Intro to Mechanical Low Back Pain

A significant amount of chronic pain patients deal with chronic low back pain.  This is a massive topic that we begin to cover in this introductory article and will dive deeper in future articles.  In this article we will discuss  mechanical back pain which is separate from discogenic back pain.  The two main types of mechanical (axial) back pain are Sacroiliac Joint Dysfunction (SI Dysfunction) and Lumbar Spondylosis.

The Sacroiliac Joints are a pair of joints as the iliac crest attaches on either side of the sacrum, which is the bone just above your tailbone.  Patients with SI pain can have bilateral or unilateral pain.  SI joint patients typically have trouble walking up inclines, getting up from a seated position and the pain is a complex combination of instability in the SI joint, inflammation and many times associated piriformis tendon involvement.  There are physical therapists that spend their entire careers focused on treating SI joint pain and the therapy for SI dysfunction is completely different than physical therapy for common low back pain.  When patients plateau with physical therapy we have found tremendous success in targeted interventional injections to the SI region.  We will typically begin worth a combination of cortisone and anesthetic to work as both a diagnostic as well as therapeutic treatment.  Patients who experience only limited benefits from this treatment are then likely candidates for prolotherapy to the region which is a specific series of injections designed to harness  our body’s own natural healing process.  This is particularly helpful in patients who have an underlying instability in their SI joint.

Lumbar Spondylosis is medical terminology for pain emanating from the facet joints in the vertebrae.  The facet joints run on the back portion of the spine and we describe them as the ‘knuckle’ joints of the spine.  They allow the spine to twist and move and are classic causes of back pain anywhere along the spine but a very common cause of low back pain.  Classically, patients with facetogenic back pain describe pain with extension or rotation activities, standing to wash dishes and lifting activities. Many time patients will describe a catching sensation or will describe back pain that runs from the spine out along the belt line. As always we recommend a trial of physical therapy and various other modalities we have discussed in previous articles.  If patients fail all more conservative treatment we will consider facet joint injections.  If the facet joints injections help but are only temporary we will then consider Radiofrequency Ablation injection to the affected facets.  RF injections have a typical period of relief from 6-12 months.

The goal of these treatments are to improve function, decrease pain and hopefully avoid surgery.  As always, diet, exercise, weight management, stress reduction are all integral in helping to improve any treatments.

Cure your pain: Meditate

Meditation is an effective tool to help avoid additional prescription medications and help cure pain. Meditation can rewire the brain’s pain circuitry. Neuronal pathways within the brain get programmed every time you expect pain to occur — in time, less and less stimulus is needed to trigger the pain reflex. Eventually, the simple thought of pain becomes the true source, not necessarily the ailment itself.

Meditation can unhook your emotional reaction to pain. Our patients can get stuck in a brutal feedback loop, without even realizing it. Their anticipation of pain creates stress, stress leads to physical tension within the body — especially near the painful area, which ultimately leads to more pain.

Meditation teaches you how to emotionally detach from your negative thoughts and physical sensations, where you no longer expect pain, nor resist it when it does occur.

Meditation can also help us treat our natural flight or fight response to pain which can be abnormally triggered in chronic pain patients. The flight or fight increases cortisol stress levels. Elevated stress levels increase blood pressure, increase inflammatory markers and increase pain. Meditation helps to reduce these harmful stress hormone levels.

Meditation can also boost natural endorphin levels which act as a natural pain reliever, decrease cortisol levels and allow patients to be in control of their pain

Cure your pain: Aquatic Therapy

Aquatic therapy is an excellent form of physical exercise which can be a critical component to helping patient’s find a ‘cure’ for their chronic pain.  Water is one of the oldest mediums of physical treatment with both physiological and psychological benefits.  Water provides an environment where one can move and exercise with little or no pain which can significantly lower stress on the joints.  The buoyancy provided by water allows chronic pain patients the ability to move with less effort.  Exercise in water allows for improved flexibility and ease of stretch.  The activity of water therapy also helps to boost natural endorphin levels a key to healing.  Staying active in a less stressful controlled water environment improves a patient’s quality of life, improves mood and can decrease a patient’s fear of pain.

Aquatic therapy represents a positive, rewarding and useful activity for enhancing mood.  It can help build hope and provide the motivation to continue activity.  Aquatic therapy provides an environment where patient’s  can focus on their abilities, not disabilities.  As we have mentioned in previous articles, becoming an active participant and enrolling in aquatic therapy is a positive decision our patients can make to decrease and control, possibly even cure, their pain.

