Pain Management Treatments

About Osteoporosis

Osteoporosis is a disease of the bone that leads to an increased risk of fracture. It is characterized by low bone mass and structural deterioration of the bone.

According to the National Osteoporosis Foundation, osteoporosis affects 10 million Americans and is responsible for 700,000 vertebral fractures each year. Multiple vertebral fractures can result in chronic pain and disability, loss of independence, stooped posture, and compression of the lungs and stomach. Nearly all vertebral fractures in otherwise healthy people are due to osteoporosis, and can occur from a minor impact, such as a bump or a fall, in those who suffer from this bone-weakening disease. People who have a spinal fracture often don't realize that they may have osteoporosis, because the disease is symptom-free until a fracture occurs.

Risks

Factors that increase the likelihood of developing osteoporosis include:

• Being female
• Being thin or having a small frame
• Advanced age
• A family history of osteoporosis
• Being past menopause
• Abnormal absence of menstrual periods
• Anorexia or bulimia
• A diet low in calcium
• Long-term use of medications such as corticosteroids or anticonvulsants
• Lack of exercise
• Smoking
• Excessive use of alcohol

Vertebroplasty

Vertebroplasty is an outpatient procedure using X-ray imaging. You will be conscious, but sedated and feel no pain. The interventional radiologist will insert a needle through a nick in the skin in your back, directing it under fluoroscopy (continuous, moving X-ray imaging) into the fractured vertebra. The physician then injects the medical-grade bone cement into the vertebra. Vertebroplasty takes one to two hours to perform, depending on how many bones are treated. The cement hardens within 15 minutes and stabilizes your fracture, like an internal cast.

The History of Vertebroplasty

Vertebroplasty was first performed in France in 1984 to treat compression fractures caused by bone cancer or bone metastasis, and later to treat compression fractures caused by osteoporosis. Percutaneous vertebroplasty was introduced in the United States in 1994 and has become widely available since 1997 as a treatment for pain associated with compression fractures due to osteoporosis. The procedure has been shown to provide continued pain relief for osteoporotic compression fractures.

A 1998 study by Dr. Deramond and colleagues reported on 80 patients with rapid and complete pain relief in more than 90 percent of osteoporotic cases. The follow-up in this patient population ranged from one month to 10 years with care for treating osteoporotic compression fractures as more patients and physicians become aware of the new advances in interventional radiology.

Recovery

Some patients experience immediate pain relief after vertebroplasty. Most report that their pain is gone or significantly better within 48 hours. You should expect to resume your normal daily activities immediately.

Second Opinion

If you have failed all other standard pain treatments and are still in severe pain, you can obtain a second opinion. Our doctors will be able to determine if you are a candidate for vertebroplasty.

Additional Treatment Options

Epidural Steroid Injections

An epidural steroid injection (ESI), more generally referred to as a nerve block, is a common type of spinal injection. An ESI is an injection of a long lasting steroid combined with a local anesthetic into the epidural space. The medication travels up and down the epidural space to coat the spinal nerves and the facet joints near the area of the injection.

Epidural steroid injections are for temporary relief of pain; they are not a cure. Pain relief often lasts from a couple of weeks to months, although these injections are not always effective. There are rare but serious risks involved.

Facet Injection

A facet injection is an injection of steroid medication into a facet joint (spinal joint) to reduce pain caused by inflammation of the facet joint. An injection may also be made around the small nerves that connect with the facet joint to help determine if the joint is the source of pain. In many cases, damaged facet joints are not the cause of back pain.

Facet injections may be used to treat moderate to severe spinal osteoarthritis (degenerative arthritis). (Epidural Steroid Injections are also used for spinal osteoarthritis.) Facet injections are usually limited to three per year as too many injections may cause more degeneration of the joint cartilage or side effects of corticosteroids.

Spinal Cord Stimulators

When oral medications and/or nerve blocks do not sufficiently control the pain, advanced pain therapies or implantable systems may be effective for treating neuropathy. Spinal cord stimulators pass low levels of electricity to the back portion of the spinal cord. This blocks transmission of pain signals from the spinal cord to the brain. When the neuropathic pain signals cannot reach the brain, then the patient does not actually feel the pain. The device is implanted during a surgical procedure and may include a fully implanted system or a system with an external power source.

Selective Nerve Root Blocks

A selective nerve root block is an injection near the affected nerve (outside the epidural space) as it exits the spinal column. Selective nerve root blocks are used both for diagnostic purposes (to determine if a specific nerve root is the source of the problem) and to relieve radicular pain caused by irritation of a specific nerve root.

If a specific nerve is actually the cause of pain the local anesthetic in the injection will give immediate relief. The steroids in the injection will reduce inflammation over the next few days and possibly provide relief of pain that lasts for weeks to months.

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To schedule a consultation, call MIT at Del Mar Vein Care at 858-792-8346.