Pain Management Physician

Pain that is localized to the low back, hips and buttocks is commonly caused by sacroiliac (SI) joint pain.   SI joint pain commonly radiates to the outside of the thigh, but rarely past the knee.  Stress applied to the joint on physician exam can suggest this as the source of pain, but is very non-specific.  A targeted injection with local anesthetic under fluoroscopic (X-Ray) guidance is really the only way to diagnose SI joint pain.  If the pain is relieved completely after injection, a definitive diagnosis can be made.  The addition of a concentrated low dose of steroid to this injection can provide long-term pain relief.  Other treatment of SI joint Arthropathy involves NSAIDs (Non-Steroidal Anti-inflammatory Drugs), local anesthetic patches (5% Lidocaine, but is off-label), and most importantly physical therapy.  Physical therapy involves gait training (how you walk) and muscle strengthening.  The results of Aquatherapy have been promising.  Radiofrequency treatment of the nerves that supply the SI Joint has also shown some promise as a long-term tratment.

Rare causes of SI joint pain include trauma, infection and tumor involvement.

Pain of Spinal Origin:

Causes of low back pain include lumbar degenerative disc disease, spinal stenosis, lumbar radiculopathy, discogenic pain, facet joint arthropathy, sacroiliac joint arthropathy / dysfunction, and myofascial pain.

Causes of chronic neck pain include cervical degenerative disc disease, spinal stenosis, cervical radiculopathy, discogenic pain, facet joint arthropathy, occipital neuralgia, and myofascial pain.

Neuropathic Pain (nerve – generated pain)

Reflex Sympathetic Dystrophy (RSD) a.k.a. Complex Regional Pain Syndrome (CRPS)

Lumbar, Thoracic, or Cervical Radiculopathy

Post-Herpetic Neuralgia (Shingles Pain)

Occipital Neuralgia

Trigeminal Neuralgia

Post-Stroke Pain (Central Pain)

Phantom Limb Pain

Multiple Sclerosis

Peripheral Neuropathy (e.g. Diabetic)

Mononeuropathies (after damage to a single nerve)

Arthritis Pain (Joint Pain)

Rheumatoid Arthritis

Osteoarthritis

Cancer Pain

 The most common problem I see in my office is low back pain.  It affects the lives of 15-20% of adults and is the most common cause of disability in the United States.  Most cases of low back pain are related to muscle strain, sprain, and spasm which normally resolve with conservative management.  Other causes of chronic low back pain are more difficult to treat. These include:

            Discogenic pain (pain directly from disc disease)

            Sacroiliac Joint Arthropathy (back of the hip)

            Lumbar Facet Joint Arthropathy (small joints of spine)

            Spinal Stenosis (narrowing of spinal canal)

Lumbar Radiculopathy (nerve root irritation) with leg pain as well

Myofascial Pain (muscular pain)

Lumbar Post-Laminectomy Syndrome (failed back surgery)

Other rare causes of back pain include infection, tumor, pancreatitis, kidney stones, and sickle cell crisis.