In the U.S., between 40-90% [1] of adults suffer from at least one episode of low back pain in their lifetime, about 20 % develop chronic low back pain with persistent pain in over a year.[2]. National Institute of Health describes the definition of chronic low back pain is as followed:
“(1) How long has back pain been an ongoing problem for you? (2) How often has low-back pain been a current problem for you over the past six months? A response of greater than three months to question #1 and a reaction of at least half the days in the past six months’ to question # 2 would define chronic low back pain.”[3]
Over the past decade number of spine surgery has increased in the U.S. from Laminectomy, Discectomy, and Spinal fusion with an overall 40-50% success rate. The other 50%-60% of the patients end up with a condition called FBSS( Failed Low Back Surgery Syndrome). [4],[5]
Consumers or patients with low back pain often are confused and overwhelmed with the choices that are presented to them. In this article, I would like to provide a road map of how I guide my patients and to answer the question that we can heal our spine without surgery? The short answer is, it depends.
Recovering from low back injury depends on multiple factors such as:
1 - Source of low back pain, 2.Genetic predisposition, (certain spinal conditions are hereditary ) 3- Posture, and load ( work, Sleep, fitness level) 4- Nutrition( process food tend to have a more inflammatory effect on the body. Therefore it delays healing). MRI Studies has shown that patient who develops chronic pain has altered in their brain structure and function. Currently, researchers are investigating as to these changes are a result of pain or, it is the brain structure that alters first which result in patients developing chronic low back pain
That is why one person gets better in three to four weeks, while others suffer longer. There are certain risk factors such as age, fitness level, weight gain, pregnancy occupational, and mental status that plays a role in developing and healing of low back pain. Disc degeneration remains the leading cause of low back pain. Studies have shown that most people with low back pain find relief with a combination of manual therapy and exercise routine. Patients often ask :
1-when to use muscle relaxant or non-steroidal anti-inflammatory?
A: Anti-inflammatory medications reduce pain by decreasing inflammation. In the short term, they are useful; however, they have various side effects, and also it could give a false sense of security for patients in the absence of pain to overload and result in more damage.
2- What are the side effect of these medications?
A: Research indicates an adverse effect of NSAIDs on GI and building tolerance
3- When to consider non-surgical treatment and how to choose?
Recent studies shown the best non-surgical treatment of mechanical low back pain in the short term is a combination of spine manipulation provided by professionals such as chiropractors and osteopaths combine with specific physical therapy exercises.
4- When to choose Chiropractic vs. Physical therapy?
Both complement one another, so patients must find practitioners who are patient-centered and integrated and open to collaborating with other professionals in their approach.
5- Which exercises should I choose?
Your Physical Therapist or Chiropractor is the one to help you; they must evaluate everyone to understand the mechanism of pain and strengthen the right muscles within a reasonable time frame to enhance the back. By strengthening the core muscle, one can reduce the pressure of the upper lumbar spine by 50% and lower lumbar by 30%. Proper loading the body without causing damage to the discs or any other structure is the key to successful recovery regardless of the cause of the pain.
6- What about Epidural injection?
Epidural injections are steroid drugs that are injected directly in the Epidural area of the spine for faster results. Despite limited evidence for their effectiveness, they are often used to treat low bar pain. The general idea is by reducing location inflammation in the vertebral column, the pain will decrease. Currently, NINDS funded researches to investigate further to understand the cause of chronic sciatica pain.[3]
7- When to consider surgery?
There are times and places for surgery. It is when all the other non-surgical treatment method has failed; pain persists or, of red flags develops such as radiculopathy( Referral pain down the leg), paraesthesia( numbness and tingling sensations), cauda equina symptoms ( loss of control of bladder and bowel) and more importantly, it indicates spinal cord envolvements. At this point, surgery is an option to consider. I do recommend the second opinion, sometimes even third opinion.
I must note that research indicates there was no further damage to the structures if patients delayed the surgery, so take your time, do your research. It is best to start with the most conservative method to the most aggressive approach.
References:
1-Scott N, Moga C, Harstall C. Managing low back pain in the primary care setting: the know-do gap.
2-Pain Res Manag. 2010;15(6):392–400. doi: 10.1155/2010/252695.[PMC free article] [PubMed] [CrossRef] [Google Scholar]
3-https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Low-Back-Pain-Fact-Sheet
4-Deyo RA, Dworkin SF, Amtmann D, et al. Report of the NIH task force on research standards for chronic low back pain. J Pain. 2014;15:569–85. [PMC free article] [PubMed] [Google Scholar]
5-Chan CW, Peng P. Failed back surgery syndrome. Pain Med 2011;12:577–606. [PubMed] [Google Scholar]