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LOWER
BACK PAIN
 Marc Darrow, M.D.
Lower
back pain is one of the most widely reported types
of pain in the United States today. It is the most
common cause of industrial disability, and the leading
cause of physical disability payments taxing our Social
Security system.
Studies suggest that the
prevalence of
lower back pain in the adult population of
the United States is at least 60% and its incidence,
about 30%. Astonishing as it may sound, 10-12% of the
population is seeking health care for
low back pain at
any given moment.
Because the structures of the lower back are very
complicated, and the specific symptoms of lower back
pain are highly varied, lower back pain is one of
the most difficult to diagnose and treat.
While some forms of back
pain are transient—such as simple bruises caused by
light trauma, which require at most an analgesic
treatment to ease the pain until it heals
naturally,—persistent or chronic lower back pain usually
develops over an extended period of time, due to
interacting causative factors involving the vertebrae
and their supporting tissues. Although these two types
of "extended pain" are similar in many respects,
researchers have distinguished them according to a few
basic guidelines.
Generally, pain is
described as "persistent" if it does not heal promptly,
based on statistical standards; or, if it recurs
regularly, in defiance of any treatments provided.
"Chronic" is the term usually reserved for pain lasting
longer than three months, which, in both cause and
effect, often involves psychological as well as physical
factors, or combinations of the two.
As with all types of pain,
there are many possible factors causing or contributing
to both types of extended lower back pain. The two main
causes are
spondylosis, or
degenerative disk disease, and muscular or ligamentous
Inflammation.
In fact, damage to
ligaments
is estimated to be responsible for up to 70% of all cases of lower back
pain. In my clinic, I would estimate these causes to be a high as 95% of
back pain.
The
chronic lower back
pain patient typically experiences some type of trauma
to the lower back that causes injury to the interspinous
and supraspinous ligaments.
This may causes some
forward slippage of the fifth lumbar vertebra onto the
sacrum, which in turn causes excessive pressure on the
vertebra disk. Fissures may occur at the annulus
fibrosis, and this begins the degenerative disk problem.
Ligaments are designed to
handle a normal amount of stress that will stretch them
to their natural limit, and will return to their normal
length once the stress is removed. If additional
(traumatic) stress is applied— stretching the
ligament
beyond its natural range of extension—the ligament will
not return to its normal length, but will instead remain
permanently
overstretched, diminishing its power. Such a
condition is called
Ligament
laxity.
Ligament laxity in the lower back, as elsewhere in the
body, may be caused by a major traumatic injury,
repeated minor injuries to the same area, or simple
normal aging. Unlike muscle tissue, ligaments have a
very limited circulatory system that means a poor supply
of blood to replenish them. This is why ligaments do not
heal well on their own, and why
Prolotherapy
is needed in these types of injuries to stimulate
circulation and to promote new cell growth.
With its overburdened matrix of ligaments, muscle,
nerves, and small, interlocking bones, the spine is
an area that benefits greatly from
Prolotherapy.
The sacrum at the base of the spine is the
"keystone" bone, on which all of the most vital structures of the body rest.
Besides the lower vertebrae and the rest of the spinal column that it supports,
it bears the weight of the entire torso with all its major organs.
And since the core of the
central nervous system is housed
in the spinal cord, and the
nerves affect not only the legs
and other extremities, but also
the glands and the organs, the
importance of keeping this area
healthy and properly aligned
becomes readily apparent. It
also explains why so much of the
pain reported to physicians is
rooted in the lower back.
Descriptions and diagnosis of
common
low back pain include:
Lumbrosacral strain or
sprain indicates a soft tissue
injury of the lower back,
equivalent to a sprained ankle.
Discogenic syndrome is
used to describe pain
originating in the lumbar disk,
due to tears in the annulus,
release of chemical mediators,
or micromotion.
Disc Herniation
indicates
a displacement of the nucleus
pulposus from the intervertebral
space into the spinal canal or
foramen, or outside the foramen.
This can "pinch" a nerve root
and cause
sciatica.
