Consultant in Pain Medicine

Back Pain

BACK PAIN

older man with back pain


Are you suffering from severe or persistent back pain?

Many of us will have an episode of back pain at some point in our lives, and usually back pain resolves quickly. For some people, however, back pain can have a significant impact on their lives.

Back pain that occurs at night can be particularly distressing. Not only does it lead to sleep deprivation, but lack of sleep affects our ability to cope with pain.

Moreover, when we sleep deeply, growth hormone is released in pulses from the pituitary gland. When growth hormone release is diminished because of interrupted sleep, the body’s restoration and healing processes are impaired.

When we lose sleep, our bodies enter a pro-inflammatory state, and sleep deprivation amplifies the brain’s response to pain. The result is an increase in painful body sensations and low mood, then the vicious circle continues.

When I meet patients who are experiencing back pain, they will often have been through a process of investigations and interventions, sometimes with many doctors and many therapists. 

They may have been told that there was a particular ‘lesion’ that was causing their pain (such as a bulging disc), and many patients worry that something awful must be happening in their spine, because their pain is severe. They may also fear moving because they are worried that they may damage their back more.

The reality may be very different. Rather than their pain being due to a ‘crumbling’ spine, their pain may arise from muscle spasm around a joint, or a temporary flare-up of nerves (rather than serious damage). This is very often the case.

How I help people with back pain

doctor examining a patient who has back pain
  • When I’m assessing a person who is suffering with back pain, I will take them through an unusually detailed examination, carefully palpating along nerve roots, lumbar discs, facet joints and soft tissues.

  • I’m usually able to ascertain which are the problematic areas, and many patients say they had never been examined like that before.

  • When it comes to treating back pain, medications may help, but they don’t cure.

  • Some patients who are experiencing back pain take to their beds, but research has taught us that it’s better to keep gently moving.  
  • Laying in bed for just 24 hours is enough to trigger muscle inhibition and muscle wasting.

  • It’s natural to feel a reluctant to move when you’re in pain, but a skilled physiotherapist can help you to ‘reactivate’, sit, stand, walk and move more comfortably and confidently.

  • This process of safe movement is in itself therapeutic. The muscles send ‘safe movement’ messages back up to the brain and help to reduce the flared-up pain responses felt in body.

  • I’m particularly choosy about the physiotherapist I refer patients to, and these highly experienced therapists have been able to help many patients who haven’t progressed with previous physios and other therapists.

In some case there is a need for spinal injection treatments, for example, nerve root injections for sciatica or arm pain coming from the neck, radiofrequency denervation for persistent facet joint pain.  

I’ve had over 25 years of experience in spinal injection procedures, and I’m one of the very few clinicians who can perform the Racz Catheter Procedure for new nerve root pain after spinal surgery.

herniated disc diagram

Racz Catheter Procedure

This procedure (which is also called Epidural Neurolysis) is used to help patients who are experiencing pain after spinal surgery, as a consequence of surgical scar tissue formation in the spine.

  • In this situation, a patient may have undergone successful spinal surgery and then, after a good recovery, a few weeks later, they may start to experience pain down the leg.

  • Subsequent MRI investigation may show no cause for this, but in fact, fine, filmy adhesions grow in the epidural space, wrapping around nerve roots, preventing them from gliding normally, and restricting the flow of blood through them.

  • Patients may experience difficulty straightening their legs, or putting their hands above the heads, or even standing up straight, because of the neural tension. 

 

  • An epidurogram (a diagnostic X-ray guided procedure which involves injecting dye into the epidural space) confirms the presence of the adhesions through abnormal dispersion of the contrast medium.

  • Under light sedation, the Racz procedure involves gently passing a fine metal flexible tube into the epidural space the catheter is steered up to the level of the scarring, guided by X-ray screening. Local anaesthetic, corticosteroid and saline solution is injected (‘hydrodissection’) to dissolve the scar tissue and reduced inflammation around the nerves.

  • This may have to be done three or four times, and each time, pain is reduced, and the person can straighten up more.

  • Although health insurers don’t automatically list this as a procedure that they automatically cover, they generally agree to cover the procedure when I send them a copy of the medical publication that I helped to write.
racz catheter

My first appointment with Dr. Ordman was reassuring after years of chronic back pain from multiple spinal surgeries.

He was understanding and compassionate as he listened to my story. Having exhausted all traditional medications and having had a spinal chord stimulator implanted and removed, I needed help. I was very interested in trying medical cannabis.

With Dr. Ordman’s guidance, we tailored the medication to my needs. It has been a game changer. I have been able to drop most of my Opioids under his care and have slowly gotten my life back. I am forever grateful to Dr. Ordman and would highly recommend him.

Dr Ordman immediately gives you confidence and always provides a solution which for me, has worked every time. His manner is very reassuring and he never leaves you without support.