Chronic back pain in the golden years.
An acute episode of back pain is suffered by the majority of the population at least once in their lifetime. Within the first month it is classed as an acute episode.
After a period of six months has passed and the pain and symptoms persist, the patient is said to be suffering with Chronic Back Pain.
The chronic back pain patient can experience a wide range of symptoms, the pain may be constant or be separate repetitive episodes. The symptoms may constant or be progressive and worsen over the years. The pain gradually forces the patient to limit their normal daily activities and pastimes.
Eventually carrying out even the simplest tasks may prove to be impossible.
The sufferer may feel condemned to live with their chronic back problem. Some patients may lack a clear diagnosis and the understanding of why their back is painful. Others may sadly put their pain as down simply wear and tear and as part of getting older. They may be misinformed of their diagnosis and the potential treatments that are on offer today.
They may be excluded from active treatments by an overwhelmed health system that opts instead for minimal conservative treatments i.e.: painkillers, physiotherapy, and walking aids.
But today we can offer a whole range of new procedures, like minimal invasive surgery or more conservative methods of treating back pain, i.e.: infiltrations of the spine. These treatments aim to ease symptoms, to relieve the pain and restore function and allow the person to return to normal life.
The older chronic back pain sufferer may be unaware that they may have options for active treatment, can still have the chance to regain their quality of life during their golden years. Today we offer a new chronic back pain assessment clinic to help you understand why your back hurts and what you can do to improve your pain and your quality of life.
Chronic back problems.
Spinal stenosis is a common cause of chronic back pain in the aging population. As we age, the spinal canal can become constricted and tight, due in part to arthritis and other conditions. If the spinal canal becomes too tight, back pain and leg pain (or weakness of legs) can result.
Spinal stenosis is a progressive disease, the pain may be more constant and severe, and the patient starts to notice a loss of power in the legs. On walking long distances he may notice he needs to stop and rest sitting then continue walking. The distances he/she is able to walk will gradually diminish as the disease finally leads to complete compression of the spinal cord and loss of the use of the legs. The legs may feel increasingly wobbly.
The patient without treatment will eventually become wheelchair bound.
This debilitating disease causes back pain because neighbouring vertebra can become unstable and begin to "slip." The most common cause of spondylolisthesis is when disease or ageing of the spine alter the normal structures which stabilise the spinal structures. The discs may lose volume (dehydrate) with age and allow small abnormal movements of the back bones. If the spine becomes unstable enough, the symptoms and back pain can become serious chronic problem.
With an unstable back pain, may start suddenly with a certain flexion movement, you may feel a jolt or a slip in the back accompanied with severe pain. The pain may be experienced in repeated episodes, becoming more frequent as the vertebrae become more “unstable”. The pain may be felt in the legs with episodes and lower back pain accompanied with a sciatic (or shooting) pain.
The discs in the back with age, wear and tear may start to fail and cause chronic symptoms. The disc may lose volume, it may lose its natural shape and sponginess. There may be a small or old hernia of the disc which causes some chronic pain and sciatica type symptoms.
Symptoms of a degenerative disc may include chronic lower back pain of varying degrees, the pain may become more severe after sitting for long periods by bending or lifting. The patient may have episodes of acute pain which improves whiles resting flat in bed.
A ruptured disc which does not resolve (or re absorb) may become a cause of chronic back pain. The pain may be severe and include leg pain and numbness and change of sensation in the legs. A failed disc and its symptoms may be permanent or until the patient seeks treatment.
The facet joints are found at every vertebral level on both sides of the lumbar spine. They provide the twisting stability in the low back.
Facet joints also prevent each vertebra from slipping over the one below. A small capsule surrounds each facet joint providing a nourishing lubricant for the joint. Also, each joint has a rich supply of tiny nerve fibers that provide a painful stimulus if a joint is injured or irritated.
Inflamed facets can cause a powerful muscle spasm. Facet Syndrome is a common cause of chronic low back pain in the aging back. It is thought to be caused by osteoarthritis (wear and tear) of the described facet joints.
It causes low back pain that increases on extension of the spine, pain which can be felt on the back of the thigh, and ends at the knee.The pain can excruciating and occur as episodes lasting sometimes weeks or months.The pain is sometimes worse after long periods lying flat or being immobile.The patient will need to get out of bed at night and walk to ease the pain.
Arthritis is a general disease which can affect any joint of the body.
It can affect the joints in the back, the spaces between the vertebrae. It can cause severe chronic back pain, inflammation and deformity of the affected bony joints.
Arthritis is a common cause of Nerve root pain, the bony arms at the sides of the vertabrae, through which exit the nerves to the extrematies of the body.If the nerve root bone becomes deformed the nerve rubs and becomes very inflammed and intensly painful.
This is a progressive disease and its symptoms and pain normally get worse over time, although it is possible to have more acute episodes after making a movement or jolt which the diseased joints do not tolerate.
The spine can be affected by any spreading space occupying tumour. Tumours can orgininate in other locations ie liver,lungs or prostate.
