Lower back pain is a common medical condition that affects about 80% of the population at some point in their lifetime. Sri Lanka is not immune to back pain and there are as many cases as you would see in the West where it is also a very common medical problem.

The main causes of lower back pain are disc bulges and facet joint arthropathy. The two joints on either side of the vertebrae are known as facet joints.

In addition, muscles that go into spasms and ligaments that join the vertebrae can cause back pain.

There are different ways to treat back pain:

  1.  Simple analgesics which is very common.
  2. Complementary therapy consists of Physiotherapy, Acupuncture, Hydrotherapy, etc.
  3.  Interventional treatment is done by carrying out procedures. Examples of interventional treatment include:
    • Trigger point injections
    • Facet joint injections done under X-ray guidance (fluoroscopy).
    • Spinal root blocks
    • Dorsal root ganglion blocks
    • Epidurals with epidurogram
    • Radio frequency denervation
    • Pulse radio frequency denervation


Can be a Lumbar, Caudal or Cervical Epidural. However, it is important to remember that Epidurals should always be carried out under X-ray while putting a contrast (Epidurogram). If someone would proceed to have an epidural, there should be an MRI-proven disc bulge that is pressing on the nerve roots. 

It is nevertheless crucial to stress the necessity of an MRI scan before administering an epidural and to provide evidence that there is in fact a nerve disruption because of a disc bulge.

In the UK, 5 million days are lost each year due to back pain, which has a serious impact on the economy.

Unfortunately, Sri Lanka lacks adequate referral systems, and patients select their own consultants, which might lead to overlap and at times, the inability to identify patients with back pains.

In England, there is a musculoskeletal pain unit consisting of a team of pain medicine consultants, neurosurgeons, and orthopedic surgeons specializing in spines, and patients are referred to the appropriate consultant by the general practitioner.

In Sri Lanka, patients are not always educated or informed enough to choose the right consultant for their disease. This system needs to change so that patients can make more informed decisions based on their condition.

Dr. Namal Senasinghe
Consultant in Pain Medicine
United Kingdom (GMC – 4498708 in the specialist register)
Sri Lanka (SLMC – 10475 in the specialist register)


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