Back pain is unpleasant, disturbing and often limits everyday mobility. It reduces quality of life and is one of the most common reasons for medical consultations. Back pain can have a variety of causes and should first be precisely clarified by detailed imaging of the spine. Frequently it is degenerative changes in the small vertebral joints that are activated and painful. Often there is direct pressure on the nerves and nerve roots in the spine; for example, due to the constricting wear of the spine, slipped discs or postoperative scarring. Nerve compression then leads to a spiral of pain with additional swelling of the nerve and an inflammatory reaction in the surrounding tissue.
In addition to conservative treatment measures, image-guided (MRI or CT-guided) local pain therapy can be highly effective. Specific pain therapy at the small vertebral joints is known as facet joint infiltration, and around the nerves as periradicular therapy (PRT). With precisely controlled infiltration, the effective medication – consisting of a local anaesthetic and anti-inflammatory cortisone – can be applied precisely “to where it happens”. The aim is to break the pain cascade and to achieve rapid pain relief and, if possible, long-term complete freedom from symptoms.
MRI or CT-guided pain therapy
Suitability, procedure and advantages
Treatment is suitable for these patients
For many patients, back pain is chronic. It occurs repeatedly and can increase in intensity over time. Often the complaints are attributable to problems at the facet joints. These are small joints between the vertebral processes. Furthermore, painful nerve compression often occurs in the regions where nerve roots emerge from the spinal cord or spinal column.
For many patients suffering from back pain, conventional pain medication, physiotherapy and physical therapy no longer bring the desired effect. Tablets and drops are often not tolerated, as these drugs have side effects and can cause nausea and stomach problems, for example.
In personal consultation, I would be happy to determine with you, based on the clinical examination findings and current imaging of the relevant spinal segment, whether the cause of the pain can be localized and whether MRI or CT-guided pain treatment is an option for you.
If local pain therapy is suitable and there are no contraindications, such as allergies or an increased tendency to bleed, therapy can be scheduled in my practice with an appointment at short notice.
Procedure of minimally invasive pain therapy
Conservative and low-complication treatment is undertaken on an outpatient basis and takes about 10-15 minutes in total. In the prone position, the segment of the spine to be treated is depicted with MRI or CT, while precisely planning the direction and depth of insertion. After skin disinfection, the sterile injection needle is positioned precisely under local anaesthesia. The anti-inflammatory and analgesic medication can then be injected with millimeter precision under position control of the injection needle.
As a rule, 1 to 3 interventions at intervals of 7 to 14 days lead to the desired therapeutic effect. Repetitions in the course are possible, as necessary.
Advantages
- Fast and usually clearly discernible pain relief with a high chance of success
- Conservative and precise application of medication under MRI or CT control
- No unnecessary medication overdose through precise local therapy, thus less stress and fewer side effects for your entire organism compared to the intake of systemic medication
- Treatment of spinal column or intervertebral disc damage with the chance of being able to live, work and exercise without pain
- Surgery, which involves risk, can usually be avoided
Help with chronic back pain
Further information on pain therapy
I perform this conservative and minimally-invasive pain therapy both CT-guided and MRI-guided in my practice in Berlin. MRI-guided pain therapy is an alternative without radiation exposure and is to be favoured, especially in younger patients. CT-guided, this local therapy can be performed with relatively less effort and is a proven method given possible MRI contraindications or claustrophobia of the patient.
Contraindications include pregnancy and breastfeeding, known coagulation disorder or taking anticoagulant drugs, as well as known intolerance of the drugs used – intervention may also be possible without the use of contrast medium.