All Spine Pain Articles

Differential Diagnoses: Inflammatory or Non-inflammatory Chronic Back Pain?

Chronic back pain can be broadly categorized as inflammatory or non-inflammatory. This article will use two hypothetical patient cases to focus on the clinical features that best distinguish inflammatory from non-inflammatory back pain and review each patient’s evaluation and management.

Adhesive Arachnoiditis: No Longer a Rare Disease

Adhesive arachnoiditis (AA) is an inflammatory disease that occurs inside the lumbar and sacral regions of the spinal canal.1-6 Simply put, arachnoiditis means inflammation of the arachnoid layer of the meninges.

Chronic Low Back Pain: Can We Find a Treatment Consensus?

Generating clinical guidelines for treating CLBP, therefore, has become a nearly impossible task. Experts from various specialties offer their perspective on the why behind this standstill.

Axial Spondyloarthritis: Updated Medication and Imaging Recommendations

with Tiziano Marovino, DPT, MPH, DAIPM

Diagnosis Is Everything: Low Back Pain As a Symptom of an Underlying Condition or Conditions

As part of this special report, PPM addresses the common and confounding problem of low back pain.

The Emotional Impact of Chronic Low Back Pain

with Michael Schatman, MD

Root Cause of Sacroiliac Joint Dysfunction: Four-Step Exercise Protocol

Editor's Note: The authors informed PPM in October 2020 that this SI joint dysfunction protocol is now being taught in orthopedic classes on how to diagnose SI joint dysfunction.

Experts Roundtable: Finding a Bottom Line in Back Pain Care

Approaches to treating low back pain vary across disciplines, so we asked practitioners across the spectrum of pain care, from anesthesiology to physical therapy, to share how they would tackle a hypothetical case.

Updated Medication and Imaging Guidelines for Managing Axial Spondyloarthritis

The ACR has updated its recommendations for the treatment of patients with ankylosing spondylitis (AS) and nonradiographic axial spondyloarthritis (SpA), including the use of NSAIDs and TNF inhibitors as well as secukinumab and ixekizumab.

Management of Severe Radiculopathy in a Pregnant Patient

Applying a multidisciplinary approach to a complex case.

Vertebroplasty Still Shown Ineffective in Recent Trial

Vertebroplasty has been shown no better than local anesthetic for osteoporotic pain in vertebral fractures.

Imagine Dragons’ Dan Reynolds Educates People About Ankylosing Spondylitis

Dan Reynolds, lead vocalist with Imagine Dragons, goes public with his diagnosis of ankylosing spondylitis and shares his efforts to manage the pain and stay active.

Arachnoiditis: Diagnosis and Treatment

PPM's expanded coverage of arachnoiditis includes a discussion of the role of glia cell activation and neuroinflammation in the progressive of this inflammatory disorder.

Chronic Back and Neck Pain in America 2015 Survey Results

Learn more about the results of the SpineUniverse Chronic Back and Neck Pain in America survey.

Updates on Smoking and Low Back Pain

This review article highlights current knowledge on the association between low back pain and smoking, with an emphasis on the role of nicotine.

Notalgia Paresthetica: An Enigmatic Condition

Investigators present a case of a woman with notalgia paresthetica, which included symptoms of severe pruritus (itching) and sporadic pain located on her back between her shoulder blades.

Arachnoiditis Part 2—Case Reports

Aggressive treatment, including some off-label, non-standard measures, can provide pain relief and improvement in patient function.

Arachnoiditis Part 1: Clinical Description

Mention the word “arachnoiditis” to experienced clinicians, and they are liable to ask, “What is it?” or state, “I’ve not heard of it.” It is no wonder that it is a poorly known disease because it is listed as “rare” by the National Organization for Rare Disorders. To those of us who deal with severe, intractable pain, however, arachnoiditis is well-known.

Pain, Impairment, Whiplash, and the New AMA Guides: What Clinicians Need to Know

Every year, approximately 3 million people in the United States suffer from whiplash,1 resulting in an estimated $43 billion in comprehensive costs.2 Over the past few decades, these injuries have been on the rise worldwide.

Lumbar Spinal Stenosis: A Review of the Treatment Options and Modalities

The incidence of lumbar spinal stenosis (LSS) in the United States has been estimated at 8% to 11% of the population. As the “baby boomers” age, an estimated 2.4 million Americans will be affected by LSS by 2021. This article review non surgical and surgical options for managing lumbar spinal stenosis

US Service Members With Polytrauma

Fall leaves US Serviceman with polytrauma: lumbar disc desiccation, bulging disc, and compression of the nerve root.

Ask the Expert: Pain Persists in Spite of High-dose Opioids

Ask the Expert from March 2013

Neck Pain: Diagnosis And Management

Article reviews the anatomy, common causes, and practical approaches to the management of neck pain.

A-Delta Pain Fiber Nerve Conduction Study Benefits Patients With Spinal Pain

Review of pain fiber nerve conduction study for diagnosing spinal pain.

