One challenge with treating back pain is that there are not that many absolute rules. For example, a spinal condition that appears relatively minor can lead to severe back pain, but a very serious condition can be barely painful at all.

Similarly, some patients with a spinal condition will develop chronic pain, while others with the same condition will not.

To better deal with these issues, the spine medicine community is increasingly starting to appreciate that pain is a uniquely personal experience, and many treatments and types of back care don’t work the same for all patients even when they have the same diagnosis.

Chronic Back Pain has its Own Unique Nature

Acute pain (e.g. lasting less than three to six months) and chronic pain (e.g. lasting more than six months) have very different characteristics.

• With acute pain, the severity of pain directly correlates to the amount of damage. This type of pain is a symptom of injured or diseased tissue, and after the underlying injury is healed then your pain goes away. For example, with a herniated disc, once the pressure on the nerve is alleviated the acute pain stops.
• As pain moves from the acute phase to the chronic stage, factors other than tissue damage and injury come more into play. These may include such things as ongoing “pain” signals in the nervous system even though there is no tissue damage, as well as thoughts and emotions.

Everyone experiences and expresses pain differently. Two people with the exact same injury will feel and show their pain in unique ways. The new theories of pain can now explain, on a physiological level, how and why people experience pain differently.

The Nature of Your Back Pain Will Guide Treatment Decisions

With chronic pain, the back pain treatment will be different depending on the underlying cause of the pain. Chronic pain may be caused by:

• A painful spine condition, such as degenerative disc disease, spinal stenosis or spondylolisthesis, which has not healed well. These conditions are due to a diagnosable anatomical problem. If the pain has not subsided after a few weeks or months of conservative (nonoperative) treatments, then surgery may usually be considered.
• Neuropathic pain, in which all signs of injury are usually gone and the pain that you feel is unrelated to an observable injury or condition. With this type of pain, the nerves continue to send pain messages to the brain even though there is no ongoing tissue damage.

Finding Effective Treatments for Back Pain is Often a Process of Trial and Error

Figuring out the best approach to manage your condition can be very frustrating, as many treatments work well for some people but not for others. For example, epidural steroid injections are successful in alleviating pain for about half of patients who have them. Which half? Why? This is not known. But it is known that if one works for you for a painful flare-up, then it is more likely to work again if you need it in the future (and vice-versa). It is also known that you shouldn’t have more than 3 injections in one year and that using fluoroscopy with the injection measurably helps the success rate.

So even though it is not always known if a treatment will work well for you, it is still a good idea to become as educated as you can on what to expect in terms of success rates and about what can positively influence the outcome (e.g. skills the spine specialist should have, technology available, etc.).

Be Careful with Decisions about Spine Surgery

There are many highly effective surgical options to treat a variety of spinal conditions. Unfortunately, however, many people are disappointed to find that most or all of their pain is still around after surgery. While there are a number of reasons a particular surgery may fail to alleviate a patient’s pain, probably the most prevalent reason is that the diagnosis was incorrect in the first place. Almost all spine surgery is elective – meaning that it is the patient’s choice to have the surgery or not – so in this area it is very important to make an educated decision.
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Topic: back pain care

There are many things you can do to help your back that your doctor may or may not have mentioned to you. We realize that you have probably already educated yourself about the basics of back care, but the following points in particular bear repeating.

1. Get an accurate clinical diagnosis: A clinical diagnosis should rule out the possibility of rare but serious conditions (such as a tumor), categorize your condition, and determine if there are neurological deficits (nerve damage). It is based on a combination of the doctor’s findings on your diagnostic tests, your physical exam and symptoms, and is essential to determine appropriate treatment options for your back pain or neck pain. See Getting an Accurate Back Pain Diagnosis.
2. To help you understand your diagnosis, it may be useful to read What’s a Herniated Disc, Pinched Nerve, Bulging Disc…?
3. Don’t smoke: People who smoke are more likely to have lower back pain and over 80% more likely to develop degenerative disc disease than non-smokers. Zyban is one medication available to help quit smoking. Read more at Does Smoking Cause Low Back Pain? and Anti-Smoking Medications.

