2601 Cherry Ave Suite #200
Bremerton, WA 98310
Phone: (360) 415-9110
Fax:(360) 479-0265

Back pain            

Back pain is a very common medical condition causing pain that can range from a dull, constant ache to a sudden, sharp pain that leaves one incapacitated. Between 70-85% of the population suffers from back pain at some point in their lives, and between 15% and 45% suffer from it in a given year. Acute back pain is often triggered by an accident, a fall, or lifting something too heavy – or it can develop more slowly. Very often pre existing, age related changes to the spine were already present before an injury occurred and before the pain started. Fortunately, most episodes of back pain will heal with time: approximately 50% of patients will feel relief from low back pain within two weeks, and approximately 90% within three months, regardless of the treatment.
When large spinal nerve are involved, the pain often travels in a specific pattern into one or both legs. This condition is commonly called sciatica or radicular pain, from the sciatic nerve that is often involved in this radicular pain. radicular pain can occur even without back pain. Although, everyone can develop back pain there are certain risk factors. Back pain is more common in people who are not physically fit. Obesity increases the load on the spine and increases the risk of back problems. People who smoke are having a higher incident of chronic back pain.

There are multiple causes for back pain. The most often associated cause for back pain is a bulging disc or a herniated disc. This disc can touch a spinal nerve and cause inflammation of the spinal nerve, resulting in back and even more common in leg pain. On the other side, a bulging disc occurs quite frequently in patients without pain and to a certain degree bulging discs must be considered normal and are not always the cause of the pain. Disc degeneration itself can cause painful conditions by altering the stability and dynamics of the spine. Pain can be caused by the disc itself. A leaking disc can cause pain when the leaking fluid of the interior disc gets into contact with a spinal nerve. Degeneration of the facet joints, small joints in the back of the spine, can cause back pain and often pain in the buttocks, hips and thighs. Muscular strains or soft tissue injury to the muscles and ligaments in the back can cause back and leg pain lasting for several months. In elderly patients spinal stenosis is a common cause for back pain and leg weakness.
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Disc degeneration        

The disc between the vertebrae consists mainly of two structures. An inner nucleus which contains a great amount of water and a outer annulus which consists of fibrous tissue and keeps the disc attached to the bones and ligaments. The inner nucleus is completely contained inside the anulus.
The intervertebral disc changes over the time. At first, the nucleus in the center of the disc contains a great amount of water, providing elasticity and flexibility. This gives the disc its ability to function as a shock absorber and allows flexibility and movement of the spine. Over time the outer part of the disc, the annulus around the nucleus weakens and begins to develop small cracks and tears. The disc loses water over time and begins to degenerate. with advancing degeneration the disc becomes thinner and the space between the vertebrae becomes smaller.
Degenerative disc disease is fairly common, and it is estimated that at least 30% of people aged 30-50 years old will have some degree of disc degeneration, although not all will have pain or ever receive a formal diagnosis. In fact, some level of disc degeneration is deemed to be a normal finding, not the exception.
Damage to the annulus can be a source of pain for three reasons. First, there are pain sensors in the outer rim of the annulus. Thosw pain sensors signal a painful response when the tear reaches the outer edge of the annulus. Second, like injuries to other tissues in the body, a tear in the annulus can cause pain due to inflammation. Third, the fluid in the nucleus contains inflammatory substances which can irritate nerves and nerve roots when released through the annular tear.
As the disc continues to degenerate, the disc loses more water content and the space between the vertebrae becomes smaller. This causes more pressure on the facet joints along the back of the spinal column. This extra pressure can damage the facet joints and cause pain. Over time, this pressure may lead to arthritis in the facet joints.
Disc degeneration is also the underlying cause for disc herniation.
Depending on the symptoms and exact location of the pain, a series of spinal injections can alleviate the pain. Often epidural steroid injections are combined with a series of medial branch block procedures.
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Disc bulge / herniation        

As a disc degenerates, it can bulge outward or herniate (the inner core extrudes) back into the spinal canal. There are differences between a bulging disc, a disc prolaps, a slipped disc and a herniated disc, but often those terms are used synonymous. All those conditions in common is, that the disc can get into contact with one or more nerves or nerve roots. The compression of the nerve by the disc or the mechanical irritation by the disc "rubbing" against the nerve can result in radicular pain into the leg and all the way down into the foot.If the disc bulging oh herniation occurs in the cervical spine, the pain will radiate into the shoulder, arm and hand.

