Low Back Pain

Low Back Pain: Overview

Eight out of ten Americans will experience a backache at some point.  Back pain is the second most common reason for visits to the doctor in the U.S.  The causes of lower back pain are numerous. Chronic Lower Back Pain. Most medical physicians rely too heavily on diagnostic tests, especially for lower back problems.  As a consequence, many patients that suffer from lower back pain do not find relief: the tests may show that little is wrong, or show abnormalities that are not the cause of the problem.  In one magnetic resonance imaging study of 98 people, none of whom had back pain, bulging disks were detected in 52% at one or more intervertebral disks and 27% had protrusions.  These findings emphasize the importance of matching test results with the patient's description of symptoms before contemplating surgery.  Some specialists recommend being very conservative in managing patients with back pain.  Before ordering an MRI there really should be a reason.

Causes and Development

Acute Lower Back Pain is usually due to muscle strain.

Some causes of chronic low back pain include: prostatitis, hidden food allergies, hypothyroidism, autointoxication or intestinal toxemia (self-poisoning by harmful gut bacteria), mercury toxicity (if stored in the sensory ganglia near the low back), arthritis, kidney involvement, and psychological issues.  In women, gynecological conditions such as endometriosis, menstrual cramps, fibroid tumors, and pregnancy are sometimes the cause.

Diagnosis and Tests

Further diagnostic work is not necessary for acute back pain unless there are red flags such as:
  • Possible fracture (following major trauma, or minor trauma in older patients or patients who may have osteoporosis)
  • Possible tumor or infection of a patient aged over 50 or under 20, a history of cancer, constitutional symptoms such as fevers, chills and weight loss, risk factors for spinal infection, recent bacterial infection, intravenous drug use or immunosuppression, pain that is worse when lying on back, or severe night-time pain.
  • Possible cauda equina syndrome (saddle anesthesia, bladder dysfunction, severe or progressive neurologic dysfunction in the legs, lax anal sphincter, major motor weakness in quadriceps (knee extensors), ankle plantar flexors, evertors, and dorsiflexors (foot drop).

Treatment and Prevention

Found Not to be Helpful: Traction – In evaluating 151 patients over 6 weeks for nonspecific low back pain it was found that traction was not effective for patients with low back pain.  ["Efficacy of Traction for Non-Specific Low Back Pain: A Randomized Clinical Trial", by Beurskens, Anna, J., et al, The Lancet, December 16, 1995;346: pp.1596-1600]

Back Belts.  In the largest prospective cohort study of back belt use, adjusted for multiple individual risk factors, neither frequent back belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain.  [JAMA.  2000;284: pp.2727-32]

Prognosis

Approximately 90% of patients with acute low back pain recover within 4 weeks without therapy.

Low Back Pain

Information On This Page

Signs, symptoms & indicators of Low Back Pain:

Symptoms - Skeletal

Having poor posture may be a sign or symptom of Low Back PainHaving poor posture
A lifetime of poor posture and poor lifting and bending habits may stress ligaments posterior to the intervertebral disk to the point that even a minor stress precipitates a herniation and low back pain.

Risk factors for Low Back Pain:

Autoimmune

Ankylosing Spondylitis increases risk of Low Back PainAnkylosing Spondylitis
The inflammation occurring in cases of ankylosing spondylitis usually starts around the sacroiliac joints i.e.  the areas where the lower spine is joined to the pelvis.  The pain is worse during periods of rest or inactivity, often awakening patients in the middle of the night.  Symptoms typically lessen with movement and exercise.  Over a period of time, pain and stiffness may progress into the upper spine and even into the chest and neck.

Habits

Problems Associated With Lack Of Exercise often increases risk of Low Back PainProblems Associated With Lack Of Exercise
Exercise that strengthens the abdominal musculature sometimes helps reduce low back pain.  Further, strenuous exercise involving significant movement of the lower back has resulted in pain reduction/elimination.

Hormones

Infections

Musculo-Skeletal

Osteoporosis - Osteopenia often increases risk of Low Back PainOsteoporosis - Osteopenia
Back pain is an early sign of bone loss.

