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Tim Tollestrup, MD

Back Pain Not Stemming from the Spine

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Why Spine Surgery Fails

In a recent post on Facebook, Dr. Tollestrup shared his thoughts on why lingering back pain may not originate from the spine but from damage to peripheral nerves around the spine, The post attracted so much attention that he decided to respond and elaborate in further detail. 

Chronic back pain is a condition that affects millions of Americans. The traditional approach to chronic back pain – spine surgery or pain management – has a mixed record of success at best. A big part of the problem is that spine surgeons, pain management doctors, neurologists and other specialists are essentially blind to the peripheral nervous system.

Doctors who treat patients with spine pain believe that all neck or back pain originates from the spine. This has led to a system where back pain tends to be treated with physical therapy at first. If that fails, then the next step is spine surgery if anything suspicious pops up on imaging. If that fails, the patient is then shuffled off to pain management where they are offered spinal injections, narcotics, and possibly a spinal cord stimulator. If imaging of the spine is totally normal, then the patient may bypass surgery and be sent straight to pain management.

Peripheral Nerve Injury

In this photo, you can see the many peripheral nerves around the spine.

But here is the rub. If the patient’s persistent back pain is due to a serious injury to peripheral nerves, like the ones in the picture, no amount of physical therapy, spine surgery, narcotics or spinal cord stimulators will ever provide the patient with effective pain relief.

All too often, spine surgeons and pain management doctors end up treating the imaging study (X-ray or MRI) rather than the patient. Very little if any effort is made to correlate the patient’s clinical symptoms with the findings on the imaging studies.

I’ve had many patients tell me that their initial evaluation by their spine surgeon consisted of a brief five-minute meeting where an MRI is thrown up against a light box and the spine surgeon proceeds to list the problems. Unfortunately, the patient undergoes a surgical procedure on their spine for a problem identified on imaging that is not even anatomically capable of producing the type of clinical symptoms the patient is suffering from!

The problem is so common that there is even a term for patients who undergo spine surgery without any improvement or even worsening of their pain. It’s called “Failed Back Surgery Syndrome.”

Simple Surgical Fix

Certainly not all, but probably the majority of patients who experience severe back pain really have some type of peripheral nerve injury. In most cases, physical examination combined with targeted nerve blocks done with local anesthetic can definitively confirm peripheral nerves as the true source of the patient’s ongoing pain. Once the correct diagnosis is arrived at, a relatively simple outpatient surgical procedure can then be performed to remove the small damaged nerves which generally results in complete relief for the patient.

If you or someone you know suffers from chronic back pain that significantly affects quality of life, there is little drawback to undergoing a peripheral nerve evaluation. You may have a problem that can actually be fixed resulting in elimination of your debilitating pain. What do you have to lose?

Dr. Tim Tollestrup

To schedule a consultation with Dr. Tollestrup please call the office at 702-666-0463 or use the web form on the righthand side of the page.