Depending on which nerve is irritated, the pain follows usually very typical patterns. In most cases, if a patient’s pain is going to resolve by itself, it will do so within about six weeks. Several conservative treatment options can help reduce the back pain, leg pain and discomfort caused by the herniated disc. These treatment options are not "healing" the disc or reversing the herniation, but they can help alleviate the pain and break through a pain cycle.
The treatment options include, physical therapy, massage therapy, anti-inflammatory medications, acupuncture and spinal injections. Very often a combination of different treatment options offers the greatest benefit. If conservative treatment options are not effective and the disc does not heal on it's own, the patient may require a surgical intervention in which part of the disc is removed the take pressure of the nerve (discectomy).
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Facet joint degeneration        

The facet joints along the back of the spinal column link the vertebrae together. These are not meant to bear much weight, but rather to limit the range of motion in the spine. However, as the disc continues to degenerate, the disc loses water content and the space between the vertebrae becomes smaller. This puts more pressure on the facet joints along the back of the spinal column. The vertebra above the disc begins to compress toward the one below. This causes the facet joints to press together. Like other joints in the body that are covered with articular cartilage, the facet joints can develop osteoarthritis as the articular cartilage wears away over time. Extra pressure on the facet joints, such as that from a collapsing disc, can speed the degeneration in the facet joints.
The swelling and inflammation from an arthritic facet joint can be a source of low back pain. The capsula of the facet joint is in closes proximity to the spinal nerves and often even connected through small ligaments with the spinal nerves. The joints are also closely situated to the insertion sites of the muscles in the back. Therefore, any inflammation of the facet joint can affect spinal nerves and/or the back musculature.
Many patients with problems of the facet joints complain about morning stiffness, pain across the lower back, increased pain in the afternoon and after heavy work, i.e. gardening. Very often the pain from the facet joints can refer into the buttocks upper legs, hips and sometimes into the groin area.
The treatment options include, physical therapy, massage therapy, anti-inflammatory medications, acupuncture and spinal injections. At the Peninsula Pain Clinic we perform most commonly medial branch injection or pulsed radiofrequency ablation for this condition. In most instances we recommend additional physical therapy, massage therapy or exercise programs.
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Sciatica / Nerve pain        

Sciatica is a very common term to describe pain radiating in the back or the side of the leg. This pain very often reaches the top or bottom of the foot. Sometimes this leg pain is associated with back pain. The term sciatica results from the sciatic nerve and in the past it was thought that the sciatic nerve is causing this specific kind of pain. The sciatic nerve is the major nerve innervating the leg. Actually, in most cases the term sciatica is not enirely correct. It is usually not the sciatic nerve itself causing the problem, but rather on of the spinal nerves forming part of the sciatic nerve.
The sciatic nerve is formed by several lumbar and sacral spinal nerves which together form the sciatic nerve. The sciatic nerve then splits up and supplies most of the innervation to the leg.
Most cases of scatica are usually caused by irritation of the 5th lumbar and/or 1st sacral spinal nerve. The correct term then would be radicular pain instead of sciatica. Radicular pain involves the spinal nerve and can be caused by many different underlying conditions. Radicular pain is often very intense and the pain is often described as a sharp and shooting pain. This pain can be caused by bulging discs, disc herniations, leaking discs, scar tissue, facet joint degeneration or even after injuries without findings in a CT or MRI scan.
A series of spinal injections, most commonly a selective nerve root injection, can alleviate this pain.
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2601 Cherry Ave Suite #200
Bremerton, WA 98310

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