Approaches to Back Pain - What are your Treatment Options?

By: Albert Huang, DC

Chances are that you or someone you know has been affected by back pain at some point in your life. The statistics are stacked against you and I, as low back pain affects at least 80% of us some time in our lives, perhaps 20-30% at any given time.

Back pain can be debilitating and can affect each person differently. Some people only experience discomfort for a few days while others suffer from it for months or even years. Acute back pain can last anywhere from days to weeks and is usually mechanical in nature. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to maintain proper posture.

The good news is that these acute episodes generally respond well to conservative therapies and have the ability to resolve relatively quickly. Albeit some acute pain syndromes can progress to become more serious if left untreated.

Chronic back pain is classified as pain persisting for three months or greater. It is generally more complicated and multi-faceted in nature. In some instances, pain may travel or radiate to another part of the body causing distal numbness, tingling, and/ or weakness. Chronic pain syndromes can involve physical, chemical, and/ or psychological components which can require more therapy time and more in-depth treatment protocols.

At any rate, back pain is debilitating and can be a lingering nuisance in our daily routines. The key to successful treatment and recovery starts with the ability to determine the primary reason(s) causing the problem.

A symptom such as pain may seem urgent but pain is merely a residual effect to a primary dysfunction. Pain fibers only make up less than ten percent of body's overall nerve fibers. This means that there can be a dysfunction, pathological problem, and/or biomechanical imbalance occurring somewhere in the body without pain being present. Therefore, basing wellbeing on pain-symptoms alone does not effectively measure one's overall health.

Getting a detailed examination by a qualified health practitioner will help determine the root cause of pain generators which accordingly can help better one's prognosis. Let's explore the viable treatment options for low back pain and the efficacy of each.

Let us first start with a visit to our primary care physician. Typically, after a short-lived appointment, the medical doctor may suggest some rest and avoidance of strenuous activity. He or she may opt to write out a prescription for a few pain killers and muscle relaxants for your back pain. Having trust in our physician, we take the medications sometimes without questioning: "Is this natural? Are pharmaceutical drugs the best solution to a small case of back pain?"

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There are several medicines your doctor may recommend, depending on the symptoms you present with, how chronic your pain is, and your medical history.

The medicines recommended most often are:

- Acetaminophen (Tylenol) and nonsteroidal anti-inflammatory drugs (NSAIDS).
- Muscle Relaxants. (sedatives) 
- Narcotic pain medicines. 
- Antidepressants. - Not only treat depression but also may help with chronic pain.
- Anaesthetic or steroid injections. - These have been prescribed for chronic low back pain.
- Anticonvulsants. - Sometimes used to treat low back pain; poor evidence that they help.

We often blindly take the meds because we like the quick and easy fix. The problem with taking medications for back pain is that they don't address the root cause of the problem and only act like a bandage to temporarily offset the pain. Additionally, medications come with a whole list of side effects such as the risk of gastrointestinal ulceration and bleeding, liver damage, drowsiness, dizziness, headaches, respiratory failure, constipation, diarrhoea, nausea, vomiting, depression, palpitations, seizures, urinary retention, addiction, and dependence to name a few. 

Patients should always check with a physician before taking drugs for pain relief. Medicines that work for some people don't work for others. Pharmaceutical drugs are synthetic compounds that are not naturally found in the body or environment and can be toxic in exceeding doses. As a personal interjection, I am not dismissing the role of the physician or prescription of medications, I just believe that it shouldn't be the first line of intervention.

Furthermore, the large majority of low back pain can be treated without surgery. In rare cases, surgery might be an option when a chronic disc problem causes pain and weakness in your legs preventing you from doing everyday tasks. Other problems that may qualify for surgery include, a spinal fracture from injury or trauma, an infection or tumour in the spine, spinal stenosis, a highly unstable spine, a loss of control of your bowel or bladder, and scoliosis exceeding 45 degrees measured by the Cobb angle. 

It is always advised to get multiple opinions from different doctors before committing to surgery since it is a permanent fix. Back surgery is not always successful. Depending on the condition, you may still have back pain after surgery. Surgery should be the last resort after all other interventions have failed. Consult your doctor for more information. 

Since back pain is usually self-limiting and recurrent about 90% of the time, we should teach patients how to prevent low back pain and how to self-manage. Trying a natural non-invasive approach to back pain is recommended in most cases and should be the first choice for treatment. 

Traditionally, ice and heat have always been recommended whenever pain or an injury has occurred. Although ice and heat have never been scientifically proven to resolve back injuries or pain, the protocol may help reduce pain and inflammation to allow greater mobility. A good rule of thumb is that immediately following trauma, patients should apply something cold to the site of injury several times a day for up to 15 minutes to reduce inflammation. After 2 to 3 days of cold treatment, one could then apply heat for brief periods to relax muscles and increase blood flow. Using an ice-heat contrast 1 week after injury may help better circulate the area to promote healing.

