Pain Management

Total Spine Clinics Motif

Ankylosing Spondylitis

Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in your spine to fuse, leading to a hunched posture and loss of flexibility. If the ribs are also affected, breathing difficulties can occur.

The exact cause is unclear although genetic factors seem to play a part. People with the HLA-B27 are at increased risk although not everyone with the gene will go on to develop the disease. It occurs more commonly in men than women and the symptoms usually start in early adulthood.

Normally worse in the morning or after periods of inactivity – include:

  • Pain and stiffness in the lower back, buttocks hip and shoulder joints.
  • Pain in the vertebrae of the lower back and sacroiliac joint (between the base of your spine and pelvis).
  • Pain in the cartilage between your breastbone and ribs and sometimes in the back of your heel.
  • Neck pain and fatigue.

Symptoms may occur inconsistently and may worsen as the disease develops. Inflammation may spread to other parts of your body including your eyes. If you experience severe light sensitivity or blurred vision you should seek urgent medical help.

Your doctor will carry out a physical examination to assess the range of movement in your spine, where the pain is worst and whether your breathing is affected. You may be given an X-ray to check for changes in your bone structure and joints or MRI scan which shows the condition of your bones and soft tissues.

Blood tests can check for inflammation or the HLA-B27 gene, although not everyone with the gene will develop ankylosing spondylitis. Early diagnosis is important as the disease can cause irreversible damage to your joints as it develops.

There is no cure for ankylosing spondylitis but there are treatments to slow the progression of the disease and reduce symptoms. These include:

  • Medication such as anti-inflammatories, TNF blockers which target a cell protein that causes inflammation in the body or IL-17 inhibitors which also play a role in inflammation.
  • Physical therapy to improve flexibility and strength.
  • Surgery is not commonly offered for ankylosing spondylitis unless there is severe pain or joint damage which may require joint replacement surgery.

It is not possible to prevent ankylosing spondylitis but there are things you can do to manage the condition better including:

  • Regular exercise to maintain flexibility and improve your posture.
  • Quitting smoking to prevent breathing problems.
  • Applying heat to painful joints to ease stiffness.
Causes

Ankylosing spondylitis is an inflammatory disease that can cause some of the vertebrae in your spine to fuse, leading to a hunched posture and loss of flexibility. If the ribs are also affected, breathing difficulties can occur.

The exact cause is unclear although genetic factors seem to play a part. People with the HLA-B27 are at increased risk although not everyone with the gene will go on to develop the disease. It occurs more commonly in men than women and the symptoms usually start in early adulthood.

Symptoms

Normally worse in the morning or after periods of inactivity – include:

  • Pain and stiffness in the lower back, buttocks hip and shoulder joints.
  • Pain in the vertebrae of the lower back and sacroiliac joint (between the base of your spine and pelvis).
  • Pain in the cartilage between your breastbone and ribs and sometimes in the back of your heel.
  • Neck pain and fatigue.

Symptoms may occur inconsistently and may worsen as the disease develops. Inflammation may spread to other parts of your body including your eyes. If you experience severe light sensitivity or blurred vision you should seek urgent medical help.

Diagnosis

Your doctor will carry out a physical examination to assess the range of movement in your spine, where the pain is worst and whether your breathing is affected. You may be given an X-ray to check for changes in your bone structure and joints or MRI scan which shows the condition of your bones and soft tissues.

Blood tests can check for inflammation or the HLA-B27 gene, although not everyone with the gene will develop ankylosing spondylitis. Early diagnosis is important as the disease can cause irreversible damage to your joints as it develops.

Treatment

There is no cure for ankylosing spondylitis but there are treatments to slow the progression of the disease and reduce symptoms. These include:

  • Medication such as anti-inflammatories, TNF blockers which target a cell protein that causes inflammation in the body or IL-17 inhibitors which also play a role in inflammation.
  • Physical therapy to improve flexibility and strength.
  • Surgery is not commonly offered for ankylosing spondylitis unless there is severe pain or joint damage which may require joint replacement surgery.
Prevention

It is not possible to prevent ankylosing spondylitis but there are things you can do to manage the condition better including:

  • Regular exercise to maintain flexibility and improve your posture.
  • Quitting smoking to prevent breathing problems.
  • Applying heat to painful joints to ease stiffness.

