About Back Pain & Back Pain Relief

According to the National Institute of Neurological Disorders & Stroke, back pain is the second most common neurological ailment in the U.S., behind headache.  Thirty-one million Americans, or approximately 10% of the U.S. population, experience low back pain at any given time; and it is estimated that 80% of people will experience back pain at some point in their lives. (Source: American Chiropractic Association cited statistics).  The direct and indirect health care costs in the USA are estimated to be over $90 billion per year (Source: The Economic Costs of Lower Back Pain, Dr. David L. Phillips,  2004 ).  Acute low back pain is the fifth most common reason for all physician visits (Hart, et al. 2005). Additionally, 50% of the working population has back pain every year (Nachemson 1992). The correlation between imaging results and symptoms is weak (Jensen, et al. 1994).  It is also estimated that 85% of patients cannot be given a precise patho-anatomical diagnosis for back pain, which further confounds the differential diagnosis.

Not only are more people seeking treatment for back pain, but the price of treatment per person continues to increase yearly. In a retrospective study published in the Journal of the American Medical Association (JAMA; Martin, et al, 2008), researchers at the University of Washington and Oregon Health & Science University compared national data from 3,179 adult patients who reported spine problems in 1997; they found that inflation-adjusted annual medical costs increased from $4,695 per person to $6,096.  Despite the rising expenditures, 15 percent of U.S. adults reported back problems in 2008, an increase from 12 percent in 1997.

The need for alternative approaches for the relief of lower back pain is also underscored by other important issues:

  • A multitude of surgical procedures are utilized in order to relieve lower back pain, but produce limited efficacy (less than 25% of back surgery patients show pain free function); in addition, surgical procedures for the lower back have significant morbidity rates (more than 35%).
  • Pharmaceutical approaches also have associated morbidity, particularly gastro-intestinal side effects. In addition, many patients find initial relief, but most analgesics lose effectiveness over time.
  • Simple devices such as back supports, hot/cold backs, and stretching apparatus have no clinical proven efficacy, but control more than $5 billion of the overall pain management market;
  • More sophisticated (and costly) devices such as TENS have shown only modest clinical efficacy.
  • There is continued interest for new pain relief products that are non-invasive and non-pharmacologic.

Few randomized, controlled studies are available to help guide the management of patients with acute low back pain. Consequently, there are wide variations in care for acute low back pain. Medical treatment for the acute phase of this condition usually begins with bed rest and non-prescription analgesics such as non-steroidal anti-inflammatory medications and/or prescription muscle relaxants. If progression to the chronic phase occurs, antidepressants are sometimes added. In addition, anticonvulsants are used in cases where neuropathic pain is suspected. On occasion, narcotic analgesia is required for acute flare-ups.  Narcotics can also be employed in treatment for chronic pain as a final step for nonparenteral pharmacologic treatment. Local anesthetics and steroids are also used.

According to several studies (e.g., Andersson 1999), chronic low back pain is back pain that lasts 8 – 12 weeks or longer. For chronic back pain sufferers, spontaneous improvement is infrequent and various treatments include exercise, bed rest, electrical acupuncture, epidural injections, and more invasive surgical treatments. All of these treatments are of unproven benefit (Deyo, et al. 1986; Weinstein, et al. 2006). Epidural steroid injections to relieve back pain have shown variable results. An analysis of 12 randomized clinical trials showed that epidural steroid was no better or worse than the reference treatment (Koes, et al. 1995).  In a recent randomized, controlled clinical study at the University of Maryland (Annals of Internal Medicine, 2005), it was shown that acupuncture was more effective than injections.

The efficacy of lumbar surgery for back pain compared to non-operative treatment has also recently been called into question (Weinstein, et al. 2006). Non-invasive adjunctive therapies such as corsets and braces have also been used, although their efficacy has not been demonstrated in methodologically sound studies (Walsh and Schwartz 1990). In non-controlled studies, however, up to 89% of patients report benefit from such therapies.

Other treatment options for chronic low back pain include transcutaneous nerve stimulator devices (TENS) and various electromagnetic stimulation protocols. Both treatments have had varied results. In fact, TENS treatment has little effect above placebo in patients with chronic low back pain (Brosseau, et al. 2002).  Despite the equivocal results from TENS clinical studies for lower back pain, it is clear that weak, non-ionizing electromagnetic fields can exert a wide range of beneficial medical effects (Ieran, et al., 1990; D. Foley-Nolan, et al, 1990). It is important to note that the reported positive results have been with low energy, low wavelength treatments; however, these technologies have been cumbersome, requiring expensive equipment residing in medical facilities (such as pulsed electromagnetic therapy, or PEMF).