Manuel G. Sanchez, MD
President, Northeast Pain Consultants
Interventional Pain Management
Fellow of the Royal College of Physicians and Surgeons of Canada
Diplomate of the American Boards of Pain Medicine
Diplomate of the American Boards of Anesthesiology
60 Rochester Hill, Suite 6, Rochester NH 03867
Tel. (603) 335-5600 Fax (603) 335-5400
ROCHESTER, NEWINGTON, EXETER, LACONIA, GILFORD

LOW BACK PAIN AND DISCOGRAPHY

It has become apparent from multiple studies that Magnetic Resonance Imaging (MRI) studies, at least 30-40% of the population has abnormal spinal pathology including herniated discs without a history of ever having back pain. The MRI was once considered the gold standard is today only one piece of information in the puzzle of low back pain generators.

Where to go from there is determine other potential sources of pain generators, based on clinical symptoms, and Diagnostic Imaging is one of the challenges that Pain Medicine specialist face every day in their practice.

There are a number of nerve blocks with local anesthetics and steroids used to map out the source of pain and decide on a permanent form of treatment. Some of the pain generators are: The ligaments that hold the spine together, the muscles that attach to the spine, the small and large joints in the spine, the Discs themselves and the Membrane that covers the spinal cord and root of the spinal nerves.

Injections of small volumes of local anesthetic to the nerves that supply the innervations to the joints in the posterior segments of the spine are diagnostic and prognostic if successful in selecting patients that will respond to Radio Frequency Neurolysis.

The injection under fluoroscopy of contrast in to the discs, is called provocative discography, and it is the ultimate test in diagnosis of painful back problems, under normal circumstances discs are not painful when injected, but discs with a painful response at low volumes of injectate are considered POSITIVE discs when they reproduce the pain felt by the patient on a daily basis. The interpretation of the discography, the remaining Diagnostic Imaging studies, the clinical examination and the response to diagnostic nerve blocks are all bundled together to treat Low back pain either by further intervention with non surgical options (IDET, Transforaminal Epidural Steroid Injections, Steroid Injections to the Scaroiliac Joint or Radio Frequency Neuroablation) or by surgical means (Disccectomy, Spinal Fusion).

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