Back Pain Archives - Orthopaedic Spine Surgery Singapore

Chronic Back Pain and Neuropathic Pain

June 1, 2021 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Back pain is a very common problem in our society. Most of them are self-limited. Some become chronic back pain which is disturbing and difficult to treat. I am going to explain how neuropathy contributes to the development of chronic back pain.

Neuropathic pain is distinct from other types of pain. If a person breaks a bone or got a cut, pain signals are carried via nerves from the site of the trauma to the brain. That is how we can feel pain when we have an injury. With neuropathic pain, however, pain signals originate in the nerves themselves.

How Neuropathic Pain Develops

In many cases, the nerves become damaged or dysfunctional after responding to an injury or trauma, causing hypersensitivity to pain. The nerves then send faulty signals of pain even when the injury has healed. Neuropathic pain or neuropathy, is a chronic condition, meaning it does not go away. Instead, the pain becomes the disease process. An estimated 7 to 10% of people have neuropathic pain. Chronic back pain is a common example of neuropathic pain.

When Back Pain Causes Neuropathy

Neuropathy can result from any type of pain that compresses or impinges on a nerve. A slipped disc, for example, could press against a nearby nerve, causing pain. Neuropathic pain originating from the back or spine may include:

Chronic pain radiating down the leg (sciatica) or the arm (cervical radiculoapthy)
Chronic back pain

Why Early Treatment is Crucial

Early treatment is important, since more aggressive treatment may be needed if symptoms are not addressed soon. Over time, exposure to significant pain can cause changes to the central nervous system that make the body become more sensitive to even a slight touch. This phenomenon is known as central sensitization.

As with other types of chronic pain, delays in treatment may also make other health problems more likely. Depression, anxiety, difficulty sleeping, and an inability to work and take part in other activities are some health issues associated with untreated neuropathy.

Managing Chronic Pain

Chronic back pain does not go away completely even with the right treatment. The treatment aims to manage the pain so that the person can be functional. The first step is to get a thorough medical evaluation to determine the cause of the pain. It can be muscle strain, arthritis, slipped disc, or other things.

The medical treatment depends on the cause of the pain. Whatever the problem is, there are a number of effective strategies for coping with chronic back pain.

Reduce the stresses in your life. It may be your job or problems in the family. You have to try your best to sort out this problem
Have enough sleep. Our body carries out repair work when we are asleep.
Avoid activities that worsen your pain. E.g. bending down, prolonged sitting, and carrying heavy things.

I hope this information is useful to all of you.

Dr Tony Setiobudi is an Orthopaedic & Spine Surgeon at Mount Elizabeth Hospital (Orchard), Singapore. He treats bone, joint, muscle and ligament problems in adults and children. He has a special interest in nerve compression and spine problems such as back & neck pain, scoliosis, kyphosis, spine tumor & infection, spinal cord injury, osteoporosis fracture, spinal stenosis and slipped disc.

Problem in Your Buttock Can Cause Low Back Pain

June 4, 2018 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

80% of the population suffer from low back pain at least once in their life time. Sometimes, low back pain is caused by injury to the muscles, joints or the discs in the lumbar region. Other time, it is related to subtle wear and tear changes that cause gradual wearing down of the cartilage or the disc.

When there is significant pain in the buttock, it may be originating from the sacroiliac joint which is a joint that connects the spine and the hip bones. Sacroiliac joint is a common cause of low back pain. However, the diagnosis may not be obvious and often requires thorough physical examination.

There are two sacroiliac joints, one on each side of the spine. These joints transfer the weight of the upper body to the lower limbs. This joint operates under tremendous strain during activities like running, jumping and sitting. Unlike the knee joint which wide range of motions, sacroiliac joint has a very little movement.

Problem in Your Buttock Can Cause Low Back Pain

Anatomy of sacroiliac joint

Problems related to the sacroiliac joint is called Sacroiliac Joint Dysfunction (SIJ dysfunction). It affects both men and women but women tend to get it more. The ligaments stabilising the sacroiliac joint become lax during childbirth causing it to be prone to injury.

