Back pain Incidence

Low back pain is a common global problem, it is the leading cause of disability worldwide with the annual prevalence of 15% to 45%.

Pain generators

Following are the contributing factors for low back pain and sciatica; alone or in combination:

• Structural abnormalities like kyphosis, scoliosis, and excessive lordosis
• Straightening of spine
• Disc related pathology
• Narrowing of spinal canal (spinal canal stenosis)
• Facet joints arthopathy, hypertrophy of the facet joint
• Sacroiliac joint syndrome
• Ligament sprains
• Muscle spasm or trigger points
• Degenerative changes like spondylosis,
• spondylolisthesis
• Inflammatory causes including osteoarthritis,
• rheumatoid arthritis, sacroilitis, ankylosing spondylitis Nerve entrapment due to degenerative changes.

Treatment Modalities

• Drugs
• Physiotherapy
• Injections in the back

Depending upon the source of pain following injections are recommended for back pain / Sciatica

• Failure of pain relief
• Drug related complications like transient increase in blood pressure or blood sugar
• Risk of infection at injection site
• Transient headache and nausea
• Allergic Reactions
• Bleeding
• Nerve damage
• Paralysis
• Facet joint injection
• Sacroiliac joint injection
• Piriformis injection
• Transformational epidural steroid injection
• Interlaminar epidural steroid injection Caudal epidural steroid injection
• Trigger point injection
• Injections are administered in operation theatre with the help of ultrasound or X-ray guided
• After evaluation of the patient the pain consultant decides the type of injection or the combination of injections.
• Patient may feel pain of needling during the procedure for which mild sedation might be given

Pain relief

• Response / relief from injection varies from patient to patient:
• It is never guaranteed that patient will get complete pain relief.
• It may take few days to two weeks to get a positive response.
• Some patients may need repeat injections.