“I am in constant pain. I can’t get any relief at all. I can’t sleep, and I’m tired all day long. I have lost all sense of enjoyment of my life. My husband and I are having problems now, and the kids have had to depend on themselves and their friends’ parents more and more these days. I am addicted to pain killers, which don’t really work for me any more, and I feel totally depressed and alone in my fight against my back pain.”

These sad words have been spoken by countless patients of mine who suffer from chronic low back pain and its devastating consequences. Living with chronic back pain is living in hell on earth. It affects people not only physically, but emotionally as well, leaving many people lonely, depressed, divorced, and jobless. Low back pain is the leading cause of disability and the number 2 cause of missed work days in the United States, according to the North American Spine Society.

A generation ago, when our parents were our age, the only treatments available to treat their low back pain were either aspirin-like drugs or surgery. They were usually told by their doctors that they would “just have to live with it.” While this may have been very difficult for them to endure, there really were no acceptable treatment options in the 1960’s, 1970’s, or even the 1980’s. Over the past decade, however, pain management physicians, working closely with scientists who study the anatomy and the way the nervous system works have discovered something very interesting: there really aren’t that many structures in the low back that can cause pain. And identifying the structure that causes the pain is absolutely critical.

My concept of “precision pain management” is based upon the fact that there is an anatomic or biochemical reason for the pain to exist, and in order to treat pain properly, we MUST first make the right diagnosis. If you had a bad cough with difficulty breathing, your doctor would first have to determine whether you had pneumonia, asthma, a deflated lung, or lung cancer; clearly these are very different diseases, and the treatment that your doctor implemented would be based upon making the correct diagnosis in the first place. Treatment of your pain should not be any different!

My approach to the diagnosis of the cause of back pain utilizes my own mnemonic to remember these different causes: FEDS and PI. These letters stand for: Facet arthritis, Epidural disease, Disc, Sacroiliac joint arthritis, Piriformis syndrome, and Instability (of the vertebral bones).

Most of us are familiar with discs that are located within the spine. The lumber discs are rubbery supportive structures that act as shock absorbers, and are shaped like slices of sausage. Over the course of time, the back wall of the lumber disc is prone to degeneration, deterioration, and dilapidation. The disc itself may become an important source of back pain, and frequently shows up on an MRI as a bulging disc. This may be associated with a much more subtle, but frequently more important phenomenon, known as internal disc disruption which shows up as a faint black line on an MRI, and is indicative of a crack or tear in the disc. This tear is, in turn, usually associated with newly generated nerves that grow into the tear, much like grass that grows through the cracks in a driveway. These nerves sensitize the discs, making them more prone to being painful. Additionally, poisonous chemicals inside the disc may ooze out of the tear into the epidural space, a thin, round space inside the spine. This may cause a chemical inflammation within the nerve roots that exit the spine and travel down the leg(s), resulting in numbness and a very painful shooting, shocking pain in the leg. The muscles in the low back, hip, and buttock, in turn, frequently go into spasm, and can become a real pain in the backside! Although massage, physical therapy, chiropractic, acupuncture, and injection of medicines into these sore muscles can often give relief, the relief is usually only temporary, and the pain returns anew, almost as if nothing had ever been done. At the Mid South Pain Treatment Center in Germantown and Southaven, we usually spend well over an hour with our patients when we first meet them so that we have all the important information we need in order to make the right diagnosis. MRI’s and other studies can be helpful in making the correct diagnosis, but the most important diagnostic tool that a doctor needs is his ears. That’s because making a diagnosis requires listening carefully to the patient with low back pain.

The obvious advantage of the pain treatment techniques that we utilize in our practice is that they can be performed in a comfortable outpatient environment, outside of a hospital, they are highly effective, and are very safe in the right pair of hands. Long-term pain and suffering is fast becoming a ghost of the past. Armed with new treatment options, compassion and thorough medical detective work, we are fortunate to live during a time in which we no longer have to live with our pain.

Michael E. Steuer M.D., did his post-graduate medical training at Harvard and Cornell.  He is a board certified educator, nationally recognized lecturer, and clinical specialist in interventional pain management.  He has published numerous medical papers, and has appeared on TV, radio, and print as a leading authority in pain management.