4. Exercise properly: Exercise provides the double-benefit of helping your back heal more quickly and helping prevent a recurrence of the back pain. A focused exercise program is a critical part of almost any back pain treatment, and should include a combination of stretching, strengthening and low-impact aerobic exercise. Exercise is important to continue even after you feel better to prevent future bouts of back pain. Read more with Physical Therapy Benefits For Back Pain.
5. Find the right spine specialist: Many people who suffer from ongoing back pain need to visit a spine specialist. Sometimes it will take a process of trial and error and seeing a number of health care professionals before finding back pain relief and a treatment program that works for you. Also, try to be patient, as treating back pain is often more an art than a science and it may take a while to find the most helpful treatment. Read more at Specialists Who Treat Back Pain.
6. Proactively manage your situation: We encourage you to proactively manage treatment for your back pain. This includes carefully preparing for your doctor visits, so that they are as productive and helpful as possible, and educating yourself with reliable information so you can ask the doctor the most useful questions. Read more with Preparing to Meet with a Spine Surgeon or Spine Specialist.

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As you probably already know, many aspects of diagnosing and treating back pain are controversial in the medical community. However, one area that the medical community does generally agree on is the role of rehabilitation (physical therapy and back exercise) in helping recover from back pain and prevent or minimize future recurrences of back pain.

Basically, if a pain problem has persisted for many weeks the body is signaling that there are barriers to the healing process that need to be eliminated. In back pain, exercise and rehabilitation are critical in stimulating the healing process.

Lack of Activity and Exercise Actually Makes the Pain Worse

Pain often prevents us from getting enough exercise and lack of exercise can worsen the pain by leading to stiffness, weakness and deconditioning. Movement is necessary to keep the discs, muscles, ligaments and joints all healthy. For example, physical activity allows diffusion of nutrients into the disc space and helps it stay healthy. Significant inactivity deprives the injured disc of the nutrition it needs and this can lead to further degeneration and pain. Additionally, activity and exercise are needed to maintain the exchange of fluids in spinal structures and reduce swelling that naturally occurs in the tissues surrounding an injured disc. This swelling can further irritate nerves that are already affected by herniated disc material, which is highly inflammatory. See Back Exercise and Fitness for Back Pain Relief and The Importance of Abdominal Exercise and Back Exercise.

Rehabilitation and Exercise Stimulate Healing

Exercise in a controlled, gradual and progressive manner is the only way we can tell our body to heal. Injections, medications and other passive therapies can be important in providing pain relief, but they cannot stimulate the healing process. The natural stimulus for the healing process is active exercise. Active exercise means we use our nervous system to tell the muscles what to do, and it requires dedication to an appropriate, comprehensive exercise and rehabilitation program. See Rehabilitation and Exercise for a Healthy Back.

Stretching, Strengthening and Aerobic Conditioning Exercises are Each Important

A comprehensive rehabilitation program should consist of stretching, strengthening and aerobic conditioning of the back and body. All three of these activities are important in your recovery.

• Stretching exercises are important because any form of inactivity, especially where an injured back is involved, is usually associated with some progressive stiffness. Patients with chronic pain may find it takes weeks or months of stretching to mobilize the spine and soft tissues, but will find that the increase in motion provides meaningful and sustained relief of their back pain. For more information, see Stretching for Back Pain Relief.
• Strengthening exercises are important in order to help prevent future recurrences of back pain. Especially if an episode of low back pain has lasted two weeks or more, a strengthening program (such as McKenzie exercises, Lumbar stabilization training and/or facilitation exercises) is critical to long-term recovery. See Strengthening and Back Pain Relief Exercises.
• Aerobic conditioning exercises are important as aerobically fit patients have fewer episodes of low back pain, and experience less pain when an episode does occur. Well-conditioned patients are also more likely to maintain their regular routine, whereas patients with chronic low back pain who do not work on aerobic conditioning are likely to lose their ability to perform daily activities over time. See Low-Impact Aerobic Exercise.

Exercise is especially helpful for sciatica, which is discussed further in Sciatica Exercises.

Try to Manage Your Anxiety about Exercising

While it is natural to feel anxious about exercising, it’s important to manage your anxiety and fear of re-injury in order to regain normal muscle function. The basis for feeling anxiety about lower back pain lies in the central nervous system, which responds to pain by instructing the muscles near the affected part to protect against further injury. Only appropriate physical training that specifically compels the muscles to improve their function can overcome this neurological barrier to normal muscle function.

