Low Back Pain
Approximately 80 percent of Americans will have at least one bout with back pain during their lifetimes,
according to the American Association of Orthopaedic Surgeons.1 In fact, Americans see their doctors for low back pain more
than any other reason except the common cold and flu.2
Symptoms of Low Back Pain
Pain in the lower back can originate
from various places: the spine, muscles, nerves or other structures in the low back. The pain may feel like a tingling or
burning sensation, a dull aching, or a sharp pain, and it often comes with muscle spasms and stiffness near the spine and
sometimes with weakness in the legs or feet.
Low back pain can be acute or chronic. Acute pain is temporary, lasting
less than a month. Chronic pain lasts longer than three months and often is continuous.2
Causes of Low Back Pain
The
causes of low back pain are numerous and range from the extreme, like lifting a heavy object or being involved in an accident,
to the very ordinary, like moving too quickly or sitting too long in one position. A number of medical conditions contribute
to low back pain, such as:
• Small fractures to the spine from osteoporosis
•
Muscle spasms (very tense muscles that remain contracted)
• Ruptured, herniated, or degenerating
disc
• Poor alignment of the vertebrae
• Spinal stenosis (narrowing
of the spinal canal)
• Strains or tears of the muscles or ligaments that support the back
• Curvature of the spine and other medical conditions2
Diagnosing Low Back Pain
To evaluate
a person’s pain condition, a physician will usually gather a thorough medical history and perform a general physical
exam. The doctor also may conduct various diagnostic tests, such as neurological tests, blood tests and imaging tests. Other
tests may be performed, depending on the particular condition, including discography, computerized tomography, magnetic resonance
imaging (MRI), electrodiagnostic procedures, bone scans, thermography and ultrasound imaging.3
Treating Low Back Pain
Various treatments for low back pain are used and often begin with the application of ice and heat. Medications also may
be administered in conjunction with other therapies. Aspirin, naproxen and ibuprofen may reduce the swelling and inflammation
enough so that the back can heal. For more intense pain conditions, prescription medicines like anticonvulsants, antidepressants
or opioids may be used. In addition, patients may be scheduled for physical therapy, electrical stimulation of the painful
nerve or pain counseling.3
If these methods are unsuccessful, physicians may recommend another level of treatment, such
as injections to relieve the pain or to destroy a nerve. Other possible therapies involve freezing or heating the nerve so
it cannot transmit pain signals. Advanced treatments can include neurostimulation, which involves implanting a device that
uses mild electrical pulses to block pain messages before they reach the brain.
According to the National Institute
of Neurological Disorders and Stroke (NINDS), surgery is a last resort: “In the most serious cases, when the condition
does not respond to other therapies, surgery may relieve pain caused by back problems or serious musculoskeletal injuries.”
However, the institute states, “It may be months following surgery before the patient is fully healed, and he or she
may suffer permanent loss of flexibility. Since invasive back surgery is not always successful, it should be performed only
in patients with progressive neurologic disease or damage to the peripheral nerves.”3
Cost of Low Back Pain
Findings published in 2006 indicate that the total cost of low back pain in America was more than $100 billion per year,
including both direct and indirect costs. Direct costs included medications, hospitalizations and outpatient visits, while
indirect costs included lost wages, decreased productivity and the expenses of caregivers. The research also showed that fewer
than 5 percent of patients with low back pain account for 75 percent of the costs.4
Resources
People who think they
might be suffering from low back pain should talk with their physicians or other healthcare providers about their symptoms.
More information about low back pain is available from the American Chronic Pain Association (www.theacpa.org), the American
Pain Foundation (www.painfoundation.org), the National Institute of Neurological Disorders and Stroke (http://www.ninds.nih.gov),
and the National Pain Foundation (www.nationalpainfoundation.org).
Sources:
1 American Association
of Orthopaedic Surgeons Web site. Musculoskeletal conditions in the U.S. October 1999 Bulletin. Available at: http://www2.aaos.org/aaos/archives/bulletin/oct99/musculo.htm.
Accessed April 30, 2007.
2 U.S. National Library of Medicine and National Institutes of Health. MedlinePlus
Web site. Medical Encyclopedia. Back pain—low. March 6, 2007. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003108.htm.
Accessed March 22, 2007.
3 National Institutes of Health, National Institute of Neurological Disorders
and Stroke (NINDS). Low back pain fact sheet. NIH pub no 03-5161, July 2003. Available at: http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm.
2007.
4 Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences [abstract].
J Bone Joint Surg Am. 2006 Apr;88 Suppl 2:21-4. Taken from: PubMed. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16595438&dopt=Abstract.
Accessed April 3, 2007.
SCS for Failed Back Surgery Pain
The number of back surgeries in
the United States increased dramatically between 1992 and 2003.1 Correspondingly, so has the number of patients experiencing
failed back surgeries. Physicians refer to the chronic pain a patient suffers after undergoing unsuccessful surgery to relieve
back pain as “failed back surgery syndrome” (FBSS), or post-laminectomy syndrome. The prevalence of FBSS in the
United States is not exactly known, but it has been estimated to affect nearly 30 percent of spinal surgery patients2.
