Dr. Amit Bhandarkar M.B.B.S., M.S., M.D. is a fellowship trained, Orthopedic Spine surgeon. Dr Bhandarkar evaluates and treats a wide variety of spine ailments consistent with his comprehensive spine training.
He has practiced and done fellowships in the USA, Canada, Seoul (South Korea), Maldives and India. His area of focus is minimally invasive spine surgery, and his special interests are spine related pain management and endoscopic spine surgery (the least invasive option) for lumbar disc related disorders.
Below is an article by Dr. Bhandarkar, outlining how to identify pain generators in the spine.
“Pain” is the predominant complaint of patients with spine ailments. Great physiologist Dr. Charles Sherrington defined pain as “psychic adjunct of imperative protective reflex.” This perfectly demonstrates how hard it is to explain what “pain” is.
At Prairie Spine & Pain Institute, the physician who is helping a patient with pain – which has often been occurring for a long period of time – has to understand the type of pain, how long they have had it, where it is and what makes it worse or better. What’s more, pain can be made worse by a person’s circumstances or state of mind. This information combined with a regular exam helps the physician make a reasonable diagnosis. Along with a physical exam, physicians can also use imaging tools such as X-ray, CT scan and MRI to help locate sources of the patient’s pain. If the results of a physical exam and imaging studies correlate with each other, a diagnosis is made. If not, further examinations would be required.
The only way to conclusively determine a particular site, as the source of pain is to block the pain coming out of that area and see how much relief patients get out of it. This is usually done with a numbing medication that is injected into the area of greatest discomfort. Not only does this injection help relieve the person’s pain, it also gives the physician further evidence for treatment.
Lower back pain can come from a number of sources and each source would have to be identified and treated to give the patient the best outcome. The various pain sources may require multiple treatment methods to give the patient the most relief.
Some of the common sources of spinal pain that can be treated surgically are:
- Discs at different levels – Cause pain due to herniation and degeneration
- Facet joints at different level – Cause pain due to inflammation, degeneration, or abnormal mobility
- SI joints – Cause pain due to inflammation, degeneration, or abnormal mobility.
- Nerve roots at different levels – Cause pain due to inflammation or compression
- Pars – Cause pain due to fracture resulting in abnormal mobility
- Hip joints – Cause pain inflammation and arthritis
- Biomechanical instability – Cause pain abnormal motion for e.g. spondylolisthesis
- Central canal stenosis – Cause pain compression of the spinal nerves
- Spinal nerves after exiting the spinal column- Cause pain due to compression
After a physician has done a physical exam, imaging, and pain injections, they are able to identify possible sources of pain in the spine and create a customized plan to treat the most sources of pain with the least amount of intervention. It is important to note that most of the spinal interventions performed to treat pain can only reduce the pain – not completely eliminate it – as it usually comes from multiple sources and it may not be possible to address all sources of pain with one intervention. This is even truer with patients who have chronic pain, as the sources of their pain can be hard to identify and they often require multiple methods of pain relief. If you’re seeking relief from your chronic spine pain, come see the interventional pain specialists at Prairie Spine & Pain Institute.