Back Pain Treatments

Back Pain Treatments

Disappearing Herniated Disc

This interesting report details the case of a 48-year-old woman who developed right-sided scapular pain after some heavy lifting. MRI showed loss of normal cervical lordosis, degeneration between C5-6 and C6-7, as well as disc herniations at C3-4, C5-6, and C6-7. The C6-7 herniation was large and was compressing the spinal cord. She was scheduled for surgery two weeks after the initial MRI scan.

On the day of her scheduled surgery, she reported that her symptoms had resolved and she declined surgery; two years later, complaining of intermittent scapular pain, she was given another MRI. "Follow-up MR imaging again demonstrated loss of normal cervical lordosis; however, the C6-7 disc herniation had resolved dramatically and, to a lesser extent, so had the herniations at the C3-4 and C5-6 levels."

The authors (neurosurgeons) conclude, "We do not advocate conservative management of a large herniated cervical disc that becomes symptomatic with myelopathy; however, this case illustrates the potential for the spontaneous regression of even significantly sized herniated cervical discs."

Westmark RM, Westmark KD, Sonntag VKH. Disappearing cervical disc: case report. Journal of Neurosurgery 1997;86:289-290.

Influence of MRIs on Low Back and Leg Pain

This study compared the clinical features of low back and leg pain patients at the time of requesting a lumbar spine MRI to the subsequent pain management plan.

72 Patients were reffered for MRI. In 65 of the cases, leg pain emerged as the main symptom. 40 Patients showed no evidence of nerve compression, but in 28 patients nerve compression was evident. Interestingly, patients planned for surgery dropped from 48 to 30, while the conservative treatment plans rose 35% after the MRI. Overall, 50% of patients' diagnoses were altered after the MRI.

MRI is typically used in the medical setting to support surgical intervention, as the physician can pinpoint the area that is to be operated on. Ironically, this study found that the real effect of MRI is to move patients to the conservative treatment.

Rankine JJ, Gill KP, Hutchinson CE, Ross ER, Williamson JB. The therapeutic impact of lumbar spine MRI on patients with low back and leg pain. Clinical Radiology 1998;53(9):688-93.

Informative Approach to Low Back Pain

This study tested the long-term effects of a light mobilization program and informative approach to low back pain (LBP). The authors compared 245 patients in an intervention group to 244 patients in a control group, to gauge the benefits of such a program, and to determine the factors that would indicate eventual return to work.

The intervention included an exam and clinical advice, and 3 hours of a "Mini Back School." The information covered the basics of coping with LBP amidst everyday living, discussed the link between pain and emotions, and stressed the importance of continuing normal activity. The program attempted to heighten awareness, rather than ordering instructions.
198 (81%) of the patients in the intervention group returned to work within five years; 160 (65%) in the control group. The control group patients were nearly twice as likely to end up permanently disabled.

After the five-year study, the researchers went back to determine the predictors of return or nonreturn to work. Nonreturners had more children, less income, and feelings of no control or power over their health status.

The authors conclude with the benefits of the program:

"The thorough examination coupled with the assurance that the patient's situation was not serious, gave the patient the confidence needed to follow the advice and resume light normal activity. Lasting behavioral modification is achieved only through experience. It is believed that it was the patient's positive experience that resulted in the favorable long-term effect. The outcome supports the view that a substantial part of LBP may be a functional disturbance, and that light normal activity may restore normal function."

Indahl A, Haldorsen E, Holm S, et al. Five-year follow-up study of a controlled clinical trial using light mobilization and an informative approach to low back pain. Spine 1998; 23(23):2625-2630.

Massage Therapy for Low Back Pain

Massage and back painAccording to medical experts, low back pain is the second most common reason why people visit their physician, only after visits for cold and flu. If you've ever suffered a backache, you know how difficult life can be when simple things like chores, sitting at a desk or even finding a comfortable sleeping position seem impossible. Unfortunately, conventional treatments are not always helpful.

A doctor may prescribe pain medications and anti-inflammatory drugs for your lower back pain or even recommend invasive surgery. Other treatments may involve physical therapy or weight reduction as many cases of lower back pain are attributed to excessive abdominal weight and improper compensation when bending or lifting. It's imperative that you learn proper lifting methods and perform exercises to strengthen the abdominals thereby reducing the stress on your lower back.

However, even with the proper care and prevention, some people continue to suffer from pain and their quality of life quickly diminishes. Fortunately, massage therapy has been found to be an extremely effective method for dealing with lower back pain. A study published in the International Journal of Neuroscience concluded that "lower back pain is reduced and range of motion was increased after massage therapy" in a group of lower back pain sufferers.1 The group was compared to a group of similar patients that underwent progressive muscle relaxation.

The group that underwent 30-minute massage therapy sessions twice a week for five weeks reported less pain, depression, anxiety and improvements in sleep. Greater trunk movement was reported and their serotonin and dopamine levels were higher. Serotonin and dopamine are responsible for feelings of calm and euphoria.

For more information on how massage therapy can reduce your lower back pain and improve the quality of YOUR life, please give our office a call.

  1. Hernandez-Reif M, Field T, Krasnegor J, Theakston H. Lower back pain is reduced and range of motion increased after massage therapy. International Journal of Neuroscience 2001;106(3-4):131-145.

