Understanding Back Pain

Marc Darrow, MDMarc Darrow, MD

There are many structures in the lower back that can cause severe pain. These include muscles, ligaments, tendons, bones, joints and discs. For example, the outer rim of the disc can be a significant source of back pain due to its rich nerve supply and tendency toward injury.

During our body’s development, there is a great deal of overlap of nerve supply to all these structures. This makes it nearly impossible for the brain to distinguish between injury to one structure versus another.

For example, a torn or herniated disc can feel identical to a bruised muscle or ligament injury. This is where an examination into the cause of the pain is important.

Axial, or mechanical back pain

This pain can run the gamut from a very sharp to a dull ache. It may occur all the time, or it may come and go. It also varies in intensity from very mild to extremely severe. One patient may report that his/ her lower back is only sore when having been seated for a long time, or after working in the garden. Another patient may report severe, debilitating pain and need assistance to walk or stand, or even to get up from a sitting position. While one patient is perfectly straight, the other is bent over and locked in a crooked posture. The one thing that is common in these conditions is that the pain is restricted to the lower back area.

Referred pain

Here, patients complain of having an achy, dull type of pain that seems to move around. The discomfort comes and goes and varies in intensity. This achy pain starts in the low back area and commonly spreads into the groin, Buttock and upper thighs.

Radicular pain

In this case, the pain is described as deep and usually constant. It follows the nerve down the leg and is often accompanied by numbness or tingling and muscle weakness.

The most common example of this type of problem is the sciatic pain that radiates along that sciatic nerve – down the back of the thigh and calf into the foot. This type of pain is caused by injury to a spinal nerve. Some of the possible causes of this are a disc protrusion or bulge, arthritic changes or a narrowing of the opening through which the nerve exits.

In all types of back pain, your health habits play an important role. For example, there are certain foods that are high in the fats that cause more Inflammation. Limiting intake of these animal fats and increasing your intake of the good fats that reduce inflammation may play an important role in your healing. Smoking is another health concern. Statistically, smokers are slow healers with respect to back pain.

Prolotherapy and Back Pain

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 Prolotherapy on back pain, 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), 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. Sixty-percent were currently using non-steroidal anti-inflammatory drugs (NSAIDS). A half-dozen were experiencing such intense pain that they were taking Narcotic. A whopping 91% had difficulty sitting still for any length of time, and 65% had difficulty sleeping due to their pain. Seventeen-percent had difficulty walking, 21% experienced decreased sexual activity, and 4% were completely bed-ridden.

Six months after the treatment, 35 of the 40 people who had 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. (Ongley M, Klein R, Dorman T, Eek B, Hubert L. A New Approach to the Treatment of Chronic Low Back Pain. Lancet. 1987;2:143-146.)