What causes back pain?

Serious causes are rare and include tumors or infections involving the spine or the spinal canal. The most common causes of back pain are related to osteoporosis, disc disease, osteoarthritis, which by thickening the bones which surround the facet joints, can narrow the space through which nerves travel from the spinal cord to the rest of the body. Another cause is looseness of the ligaments and tendons which stabilize the many joints in the spine. This looseness can be the result of injuries such as whiplash injury where ligaments and tendons get overstretched so much they cannot regain their original elasticity, poor posture, or age. Ligaments and tendons are made up of collagen, the same substance that holds up your skin, and, just as your skin loses its tone as you get older, so do your ligaments and tendons. If one of your vertebrae collapses because of osteoporosis, or if a disk collapses, the space between vertebrae decreases the ligaments and tendons which tether these structures are automatically loosened. There can then be slippage of the vertebrae one on the other causing severe pain.

Whiplash injury

It can also cause damage to the nerves that supply the skin of the back. These nerves have to cross the fascia, the fibrous sheath covering the muscles and bones of the back through tiny holes. Whiplash stretches the fascia and distorts these holes, which become slits. These squeeze the nerves and cause them to swell. Once swollen, the nerves are trapped in these holes and cannot slim down as they keep re-injuring themselves on the walls of these holes. As long as they remain swollen, these nerves will send pain messages to the brain. This pain can spread down the legs, and last for many years. Pain due to loose ligaments or tendons or arthritis only comes when you move the ligaments or tendons or the joints. Nerve pain, on the other hand, can be severe and happen at any time even when you are not moving at all. If you press lightly on an area with nerve pain, the pain gets much worse.

Back pain treatments

One of the most effective treatments for chronic low back pain is perineural injection therapy (nerve blocks ). If you have suffered from back pain for a long time, there is a very high likelihood that it is at least in part due to swollen nerves supplying the skin of your back. When these nerves are injured, they swell, and when they swell, they are too big for the tiny holes in the tough membrane which covers the muscles of the back. Because of this, whenever you move, the nerves move back and forth in these holes, rubbing themselves against the walls of these holes, injuring themselves even more, which makes them swell even more. Perineural injection therapy (nerve blocks ) reduces the swelling of these nerves. When they are back to normal size, they no longer injure themselves, and your pain stops. You can usually tell if your pain is coming from the nerves that supply the skin of your back. Nerve pain can be severe even when you are resting and can be made worse by pressing lightly on the affected areas. Many people with chronic back pain have been successfully treated with nerve blocks . Because this treatment is very safe, it is worth trying at least once, particularly if your pain has not been helped by other treatments.

Belts which can provide support for your spine and also relieve your pain, when you’re wearing them. Unfortunately, like every girdle, they will prevent your own muscles from working and muscles which are not used tend to waste away, leaving your spine ever more unstable and likely to hurt.
Prolotherapy is another treatment for back pain back pain. Prolotherapy, a series of injections of growth promoting substances has been shown to be effective in stimulating the growth and repair of ligaments and tendons. Injections to the spine ligament and tendon insertions strengthen and thicken them. These stronger ligaments and tendons will help restore the stability of your spine and help correct the cause of back pain. Prolotherapy has been shown to reduce the overgrowth of bone which occurs in osteoarthritis of the fingers and of the knee. It probably does so because it stabilizes the joints by strengthening the ligaments that surround them. This reduces the wear and tear on the joints which is the main reason bones around the joints proliferate. If this occurs in your back it may help free up the nerves that are squeezed because of osteoarthritis of the facet joints. If you have tried all the other treatments and still experience pain, you may want to try prolotherapy. There is a good chance that prolotherapy can bring you relief from your back pain. There have been several randomized, double-blind, placebo-controlled “gold standard “ studies on people with severe and prolonged low back pain which prove that prolotherapy works better for back pain than conventional treatments. A retrospective study published in 2009 of 145 patients with low back pain for more than four years treated with prolotherapy showed that 89% had more than 50% pain relief, 75% were able to completely stop taking pain medication, more than 80% showed improvements in walking, exercise ability, anxiety, depression and overall disability.
Surgery may be needed if the cause is serious, such as a tumor, or a severe narrowing of the spinal canal or of the space between the vertebrae where nerves leave the spinal cord to reach other body parts. At times, it becomes necessary to remove parts of the vertebrae to relieve the pressure on the spinal cord. This may leave you with an even more unstable spine. Minimally invasive procedures can now be used to blow up a collapsed vertebra, but the heat generated when the glue is inserted in the vertebra can damage nearby nerves or the spinal cord. A slipped disc, or bone encroaching on a nerve can be removed with keyhole surgery. In Canada, there can be long wait lists for these procedures. Elsewhere, they are very costly.
Physiotherapy may help back pain by improving your posture and strengthening the muscles which stabilize your back. Pilates exercises because they strengthen the muscles which control the body’s core can prove very effective in controlling back pain. Unfortunately, it is impossible to strengthen ligaments and tendons with exercise. Since your muscles are pulling on these weakened ligaments and tendons, your symptoms are likely to recur.

Narcotics can be used to deaden the pain and do not interfere with inflammation, but they can be addictive and should be used very sparingly.
Traction machines can at times help reduce a collapsed disc or slipped vertebrae and, thereby relieve the pressure on nearby structures. Unfortunately, if the back remains unstable because of loose ligaments and tendons which now have been additionally overstretched by the traction machine, the collapse or slippage is likely to recur.

Chiropractors may realign your back, but if your vertebrae are not solidly stacked and held together one on top of the other by strong ligaments and tendons, it is likely your back pain will recur as they once again slip out of place.
Acetaminophen, Tylenol and anti-inflammatory medications such as aspirin, ibuprofen, Advil, Motrin all relieve the symptoms that occur with overstretched ligaments and tendons. They relieve inflammation which is a cause of pain. Unfortunately, inflammation is the mechanism the body uses to repair itself, and using these medications interferes with the process which would help regrow the affected ligaments and tendons. Nonsteroidal anti-inflammatory references

References on prolotherapy for low back pain

Ross A. Hauser, MD, Marion A. Hauser MS RD Dextrose prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study Journal of prolotherapy 2009; 3:145 – 155

http://drreeves.com/Low-back-pain.html an excellent review of all the literature on prolotherapy in low back pain.

Donna Alderman, DO prolotherapy for low back pain, reasonable and conservative approach to musculoskeletal low back pain,disc disease, and sciatica. Practical pain management, May 2007 58-63. A good review, easy to read and understand and four case reports.

Klein RG et al. A randomized double-blind trial of dextrose glycerin phenol injections for chronic low back pain J spinal disord 1993; 6:23 33. 77% of subjects (53% of controls) had greater than 50% pain control at six months.

Ongley MJ et al. a new approach to the treatment of chronic low back pain. Lancet 1987; 2:143 – 6. 88% of subjects (39% of controls) had >50% pain reduction at six months.

Prolotherapy References