Apart from injury, weak muscles surrounding the joint are often the cause of SIJ dysfunction. If this is not addressed, the pain persists and becomes chronic. The nerves supplying the joint constantly send pain signal to the brain causing discomfort. Sometimes, the pain signal process continues independently of the original issue. This means after all identifiable problems are addressed, the pain can still persist.

People with SIJ dysfunction complain of low back pain very close to the buttock. It can affect one side or both sides of sacroiliac joints. The pain may radiate to the hips, thighs and calves especially when the nerves crossing in front of the sacroiliac joint are irritated. Initially, the pain comes on after prolonged sitting. When it gets worse, other activities like walking, climbing and running can trigger the pain.

SIJ dysfunction can be treated with medications and physical therapy. Strengthening the surrounding muscles and the core muscles helps to stabilise the sacroiliac joint. More severe form of SIJ dysfunction may require more invasive procedures like steroid injections or radiofrequency ablation. Radiofrequency ablation is done by passing heat in the form of electric current to desensitise the nerves supplying the sacroiliac joint. It can provide an excellent pain-relief. Operation to fuse the sacroiliac joint is rarely required. It is reserved for severe debilitating problems in the sacroiliac joint that do not respond well to less invasive forms of treatment.

Tumor Tulang Belakang – Salah Satu Penyebab Sakit Pinggang

November 1, 2017 by Tony Setiobudi

By Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho)

Pernahkan anda mengalami sakit pinggang?

Kebanyakan kita menyepelekan sakit pinggang yang sebagian besar akan sembuh sendiri jika beristirahat. Padahal, bisa jadi itu bukan sakit pinggang biasa. Untuk sakit pinggang yang berhubungan dengan masalah otot dan degenerative memang tidak serius. Tapi, sakit pinggang ini bisa menjadi masalah serius jika disebabkan oleh tumor.

Berikut ini adalah contoh kasus tumor tulang belakang.

Ibu Maria (bukan nama sebenarnya), 42 tahun, mengeluh sakit pinggang selama 3 bulan. Berat badan turun 5 kg. Dua hari sebelum ke dokter, secara tiba-tiba beliau tidak bisa jalan karena kaki merasa sangat lemah. Hasil pemeriksaan lengkap menunjukkan ibu Maria menderita tumor tulang belakang yang menjepit saraf. Tumor ini menyebar dari usus besar (tumor primari). Saraf yang terjepit menyebabkan kelemahan di otot kaki sampai pasien tidak kuat berjalan. Beliau menjalani operasi untuk mengambil tumor, membebaskan saraf dan menstabilkan tulang belakang. Setelah operasi ibu Maria bisa berjalan kembali dengan normal. Pasien menjalani chemotherapy dan radiotherapy untuk membasmi tumor lebih lanjut.

Tumor di tulang belakang adalah penyebab sakit pinggang yang berbahaya yang memerlukan penanganan segera. Tumor ini dapat membesar secara cepat dan tiba-tiba. Jika menjepit saraf, pasien bisa mengalami kelumpuhan secara tiba-tiba. Sering kali tumor di tulang belakang terjadi karena penyebaran sel tumor dari tempat lain seperti di usus, prostat, payudara dan lain-lain. Banyak sekali pasien yang mengeluh sakit pinggang tanpa keluhan lain seperti kasus Ibu Maria. Dengan pemeriksaan lengkap, tumor di tulang belakang dan asal tumor (tumor primari) bisa ditemukan dan ditangani secara keseluruhan. Jika pasien mengabaikan keluhan sakit pinggang, tumor ini tidak akan terdeteksi atau mungkin akan terdeteksi dalam kondisi yang lebih parah.

Jenis sakit pinggang seperti apa yang tidak boleh diabaikan?

