September is Pain Awareness Month, an opportunity to recognize the enormous impact chronic pain has on many patients, as well as how our understanding of pain continues to evolve. Low back pain remains one of the most common health problems in adults and consumes significant resources, both in terms of healthcare spending and lost productivity. It is a complex problem.
Muscles, joints, intervertebral discs, bones, ligaments and nerves can lead to pain in the back. Recently, physicians have gained a better understanding of another important source of chronic low back pain: the vertebral endplate.
The vertebral endplate is the part of the vertebral body that interfaces with the intervertebral disc. As discs degenerate, these endplates become damaged and inflamed and can transmit pain signals through a small nerve located inside the vertebral body, known as the basivertebral nerve. Pain arising from this pathway is often referred to as vertebrogenic back pain. Recent research has helped establish these pathways as a cause of back pain in many patients.
People with vertebrogenic pain often experience persistent pain in the central lower back, which may be worse with sitting, leaning forward, lifting or other activities that stress the anterior structures of the lumbar spine. MRI imaging of the lumbar spine provides additional important diagnostic information. Physicians look for characteristic changes in the vertebral endplates and adjacent bone marrow, called Modic changes, which often correlate with clinical symptoms associated with vertebrogenic low back pain.
For appropriately selected patients, a procedure called basivertebral nerve ablation, or BVNA, may offer a path to pain relief. It's a minimally invasive procedure performed using image guidance. The treating physician advances specialized instruments into the affected vertebral body and positions a radiofrequency probe near the basivertebral nerve. Controlled radiofrequency energy heats and ablates the targeted nerve, reducing its ability to transmit pain signals from the damaged vertebral endplates.
BVNA is not intended for everyone with low back pain. Major studies have focused on adults who experienced chronic low back pain for at least six months, had not obtained relief with conservative treatment, and had Modic changes on MRI at appropriate levels.
For a carefully selected group of patients whose pain originates from damaged vertebral endplates, BVNA represents a targeted, minimally invasive treatment based on an increasingly well-defined generator of chronic low back pain. Northside Hospital Interventional Pain & Spine Care can provide comprehensive evaluation and treatment of low back pain, as well as many other painful conditions. If you or a loved one is suffering from pain, call today for an appointment.
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