The first step in relieving low back pain is determining the source of the pain. There are many structures in the back that can be the source of the pain. Determining where the pain is coming from requires a number of steps.

The first step is taking a detailed history of the patient’s pain symptoms. Is the pain localized to a particular site in the back? Is it on one side or both sides? Is it there all of the time or is it intermittent? Are there particular positions or activities that cause or aggravate the pain such as sitting, standing, bending, lifting, twisting, etc. Does the severity of the pain change? Is it sharp, dull, stabbing, burning or what is the quality of the pain? How severe is the pain on a scale from 0 to 10? What relieves the pain? Lying down, sitting, bending forward, squatting down? Are you limited in how long you can stand or how far you can walk? Is there any numbness or tingling in the legs? Is there weakness in the legs? Are there any problems with bladder control? The answers to these types of questions help the physician determine where the pain could be coming from.

Back pain and leg pain are often caused by different things. Leg pain is more often due to a pinched nerve in the spine. The two most common causes are sciatica due to a disc herniation or claudication due to spinal stenosis. Back pain is more often due to arthritis in the facet joints or the sacroiliac joints or from the soft tissue which is referred to as myofascial pain. If pain is long standing and fluctuates in severity it is more likely due to degenerative changes like arthritis. Pain due to cancer or infections usually starts and progressively gets worse over time and can be associated with neurological symptoms including leg weakness, progressive numbness in the legs, fever, chills and other symptoms. Degenerative causes are much more common than back pain due to cancer or infection. The history and physical examination are the first steps in determining whether the pain is due to a serious disease that requires more urgent investigation and treatment.

Investigations for back pain and / or leg pain include imaging tests like CT scans and MRI scans. Plain x-rays will show if there is a broken bone and can sometimes show signs of infection or cancer. CT scans use x-rays to create better images of the bone but are not as good for looking at soft tissue such as disc herniations or pinched nerves. MRI scans are much better are detecting serious conditions like cancer and infections and are better for looking at the soft tissue structures including the discs, spinal cord and pinched nerves.

Performing image guided injections of local anesthetic is the best method of determining the source of low back pain. Freezing the nerves to individual joints such as the facet joint and the sacroiliac joints when a person is in pain results in almost instant relief of the pain. The worse the pain is at the time of the injection the easier it is to determine the source of the pain. When people have chronic low back pain the muscles in the back tense up to limit movement as a means of limiting the pain. If this goes on a days, weeks or months the muscles fatigue and they become sore as well. Local anesthetic injections does not immediately relieve the muscle component of the pain. However, if the underlying source of the pain is identified and relieved then the muscle component of the pain will gradually go away as well.

The Welcome Back Clinic offers many options for determining the source of back pain and treating it. Consultation with a back specialist, MRI scans, local anesthetic injections under x-ray guidance and various forms of treatment can lead to relief of the pain and the ability to return to normal activity which was previously limited by the pain. Consultation, MRI imaging and diagnostic injections can often be obtained all in one visit to the clinic.