Spontaneous Low Back Pain, Radiculopathy, And Weakness in a 28-Year-Old

A 28-year-old fluoroscopy technician spontaneously developed familiar, aching low back discomfort one week ago. He indicated that, on average, he experiences one flare-up of back pain monthly, which lasts about one week, and resolves spontaneously. This recent flare-up is not resolving as expected. How would you treat him?

Can Yoga and Stretching Exercises Relieve Chronic Low Back Pain?

PPM sat down with the lead researcher of a recent yoga study: is it more effective than stretching or self-care for chronic low back pain? Practical information you can incorporate in your chronic pain patients' treatment plans.

Dry Needling Offers Relief From Chronic Low Back Pain

Dry needling (DN) is a unique treatment option for chronic low back pain. DN is a procedure in which filiform needles—needles commonly used in acupuncture—are used to deactivate myofascial trigger points (MTrPs).

Medications For Low Back Pain

This educational review summarizes the different classes of medications commonly used in the treatment of low back pain, discussing the mechanism of action, efficacy, complications, contraindications, and current clinical research for each class or group of medications.

Axial Neck Pain, Radiculopathy, and Myelopathy: Recognition and Treatment

Neck pain, radiculopathy, and myelopathy are common presentations of cervical pathology across populations and age groups. Learn more about diagnosis and treatment in this article.

Mother With Low Back Pain

Review this case of a 32-year-old mother of two with a 6-week history of low back pain. How would you treat her?

Diagnosis of Neck and Upper Extremity Pain

Patients with neck and upper extremity pain and underlying multilevel cervical disc disease present special problems in the diagnosis and management of the primary pain generator.

The Skeptical Radiology Nurse

Case describes surgical results in a 49-year-old radiology nurse who has battled chronic low back pain for years.

Cost-effectiveness Of Treatments for Low Back Pain

The burden to the healthcare system from low back pain is considerable. LBP is the second-leading symptomatic cause for physician visits, the third-most-common reason for surgical procedures, and the fifth-most-common reason for hospitalizations.

Suspecting and Diagnosing Arachnoiditis

This article provides a review of the symptoms noted in a group of patients with arachnoiditis and presents an analysis of clinical observations of this disease.

Infusion Catheter Epidural

Continuous infusion of lumbar epidural corticosteroid effectively reduces inflammation and pain by “bathing” the suspect spinal structure over a three day period.

Breakthrough Pain In Non-Cancer Patients

An observational study of breakthrough pain in non-cancer patients with chronic low back pain.

Smoking and Low Back Pain

Article provides a review of research findings regarding the relationship of smoking and low back pain.

Minimally Invasive Interventional Spine Treatment – Part 1

Diagnosing the cause of back pain is a detailed process. The patient diagnostic work-up should commence with a well-documented, detailed, and directed historical account, together with a focused physical examination of the involved body parts.

Myofascial Elements of Low Back Pain

The etiologies of chronic low back pain are many, and sometimes diverse. While herniated disc, spinal stenosis, spondylosis, and facet arthropathy are often considered along with myofascial origins, myofascial trigger points (TrPs) have been shown as coexisting with the other commonly accepted causes.

Botox Treatment of Chronic Refractory Low Back Pain

Studies indicate that a specific treatment protocol using Botulinum Neurotoxin A can provide a sustained reduction in chronic, refractory low back pain for about 50% of such patients.

Failed Back Surgery Syndrome

Back surgery is an important treatment option yet a significant percentage have a poor outcome and may require either additional surgery, interdisciplinary treatment, or implantable devices to manage ensuing pain.

Persistent Spine-centered Chronic Pain Scenarios and Treatment Options

Article discusses the clinical scenarios involving the complex issues surrounding adequate pain relief for spine-related chronic pain patients.

Adhesive Arachnoiditis:A Continuing Challenge

Adhesive arachnoiditis a ‘clear and present danger’ that practitioners need to be aware of since it remains a life sentence of unremitting pain and disability imposed, in some cases, very early in life.

Objective Documentation of Spine Pain

An important question any pain physician needs to address is how to properly evaluate spine pain. Specifically, how does one objectively measure pain?

Minimally Invasive Spine Interventions

Learn about a technology update of current minimally invasive treatment options for lumbar discogenic pathology and internal disc disruption.

Distraction Techniques for Lumbar Pain

Learn about intervertebral decompression as a treatment for lumbar spine pain. Should your patients have this done to treat their chronic spine pain?

Blocking Out the Pain

Electrical nerve blocks can be used to treat sciatica, a type of radiculopathy.

Whiplash Injuries in Motor Vehicle Accidents

Article discusses whiplash injuries in motor vehicle accidents, including diagnosis and treatment.

Treating Back Pain Lumbar

Article provides an overview of treating back pain in the lumbar spine. Includes discussion of how injection techniques play a major role in the management of disorders of the musculoskeletal system.

Accidentally Speaking

The diagnosis and treatment of soft tissue trauma as a result of MVAs is an area in which all clinicians find common ground. Article covers soft tissue injury and spinal trauma from car accidents.

