Back

Pain

1. What’s arachnoiditis and is there anything I can do for pain relief?
   

   Arachnoiditis refers to inflammation or injury to the membrane that separates the outer covering of the spinal cord (dura mater) from the surface of the spinal cord (pia mater). Ccerebrospinal fluid bathes the spinal cord beneath this arachnoid membrane. Symptoms consists of persistent burning, aching through the day and evening unrelieved by movement or change in position.
   Arachnoiditis has been an extremely difficulty problem. Most patients remain symptomatic for a lifetime. A few patients have shown progressive worsening of their condition even to the point of paraplegia. Fortunately this has been a rarity balanced by another group of patients who have shown resolution of their symptoms.
   Support has been low impact aerobics, pain medicines including anti-inflammatory drugs, a variety of narcotics, anti-depressants and anti-seizure medicines. Emotional support and low impact aerobics have been elements that have been the most helpful in the group of patients that we have seen. Narcotics have been helpful but have also been problematic in the sense that the patients who rely on narcotics for pain relief tend to need a constantly increasing dosage.
   Implants such as spinal cord stimulators or intrathecal narcotic pumps have been useful but have not been a panacea as there are problems associated with these modalities as well. The spinal cord stimulators have been most helpful for patients who have primarily peripheral pain. The intrathecal narcotic pumps have been more useful for patients with central pain that is along the spinal axis. Those types of surgery are associated with problems in the sense that there is tolerance with time and the implants become less effective. There has also been a significant risk of infection with the pumps due to the need to refill the reservoirs intermittently. Of course, these procedures are expensive. Physicians that might be helpful to you would be anesthesiologists who have an interest in chronic pain problems or physiatritst, that is, physicians specializing in rehabilitation medicine.
   In the meantime, you can always search for other problems that might be contributing to the pain which might be correctable, in particular, instabilities or residual infections.

2. Will I have to take medication for pain? Are there any medications I should be concerned about?
   

   The goal of the surgery should be to allow the patient to enjoy a higher level of function without the ongoing need for medication. In the immediate post-operative period, narcotic pain medication allows for early mobilization essential for a good recovery. This incisional pain usually subsides within a week or so allowing many patients to continue to recover without any medication at all. The long-term use of narcotic pain medication is not recommended for several reasons.
   These medications act on the brain depressing the response to pain. As such they have other depressive side effects on the brain as well as other organ systems such as the intestinal tract. This can lead to painful constipation. There may also be a detrimental effect on certain types of sleep patterns. In addition, over time there will be a need for higher doses and eventually physical addiction may occur. It is important to remember that pain is not a condition, it is a symptom of a condition. It is a necessary signal to tell us when something is not right. In the post-operative period it can be dangerous to block this symptom completely or further damage may occur.

3. I have heard people talk about hip pain after harvesting lasting up to 2 years or longer. Is that true?
   

   One of the disadvantages of taking bone from the hip is local pain at the harvesting site. This pain can sometimes be of significant intensity. Most often, it is temporary and resolves during the spinal recovery period. Occasionally, the pain may be of a more chronic nature.
   Approximately 35 percent of patients experience pain at the site of the bone harvest in the hip that can last for two years or longer.

4. What are common causes of back pain?
   

   Back pain is one of the most common ailments known to man. Eighty percent of the adult population will be required to take time off work because of significant back pain. The causes of back pain are many. Wear and tear conditions such as degenerative arthritis as well as degenerative discs are some of the most common causes that orthopaedic spine doctors see on a regular basis. Muscle pulls and tears are also frequent, but they are usually very short lived their duration frequently lasting less than a week. When the pain lasts for longer than a week, it is more frequent that the degenerative problems such as arthritis and/or degenerative disc disease are the culprit. Uncommon causes of pain of very long-standing duration are infection and/or tumors. A very effective means of looking at the spine on radiology studies now, such as MRI can make certain that a person doesn't have these problems very quickly.

5. How do disc injuries cause back pain?
   

   Injury to the disc can cause pain in three different ways. First, the injured disc can itself be painful. The damage results in development of pain coming directly from the disc. Second, the injured disc may be weakened to the point that it no longer functions as it should. Normally, the discs allow for normal movement of the spine by acting as "shock absorbers" between the blocks of bone of the spine (vertebra). When the disc fails to do its job, the other parts of the spine, such as the joints known as facet joints, may suffer. This can generate secondary pain arising from the other structures. Finally, an injured disc may be displaced from its normal position and pinch (compress) a nerve, causing pain. If the displaced disc compresses or inflames a nerve, there may be back pain, leg pain or a combination of both.