Back, Neck & Spine

It is estimated that ninety percent of people will suffer from back pain at some time during their life. Usually, these episodes of back pain are self-limited and resolve within one to two weeks of onset. People with persistent low back pain are a small percentage of the population. The personal, economic, social and functional impact of persistent low back pain can be substantial.

There have been many studies which have recently helped us to better understand the common causes of low back pain. Many of these causes have been elucidated by diagnostic precise spinal injections, specifically blocking nerves that go to the joints, muscles, tendons, ligaments, discs, and nerves to enable diagnosis of the causes of low back pain. Until recently, many people have suffered with low back pain without a clear diagnosis for their low back pain. Doctors have diagnosed their pain as “low back pain”. While this is a description it does not offer a diagnosis or specific cause. Accurate diagnosis helps us to better understand the causes of low back pain and eventually treat these specific causes.

Diagnostic tests that are used to help us better understand low back pain including MRI scans, radiographs (x-rays), EMG nerve conduction studies, CT scans, diagnostic injections, myelograms, CT myelograms.

Structures that cause low back pain include facet joints, discs, nerve roots, muscles, tendons, ligaments, soft tissues, sacroiliac joint, and the coccyx. There can be other anatomic structures that are confused with low back pain, including the hip joint, and this must be ruled out as well as a cause of the low back pain.

In summary low back pain is common and can cause debilitating pain as well as functional impairment. Accurate diagnosis is the key to effective treatment. Conservative therapy must be utilized before considering surgery.

The gold standard for diagnosis of neck pain secondary to facet joints is by injection of local anesthetic around the nerves that innervate to the facet joints. Despite the recent explosion in popularity of imaging studies such as X-rays, MRI scans and CT scans, facet joint pain doesn’t always show up on these studies. In fact most are not reliable for the diagnosis of facet related pain. MRI’s may or may not show facet joint related pain.

The prevalence of neck pain is up to 14% of patients reporting Grade 2 to 4 neck pain, which is defined as high pain and dense intensity with disability. This is long lasting pain that impairs patients’ functions and it’s associated with significant health impacts, social impacts and economic impacts as well.

Based on multiple studies, the facet joints are a significant pain generator for cervical pain, headache pain, shoulder pain and even upper extremity pain. If the pain is secondary to the facet joints then this can be shown by injecting local anesthetic around the joints. Long lasting pain relief can be obtained by radiofrequency ablation, which is commonly known as burning of the nerves. This gives anywhere from 9 to 18 months of continuous pain relief.

Causes of neck pain can include traumatic events, degeneration, fracture or dislocation, tumor, or infection. Degeneration and trauma are the most common causes. Other structures that can cause pain in the neck include the discs, nerve roots, bones, soft tissues such as muscles, tendons, bursa and ligaments.

Diagnostic studies that can help to diagnose the site of pain include radiographs (x-rays), MRI scans, CT scans and EMG nerve conduction studies. MRI scans utilize magnetic waves in order to image the body tissues. The imaging provided by MRI is excellent for soft tissues (discs, nerve roots, the bones, soft tissues such as muscles, tendons, bursa and ligaments), while CT scans and x-rays are much better at imaging bones and high density structures. EMG nerve conduction studies help to evaluate the integrity of the nervous system and conduction of both motor and sensory nerves.

Treatments for neck pain include non-steroidal anti-inflammatory medications (NSAIDs), anti-depressant medications (Elavil, trazodone), anti-convulsants (Lyrica, Neurontin), opiate pain medications, physical therapy, chiropractic care, bracing including neck braces, gravity inversion therapy, stretching, manipulation therapy, injection therapy and spine surgery.

Spine surgery should be a last resort and should be embarked on only after conservative therapy has not alleviated the pain. In summary accurate diagnosis is the key to successful therapy with patients suffering from chronic neck pain.

Kozmary Center for Pain Management offers spinal infusion pump therapy. We’re the largest provider of spinal infusion pump therapy for Medtronic spinal infusion pumps. We offer this therapy as part of our comprehensive ability to treat the patients with pain problems from simple to complex. Currently we have over 160 patients with spinal infusion pumps; typically, we offer these to patients who have failed conservative therapy, including physical therapy, non-steroidal anti-inflammatory medications, injection therapy, as part of their pain program. This type of therapy is reserved for patients with moderate to severe pain. It is extremely effective. It alleviates the side effects typically associated with oral or transdermal medication management. It leaves patients feeling much better with a clearer head. It reduces the amount of medications because the intrathecal dose is 100 to 300 times as potent as an oral dose of medication. We are considered experts in delivery of intrathecal drug delivery and have the largest intrathecal infusion practice in Nevada. Our staff includes Dr. Steve Kozmary who is board certified in Pain Management, nurse practitioner, a physician assistant, a physical therapist and as well as an RN who are dedicated to patients with chronic pain problems.