Facet syndrome describes
pain originating in the
zygapophyseal or "facet" joints
between the vertebrae,
characteristically localized in
the back, aggravated by movement
and alleviated by rest.
Spondylolisthesis
is the
slipping forward of one
vertebral segment onto another.
Retrolisthesis describes the
inverse: the slipping backward
of one vertebra onto another.
Spondylolysis indicates a
defect in the structure of the
pars interarticularis, while
spondylosis is a catch-all
phrase describing the changes
that occur as a result of
degenerative disk disease, such
as desiccation of the disk,
narrowing of the interspace,
inflammation,
spurring or degeneration of the
bone, and ligament hypertrophy.
Spinal
stenosis is
used to describe the narrowing,
in part or in whole, of the
spinal canal, either through
spondylosis or a congenital
defect.
Spinal instability is a
very general term used when a
more precise diagnosis eludes
the physician. Specifically, it
refers to excess motion of the
vertebrae, and can be shown on
flexion and extension
x-rays. If
instability is severe, it can
cause spinal cord injury and
paralysis.
Perhaps the most distressing is "failed
back syndrome" -- an official-sounding term to
describe the pain of those poor patients whose surgical attempts have failed to
correct their problem.
The most common cause of failed
back syndrome is poor judgment
on the part of the physician.
Surgery prescribed as a last
resort, with a hope and a prayer
that it might alleviate the
pain.
Unfortunately, often times
surgery does little to help, and
in fact can make things worse.
Frequently surgery results in
post-operative scarring, which
often exacerbates the initial
problem or causes new pain
syndromes.
Subsequent "corrective" surgery
can help in some cases,
particularly if the damage done
by the first operation involves
clearly observable physical
complications like nerve root
compression, massive scarring,
bone spurring or foraminal
compression.
Unfortunately,
the rate
of
success
for
second
surgical
operations
in the
case of
"failed
back
syndrome"
is no
greater
than it
was for
the
initial
operation,
and
declines
with
further
attempts.
In the
words of
a
surgeon
involved
in such
procedures,
"In our
extensive
experience,
satisfactory
outcome
is
achieved
about
60% of
the
time.
Evidence
indicates
that
many
patients
suffering
from
residual
pain
after
multiple
operations
can
benefit
from an
intensive
rehabilitation
program.
Prolotherapy
to the
Rescue
A study
published
in 1987—by
which
time the
procedures
of
Prolotherapy
were
fairly
well
established—offered
dramatic
support
to
proponents
of the
still
basically
unknown
technique.
In the
first
double-blind
study on
the
effects
of the
treatment,
two
groups
of
carefully
screened
patients—with
at least
a one
year
history
of back
problems
that
hadn't
responded
to other
non-surgical
treatments—were
injected
with
either a
true
Prolotherapy
proliferant
(a
dextrose-glycerine-phenol
solution
originally
developed
to treat
varicose
veins),
or with
a
saline-based
placebo.
The test
subjects
had been
thoroughly
pre-screened,
with
full
clinical
evaluations,
x-rays
and lab
tests,
and the
82
patients
accepted
had
arrived
with
painful
conditions.
60% were
currently
using
non-steroidal
anti-inflammatory
drugs. A
half-dozen
were
experiencing
such
intense
pain
that
they
were
taking
Narcotic
medications
for
relief.
A
whopping
91% had
difficulty
sitting
still
for any
length
of time,
and 65%
had
difficulty
sleeping
due to
their
pain.
17% had
difficulty
walking,
sexual
activity
was down
in 21%,
and 4%
were
completely
bed-ridden.
Six
months
after
the
treatment,
35 of
the 40
people
who'd
received
the
actual
Prolotherapy
treatment
had
experienced
at least
a 50%
reduction
in
pain—a
success
rate of
88%. And
15 of
them
were
completely
pain
free--compared
to only
4 in the
control
group.
Other
"pain
score"
indicators
backed
up the
results
of this
data,
confirming
the
success
of the
therapy.
One
thing
was
eminently
clear: Prolotherapy
worked
for the
treatment
of
chronic
low back
pain. |