Treating Failed Back Surgery Syndrome
For a patient with FBSS, treatment options usually are very limited. This is
because more conservative and less invasive measures typically have been tried already, without success. After the failure
of one back surgery, patients may have the option of another back surgery. Some patients also are given the choice of spinal
cord stimulation (SCS), which has been available for several years with good results for many FBSS patients.
In a study
published in 2005, FBSS patients were randomly assigned either to have an SCS system implanted or to have a repeat back surgery.
The study found that 47 percent of patients treated with SCS were satisfied with the therapy, experiencing at least a 50 percent
reduction in pain; however, only 12 percent of patients with repeat surgery were satisfied. All of the patients were given
the opportunity to try the treatment that they had not been originally assigned. Of those who had an additional procedure,
43 percent of the repeat-surgery patients who tried SCS were satisfied with SCS, but none of the SCS patients who tried repeat
surgery were satisfied with the additional surgery.3
In a 2007 study, 74 percent of the patients studied said that SCS
was beneficial. The authors concluded that SCS does decrease the low back pain associated with FBSS.4 Further, in a comprehensive
review of medical literature by the department of neurosurgery at Wayne State University, it was reported that SCS was an
effective treatment for FBSS pain, with 60 to 80 percent of patients achieving effective pain relief with SCS. Additionally,
these patients had significant improvements in their quality of life and a much greater chance of returning to work than patients
who did not undergo SCS.5
Cost of Therapy
In the United States, Medicare spending for inpatient back surgery more
than doubled between 1992 and 2003. The biggest increase was in lumbar fusion surgery, which jumped from $75 million to $482
million, accounting for almost half of the more than $1 billion dollars spent on back surgeries in 2003.1
A 2004 review
of medical literature revealed that SCS was cost effective for the treatment of chronic pain. The researchers concluded that
SCS saved money in the long run by reducing patients’ demand for future healthcare.6 One study by British researchers
also showed SCS to be less costly and more effective than conventional, non-surgical medical care over the course of a patient’s
life.7
In an article published in Pain Practitioner in 2006, two European doctors wrote, “Studies consistently
report that over time, SCS is potentially cost saving to the healthcare system. At present, SCS is considered a ‘last
resort’ in the treatment of refractory neuropathic pain, yet evidence suggests that early intervention with SCS results
in greater efficacy and, in the case of FBSS, should be considered before re-operation.”8
Resources
People
suffering from pain after back surgery should talk with a physician, such as an interventional pain physician, or other healthcare
provider about their symptoms. More information about SCS is available from Advanced Neuromodulation Systems (www.Poweroveryourpain.com).
Sources:
1 Weinstein JN, Lurie JD, Olson PR, Bronner KK, Fisher ES. United States’ trends and
regional variations in lumbar spine surgery: 1992-2003 [abstract]. Spine. 2006;31(23):2707-2714. Taken from: PubMed. Available
at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=17077740. Accessed
April 30, 2007.
2 Javid MJ, Hadar EJ. Long term follow-up review of patients who underwent laminectomy
for lumbar stenosis: a prospective study. J Neurosurg. 1998;89(1):1-7. Taken from: PubMed. Available at: http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=9647165&ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum.
Accessed June 8, 2007.
3 North RB, Kidd DH, Farrokhi F, Piantadosi SA. Spinal cord stimulation versus
repeated lumbosacral spine surgery for chronic pain: a randomized, controlled trial. Neurosurgery. Jan 2005;56(4):98-107.
4 De Andres J, et al. Patient satisfaction with spinal cord stimulation for failed back surgery syndrome
[abstract]. Rev Esp Anestesiol Reanim. 2007 Jan;54(1):17-22. Taken from: PubMed. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17319430&query_hl=2&itool=pubmed_docsum.
Accessed April 25, 2007.
5 Lee AW, Pilitsis JG. Spinal cord stimulation: indications and outcomes [abstract].
Neurosurg Focus. 2006 Dec 15;21(6):E3. Taken from: PubMed. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17341047&query_hl=2&itool=pubmed_docsum.
Accessed April 25, 2007.
6 Taylor RS, et al. The cost effectiveness of spinal cord stimulation in the
treatment of pain: a systematic review of the literature. Journal of Pain and Symptom Management. Apr 2004;27(4) 370-378.
Taken from: ScienceDirect. Available at: http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T8R-4C1C83C-C&_user=10&_coverDate=04%2F30%2F2004&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a64adacf1044ee2fa755266cef07b45c
7 Taylor RJ, Taylor RS. Spinal cord stimulation for failed back surgery syndrome: a decision-analytic
model and cost-effectiveness analysis [abstract]. Int J Technol Assess Health Care. 2005 Summer;21(3):351-358. Taken from:
PubMed. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=16110715&dopt=Abstract.
Accessed April 26, 2007.
8 De Andres J, Van Buyten JP. Neural modulation by stimulation [abstract].
Pain Pract. 2006 Mar;6(1):39-45. Taken from: PubMed. Available at: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=17309708&query_hl=2&itool=pubmed_docsum.
Accessed April 25, 2007.
This is information was sent to me by the National Pain Foundation. I thought
these articles would be of interest to those with back troubles as well as CRPS.