Story last updated at 12/10/2008 - 11:29 am
For those who can relate to voiced complaints about serious back pain, there may be consolation in knowing that men of science are listening.
Among the pioneers of a procedure called epiduroscopy is Dr. Hemmo Bosscher, who came to the United States from Holland in 1988 to train as an anesthesiologist.
Since 2000, he has added a technique of inserting a fiberoptic tube into the spinal canal to look around for what is causing a particular back pain as a tool in pain management.
"It's a large needle in a flexible tube with a light source, and there's a working channel so we can put our tools through there and inject medications," he explained.
"The flexibility of the scope allows us to not only look inside, but to place the scope in the area that we think is responsible for the patient's pain."
The work is requiring extensive research and collaboration with other disciplines such as anatomy.
"Currently we do detailed anatomy research of the target area. We also study cells and their biochemistry, and we hope to come up with more detailed answers in the next year or two," he said.
"The actual procedure itself is technically not that demanding. But to make sense of the images we are getting is very difficult. It is only since the last three or four years that we started to make sense out of the images and started to understand why so many people are hurting with back pain."
Back pain can be separated into three main categories based on the epiduroscopies, according to Bosscher.
"One of them is patients who have back surgery, and still have back pain.
"Then there is a group of patients, particularly the elderly, who have narrowing of the spinal canal.
"And the third category is where we have made the most progress. It is that group of patients - which is a large group of patients - who have back pain occasionally, and it sometimes shoots down the leg and all kinds of patterns," he said.
That category could include nearly anyone: "Someone with a heavy physical-labor job, or someone who sits behind a desk all day."
He said, "With this scope we can pinpoint the origin of their pain to one small area."
Bosscher acknowledges that interpretation of the images is an evolving science.
"We still do not understand the precise cause of this pain, why it's doing that. One of the things we found very early on is that it's not because the nerve is pinched, like so many people think. It's most likely based on inflammation or arthritis that eventually may affect the nerve, possibly through its blood supply."
There are certain risks, according to Bosscher.
"We go inside the spinal canal where the nerves are. Similar procedures have been done for many years safely, but the risks are always bleedings. Blood vessels are there that can be ruptured, and occasionally that happens; however, that can almost always be controlled very nicely.
"Other risks are nerve damage, of course, and infection. Like any procedure that is being done on the spine, there is always the potential to some rare anomalies, that a patient can develop serious complications. However, those chances are quite small."
According to Bosscher, the main advantage of the procedure is that it can be done through a needle. "You don't need surgery with this procedure. It gets us direct information on what's going on with a particular patient."
Although Bosscher is in private practice in Lubbock, Texas, he is not alone in the research.
"We feel very fortunate to have found people who are so supportive. That would include the strong community of spine surgeons, who have supported me indirectly in all of this work and guided me indirectly in how to approach patients with back pain."
Bosscher said about 1,000 patients have received epiduroscopies since 2000.
The procedure is done under heavy sedation, but not general anesthesia.
"We hope that in the next year or so we can get more information and have a better understanding of exactly what is going on, and hopefully devise some ways of treatment, or treatment modalities, that might help all these patients.
"It's like studying a picture through a small tube where you see only one image at a time and put them all together," he said.
"There's a lot of research involved. It's just like a puzzle we are trying to solve: we are getting closer and closer to finishing it."