There are probably more causes of back pain
than there are letters in the alphabet,
and it all goes back to the complex
structure that is the spine itself.
Not only do you have bones,
you have muscles, you have ligaments,
you have tendons, you have cartilage,
you have discs, you have nerves,
many things that all are supposed to come
together and for the most part to do and
work fairly elegantly and effortlessly.
The back is made-up of your vertebrae,
and each of those bones or vertebrae
have a disc that sits in between them.
And you want that disc to stay in place and
protect the vertebrae from damage over time.
But through wear and tear or through injury,
that disc can move out of position
and that's when you will find that
it can put pressure on the nerves.
The nerves that travel from the
spinal cord to your arms and legs
really control your movements,
and they determine whether
or not you experience pain.
So if there's compression there,
your body can start to send
abnormal pain signals,
or in severe cases,
it can lead to weakness or loss
of use of your arm or leg.
So being able to target each of those nerves,
knowing where they are, knowing which
nerves are responsible for which function,
is instrumental in knowing how to approach
a patient that has low back pain. If
the symptoms are severe enough
or if they're not improving
with the standard treatments,
we may refer a patient to get
an injection in the back to
help reduce the pain symptoms,
and in more severe cases we may refer
them for radiofrequency ablation.
A radiofrequency ablation is one
of the thermal ablation modalities
that are available to treat disease.
Ablation is a fancy word,
but it it means tissue destruction.
We can target nerves using,
for the most Part, 2 basic flavors,
either heat or cold.
The way we deliver that heat
or cold is via small probes.
They're little needles,
basically that we percutaneously
through the skin insert under
imaging guidance very precisely
to the area where we know are
nerves that cause certain pain.
And the way we can deal with that kind of
pain is we can target the sensory nerves,
So nerves that supply sensation
to that area and stand or destroy
a small section of the nerve that
then interrupts that pain signal.
And thus the patient is no
longer aware of the pain,
no longer experiences pain.
So the hope
is if you reduce the pain,
you can add in things like
physical therapy or slowly
increase physical activity,
which overall should help
the health of the spine.
I love being here at Yale because
we can work as a multidisciplinary
team and I can talk with others in
similar specialties that see the
patients that I follow and we can
come up with a very good game plan.
Any given day, I see five to
six new consults for management
of not just low back pain,
but other types of pain,
shoulder pain and knee pain,
any number of things that we deal with. I
think minimally invasive procedures
have provided great pain relief
for patients where there didn't
used to be great options. There's
something to be said about being
at a place like Yale where we have
the expertise and the volume of
patients that allows us to maintain
and further refine this expertise
to further serve our patients.