OrthoNeuroSpine & Pain Institute

Pain Mapping

OrthoNeuroSpine provide the most advanced diagnostic techniques and treatments of back pain through comprehensive physical examination along with spinal pain mapping procedures. When physical examination or imaging studies fail to determine the etiology of pain, we will provide spinal pain mapping techniques through selective nerve root blocks, medial branch nerve blocks of the facet joints, sacroiliac joint injection, peripheral nerve blocks, provocative discography and sympathetic blocks in the diagnosis of low back pain of undetermined etiology.

Pain mapping is a technology that allows your doctor to record your responses to physical stimulation of your muscles and detect any areas of unusual pain sensitivity. This information can help him diagnose the source of your pain symptoms and develop an appropriate approach to treatment.

Pain Mapping Basics

Pain is your body’s programmed response to physical damage that can harm your health. In some circumstances, you experience this sensation when serious damage has already occurred. In other circumstances, the sensation arises in cases of relatively minor damage and helps you avoid serious damage. In the average person’s lifetime, chronic or persistent pain can easily develop in the neck or lower back. Pain in these areas has a wide array of possible origins, and before your doctor can help alleviate your particular pain symptoms, he must uncover their underlying cause. Scanning technologies such as computed tomography (CT) scans, X-rays and magnetic resonance imaging (MRI) can help your doctor gather some of the necessary information. However, these technologies can’t always tell your doctor where you subjectively feel pain.

Pain mapping helps your doctor gather this subjective information by measuring your responses to a standard level of pressure applied to an isolated portion of a muscle, to a whole muscle or to a group of muscles. He will apply this pressure with a handheld instrument called a pressure pain algometer, which also records pressure levels and allows your doctor to form a sort of “map” of your pain responses. When a given level of pressure from the algometer starts to provoke a painful reaction in your muscle tissue, your doctor will record that level as your pain threshold.

Pain signals are generated from nerve roots and travel neural pathways through our body. When nerve roots are compressed, they generate pain signals that can be felt in different areas throughout the body.

Patients with lumbar disc problems, for example, often report pain radiating into one or both legs. This is because the nerve roots that travel to our legs exit our spine in the lumbar chain. More commonly, however, chronic back pain patients present with several painful areas resulting from pathology at multiple levels. Further, many patients will have combinations of facet joint and disc problems. If a patient has a prior back surgery, there is likely to be scar tissue as well. Back pain is very complex and difficult to treat comprehensively and effectively – a statement that will not surprise any chronic back pain sufferer who has tried multiple treatments with limited or no success.

Pain mapping combines diagnostic algorithms with cutting-edge neurostimulation techniques and conservative pain management to isolate the origins of your pain without pain or lasting side effects. Only when an exact cause is known can the pathology be treated with the highest degree of confidence and provide the best chance for success.

Innovative Pain Mapping

Utilizing state-of-the-art tools, pain mapping is a groundbreaking process that allows for the precise pinpointing and isolation of back and neck pain. When a nerve becomes irritated, it can be extremely challenging to find the exact pain source and often MRIs or CT scans are not adequate.

Lower back pain is the number one pain problem seen in general pain clinic. The cause of lower back pain can be difficult to diagnose at times and the pain sources are difficult to identify with the conventional methods. Spinal pain mapping is a sequence of well organized nerve block procedures.

Pain Mapping Study

In one study, 104 adult patients underwent spinal pain mapping and were then examined and analyzed. All of the patients had intractable lower back pain of an undetermined cause after medical history, physical examination and 4-view roentgenographic evaluation of the lumbar spine had been undertaken to locate the cause of the pain. Additionally, forty one patients (thirty nine percent) had one or multiple of the following additional tests done, which included CT, MRI, EMG/NC but all failed to identify the causes of the pain. All patients had failed to respond to any of the conservative therapies.

Results of Pain Mapping

Cause of Pain

Sacro-iliac joint 6%

Facet joint 24%

Lumbar nerve root 20%

Combined lumbar nerve root and facet disease 24%

Internal disc disorder 7%

Combined facet and sacro-iliac joint 4%

Pain mapping failed to diagnose cause 13%

Lumbar sympathetic dystrophy 2%

Considering the difficult nature of this particular group of patients, the spinal pain mapping provided an extremely useful functional tool to the diagnosis of lower back pain in 87% of the patients in the study.

Pain Mapping Benefits

Doctors perform pain mapping on people with known forms of pain and on healthy people with no known problems. Using the collected information from these maps, he can compare your pain responses to these populations and see if your pain appears in a pattern that indicates a specific underlying problem. He can also detect unusual pain sensitivities that might not be directly related to your current condition. As an alternative to maps that record your responses to direct pressure, your doctor can create pain maps that record your responses to a heat source or a cold source.

Pain Mapping Risks

The pressure from pain mapping itself can eventually lower your normal pain threshold if you undergo repeated procedures on the same tissues over the course of a few days. In turn, this altered response can thwart your doctor’s attempts to accurately record your pain symptoms. To avoid gathering this type of false information, your doctor will either need to avoid taking pressure readings on several consecutive days, or make the proper adjustments in his interpretation of your recorded pain responses.