Muscle Relaxants Ineffective for Acute Low Back Pain

Low back pain is a common condition in the US. A current study from the journal Spine sums up the scope of the problem:

“[Low back pain] accounts for 15 million physician visits per year and an estimated cost of $192 million in 1990. Low back problems are the second most common cause for office visits to primary care physicians, and back pain is the most common reason for office visits to orthopedic surgeons, neurosurgeons, and occupational medicine physicians. It ranks third among indications for surgery. The content of the care provided by these allopathic physicians consists of evaluation, reassurance, advice regarding activities, physical methods, medications, and surgery.”

The goal of this study was to evaluate the effectiveness of muscle relaxant use in patients with acute low back pain. The authors prospectively collected data on 1,633 patients from a wide range of health care providers: primary care, chiropractic, orthopedic, and HMO patients.

The individual practitioners treated the study subjects as they would treat any other patient. Each subject was given the Roland-Morris survey to assess loss of function. The authors of the study then contacted the patients at 2, 4, 8, 12 and 24 weeks after the baseline interview to see if they were “completely better.”

  • The patients taking muscle relaxants had higher Roland-Morris scores.
  • 49% of the patients received muscle relaxants at some point during the study.
  • The researchers found that patients receiving muscle relaxants had a significantly longer recovery period than did those who did not receive the drugs:

Muscle Relaxants and Chiropractic

“[The findings] indicate that patients taking muscle relaxants, after controlling for baseline status, return to self-assessed ability to perform their daily activities more slowly than patients who do not take muscle relaxants.”

The authors then wondered if perhaps the delayed recovery was due to an initially higher score on the Roland test. The authors then looked at just those patients with Roland scores higher than 12. The authors found that the high-scoring patients who were prescribed muscle relaxants took 19% longer to reach functional recovery than patients who were not given muscle relaxants.

An additional area of concern is the adverse affects that can be experienced with these medications:

“Muscle relaxants can be sedating, may increase fall risk, and impair the ability to drive automobiles or operate machinery. There is also some concern relating to possible risk of dependency for benzodiazepine medications.”

The authors conclude:

“This large cohort study showed no evidence of benefit and even a delay in functional recovery for severely affected patients who take muscle relaxants in the setting of acute back pain.”

Bernstein E, Carey TS, Garrett JM. The use of muscle relaxant medications in acute low back pain. Spine 2004;29(12):1346-1351.

Performance Testing of Low Back Pain Patients

This study was designed to evaluate if physical performance tests were reliable and valid in low back pain patients. Using a sample of 44 LBP patients and 48 pain-free subjects, the authors compared the two groups as they performed in multiple tests—such as the "Lumbar Flexion," "Five-Minute Walk," "Sorensen fatigue test," and "Repeated Sit-to-Stand." As well, the subjects took self-report tests to express their perceived levels of pain and disability, as a means of comparison to the physical functioning and endurance tests.

The authors found the battery of tests reliable. Another benefit of these tests is that since they are easily administered, good reliability can be found in a clinical context. And after testing and retesting subjects, scores still were stable—which indicates a patient only has to perform the task/test once, and a reliable score will emerge.

The authors found a moderate correlation between the physical performance tests and the self-report pain questionnaires:

"Further, although physical performance and self-report of disability were moderately correlated, the correlation between disability and lumbar flexion was trivial. This shows that physical performance measures are much better indicators of a patient�s ability to function than the frequently used impairment measure of spinal range of motion. Low back pain is a problem of activity intolerance; therefore, clinical assessments should be activity based."

The authors conclude that the battery of tests are useful indicators of disability. A strong correlation between the self-reports of disability and the tests confirmed an association between a patient�s perception of their disability and their actual physical performance.

Simmonds MJ, Olson SL, Jones S, et al. Psychometric characteristics and clinical usefulness of physical performance tests in patients with low back pain. Spine 1998; 23(22):2412-2421.

Pre-Work Screenings and Low Back Injuries

This study set out to assess if pre-work screening methods with hospital employees reduced the low back injury rate, lost workdays, and medical costs. The screening was intended to match an employee's physical capabilities with the physical demands of a job. The screening consisted of assessing posture, flexibility, strength, and range of motion. Additionally, the session included instruction on lifting techniques and body mechanics.

Over 10 1/2 years, 1457 pre-work screening were performed. In that time 177 back sprains and strains occurred. When comparing the rate of back injuries between the screened and unscreened personnel, no significant differences occurred. But, the amount of lost work days and medical costs decreased significantly among the screened employees:

"These findings suggest that though the rate of back sprain or strain injuries do not decrease, the severity of those injuries do decrease significantly over time. Also, the use of the prework functional screen offers the employer the highest degree of protection against rising lost work days and incurred medical costs that occur as the result of back sprain or strain injuries."

�The authors conclude that preventive measures and pre-work screenings will aid an employer in reducing its various costs and help identify the individuals who are not able to perform the physical demands of the job they are being hired for.

Nassau D. The effects of prework functional screening on lowering an employer's injury rate, medical costs and lost work days. Spine 1999;24(3): 269-274.