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Causes and Treatments for back Pain

Causes and Treatments for back pain

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Causes and Treatments overview for back pain

Back pain can be broadly divided into three categories:

  1. Muscle strains:

this type of back pain is usually caused by an acute injury where the muscles are overworked by lifting something heavy.  The pain is often sudden and can be very painful. Patients will complain of muscle spasms and pain with most activities. Usually there is no complain of leg pain.


  1. Osteoarthritic back pain:

this type of back pain is often long standing and is caused by age related arthritis in the facet or the disc. Often, these patients have pre-existing back pain caused by a disc collapse, facet arthritis or other arthritic related conditions which is made worse by the work injury. The goal of treatment is to get the patients back to their baseline.


  1. Neurogenic (nerve related) back pain:

this type of back pain is caused by nerve impingement from either by a disc herniation, lumbar stenosis and a spondylolisthesis. Pain is worse with standing or walking and relieved by sitting. As with osteoarthritic back pain, these patients often have pre-existing symptoms which are made worse by their work injury.

Treatment approach

  1. The initial treatment for all three causes is medications (avoid narcotics) and therapy. This is usually very effective for muscle strain type back pain. Pain should resolve within 6 weeks
  2. For osteoarthritic and neurogenic back pain, selective injections can be added as needed :

Osteoarthritis : facet injection

Neurogenic : epidural or extra-foraminal injections

  1. Surgery is a treatment option for osteoarthritic and neurogenic back pain if everything else fails but is not an option for muscle strain type back pain.
    1. Decompression or laminectomy surgery is used for neurogenic back pain. Sometimes a fusion is combined with a decompression is there are other factors such as a pars defect or a spondylolisthesis.
    2. Fusion is used for discogenic or arthritic back pain. It is also used in conjunction with a decompression if instability is present. (please see above).


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