See an Appropriately Trained Health Professional for Rehabilitation

For all forms of exercise, it is advisable to see an appropriately trained and licensed spine specialist — such as a physical therapist, occupational therapist, physical medicine and rehabilitation physician (also called a physiatrist) or doctor of chiropractic. Depending on your specific diagnosis and level of pain, the rehabilitation and exercise program will be very different, and spine specialists are trained to develop an appropriate rehabilitation program and provide instruction on correct form and technique. See How a Physical Therapist can Help with Exercise and Back Exercise and Physical Therapy for Back Pain. Stephanie Burke
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While spine surgery may be the right option for certain patients, many people suffering from back pain have decided that they will do almost anything to avoid surgery. If avoiding surgery is an option for you, it’s worth exploring some of the less common options.

Please note that it is better to first find out if you have a readily correctable anatomic lesion (such as a disc herniation) that would lend itself to minimally invasive surgery, as this may be less expensive and more effective than some of the non-surgical options available.

The following simply highlights several treatment options — this is by no means an exhaustive list. We have selected several treatment options that are relatively new and you may not yet have heard about.

Delivering Electrical Impulses through the Skin

Electricity has been used to treat pain for over 100 years. Early proponents of electricity were labeled as charlatans, but more recent scientific research has shown that electricity can reduce both acute and chronic pain. One type of electrical stimulation available delivers the electricity directly to the deeper tissues (muscles, ligaments, tendons) near the spine through several needle electrodes. The placement of the needle electrodes is designed to reach the specific nerve pathways that may be impacting the pain. The theory is that this type of electrical stimulation helps curtail the central nervous system hypersensitivity that leads to chronic pain. See also Percutaneous Neuromodulation Therapy (PNT).

Reducing Pressure on the Lower Spine with Bracing

Another type of brace may help certain patients to better participate in their daily activities by reducing the pain and symptoms that make it difficult to function. This brace is a pneumatic vest, worn during everyday activities, that uses pneumatic lifters to help take some of the weight off the lower spine and thereby decreasing the pressure on the lower back. Patients most likely to benefit from using this pneumatic vest tend to meet four specific criteria. See Pneumatic Vest – A New Lower Back Pain Treatment Option.

Breaking Down Scar Tissue

There are many treatment options available for back pain caused by soft tissue problems. Two relatively new approaches that are aimed at breaking down scar tissue and fibrous adhesions are:

• The Graston Technique is a form of soft tissue mobilization that uses specifically designed stainless steel instruments to help identify and break down scar tissue. The majority of practitioners specializing in this technique are chiropractors, athletic trainers, physical therapists and occupational therapists.
• Manipulation under anesthesia (MUA), is a non-invasive procedure increasingly offered for acute and chronic neck pain and back pain. Manipulation under anesthesia uses a combination of specific short lever manipulations, passive stretches and specific articular and postural kinesthetic maneuvers in order to break up fibrous adhesions and scar tissue around the spine and surrounding tissue.

Interrupting the Pain Signals with a Spinal Cord Stimulator

OK, this option does involve surgery to implant the device, but we wanted to take note there are now newer technologies that eliminate the need for frequent (e.g. annual) additional surgeries to replace the batteries in the stimulator. Spinal cord stimulatorsare small devices implanted under the skin in the low back that use electrical impulses to stop pain signals from reaching the brain. Certain models contain batteries that can last 5 to 9 years before needing to be replaced. While spinal cord stimulation does not work for a lot of patients with chronic pain, for some with nerve pain (e.g., burning, severe shooting pain and/or numbness or tingling) or chronic pain due to radiculopathy (e.g., radiating pain like sciatica) or failed back surgery, spinal cord stimulation may be recommended in an effort to reduce the pain to a more manageable level. This procedure is usually only considered after more traditional non-surgical treatment options have been exhausted. To learn more, see Rechargeable Spinal Cord Stimulators for Chronic Pain.

Finally, Ice and/or Heat Therapy is Almost Always Beneficial

While often used for acute pain due to a back muscle strain, ice and heat packs/wraps/pads can also be used to alleviate ongoing pain and to reduce activity-related discomfort for those with chronic back problems. Among other benefits, ice or cold packs help reduce inflammation and numb sore tissues, acting as an anesthetic for the painful area. Application of heat enlarges the blood vessels, which increases the flow of oxygen and healing nutrients to the injured area.

Importantly, ice and heat can really help you deal with the discomfort and pain of physical therapy and exercise, helping improve your chances of completing this essential aspect of your recovery. Usually, a hot pack is used to warm up the muscles and soft tissues before starting exercise and stretching, and soothing ice packs or cold packs are used to help the muscles and soft tissues calm down after exercise. For more helpful uses of cold and heat packs, see also:

• Ice Massage for Back Pain Relief
• Benefits of Heat Therapy for Lower Back Pain

For a myriad of reasons, back surgery may not be the preferred option for your particular pain situation, or you may prefer to try more non-surgical approaches to manage your pain before you’ll really consider surgery. By increasing your understanding of the many non-surgical treatments available for back pain — including ones that your doctor or physical therapist may not have mentioned — you may find one that really makes a difference in your pain level.