Back pain can herrald the symptoms for Lymphoma, cancer of the lymph nodes which may spread to the bones, including the vertebrae.
The majority of tumours will cause severe pain and as space occupying tumours, they can cause a degree of compression, ie a feeling of weaknees or change in sensations in the legs along with bony pain which worsens as the tumour grows and destoys the bones.
This is a generalised thinning of the bones as the result of the body loosing calcium deposits. The patient may not have symptoms of Osteoporosis until the bones become soft enough to collapse or fracture after a seeminly small accident or jolt.
The vertebral bones in the back support the bodies weight and take the stress of our movments. The vertebrae can collapse and cause intense pain and muscle spasm, this happens with age and as the osteoporosis progresses. The vertebrae can be fractured after what seems a very small accident, like miss stepping or a small fall. The fracture can be undiagnosed for a long period of time, and may be discovered after several weeks or months when the acute back pain does not improve and leads the patient to seek a specialists advice. This disease affects mainly ladies after the menapause but can also affect men.
The treatment of your chronic back pain.
Once you have your place on our you will have an appointment with our physiotherapist. He will assess your back pain, strength, mobility, range of motion and symptoms. He will prepare a report of his findings. You will then have an MRI scan and x-rays of your back.
The Specialist spine Consultant will see you in clinic to review all your results and discuss the cause of your chronic back pain.
Once you have a diagnosis you will be given recommendations for your future treatment.
They may or may not include:
: as prescribed by your doctor.
: normally non steroidal analgesics.
: Special infiltrations and injections may be given in the operating theatre under x-ray guidance. This allows the specialist to place small amounts of local anaesthetic and anti-inflammatory medicines right into the origin of your pain. The anti-inflammatory drug will act to reduce inflammation and your pain over a period of time. This procedure may be diagnostic, allowing the specialist to confirm the point where your pain originates, or it may be a conservative treatment (non operative) for your pain. These injections may be repeated.
: Sometimes it is possible to remove the sensitivity around the facet joints through minimally invasive methods. Normally using a needle shape probe guided by x-rays that works with radiofrequency of intensive cold. The method tends to improve pain from the facets for a limited period of time.
Spinal De-compression.
This operation is to halt the progression of Spinal Stenosis, which would eventually leave the patient wheelchair bound. The surgery aims to improve the pain, symptoms and function of the patient’s legs.
The specialist opens up the narrow canal and makes more space for the spinal cord, and the roots of the nerves that exit the spine to pass. He may remove overgrowths of bone and shave bony spurs. This spinal de-compression may be needed at several levels.
A new surgical concept for the treatment of spinal instability, failed disc disease or spondylolisthesis.
Under general anaesthetic and through tiny keyholes in your back Dr can introduce one of a range of metallic spring devices which fix onto the spine with screws. The device is designed to support failing joints in the back whilst maintaining normal back movements. The range of devices are said to be dynamic i.e.: designed to mimic the normal range of flexion in your spine.
These new operations may avoid the need to open up the back and perform major surgery along with bon grafting to fuse parts of the spine. The new advances mean a much shorter hospital stay and much faster recovery period. The device is designed to allow for flexibility and movements of your back and allows you to regain your normal life.
Your specialist may treat your vertebral fracture conservatively with a support corset and pain medication. The consultant would arrange for thorough investigations to confirm Osteoporosis and to monitor and/or give medication to prevent further fractures in the back and to stop the osteoporosis from progressing.
These fractures can be intensely painful and if unstable would need to be fixed into place. There is an option for a minimal invasive surgery to secure the fracture. Special liquid cement is injected through special canulas, which are inserted into tiny holes into the broken vertebral bones. The aim is to stabilise the fracture and thus reduce significantly the patient’s pain.
Depending of the diagnosis and conditions of each individual, the above operations are not applicable to all the patients with back pain, but to a percentage. In many cases, the standard operations mentioned before will apply.
Dr Miguel Bañuls LMS, MSc Orth (London), MCh Orth (Liverpool): Consultant Orthopaedic Surgeon.
Dr Bañuls is pleased to offer a comprehensive Orthopaedic service that speaks your language. British trained and fluent in English.
Dr Bañuls has a very special interest in spinal surgery and the treatment of chronic back pain. Dr Bañuls continues to develop and apply new advances and techniques as they develop.
Dr Bañuls is pleased to offer a new Chronic Back pain diagnosis clinic, with a promotional all inclusive one payment price. This offer is exclusive to us and the service starts in January 2011.
This new service is open to all new patients with a history of more than six months of chronic back pain.
The package of care includes full assessment with our Physiotherapist, an MRI scan, an X-Ray of the back and a clinic appointment with our Specialist to review the results and discuss your options for future treatments.
This offer is subject to conditions. Please call or contact us by email for more information and to book your place with our promotional pricing.
606914833
Or visit our website: www.drbanuls.com
Or send your enquiries to t.banuls@terra.es
