Submitted by the Illinois Pain Institute
Sciatica and low back pain are leading complaints of pain and discomfort among adults. Typically, people associate such pain with a pinched nerve or bulging disc. Often times, some of the other common causes of low back pain are overlooked and subject patients to sometimes unnecessary, invasive, sometimes painful, and expensive diagnostic procedures. Common disorders, symptoms, and physical signs causing low back pain are listed below.
Painful Conditions
Sacroiliitis
- Symptoms: Low back and buttock pain; when severe, may radiate to the posterior thigh
- Physical Signs: Joint tenderness on palpation.
Myofascial Pain (Quadratus Lumborum Muscle)
- Symptoms: Backache, hip, or buttock pain, abdomen or groin pain
- Physical Signs: Tenderness below and close to the 12th rib, just along side of the spine
Myofascial Pain (Gluteus Medius Muscle)
- Symptoms: Low back and buttock pain; increasing with lying or sitting on affected site
- Physical Signs: Tenderness above hip with painful sensations along the side of the leg. Taught band of muscles or knot felt under the skin.
Myofascial Pain (Piriformis Muscle)
- Symptoms: Pain in lower back, groin, perineum, buttock, hip, posterior thigh, leg, or foot
- Physical Signs: Localized tenderness at the tailbone
Facet Syndrome
- Symptoms: Dull, aching low back pain with referred leg, buttock, or thigh pain
- Physical Signs: Increasing pain with bending of the spine to the side.
Trochanteric Bursitis
- Symptoms: Aching or burning pain in the high, lateral part of the thigh and in the buttock
- Physical Signs: Tenderness over hip area and increasing pain by lying on the painful side
References:
Advanced Pain Management: Facet Joint Syndrome. Advanced Pain Management Resource Guide, p. A4, 2010
Illinois Pain Institute: Diagnosis and Treatment of Back Pain. The Illinois Pain Institute Quarterly Vol. 1:1, 1995
Treatment:
Treatments for lower back pain and sciatica may include oral or topical medications, physical therapy, trigger point injections, transforaminal epidural injections, and other strategies tailored specifically to each individual patient.
Case Study I
A forty-one year old woman had been experiencing low back pain with leg pain for about a year. She stated that her back “went out” while cleaning. The original MRI showed a mild bulging of the lower three lumbar discs with a central disk herniation. Previous treatments, which were ineffective, included oral medication and therapy. Terri Dallas-Prunskis, M.D. of the Illinois Pain Institute provided an initial consultation. During subsequent office visits, transforaminal epidural steroid injections and sacroiliac joint injections were performed. After receiving these treatments, the patient felt excellent pain relief and was able to return to work.
Case Study II
A fifty-two year old male had been referred for treatment of back pain. He had been unsuccessfully treated elsewhere with epidural injections. After a complete history and physical examination, it was determined that his pain was a combination of myofascial pain, stemming from spinal muscle spasm, and facet arthropathy. John V. Prunskis, M.D. of the Illinois Pain Institute performed a site-specific, fluoroscopically guided facet joint injection and prescribed oral medication and physical therapy, which resulted in good pain relief for the patient.
Case Study III
A forty-four year old man had been suffering from chronic low back pain with leg pain and muscle pain from a work-related injury. He had spinal surgery years earlier in addition to previous treatments, which had limited effectiveness, including oral medications, physical therapy, and TENS/Ultrasound. Terri Dallas-Prunskis, M.D. of the Illinois Pain Institute provided an initial consultation. At the patient’s subsequent visit, transforaminal epidural steroid injections were performed; however, these treatments provided only short-term pain relief. The long-term treatment plan included: insertion of a spinal cord stimulator after a successful trial period, physical therapy, and aquatic therapy. After the long-term treatment plan, the patient felt excellent relief and pursued vocational training.
About the Illinois Pain Institute
The Illinois Pain Institute is the longest established, premier interventional pain management practice in the Chicago-area with locations in Barrington, Elgin, Itasca, Libertyville, and McHenry. The Illinois Pain Institute specialized in the diagnosis and treatment of neck pain, back pain, headaches, sciatica, and other painful conditions, and is co-directed by John V. Prunskis, MD, FIPP, five-time “Top Doctor” and Terri Dallas-Prunskis, MD, developer and former chairman of the University of Chicago academic and clinical pain program. They are joined by highly regarded Andrew J. Yu, MD; Shingo M. Yano, MD, FIPP; and Chadi I. Yaacoub, MD, along with the compassionate, caring Illinois Pain Institute team. For more information about back pain or the Illinois Pain Institute, visit www.illinoispain.com, call 847.289.8822, and follow ‘illinoispain’ on twitter and facebook.