Find out more at Scotchtown Chiropractic and Physical Therapy

Topic: Back surgery July 25, 2011 Stephanie Burke

August 1, 2011
By: Jim Payseur

After increasing reports of complications using bone morphogenetic proteins (BMPs), The Spine Journal reviewed all of the past publications regarding BMPs. They found there may be a higher incidence of side effects or adverse effects than previously published research suggests. The specific complications that are drawing the most concern include swelling in the neck and throat, radiating leg pain, and male sterility.

Most of these complications occur if the BMP – specifically rhBMP-2 – causes swelling at the surgical site, which then affects surrounding tissues and organs. Some of the complications include:

• Complications to the throat following cervical spinal fusion with BMPs. Some of the cases blocked the patient’s airway and were fatal.
• Complications of male infertility due to retrograde ejaculation following a lumbar fusion using BMPs, which is defined here: Potential Risks and Complications with ALIF Surgery.
• Other complications involved cases of infection, dislodgement of the implant, radiculitis, poorer outcomes from the surgery, among others.

The Spine Journal’s review concludes that the scope and severity of potential risks and complications associated with using rhBMP-2 are significantly greater than had been originally reported from the clinical trials.

The FDA only recommends the use of BMPs for lumbar surgery using the anterior approach. Surgeons, however, may use the product for other “off-label” uses, including surgery with other approaches or on other sections of the spine.

Read more from these sources:

The Spine Journal – BMP Abstract
FDA Guidelines for BMPs.

August 4, 2011
By: Stephanie Burke

Many people are looking for information on non-medical treatment alternatives, so we did some research and have included information on Spine-health.com that includes a number of alternative health options for people trying to manage their back condition. Please note that many people find that the greatest benefits come from combining medical options (such as back pain medications, injections, spine surgery, etc) along with alternative health care options like yoga or Pilates.

Here are just a few alternative options that you might want to consider:

Acupuncture has Pain-Relieving Qualities

In 1998, the National Institutes of Health (NIH) released a statement that said there is enough evidence to demonstrate that acupuncture had beneficial pain-relieving qualities that might be useful as a treatment for lower back pain and for a number of other painful conditions. The mechanisms of acupuncture, though not solidly proven, seem to stimulate the central nervous system – the brain and spinal cord – and it is thought that acupuncture causes specific chemicals to be released into the body that physically and psychologically affect pain. See also Acupuncture: An Ancient Treatment for a Current Problem.

Yoga Ensures Flexibility

Most people know that yoga involves a lot of stretching. But what they don’t know is how important regular stretching is to alleviate many forms of lower back pain. For example, stretching the hamstring muscles (in the back of the thigh) helps expand the motion in the pelvis, which decreases stress across the lower back. Stretching with yoga also increases blood flow, allowing nutrients to flow in, toxins to flow out, and providing overall nourishment of the muscles and soft tissues in the lower back. See also Healing Benefits of Yoga.

Tai Chi is a Very Gentle Form of Exercise

Unlike other forms of exercise such as yoga, Tai Chi involves a greater degree of movement. And unlike many types of aerobic exercise (such as running) Tai Chi does not involve any jarring motions that create impact on the spine. It is a slow, deliberate, and gentle flowing movement of the body. Importantly, because Tai Chi is gentle on the spine, many people with back pain find it easier to tolerate than many other forms of exercise. See also Tai Chi for Posture and Back Pain.

Pilates Exercise Helps Support the Spine

Pilates is an exercise program that focuses on the core postural muscles that are essential to providing support for the spine and helping alleviate back pain. Learning awareness of neutral alignment of the spine and strengthening the deep postural muscles that support this alignment are important skills for the back pain patient. Patients with pain stemming from excessive movement and degeneration of the intervertebral discs and joints (e.g. degenerative disc disease) are particularly likely to benefit from a Pilates exercise program. See also Pilates Exercise System to Promote Back Health.