Getting Back on Track

Acupuncture is a complementary treatment strategy that can be employed alone or in conjunction with other modalities to treat lumbar pain.

Tethered Spinal Cord Syndrome: Pathophysiology and Radiologic Diagnosis

The diagnosis of Tethered Cord Syndrome (TCS) relies primarily on clinical and radiologic criteria. Similar to a variety of other spinal pathologies, TCS may manifest as diffuse or localized lumbar pain, lower extremity motor or sensory deficits, muscular atrophy, and urinary incontinence. TCS has been broadly sub-categorized as either primary/childhood or acquired/adult-onset.

Sonoanatomy and Injection Technique of the Iliolumbar Ligament

The iliolumbar ligament plays an important biomechanical role in anchoring the spine to the pelvic ring and stabilizing the sacroiliac joint. 1 Iliolumbar syndrome is a painful condition caused by pathology of the iliolumbar ligament. It commonly occurs in people lifting Figure 1. In the ultrasound guided iliolumbar injection technique, the ultrasound transducer is initially placed over the iliac crest in a sagital plane.heavy loads while rotating laterally (manual workers, golf players, etc).

Back Surgery That Does Not Relieve Pain

In 2004, Gatchel, Miller and Lou 1 published a review of failed back surgery syndrome (FBSS) in Practical Pain Management. While the Editor’s Note preceding this article notes that FBSS is not an optimal term to use, it will be used herein due to the lack of a better term at this point.

Platelet-Rich Plasma Prolotherapy for Low Back Pain Caused by Sacroiliac Joint Laxity

A relatively new treatment modality, platelet rich plasma prolotherapy, demonstrates effectiveness in case studies of patients with sacroiliac (SI) joint ligament laxity and painful dysfunction.

Occipito-Atlanto (C0-C1) Joints as a Source of Spinal Pain

Fluoroscopic-guided injection of anesthetic and corticosteroids into the occipito-atlanto joints may successfully treat occipital headaches and upper spine pain.

Expanding Ellipsoidal Decompression (EED®) of the Spine

A novel approach to the treatment of neck pain and postural dysfunction by a self-administered therapy provides an immediate treatment effect in the form of disc positional and conformational changes.

Cervical Disc Disease with Referred Pain to TMJ

This article highlights some of the common causes of cervical-related pain and referred pain. Article also includes a case report that shows the premise of referred TMJ pain from cervical injury.

Deep Cervical Muscle Dysfunction and Head/Neck/Face Pain–Part 1

About half of the population will experience cervical spine pain or headaches at some point in their lives. Article discusses deep cervical muscle dysfunction and its role in myofascial pain.

Restoration of Normal Cervical Lordosis

Poor posture is sometimes at the root of neck pain; article reviews a treatment to restore cervical lordosis.

Prolotherapy for Sacroiliac Joint Laxity

Using the prone posterior iliac glide test, the pain practitioner can clinically detect instability of the sacroiliac joint and confirm restoration of stability following prolotherapy.

Spinal Pain and Neuromuscular Deficiency

The plethora of available treatment methods for low back pain (LBP) is a clear testimonial to the lack of efficacy of any one method to significantly reduce low back pain. Articles looks at neuromuscular deep core muscle reactivation as a treatment for low back pain.

Diagnosis of Low Back Pain

Low back pain doesn’t always come from the back. Physical diagnosis techniques exist to help differentiate back pain originating from other than the lumbar spine. Learn more about these back pain diagnostic techniques.

Non-surgical Spinal Decompression (NSSD)

In the presence of overt, symptomatic intervertebral disc disease, preliminary results of non-surgical spinal decompression (NSSD) suggest a stronger therapeutic effect than conventional traction and may offer a non-surgical alternative to some patients.

Interventions for Radiating Upper Extremity and Cervical Facet Pain

Patients suffering from cervical radiating pain require careful evaluation, diagnosis, and treatment to address their condition.

Deep Cervical Muscle Dysfunction and Head/Neck/Face Pain–Part 2

This article discusses how strength and endurance training can help manage symptoms related to mechanical impairment of the neck.

Disordered Sacroiliac Joint Pain

The partial displacement or dislocation of the sacroiliac joint is a poorly understood and seldom diagnosed condition that may be responsible for a number of back pain or upper body painful conditions. Learn more in this article.

Spine-related Pain in Sports Medicine

Article provides a brief review of evaluation and treatment strategies for sports-specific disorders for patients who have spine pain.

Prolotherapy for Low Back Pain

Prolotherapy is a reasonable and conservative treatment option for musculoskeletal low back pain, disc disease, and sciatica. Article gives an overview of prolotherapy for low back pain.

Dextrose Prolotherapy for Unresolved Neck Pain

This article discusses a study of patients with neck pain who were treated with dextrose prolotherapy at an outpatient charity clinic in rural Illinois.

Laser Therapy

Treatment of Chronic Neck Pain Utilizing Low Level Laser Therapy