Back pain – it can rip your life away from you making your every position, movement and activity excruciatingly painful beyond your imagination. You can’t sleep. Dressing yourself is difficult if not impossible and going to the toilet can be agonizing. The constancy of your pain can wear you down to the point where your whole world is consumed by “the pain”.
If that’s not enough the confusing array of information, advice and treatment options offered by often well-meaning people can often compound your sense of disillusionment and powerlessness.
Everyone you speak to has a different opinion or magic cure. Friends will often tell you about their “guru” therapist that you must see. Therapists will give you many and varied diagnoses and treatments all promising to “fix” your problem. Doctors may send you for X-rays, CT scans and MRI scans but often the long words of these technical reports heightens your fears that something is seriously wrong and that hope of a cure for your pain is fading.
And then under the advice of your treating health professional you undergo any number of different treatments including nerve blocks, epidurals, radiofrequency neurotomies, prolotherapy and intradiskal electrothermal therapy, unbeknown to you, that most of these treatments offer at best between 30-60% of short term pain relief. 1,2,3,4
Is it no wonder that Australia is following America’s lead with spinal surgery increasing at 10% a year?5 In America, experts estimate that nearly 600,000 people opt for back operations each year. Yet, a new study in the journal Spine shows that in many cases that even surgery can backfire, leaving patients in more pain.
Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.
After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.
The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine.
Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.
27 million adults with back problems
A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physiotherapy, pain management, chiropractor visits, and other non-invasive therapies, the majority pays for spine surgeries.
Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there has been an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.
For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. The indications for spinal surgery include:
• Nerve root compression resulting in persistent toileting problems, leg pain or numbness, tingling and muscle weakness;
• Persistent pain due to instability of a single intervertebral segment.
“But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”
Despite the fact that over 250,000 lower back fusions are performed every year in the USA, there is no evidence to support this operation for discogenic back pain.6,7
Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.
“We are very successful at improving leg symptoms," says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”
Source of pain is often hard to pinpoint
The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain.
Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says. And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.
In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent.
Proven strategies for treating lower back pain involve:
• Taking the load off the pain sensitive tissues and structures by getting into the most pain free positions as possible;
• Reducing inflammation with cold packs or medication;
• Protecting against re-injury with the use of tape or bracing;
• Promoting healing by reducing tissue tension with “hands on” techniques along with easy pain free, mobility exercises and heat treatment;
• Targeted stretching and strengthening exercises to correct muscle imbalances and joint alignment;
• Correction of posture, functional movement patterns (habits) and sporting techniques to prevent irritation of body structures and tissues;
• Core stabilisation exercises to build a strong, stable platform upon which whole body strengthening can be built;
• Functional strengthening to build your body’s capacity to cope with daily physical demands.
It is important that you understand that healing any tissue takes about 6 weeks and involves and a well-recognised progression through phases of healing. For example, the Bleeding Phase can last from 6-24 hours, Inflammatory Phase 2-5 days, Proliferation / Regrowth (framework) Phase 5 to 14 days, the Remodelling Phase 2 to 6 weeks and the Maturation Phase from 6 weeks to up to 12 months and beyond.
It therefore makes sense that if each of these phases are optimised, physically, nutritionally and psychologically and the actual causes of your back pain are corrected, then healing should not just be possible, but inevitable.
It is often quoted that it takes about 4 weeks to strengthen your muscles and at least 4 weeks to correct your posture or movement habit. So whilst not a quick fix, understanding that if you follow an evidenced based rehabilitation system that has been proven deliver results over time, you too can also achieve sustained improvement, through a progressive rehabilitation and conditioning program that will prevent re-injury and optimise your physical capacity.
If you are interested in learning about a 7 step plan that thousands of people have experienced relief through, call 1 300 BODYWISE (263 994) for a FREE Assessment and Recovery Action Plan. This plan will detail the specific steps that you need to take to on your road to recovery. Wishing you the best of health.
Director Bodywise Health
P.S. If you are in pain and you want relief, don’t put off getting effective treatment any longer.
Call 1300 BODYWISE (263 994) for a FREE, No Obligation back assessment and advice. You have absolutely nothing to lose except your pain and a healthier, happier life to gain.
1. Dreyfuss P. Hallbrook B, Pauza K et al. Efficacy and validity of radiofrequency neurotomy for chronic lumbar zygoapophysial joint pain. Spine (Phila Pa 1976)2000 25(10):1270-7.
2. Van Kleef M, Barendse GA, Kessels A et al. Randomised trial of radiofrequency lumbar facet denervation for chronic low back pain. Spine (Phila Pa 1976) 1999:24(18):1937-42.
3. Yin W, Willard F, Carreiro J et al. Sensory stimulation-guided sacroiliac joint radiofrequency neurotomy: technique based on neuroanatomy of the dorsal sacral plexus. Spine (Phila Pa 1976) 2003;28(20):2419-25.
4. Pauza KJ, Howell S, Dreyfuss P et al. A randomised placebo controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine j 2004:4(1):27-35.
5. IA Harris, ATT Dao. Trends of spinal fusion surgery in Australia: 1997 to 2006 - ANZ journal of surgery, 2009 - Wiley Online Library
6. Carragee EJ. The surgical treatment of disc degeneration: is the race not too swift? Spine J 2005:5(6):587-8.
7. Deyo RA, Nachemson A, Miirza SK, Spinal fusion surgery – the case for restraint. N Engl J MED 2004:350(7):722-6