Cure your pain: Patience

To ‘cure’ your pain a patient must learn patience. Your chronic pain is a complex web that developed through a course of misfortunate events and set up an engrained neurological pathway signal of pain to your brain.  We give the example of a girl walking across a dewy meadow.  A girl walks across the meadow in the morning, you would not see her path later in the day.  However, if that same girl walks across the meadow everyday for the next 6 months, even if she then misses one day you will be able to see the path she has walked.  This is the same as chronic pain patterns.

It took a long time to get to the point of your chronic pain and your ‘cure’ will also take a period of time and be a process to heal.  Don’t expect any magical healthcare provider to be able to solve all your ills in one visit.  Instead, understand that a patient with patience and understanding will have the best results.  Patience also helps to curb anxiety that intensifies pain and hinders the healing process.

We recommend mindful meditation, prayer, exercise or relaxation techniques to help patients practice patience.  These techniques will help decrease stress cortisol levels, boost natural endorphins and will help patients become more in tune with their body and help the healing process.

Cure your pain: Find your team!

To ‘cure’ your pain you will need to actively seek a health care team dedicated to achieving your goals.  Although our practice is only one example, you will want to seek providers that take a multidimensional approach.  Ideally you will have a healthcare provider who can manage any approach medication options needed.  Find a provider that doesn’t treat you like cattle.  Find  a provider that takes the time to know their patients and not someone who kicks you out the door after 10 minutes.  Avoid the ‘pill mill’ clinics!  If you suffer with underlying anxiety and depression, which is almost every patient, you will want to also work with a pain psychologist or psychiatrist to help with coping skills.

Some alternative add-ons that we recommend would involve joining a pain support group, either one specifically for your pain condition or one for chronic pain.  Having a support group to vent at, share ideas, share victories or frustrations is a critical component.  I like to call it the “Oprah  effect” as Oprah has done wonders with addressing issues and bringing them into the viewer’s living room.  So can these support groups be your “Oprah effect”.

As you become a more active participant, we then encourage our patients to actively seek an exercise instructor with experience in pain patients.  Yoga, Tai Chi, Pilates, aquatic Therapy are all wonderful examples of improving strength and flexibility while decreasing pain.

The goal is finding the right members to fill out your pain fighting team!

Cure for your pain: Friendship

An often overlooked part of any patient’s find for a ‘cure’ is a friend to offer support.  A friend, or some form of a supportive social network, is key to any recovery.  This can range from a family member, understanding neighbor, friend or online support group.

It’s seems that for some of our pain patients we act as much a counselor rather than a traditional medical provider.  Sometimes patients just simply need someone to vent their frustrations and aggravations to, someon who will take the time to listen and empathize with their situation.  For some of our patients, a trip to the office is the highlight of their social calendar for the month.

We encourage all patients to find someone who they can spend quality time with in a supportive and caring manner.  This social bond has an psychological impact on a patient’s recovery.  Having social support helps to motivate patients to be more active and involved.  For some patients, their social network is severely limited due to their disability or lack of proximity to family and friends.  Even patients with severe isolation issues can find some form of social network.  We encourage home bound patients to join an online therapy or support group that is tailored to patients with their similar condition.  This can be an effective tool to use as a sounding board for advice or support.  Of course, always discuss any information gathered on theses message boards with your local provider before implementing.

Find a friend who will listen and get involved.

‘Cure’ for your pain: Laughter

A very successful and overlooked tool in the treatment and eventual ‘cure’ of your pain is laughter.  Laughter holds many known benefits for the body from a both psychological and physiological perspective.

Laughter is known to lower blood pressure and reduce stress hormone levels.  Laughter, the actual act of laughing, can also improve cardiac health.  Laughter is known to improve immune function which is a vital factor in your recovery.  Laughing also triggers the release of endorphins which are your body’s natural pain killers.  Laughing also improves a patient’s general well being.  Laughter improves circulation and smooth muscle relaxation, of vital importance to patient’s suffering from chronic muscular pain conditions and ailments.

Beyond these physical responses to laughter, we have found that patients who regularly incorporate laughter have an improved outlook to their pain.  Patient’s who have the insight to laugh at their circumstances have improved quality of life and improved overall function.  The old theory of the glass half full really does seem to apply to pain patients and helps to set realistic expectations.

So find a few moments every day to add some laughter back into your life.