Nervous System

Guillain-Barre Syndrome often increases risk of Low Back PainGuillain-Barre Syndrome
Pain in the lower back, buttocks or thighs is common, and is often the earliest symptom.

Nutrients

Copper Deficiency may increase risk of Low Back PainCopper Deficiency
A copper deficiency has been associated with weakening of connective tissue, which in turn can contribute to the development of slipped or herniated discs.

Reproductive

Tumors, Benign

Fibroids often increases risk of Low Back PainFibroids
See link between Constipation and Fibroids.

Tumors, Malignant

Low Back Pain suggests the following may be present:

Autoimmune

Low Back Pain may suggest Ankylosing SpondylitisAnkylosing Spondylitis
The inflammation occurring in cases of ankylosing spondylitis usually starts around the sacroiliac joints i.e.  the areas where the lower spine is joined to the pelvis.  The pain is worse during periods of rest or inactivity, often awakening patients in the middle of the night.  Symptoms typically lessen with movement and exercise.  Over a period of time, pain and stiffness may progress into the upper spine and even into the chest and neck.

Infections

Nervous System

Low Back Pain may suggest Guillain-Barre SyndromeGuillain-Barre Syndrome
Pain in the lower back, buttocks or thighs is common, and is often the earliest symptom.

Tumors, Malignant

Recommendations for Low Back Pain:

Action

Book Reading may help with Low Back PainBook Reading
John E.  Sarno, MD, has successfully educated a high number of chronic low back pain sufferers by teaching them how psychological issues can be converted into back pain.  The pain is then eliminated or controlled by a new awareness of the real reason behind the pain.  When no structural or organic cause is detected, his success rate is 80-90%.  All required information is in his book, The Mindbody Prescription.

Amino Acid / Protein

L-Phenylalanine may help with Low Back PainL-Phenylalanine
The brain responds to pain signals by producing and activating morphine-like hormones called endorphins.  This pain relief effect lasts for about 30 hours (longer than known analgesics), and without side-effects when given frequently.  It was discovered that d- and dl-Phenylalanine (DLPA), but not l-Phenylalanine, inhibit several of the enzymes responsible for endorphin destruction.  DLPA appears to restore endorphin levels to a normal range, while simultaneously producing a reduction in pain.  It often equals or exceeds morphine or other opiate derivatives in its effect and is non-addictive.  Start with 500mg qd and work up to 3-4gm qd.  This is a precursor for epinephrine and phenylethylamine (PEA).  PEA has amphetamine-like stimulant properties.  Chocolate contains high levels of PEA.

Botanical

Boswellia may help with Low Back PainBoswellia
Boswellin is a standardized extract from the Boswellia Serrata tree in India.  It is the first herbal remedy to have documented clinical evidence that it is useful in rheumatoid arthritis, osteoarthritis, low back pain, soft tissue rheumatism and myosistis symptoms.
Chlorella may help with Low Back PainChlorella
Chlorella or other algae may reduce circulating toxins and bowel autointoxication, and consequently improve chronic lower back pain.

Diet

Increased Water Consumption is highly recommended for Low Back PainIncreased Water Consumption
Drink lots of water to maintain optimal hydration for disc integrity, and help reduce any acid buildup in muscles.  Often two large glasses of water helps within minutes.  Consistent rehydration may eliminate and prevent future low back pain.

Digestion

Bromelain may help with Low Back PainBromelain
See the link between Lower Back Pain and Digestive Enzymes.

Drug

NSAIDs may help with Low Back PainNSAIDs
Use pain medication, if necessary, such as Tylenol, Aleve or another NSAID, such as aspirin.

Habits

Posture Improvement often helps with Low Back PainPosture Improvement
Be careful when getting out of bed.  Turn to your side, bring your knees up, and then push up as knees swing down toward the floor.  Most importantly, always follow the advice "bend with your knees, not your back" – especially when lifting heavy objects.  Better still, don't lift heavy objects!