Sebagian besar sakit pinggang tidak berbahaya. Jika sakit pinggang disertai berat badan menurun secara drastis, sakit pinggang lebih parah saat beristirahat, atau sakit pinggang yang terus menerus dan tidak pulih lebih dari satu bulan, pasien perlu segera periksa ke dokter untuk menegakkan diagnosa apakah hal ini berhubungan dengan tumor.

Mengapa tumor tulang belakang mengakibatkan sakit pinggang?

Tumor tulang belakang dapat menyebabkan sakit pinggang karena beberapa hal.

Tumor membuat tulang belakang menjadi tidak stabil.
Tumor membuat tulang belakang rapuh dan gampang patah. Sakit pinggang meningkat secara tiba-tiba jika ada patah tulang di punggung.
Tumor bisa menjepit saraf. Hal ini menyebabkan sakit pinggang terkadang menjalar ke kaki atau ke perut dan dada.

Apakah pentingnya untuk mendeteksi tumor tulang belakang secara dini?

Dengan berjalan waktu tumor bisa makin membesar, jika masih berukuran kecil tentu saja lebih gampang dioperasi dari pada sudah berukuran besar. Lebih baik lagi dioperasi sebelum tumor menjepit saraf dan mengakibatkan kelumpuhan.

Jadi jangan menyepelekan sakit pinggang yang tidak kunjung membaik apalagi jika berat badan menurun dan sakit pinggang memburuk saat istirahat. Segera periksalah ke dokter untuk mencari penyebabnya.

Dr Tony Setiobudi adalah spesialis bedah tulang dan super-spesialis bedah tulang belakang di Mount Elizabeth Hospital (Orchard), Singapore. Dr Tony menangani masalah tulang, sendi, saraf, otot dan ligamen pada orang dewasa dan anak. Dr Tony mempunyai keahlian khusus dalam penanganan saraf terjepit (HNP & spinal stenosis) & masalah tulang belakang seperti nyeri punggung & leher, scoliosis, postur bungkuk (kyphosis), tumor & infeksi tulang belakang, cedera saraf besar (spinal cord) & patah tulang osteoporosis.

If Your Back Pain does not Get Better with any Treatment ….

September 4, 2016 by Tony Setiobudi

You may have troublesome chronic back pain for a long time. You may have tried many things including Pain-killers, Physiotherapy, Chiropractic, Yoga, Pilates, Traditional Chinese Medicine, Acupuncture or other Alternative Medicines. If you don’t get better you need to see a specialist who have experience in this area.

Now the most important thing is to exclude any serious conditions such as spine tumor, infection or fracture. This requires a thorough examination and investigations.

After serious conditions are excluded, we can relax a little bit. Many times, the causes are related to your activities and life-style such as sitting or driving too long and lack of exercises. Often with proper education and understanding and a change of life-style, chronic back pain can get significantly better. Sometimes, simple measures such as standing every 20-30 minutes when you need to sit for a long time can improve your back pain significantly.

Chronic back pain requires a more regular follow-up. The treatment often requires multidisciplinary approach. The treatment modalities that you have tried may be appropriate but need to be coordinated appropriately together with medications. The treatment aims to reduce the pain so that you can carry on with your regular activities comfortably with minimal or no medication.

Sometimes, the back pain is associated with mechanical problems such as spinal instability or nerve compression. Strengthening the core muscle is the key to this problem. In severe cases, surgical intervention is required. Fortunately, when the problem is clearly associated with spinal instability or nerve compression, surgical treatment has high chance to solve the problem. But don’t worry because surgical treatment is reserved only as the last resort and most patients don’t need it.

In summary, if your back pain don’t get better after your maximum efforts to treat it, you should consult specialist that has adequate experience in this area.

Author: Dr Tony Setiobudi BMedSci, MBBS, MRCS, MMed (Ortho), FRCS (Ortho), Orthopaedic and Spine Surgeon, Mount Elizabeth Hospital, Singapore