The United States leads the world in diagnostic technology yet for many patients, doctors can’t accurately diagnose their back pain. Relying on MRIs and/or surgery to help identify the problem isn’t working either. Half the patients with abnormal MRIs feel perfectly normal — no back pain at all. And for those with chronic back pain who have surgery the expected pain relief never comes. In fact, they may end up with worse pain than before.
Folks like yourself search for answers they can’t find. It turns out that the diagnosis of back pain IS complex and can be very challenging. Studies done so far show that in many cases, there isn’t just one single pain generator. The discs, ligaments, muscles, bone, nerve roots, and even the coverings and linings of these structures can all turn on a pain signal. When more than one area is affected, the pain messages can overlap, creating back pain that may not respond to one single treatment technique.
It can take a long time and a lot of patience on the part of the patient and the doctor when sorting out individual factors contributing to chronic pain. It can be a process of elimination trying first one treatment technique and then another.
Getting an accurate diagnosis is certainly an important first step. There is good evidence that nerve blocks can be used to diagnose and treat pain coming from spinal joints. Once the involved area has been identified, injections using a local anesthetic (numbing agent) can be given every two months for up to six months. Similar injections using steroid medication (antiinflammatory) can be given every two months for up to a year.
Studies have shown that the sacroiliac joint generates pain signals that can become chronic. Injecting the joint with a local anesthetic and/or steroid or using radiofrequency to stop nerve messages may confirm that area as the source of pain. In fact the diagnostic test is also a form of treatment. Short- to medium-term pain relief is possible. Evidence for the effectiveness of these treatments over a long period is very limited right now.
You are caught in a situation that reflects the current state of affairs when it comes to the diagnosis and treatment of chronic low back pain: there are more questions than answers! Don’t give up. Many patients are able to get the relief they want and need with time, persistence, and perserverance.