Arachnoiditis

Arachnoiditis is inflammation of the arachnoid, one of the membranes that surrounds and protects the nerves of the spinal cord.

Inflammation can be the result of injury to the spine; dyes formerly used in spinal diagnostic tests (these are no longer used) or preservatives in epidural injections, invasive spinal procedures such as lumbar punctures or surgery, infections from bacteria, viruses or parasites or diseases that cause chronic compression of spinal nerves.

Symptoms can vary from person to person but include a severe burning pain and neurological problems. Pain may occur in the lower back and legs. It may also cause:

  • Weakness in the legs that may be accompanied by tingling or numbness.
  • Severe shooting pain similar to an electric shock.
  • Twitching or muscle spasms.
  • A crawling sensation on the skin.
  • Bladder and bowel problems.

In severe cases there may be a loss of movement in the body and legs, which may lead to partial or total paralysis of the lower part of the body.

Among the tests used to diagnose arachnoiditis are CT scans and MRI scans. An electromyogram (EMG) may also be used to assess damage to the affected nerves using an electrical impulse.

There is no cure for arachnoiditis but you may be offered treatments to help you to manage the pain and improve your day-to-day life.

This might include medication such as corticosteroids, anti-spasmodic drugs or narcotics, physiotherapy, psychotherapy and exercise. Surgery is not normally recommended as it is often ineffective.

The nature of the condition means it is impossible to take preventative measures

Causes

Arachnoiditis is inflammation of the arachnoid, one of the membranes that surrounds and protects the nerves of the spinal cord.

Inflammation can be the result of injury to the spine; dyes formerly used in spinal diagnostic tests (these are no longer used) or preservatives in epidural injections, invasive spinal procedures such as lumbar punctures or surgery, infections from bacteria, viruses or parasites or diseases that cause chronic compression of spinal nerves.

Symptoms

Symptoms can vary from person to person but include a severe burning pain and neurological problems. Pain may occur in the lower back and legs. It may also cause:

  • Weakness in the legs that may be accompanied by tingling or numbness.
  • Severe shooting pain similar to an electric shock.
  • Twitching or muscle spasms.
  • A crawling sensation on the skin.
  • Bladder and bowel problems.

In severe cases there may be a loss of movement in the body and legs, which may lead to partial or total paralysis of the lower part of the body.

Diagnosis

Among the tests used to diagnose arachnoiditis are CT scans and MRI scans. An electromyogram (EMG) may also be used to assess damage to the affected nerves using an electrical impulse.

Treatment

There is no cure for arachnoiditis but you may be offered treatments to help you to manage the pain and improve your day-to-day life.

This might include medication such as corticosteroids, anti-spasmodic drugs or narcotics, physiotherapy, psychotherapy and exercise. Surgery is not normally recommended as it is often ineffective.

Prevention

The nature of the condition means it is impossible to take preventative measures

Cauda Equina Syndrome

Cauda Equina Syndrome causes sudden, severe back pain and is a medical emergency. It is caused by something compressing the cauda equina, a group of nerves in the lower part of your spine.

These nerves send messages to and from your pelvic organs, legs and feet and if they are damaged you may become incontinent or suffer paralysis.

Among the possible causes of Cauda Equina Syndrome are:

  • A tumor or lesion on the spine
  • Severe ruptured disk
  • Severe spinal injury
  • Narrowing of the spinal canal
  • Fracture, haemorrhage or spinal infection
  • Birth defect

Symptoms, which may develop slowly except in the case of injury, include:

  • Severe lower back pain
  • Pain, numbness or weakness in legs or buttocks
  • Problems with bowel or bladder function

It is not always easy to diagnose Cauda Equina Syndrome as it shares symptoms with other conditions.

Your doctor will conduct a physical examination to assess your strength, stability and sensation in the affected area.

You may be given an MRI scan or a CT scan.

You will need urgent surgery to relieve the pressure on the nerves and prevent permanent damage, which could lead to paralysis and loss of bladder and bowel control.

If the cause of Cauda Equina Syndrome is a tumour you may need radiation or chemotherapy, before or after surgery.

It is not possible to prevent Cauda Equina Syndrome but if surgery is successful you may continue to recover bowel and bladder function even several years after treatment.

Causes

Cauda Equina Syndrome causes sudden, severe back pain and is a medical emergency. It is caused by something compressing the cauda equina, a group of nerves in the lower part of your spine.

