting a needle into a degenerative disc under x-ray guidance. Once the needle is in the centre of the disc the doctor injects contrast material (x-ray dye) that can be seen with an x-ray machine called a fluoroscope. The dye is injected while measuring the pressure in the disc. Abnormal discs reveal leakage of the dye. The main component of the test is that the injection should cause the same pain that the person usually experiences. This used to be a commonly performed procedure but is seldom done now, because the discs are probably not a common source of back pain.

Figure 3: Discs are located in the front of the spine between the vertebrae. They act as shock absorbers. Degeneration results in loss of fluid and a decrease in the height of the disc. This can result in back pain.

The muscles in the back help keep the body upright and control movement of the spine. They often tense up when there is pain in the back resulting in restricted movement. The muscles can become painful as well. Exercises can strengthen the muscles resulting in pain relief. Physiotherapists can provide a program of stretches and core strengthening exercises that are important ways a person can manage their pain.

Once the source of a person’s pain has been identified then there are a number of options that can be offered to provide more long-term pain relief. For facet joint pain or sacroiliac joint pain treatment options include cortisone injections, Platelet Rich Plasma (PRP) injections, Stem cell injections or radiofrequency coagulation of the nerves that transmit the pain which is called a rhizotomy or radiofrequency neurotomy. Fusion operations can be effective in certain conditions but are much more invasive with longer recovery times and a higher risk of complications. Discogenic back pain can be treated with stem cell injections, artificial disc operations and sometimes fusions.

The Welcome Back Clinic can set up an Assessment that can offer treatment options that will potentially bring you some pain relief.

For more information call 250-828-6740 or email us at

Eliminate Back Pain with a Rhizotomy