Clinical Conditions
PAINFUL CONDITIONS
Majority of patients that consult at a pain clinic do so for the following conditions. For more details of other painful conditions, please refer to the interactive body map (link).
Osteoarthritis (Spondylosis)
Spinal osteoarthritis, or spondylosis, is a degenerative disorder that may cause loss of normal spinal structure and function. Although aging is the primary cause, the location and rate of degeneration is individual. The degenerative process may impact the cervical, thoracic, and/or lumbar regions of the spine affecting the discs and spinal joints. This degenerative process may be inevitable but the pain that sometimes accompanies it can be avoided or treated.
Osteoporosis
Osteoporosis commonly affects the thoracic and thoracolumbar regions of the spine and may cause debilitating pain. This disorder is caused by a loss of bone mineral density resulting in fragile bones, which may fracture. Osteoporosis may cause vertebral compression fractures, loss of height, stooped posture, even a humped back. The patient can control some of the risks for osteoporosis. These include poor diet, smoking, excessive intake of alcohol, and inactivity. Refer to the following Osteoporosis segment for further details.
Compression Fracture
A compression fracture is a common fracture of the spine that may range from mild to severe. Each vertebral body is separated from the other by a disc. When an external force is applied to the spine, such as from a fall or carrying a sudden heavy weight, the forces may exceed the ability of the bone within the vertebral body to support the load. This may cause the vertebral body to crush. This is known as a compression fracture. If the entire vertebral body breaks, this is considered a burst fracture. Compression fractures are often associated with marked osteoporosis.
Whiplash
Whiplash injuries refers to neck pain which occurs following a motor vehicle accident. This is typically caused by hyperextension and/or hyperflexion because the head is forced to move backward and/or forward rapidly beyond the neck’s normal range of motion. The unnatural and forceful movement affects the muscles, ligaments and joints in the neck. Muscles may react by tightening and contracting, creating muscle fatigue, resulting in pain and stiffness.
Herniated Disc
A disc herniation is a disc rupture. This may occur if the nucleus pulposus (gel-like center) erupts through the annulus fibrosus (protective disc wall) or if the annulus fibrosus fragments. The progression to an actual herniation varies from slow to sudden onset of symptoms.
There are four types of herniated disc:
- disc protrusion or bulge
- prolapsed disc
- disc extrusion
- sequestered disc
Stages 1 and 2 are referred to as incomplete, where 3 and 4 are complete herniations.
Sciatica
The term ‘sciatica’ was commonly used to describe pain that travels along the sciatic nerve, the largest nerve in the body. Today, it refers to pain which may be sharp, dull, burning, or shocks of shooting currents beginning in the back/buttock and traveling downward to the back of the thigh and leg. The most common cause of sciatica is a herniated disc in the lumbar spine.
Spinal Stenosis
Spinal stenosis results when the small neural passageways termed ‘foramen’ narrow. The narrowing of the foramen may compress and entrap nerve roots. Nerves react to pressure by swelling, which further reduces foraminal space. Stenosis can cause excruciating pain, numbness, tingling, or burning in the involved extremity (e.g. leg, arm). Stenosis can also occur with compression from a disc, osteophytes (e.g. bone spurs), and ligaments.
Scoliosis
Scoliosis causes the spine to curve laterally to the left or right and affects children and adults. Scoliosis is a complex three-dimensional disease. To understand this concept, consider that in some cases, as the spine abnormally curves, the involved vertebrae are forced to rotate. At the thoracic level, vertebral turning impacts the rib cage and may result in rib prominence on the opposite side of the curve. Deformity is the primary complaint. Unequal weight loading on the different portions of the curved spine is one of the reasons for back pain associated with scoliosis.