July 27, 2010
Health Sciences Campus, Kochi
 

Dr. Sundar Cherala, the Interventional Pain Physician and Medical Director from Fox Valley Pain Center, Chicago, was in Amrita recently to deliver a talk on Diagnosis and Management of Back Pain.
 

An expert in managing pain and in performing various interventional procedures, Dr. Sundar presented his thoughts on this common condition that can affect anyone, regardless of age. The doctor elaborated on various kinds of back pain diagnoses he had encountered in his clinical practice.
 

“Lower back pain or lumbago is defined as mild to severe pain in the lumbar portion of the back,” he explained. “The lumbar vertebrae, L1-L5, are most frequently involved in back pain; these carry the most amount of body weight and are subject to the largest forces and stresses along the spine.”
 

“The most common type of back pain is that arising from muscular aches and pains,” he elaborated. “A common area in the lower back prone to pain is the area of the joints between the vertebrae called the facet joints or the zygapophysial joints. The pain here tends to be very localized.”
 

“The classic lower back pain can also be due to displacement of the cartilaginous cushions between the vertebrae or the intervertebral discs. This pain can be localized or it radiate down.”
 

Radiating pain usually occurs when the nerve root is pinched, explained the doctor. Coughing, sneezing, straining for bowel movements, etc. can aggravate this pain.
 

The doctor recalled the example of a patient who had an L4-L5 intervertebral disc, that caused a significant left-sided herniation, where the left-sided nerve was significantly compromised, causing very severe back pain to the patient.
 

“Sacroiliac joint pains are the most difficult to manage since the joints are fixed, with very little movement,” the doctor added.
 

“Hip joint can be a source of pain; moreover patients do not often realize that the pain is coming from the hip. More and more patients are getting their joints replaced and there is always a leg length discrepancy (LLD), which puts more pressure on the sacroiliac joint causing problems.”
 

“Vertebra can also be a source of problems. Compression fractures from osteoporosis, high-speed traffic contributing significantly to traumatic problems of the spine, immune-compromised patients with discitis in the spine cause problems.”
 

“If the pain is worse at night time, where the patients are not able to sleep, it may be cancer.”
 

Dr. Cherala also enlightened the audience on various interventional aspects for back pain management such as lumbar epidural injections, transforaminal epidural injections, cervical epidurals, radio-frequency ablations, discogram, intradiscal electrothermoplasty (IDET), nucleoplasty, spinal cord stimulator and subachromial AC joint injections.