These nerves send messages to and from your pelvic organs, legs and feet and if they are damaged you may become incontinent or suffer paralysis.

Among the possible causes of Cauda Equina Syndrome are:

  • A tumor or lesion on the spine
  • Severe ruptured disk
  • Severe spinal injury
  • Narrowing of the spinal canal
  • Fracture, haemorrhage or spinal infection
  • Birth defect
Symptoms

Symptoms, which may develop slowly except in the case of injury, include:

  • Severe lower back pain
  • Pain, numbness or weakness in legs or buttocks
  • Problems with bowel or bladder function
Diagnosis

It is not always easy to diagnose Cauda Equina Syndrome as it shares symptoms with other conditions.

Your doctor will conduct a physical examination to assess your strength, stability and sensation in the affected area.

You may be given an MRI scan or a CT scan.

Treatment

You will need urgent surgery to relieve the pressure on the nerves and prevent permanent damage, which could lead to paralysis and loss of bladder and bowel control.

If the cause of Cauda Equina Syndrome is a tumour you may need radiation or chemotherapy, before or after surgery.

Prevention

It is not possible to prevent Cauda Equina Syndrome but if surgery is successful you may continue to recover bowel and bladder function even several years after treatment.

Spinal Stenosis

Spinal stenosis is a narrowing of the spinal canal. This puts pressure on the nerves that travel through the spinal canal resulting in pain, numbness, tingling or muscle weakness, which may worsen over time. For some people there may be no symptoms.

It is caused by damage to the spine related to age. This is a degenerative condition that causes bony spurs to develop on your spine narrowing the spinal canal. Spinal stenosis may also be caused by:

  • A tumor in the spinal cord
  • Spinal injuries
  • Thickened ligaments which bulge into the spinal canal
  • Herniated disc which may press onto the spinal cord

Other possible causes are congenital spinal deformity (such as scoliosis) and genetic diseases that affect bone and muscle development.

Spinal stenosis may occur in your neck (cervical spine) or lower back (lumbar spine). It is possible to have both types simultaneously.

Following a physical examination your doctor may request an MRI scan or CT scan to detect bony spurs, disc and ligament damage, or tumour.

This includes:

  • Medication such as pain relievers, antidepressants to ease chronic pain, anti-seizure drugs and opioids.
  • Physical therapy to maintain flexibility, improve balance and build strength.
  • Steroid injections to reduce inflammation.
  • Percutaneous image-guided lumbar decompression to remove thickened ligaments.
  • Surgery to relieve pressure on the spinal cord by creating more space in the spinal canal.

It is not possible to prevent the condition but it is important to receive a prompt diagnosis as untreated severe spinal stenosis can result in balance problems, incontinence and paralysis.

Causes

Spinal stenosis is a narrowing of the spinal canal. This puts pressure on the nerves that travel through the spinal canal resulting in pain, numbness, tingling or muscle weakness, which may worsen over time. For some people there may be no symptoms.

It is caused by damage to the spine related to age. This is a degenerative condition that causes bony spurs to develop on your spine narrowing the spinal canal. Spinal stenosis may also be caused by:

  • A tumor in the spinal cord
  • Spinal injuries
  • Thickened ligaments which bulge into the spinal canal
  • Herniated disc which may press onto the spinal cord

Other possible causes are congenital spinal deformity (such as scoliosis) and genetic diseases that affect bone and muscle development.

Spinal stenosis may occur in your neck (cervical spine) or lower back (lumbar spine). It is possible to have both types simultaneously.

Diagnosis

Following a physical examination your doctor may request an MRI scan or CT scan to detect bony spurs, disc and ligament damage, or tumour.

Treatment

This includes:

  • Medication such as pain relievers, antidepressants to ease chronic pain, anti-seizure drugs and opioids.
  • Physical therapy to maintain flexibility, improve balance and build strength.
  • Steroid injections to reduce inflammation.
  • Percutaneous image-guided lumbar decompression to remove thickened ligaments.
  • Surgery to relieve pressure on the spinal cord by creating more space in the spinal canal.
Prevention

It is not possible to prevent the condition but it is important to receive a prompt diagnosis as untreated severe spinal stenosis can result in balance problems, incontinence and paralysis.