Exercise may be the most effective way to speed recovery from back-related pain. Important focus on core strengthening, notably the back and abdominal muscles are crucial in spinal stabilization and healing. Exercise increases the propensity of muscle recruitment and coordination to prevent re-injury, faster recovery, and restoration of normal motor patterns. Exercise naturally increases circulation and improves mind-body awareness to enhance proprioceptive feedback and communication within the nervous system. 

Adopting a daily routine of stretching, resistance exercises, cardiovascular training, walking, and movement therapy will improve posture, balance, and endurance. Cycling or swimming are great non-weight bearing exercises which can help spare the joints in the body. Yoga is an excellent way to stretch muscles and achieve relaxation. Pilates has been shown to be effective in core strengthening and pain reduction. Getting a detailed exercise regimen from your MD, chiropractor, physical therapist, or personal trainer can significantly improve your prognosis. 

Treatment for back and neck pain has commonly been associated with chiropractic care. Although chiropractors do effectively treat back pain, finding a good and knowledgeable practitioner with strong manual skills can significantly help your cause. There are different techniques and ways to practice chiropractic so don't be afraid to shop around and try out different chiropractors to find one that best suits your needs. 

As a chiropractic doctor, I recommend finding a practitioner who is diversified in their treatment protocols and spends more than 10 minutes on their patients. They should use a repertoire of dynamic treatments such as hands-on muscle work, spinal manipulation, mobilizations, strengthening or stretching prescription, and the use of modalities sparingly. Chiropractic is a safe, non-invasive natural form of medicine. It is a drug-free approach and focuses on healing from within. The chiropractor is a good place to start if you are suffering any spine-related pain. 

Another viable option is acupuncture. It involves the insertion of small sterile needles in specific points throughout the body. The procedure is usually painless. The basis of acupuncture comes from traditional Chinese medicine where the needles are used to stimulate the flow of energy within the body. Acupuncture provides a stimulus to increase circulation, initiate healing, and modulate pain by the release of naturally occurring painkilling molecules, called peptides, in the body. Studies have shown that acupuncture can be an effective treatment for low back pain. 

Massage therapy has become an increasingly popular remedy for back pain management. Massage is a non-invasive, hands-on procedure which works with the muscular systems of the body. Tension and stiff muscles can result from a build up in physical or emotional stress. A relaxing massage can be a great solution to stress reduction as well back pain. 

As a note, understand that not all back pain is muscular in nature so co-intervention with another health-care provider could yield even better results in some instances. 

The use of modalities or machines should be used sparingly and never as a stand-alone treatment. They may be effective when coupled as an adjunctive to other manual-therapies.

Transcutaneous electrical nerve stimulation (TENS) is a device that sends mild electric pulses along nerve fibers to block pain signals to the brain. Small electrodes placed on the skin at or near the site of pain generate nerve impulses that may also help stimulate the brain’s production of endorphins which are pain-relieving chemicals.

Ultrasound is an external therapy used to warm the body’s internal tissues. Sound waves pass through the skin and into the injured muscles and other soft tissues to help them relax. 

Cold Laser Therapy or Low Level Laser Therapy (LLLT) is a treatment that utilizes specific wavelengths of light to interact with tissue and is thought to help accelerate the healing process. When cells absorb this light energy, it initiates a series of events in the cell that is theorized to normalize damaged or injured tissue, reduce pain, inflammation, and swelling.

The use of modalities can help with temporary pain modulation and inflammation which can help with acute conditions, but may not always address the primary dysfunction or root cause. Thus, be mindful and suspicious about your therapy if it only consists of machine-based treatments. 

Recurring back pain resulting from improper body mechanics or other non-traumatic causes is often preventable. Developing proper lifting techniques, maintaining proper spine mechanics, and correct posture can help prevent injuries. Every individual is different so certain therapies that work for one person may not work for another. Be proactive and preventative in your health, because your mobility and independence starts with a strong healthy spine. 

Some tips for maintaining a strong healthy back include, 

- Avoid prolonged sitting - get up and move every 30 minutes if possible. 
- When sitting try not to slouch or have too much forward head posture
- Get an ergonomic assessment of your workspace to ensure optimal body mechanics
- Always start with a warm up for 5-10 minutes prior to any physical activity or sport and stretch after your activity
- Avoid sleeping on your stomach as it places undue strain on the neck
- Lift with your legs and core musculature, not your back
- Wear shoes with good stability and try not to wear heels when possible
- Maintain proper nutrition and diet to reduce and prevent excessive weight to spare the discs and joints in the spine
- Quit smoking as it slows the healing process 
- Exercise daily to keep your muscles strong and body stimulated
- Reduce stress, find relaxation, and get treated!

By: Albert Huang, DC

References

http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
http://shp.missouri.edu/vhct/case1699/preval_costs.htm
http://www.webmd.com/back-pain/tc/low-back-pain