Massage Therapy is Relaxing and Aids Healing

Research shows that massage therapy provides several important health benefits for people with back pain, including: helping sore back muscles heal by improving blood circulation, relaxing the muscles and improving range of motion, and helping manage chronic pain by increasing the level of endorphins in the body. Neuromuscular therapy is recognized by The American Academy of Pain Management as an effective treatment for back pain caused by soft tissue injury (such as muscle strain). See also Massage Therapy for Lower Back Pain.

August 10, 2011
By: Stephanie Burke

Even if the pain is severe, episodes of back pain—and pain from ongoing back conditions—can be somewhat relieved with some first aid methods you can do at home. After an injury, resting for a day or two can give your back a chance to recover and start to heal on its own. In addition, some combination of the following treatments is usually recommended to help alleviate or at least manage the pain.

Pain Medication

Two main types of medications can be very helpful for relieving many types of back pain – acetaminophen and non-steroidal anti-inflammatory drugs (NSAID’s).

• Acetaminophen (such as Tylenol) works by blocking the brain’s perception of pain. It can be very effective, and has little chance of any side effects. Patients with liver disease must check with their doctor before taking acetaminophen.
• NSAIDs work by limiting inflammation, which is often at least partially responsible for back pain. There are different types of NSAID’s, including ibuprofen (such as Advil, Motrin or Nuprin), naproxen (such as Aleve or Naprosyn), and the newest class, COX-2 inhibitors, (such as Celebrex). This last type requires a prescription and is easier on the stomach lining than other NSAID’s. Patients with kidney problems, over 65, or with any history of stomach ulcer should check with their doctor before using NSAID’s.

Because acetaminophen and NSAID’s work differently, they can be used together, and some patients find that they are more effective that way. See also Medications for Back Pain and Neck Pain.

Ice Therapy

Muscle strain is a major cause of back pain. Placing an ice pack on the area shortly after the occurrence of pain (within 48 hours) can help in the following ways:

• Reduces inflammation, which often contributes to the pain
• Numbs the sore tissues, acting as an anesthetic
• Slows the nerve impulses, interrupting pain signals to the brain
• Decreases tissue damage
• Aids in natural healing by rushing blood and nutrients to the affected area when the ice is removed.

See also Ice Massage for Back Pain Relief.

Heat Therapy

Heat is also good for sore back muscles, especially after the first 48 hours has passed. Either dry heat (such as an electric heating pad) or moist heat (such as a hot bath or steamed towels) can be used to provide the following benefits:

• Enlarges the blood vessels, increasing the flow of oxygen and nutrients to the injured area
• Stimulates the sensory receptors in the skin, which reduces the number of pain signals that are sent to the brain
• Helps the tissues around the spine stretch more easily. This reduces stiffness, and gives the back better flexibility, which is important for a healthy back.

Both heat and ice must be applied carefully to avoid further injury. See also Benefits of Heat Therapy for Lower Back Pain.

Stretching and Exercise

The methods described above will hopefully reduce your pain enough to be able to do some physical therapy and exercise, which is essential for long term recovery.

• Stretching should include the muscles, ligaments and tendons in the back and around the spine, as well as your hamstring muscles (in the back of the thighs). For patients with chronic back pain, it may take weeks of stretching to get results, but the increased amount of motion gained can provide noticeable and long-term relief. To be most helpful, stretching exercises should be done twice a day. A good way to remember to stretch is to work it into your daily routine, such as stretching when you brush your teeth in the morning and evening. See also Exercise and Back Pain.
• Regular exercise must be taken on slowly so that you don’t make your pain worse or re-injure your back. Exercising your back increases the distribution of nutrients, which helps you recover from injury more quickly, and makes your back healthier overall. It also reduces stiffness and strengthens muscles, preventing future injury and pain. Back and abdominal muscles need to be strong enough to provide support for the spine and its surrounding structures. See also Exercise and Fitness to Help Your Back.

Mindful Techniques for Chronic Back Pain

For patients with ongoing pain, some measure of relief can often be gained by focusing your mind on something other than the pain. Learning some relaxation and distraction techniques can make your brain pay less attention to the pain signals, which can make you feel better. This may sound like hocus pocus, but many patients who have tried a variety of chronic pain management techniques say that this is the most helpful – and say they like it because it puts them in control of their own state of being. See also Chronic Pain Coping Techniques – Pain Management.

If the pain is severe and/or lasts more than a couple of weeks, it is usually advisable to see a health care professional – either your primary care physician, chiropractor, or another type of spine specialist. We believe that it’s the combination of treatment from an experienced, well-qualified spine care professional and your own initiative that gives you the best chance for successfully managing your back condition.