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Physicians whose patients suffer from chronic axial spine pain may believe that there are no available options to help provide relief; however, many techniques are now available to reduce and/or eliminate axial spine pain.

Axial spine pain — pain that affects the middle portion of the back or neck that does not radiate into the extremities — is a common condition that affects many adults. In some cases, axial spine pain resolves on its own, although in a significant number of patients, axial spine pain represents a chronic pain problem.

Determining the Underlying 
Pain Generator

At the Augusta Pain Center, Richard Epter, M.D., Medical Director, provides both diagnostic and therapeutic services for management of axial spine pain, including facet nerve blocks, provocative discography and differential diagnostic injections.

Axial spine pain most commonly originates from the intervertebral discs, facet joints or sacroiliac joints. Axial spine pain resulting from the facet joints presents from the upper cervical region down to the lumbosacral junction. Often referred to as spinal arthritis, axial spine pain resulting from the facet joints affects spinal mobility and movement.

To diagnose axial spine pain resulting from the facet joints, a differential diagnostic medial branch block is performed under fluoroscopic guidance. This test is generally performed twice, with one to two weeks in between, and involves administering different medications during each test to reduce the risk of a false-positive test result.

“Ten to 20 years ago, 85% of back pain could not be diagnosed,” says Dr. Epter. “MRIs, CT scans and X-rays are beneficial in showing structural abnormalities of the spine; however, to identify the true source of pain, you need to isolate the nerve that is transmitting pain through that structure. If the patient experiences relief after the diagnostic injection, 
you have determined the actual 
pain generator.”

If axial spine pain is coming directly from the facet joints, a treatment plan can be developed. In some cases, the differential diagnostic medial branch block is successful in providing temporary pain relief. In some instances, radiofrequency lesioning may also be used. Both of these modalities are generally used in combination with aquatic therapy, physical therapy and medication.

“Conservative therapies are usually stressed first,” says Dr. Epter. “However, once conservative measures have been exhausted, it becomes necessary to employ other techniques. I have treated patients who were unable to function prior to intervention and have since been able to get their lives back. At the Augusta Pain Center, we focus on identifying each patient’s specific pain generator and employing an individualized therapy plan that will ultimately help to restore their functioning and quality of life.”

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