Low Back Pain, a real pain in the ass

Low back pain is one of the most common causes for a trip to the doctor’s office.  Back pain can either be acute or chronic.  Chronic back pain is defined as pain that has lasted for greater than 12 weeks.

Millions of Americans suffer from chronic pain.

Chronic pain sucks.  Just ask anyone that deals with it.  It can take over your life.

And if you suffer from chronic back pain, good luck getting help. I mean just watch the look on your doctor’s face when you tell him/her that you need help with chronic back pain.  This isn’t all the doctor’s fault.  They just don’t know what to do.  It is very difficult to tell someone that you can’t help them.  It’s even more difficult to explain, “yes, I have a medicine that can give you freedom from pain, but it probably won’t work for very long”.  Because your response to that will be “I don’t care.  I hurt now.  I need help now.  I will worry about the future when it get’s here”

The truth is, there is no good treatment. There is definitely no one size fits all treatment.

So let’s talk medicine:

1. NSAIDs:  These are non-steroid anti-inflammatory drugs.  They help pain.  They help inflammation.  But, they don’t always help that much.  And long term use could cause such complications as kidney disease, stomach ulcers, and heart disease.   Examples: ibuprofen, diclofenac, meloxicam, naproxen.   So, in the right situation these work well.  But for long term use: better use caution.
2.  Acetaminophen (tylenol): mild pain reducer.  Could cause liver damage in excessive amounts.
3.  Muscle relaxers:  Not really a class of medicine, but a grouping of medicines with similar effects.  They are helpful with muscle spasms and pain reduction. They may cause drowsiness (normally beneficial if pain keeps you awake), or have dangerous interactions with other medications.  They could cause muscle weakness with long term use.  You may have problems if you have to stop them abruptly.
4. Opiates: Ah, now here is the thick of it.  Morphine, was once called “God’s own medicine”.  So what does that tell you?   Opiates include such medicines as hydrocodone (vicodin/lortab/norco), oxycodone (percocet, oxycontin), fentanyl, dilaudid, and heroin.  Considered to be a much stronger pain reliever than the above medicines.  So, why are people not getting better?  Why are people still in pain, when we have “god’s medicine” right at our finger tips?  I will explain more below.

Opiates work.  But like the other meds above, they carry great risk when used for extended periods of time.  Everyone understands that they carry the risk of addiction, but many people do not understand that addiction doesn’t just happen when someone tries to “get high”.  It also happens to normal people that just want to not hurt anymore.  Daily use of opiates can lead to tolerance (and the need for escalation of dosing), dependence (you may have withdrawal symptoms if stopping), and addiction.   Opiates can interact with other medicines and potentiate worrisome risks/side effects. Taking opiates every day can actually run you the risk of having increased pain (a complicated process that I won’t try to explain here).

My point is not to get bogged down into the details, but we need to be clear: there is no perfect medication treatment for pain.

What about non-medical treatment options?

1. manipulation (osteopathic or chiropractic)
2. water aerobics
3. acupuncture
4. physical therapy

These have their place, and they definitely can help.  I have found that people do best with these modalities when they have fewer overall medical problems and on less medications.  Now, that is purely anecdotal.

My tips

I have some things that are a little less conventional that could help.  Try it and see.

1. cold showers.  Stand in the shower and turn the hot water off.  Take 3 deep breaths in and out while the cold water runs over your head.  Try to not think of anything but your breathing.  Ignore the water.  Just breathe.  Now, after 3 breaths turn the warm water back on and warm back up.  Do this a total of 5 times.  Your goal will eventually be 5 times for 5 breaths, but you can build up to it.  This is a form of meditation.  Just focus on your breaths.  In/out/in/out/in/out.   Pain is nothing but nerves and chemicals telling your brain that you hurt.  If you can learn to master your brain, then you can master your pain.   Now, during the course of your day when you start to be overwhelmed by your pain, just start taking some slow deep breaths.  In/out/in/out.  Ignore the pain.  Just breathe.
2. meditate.  Similar to the above.  We are going to learn to master our brain, our emotions, and our senses.   Find a quiet area.  Sit down.  Close your eyes and breathe.  Count your breaths.  Start over counting after 4 breaths.  Try to release yourself of any other thoughts.  This will be difficult and take practice.  Eventually, try to build up to 20 minutes per day.  Another technique you could use, is to repeat a mantra.  As you breathe, say to yourself: breathing in I am happy, breathing out I am free.
3. lose weight.  This should be first on the list.  If you are overweight, then you need to lose some weight.  If I gave you a bag with a 15lb bowling ball and asked you to carry it around, you would look at me like I was crazy and promptly remind me that you have chronic back pain.  So, why not take off the bag that you are currently carrying.
4. posture.  Use good posture, whenever possible.
5. shoes.  Change your shoes.  I can’t tell you what kind you need.  Maybe you need more support, or maybe you need less.  Try going barefoot most of the time.  Do not wear heels.
6. bag.  Don’t carry a bag/heavy purse on one side of your body.  You are inadvertently twisting your spine and readjusting all day.  Try an old school backpack over both shoulders if you need to carry something.
7. eat better.  Eat healthy foods.  It can only help.
8. read.   Research and read about people that overcome obstacles and succeed.  It is possible.  Get inspired.   There are stories upon stories out there.  People that overcome great odds, monks that can defy reason with their pain tolerance, stories of inhuman strength, and courage at the brink of death.   You can be one of these people.
9. exercise.  Yes, I know you hurt.  Yes, you can still exercise.  Get creative.  You need to circulate blood and oxygen to your brain and muscles.   This will help you feel better.  This will help you heal.
10. cryotherapy.  An immersion of your body to subzero temperatures.  I am not an expert on this treatment modality by any means, but I feel it has a promising future.   It claims to help with recovery and pain relief.  I had one patient try it, and he felt it helped some.  I would be interested to see the effects of multiple treatments.  (An aside: I was asked by a friend to partner with him on a business.  It was a cryo-treatment facility.  I liked the idea, but I just didn’t have the time to commit, and I didn’t feel it would be profitable unless I was fully involved in the marketing of it, so I had to say no.  Such is life.  You can read my views on saying no here or read Derek Sivers’ views here)

So, there you have it.  I probably didn’t change your life with this article.  But, maybe now you have a better understanding of the problems with treating chronic back pain.  It can be a real pain in the ass.

ADDENDUM: There has been some recent negative press on cryotherapy.  Do your research before engaging.