There is a particular exercise that has relieved back pain that occurs after prolonged periods of sitting.  The technique is: "Sit up straight.  Put your feet on the floor, then raise both feet off the floor at the same time 1 inch.  This lightens the abdominal muscles and is the sitting-up equivalent of the old bent knee sit-up exercises".  This exercise can be done almost anywhere.
Aerobic Exercise may help with Low Back PainAerobic Exercise
For ACUTE lower back pain, exercise should be avoided during the recovery period.  [The New Eng J of Med.  Feb.  9, 1995;332(6):35 pp.1-55]

However, in cases of CHRONIC lower back pain, normal activity produces better recovery than bed rest, so you should stay mobile.  The success of using exercise as a treatment of low back pain and rehabilitation is overwhelming.  The tissues of the vertebral column need the stresses of exercise, even under conditions of back pain.  Exercises to strengthen the back and abdominal muscles can be useful, but only after recovery from the acute phase.
Weight Training may help with Low Back PainWeight Training
See the link between Lower Back Pain and Aerobic Exercise.

Mineral

MSM (Methyl Sulfonyl Methane) often helps with Low Back PainMSM (Methyl Sulfonyl Methane)
Many have reported that the use of MSM has relieved chronic lower back pain and spasms/cramps.
Magnesium may help with Low Back PainMagnesium
Some doctors consider the use of magnesium to be beneficial for reducing muscle spasm.
Molybdenum may help with Low Back PainMolybdenum
Margaret Moss, MA, found that taking oral molybdenum over a 28-day period produces a "statistically significant improvement" in patients with arthritis and other aches and pains as well as in their general health.  Moss monitored
14 middle-aged people with symptoms of arthritis, low back pain, frozen shoulder, rheumatoid and osteoarthritis, as they took 400-500mcg daily (in 4-5 doses of 100mcg) of molybdenum amino acid chelate.

Nutrient

Oriental Medicine

Acupuncture may help with Low Back PainAcupuncture
Acupuncture can help in cases of chronic lower back pain.

Physical Medicine

Calming / Stretching Exercises often helps with Low Back PainCalming / Stretching Exercises
Yoga has consistently been used to cure and prevent back pain by enhancing strength and flexibility.  Both acute and long-term stress can lead to muscle tension and exacerbate back problems.  A number of components of yoga help to ease back pain.  Yoga postures provide gentle stretching as well as movements that increase flexibility and help correct bad posture.  Breathing exercises can affect the spine in various ways, such as movement of the ribs and changes in pressure within the chest and abdomen.  Exhaling can help relax muscles; relaxation provides a physiologic antidote to stress.
Neurostructural Therapy may help with Low Back PainNeurostructural Therapy
Neurostructural therapy can help remove chronic low back pain permanently.
Hydrotherapy may help with Low Back PainHydrotherapy
A warm bath with Epsom salts and/or heating pad two to three times for 20-30 minutes or longer, can help.
Manipulation may help with Low Back PainManipulation
Spinal adjustment can help in acute cases, but not in chronic cases unless a single adjustment proves helpful.
Not recommended:
Rest is sometimes not recommended for Low Back PainRest
Inactivity is definitely detrimental to patients with low back pain.

Surgery/Invasive

Prolotherapy often helps with Low Back PainProlotherapy
Chronic lower back pain is one of the easiest conditions to treat with prolotherapy.  See Pain, Pain, Go Away, by William J.  Faber, DO and Morton Walker, DPM.
Surgery may help with Low Back PainSurgery
Some dentists report treating chronic low back pain patients by removing infected bone in the third molar area.  Chronic fatigue and arthritic pain disappear in many patients with these conditions after removing dental infections.

KEY

Weak or unproven link: may be a sign or symptom of; may increase risk of; may suggest
Weak or unproven link:
may be a sign or symptom of; may increase risk of; may suggest
Strong or generally accepted link: often increases risk of
Strong or generally accepted link:
often increases risk of
Definite or direct link: is a sign or symptom of; increases risk of
Definite or direct link:
is a sign or symptom of; increases risk of
May be useful: may help with
May be useful:
may help with
Moderately useful: often helps with
Moderately useful:
often helps with
Very useful: is highly recommended for
Very useful:
is highly recommended for
Caution: is sometimes not recommended for
Caution:
is sometimes not recommended for