Back Pain Assessment and Advice in Primary Care

Previous studies of low back pain indicate positive outcomes if the patient resumes their daily activities and routine. This study examined how primary care physicians evaluate the functional limitations of a low back pain patient, or what guidance they suggest about returning to normal activities.

The researchers found that providers failed to inquire about the back pain interference with the patient's job or activity. In 40% of the visit, functional impairments were not discussed. And 81% of the patients did not receive information on how to resume regular activities. Therefore, an assessment of functioning status, and advice to resume normal activities was not given consistently in primary care visits. The authors stress:

"Considerable research findings support the importance of psychosocial factors in back pain, disability, and health care use, and in predicting future back pain and disability...How the health care provider perceives the patient's back pain problem and communicates that perception to the patient may well influence the patient's attitudes and behavior relating to functional limitations and seeking health care."

From this study, it is clear that most doctors are not performing this function adequately.

Turner JA, LeResche L, Von Korff M, Ehrlich K. Back pain in primary care: patient characteristics, content of initial visit, and short-term outcomes. Spine 1998;23:463-469.

Aortic Calcification, Disc Degeneration, and Back Pain

Researchers¹ studying data from the Framingham Heart Study recently came across an interesting relationship unrelated to the original heart study.

This study examined the records of 606 patients who had lateral lumbar radiographs taken in 1967-1968 and again in 1992-1993. The authors recorded the presence of aortic calcification in the posterior wall of the aorta, and the presence of lumbar disc degeneration and report of back pain.

The study found that subjects with aortic calcification were more likely to have general disc degeneration. Furthermore, there was a strong relationship between the level of calcification and the degeneration of the corresponding disc; and, patients with more severe aortic calcification were found to be at a significantly higher risk of back pain.

"We conclude that aortic calcification, a marker for advanced atherosclerosis, increases a person's risk for development of disc degeneration and is associated with the occurrence of back pain. Posterior calcification may be a sign of atheromatous obliteration of a feeding artery or arteries of the lumbar spine, which leads to impaired nutrition of the lumbar spine. The intervertebral disc, with its precarious nutrient supply, may be one of the first structures to suffer from insufficient nutrient supply, thus linking aortic calcification with radiographic disc degeneration. The relationship between aortic calcification and back pain is either through pain-sensitive structures, such as nerve roots, bones, and muscles that suffer from ischemic pain; through spinal dysfunction, caused by ischemic atrophy and degeneration of structures; or through a combination of both."

Nerve Growth in Degenerated Discs

In a separate, but related study, other clues to the enigma of back pain have been published.² In this study, researchers examined 46 samples of intervertebral discs collected from 38 patients who underwent spinal fusion surgery for chronic low back pain (longer than 12 months). These were compared to 34 samples taken from healthy lumbar spines.

The authors found that nerve growth in the control samples was limited to the outer one third of the anulus fibrosus. In the damaged discs, though, nerve growth had extended into the inner one third of the anulus fibrosus in 46% of the samples, and had infiltrated the nucleus pulposus in 22% of the samples. Most of the time, blood vessels were found along with the nerve growth, but in 14 back pain samples (30%) the nerve cells were isolated in the discal matrix.

"So what is the biological purpose of nerve ingrowth into intervertebral discs? By analogy with other connective tissues, nerve ingrowth into damaged intervertebral discs could mediate various tissue events, notably healing. Initially, an immobilising nociceptive component to nerve ingrowth might be beneficial, but because the healing process is thought to be poor in this tissue, unproductive nerve ingrowth and pain may result."

1. Kauppila LI, McAlindon T, Evans S, et al. Disc degeneration/back pain and calcification of the abdominal aorta: a 25-year follow-up study in Framingham. Spine 1997;22(14):1642-1649.
2. Freemont AJ, Peacock TE, Goupille P, et al. Nerve ingrowth into diseased intervertebral disc in chronic back pain. The Lancet 1997;350:178-181.

