What is Chronic Back Pain(CBP)?
If you have lower back pain, you are not alone. Over a lifetime, 80% of people will have had lower back pain, with 26% of American adults reporting low back pain of at least one day in duration, every 3 months, 41% of adults between the ages of 26 - 44 years, will have reported having back pain in the previous 6 months. In the United States, it has been estimated that the costs of low back pain treatment, range between $38 - $50 billion a year and there are 300,000 operations annually. Along with the neck, lower back operations are the 3rd most common form of surgery that is performed in the United States.
Chronic back pain is measured by duration. While the typical waiting period to be considered chronic is 3 months, in our office, we consider anything over 1 month to be chronic in nature.
Chronic low back pain can come from any number of disorders and diseases, located in the back or near it, like degenerative disc disease, back strain, sciatica, disc herniation, or spinal stenosis.
What tests will diagnose Chronic Low Back Pain?
- History and Examination – this is often the most neglected, yet, by far the most important part of the diagnosis process. Quoting one of the best diagnosticians, Sir William Osler MD “Listen to your patients, they are telling you the diagnosis”. It is absolutely crucial to spend the time taking a detailed history.” You cannot find what you do not look for”. It is absolutely crucial to spend the time performing a detailed exam. Based upon the results, a determination will be made as to whether to begin treatment or to order further tests.
- X-Rays – disc degeneration, facet enlargement, sliding of the vertebrae, and the development of bone spurs can all be seen. Can also used to evaluate spinal alignment.
- Cat Scan (CT) – used to see boney structure, disc herniation and spinal stenosis, While less expensive than an MRI, it will expose the patient to high levels of radiation. Generally not the test of choice.
- MRI - is the most common procedure used to evaluate the vertebrae, discs, joints, nerves and soft tissues in the lumbar spine. While this is an excellent test to help differentially diagnosis low back pain, there are inherent problems as well. First is the cost, which can be as high $2000 Second, is that the time to perform the test is about 30-45 minutes and you must lie still. This may be very difficult for many patients. Third and most importantly, is that very often, the findings that the MRI shows may have nothing to do with the presenting condition. You have to “marry the patient to the MRI, not the MRI to the patient”. Again, the history and examination will determine treatment going forward, in spite of the MRI findings.
What treatment can be done to help Chronic Low Back Pain?
While there are certainly many different types of treatment, that are effective for chronic low back pain, many of which we readily use in our office, namely spinal manipulation, electric muscle stimulation, ultrasound and spinal exercises, it is not the intent of this article to list all of them but simply to introduce you to a type of treatment that you may not be aware of. SDT is not meant to necessarily replace any of the above therapies. In fact, utilizing them can be very helpful and will often enhance recovery. As a stand alone therapy or as an adjunct to pre-existing therapies, STD can be extremely effective to help you get well.
Spinal Decompression Therapy
Spinal Decompression Therapy is FDA approved and has a very high success rate for pain associated with herniated discs, degenerative disc disease and spinal stenosis.… even after failed surgery. It is a non-surgical, traction based therapy for the relief of back/ leg pain or neck/arm pain. During this procedure, we have the ability to cycle through distraction and relaxation phases and by proper positioning, a spinal disc can be isolated and placed under negative pressure, causing a vacuum effect within it, drawing it back from its herniated position and away from the nerve. If your condition is not discal and is secondary to arthritis, which can lead to spinal stenosis, we can change the parameters to focus on a more continuous shorter hold/relax phases, creating a “milking of the joints”. This will help to reduce inflammation and allow diffusion (absorption) of nutrients into the arthritic areas to lubricate and heal the irritated structures.