Low back pain is a very common pain symptom. One out of three of us suffer from some kind of back pain every year, and many people live with chronic spinal pain.

The good news is that chiropractic has been shown over and over to be an effective treatment of back pain. Here's a collection of articles that discuss how chiropractic can help in the treatment of back pain.

Additional Back Pain Sections

Back Pain After Auto Accidents

The Effectiveness of Chiropractic for Back Pain

Back Pain Articles:

Back Pain After Auto Accidents

Browse our articles to learn about conditions caused by automotive accidents.

Spinal Cord Stimulation and Whiplash Injury

Electrical spinal cord stimulation (SCS) is a technique used to treat a select group of patients with chronic, intractable pain. This case report investigates the effectiveness of SCS on a patient a whiplash-type injury.

The patient had a 4-year history of chronic pain, all stemming from a neck injury. His pain was localized into the left side of pharynx and the base of tongue radiating to the left cheek and ear. In course of his treatment heavy medications, physiotherapy, TNS-treatment, trigger joint injections, and stellate ganglion block were all tried but to no benefit. At this point, the treating physicians decided to try epidural spinal cord stimulation:

"As it is important to achieve stimulation paresthesias in the topographical representation of the patient's pain, we were forced to advance the tip of the electrode to the level of the base of the dens until satisfactory paresthesias were achieved. Interestingly, the first subjective feeling from stimulation was a warm, almost burning sensation over the previously painful area. During the trial stimulation pain symptoms started to disappear. First to give way were allodynia and hyperesthesia around the left ear. Last to disappear were the lancinating sensations, which sporadically appeared even a few weeks after the internalization of the system."

"SCS is an expensive and invasive way to treat pain. However, in addition to relieving pain and improving the quality of life of out patient, it has already caused considerable savings�Our case shows that SCS can offer an alternative treatment in whiplash-type pain syndrome of this complexity."

At last assessment, the patient had been without pain and analgesics for 18 months.

Kirvela OA, Kotilainen E. Successful treatment of whiplash-type injury induced severe pain syndrome with epidural stimulation: a case report. Pain 1999;80:441-443.

What causes radicular pain after an auto collision?

Radicular pain, or radiating pain, is caused by interference or pinching of the spinal nerves. This results in pain, tingling, or numbness in parts of your body far from the actual source of the problem.

If your spine is injured, there are a number of things that can affect the nerves.Injured ligaments and muscles can cause inflammation of the nerve root, which can disrupt the function of the nerve. If a spinal disk is damaged, it can cause the disk to bulge or herniate, pinching the nerve. And if the spinal joints begin to calcify, it can cause spinal stenosis, or a narrowing of the canal that the spinal nerves pass through.

All this can lead to a number of conditions such as sciatica, carpal tunnel syndrome, low-back pain, shoulder pain, and more. It's crucial to treat these conditions to prevent further nerve damage or worsening symptoms.

The key to treating radicular pain is to pinpoint its source in the spine. After determining the root of your pain, a chiropractor can relieve pressure on the impinged nerves. This allows the nerves to heal by reducing inflammation and irritation.

Multiple studies have confirmed the efficacy of chiropractic adjustments in alleviating radicular pain. If you're looking for a natural, effective pain relief, chiropractic could help. Call our office to learn more.

References

Christensen KD, Buswell K. Chiropractic outcomes managing radiculopathy in a hospital setting: a retrospective review of 162 patients. Journal of Chiropractic Medicine 2008; 7(3):115-25.

Orlin JR, Didriksen A. Results of chiropractic treatment of lumbopelvic fixation in 44 patients admitted to an orthopedic department. Journal of Manipulative and Physiological Therapeutics 2007;30:135-139.

Rodine RJ, Vernon H. Cervical radiculopathy: a systematic review on treatment by spinal manipulation and measurement with the Neck Disability Index. Journal of the Canadian Chiropractic Association 2012; 56(1):18-28.