Why does my back hurt?

Part II

Dr. Dwight Tyndall

There are as many treatments for back pain as there are causes of back pain. In part one of this column, I explored the various reasons for back pain. In this column, the various treatments available are explored. If back pain is caused by an intra-abdominal or intra-pelvic process such as kidney stones or endometriosis, the treatment is naturally geared toward fixing that problem once the correct diagnosis is made. If the patient is still having back pain after other causes have been treated or ruled out, then effort is focused on the spine for treatment of the patient’s back pain. Back pain can be caused by arthritis, muscle strain or injury, or the results of nerve compression. Treatment for back pain caused by arthritis or muscle strain is initially treated by non-surgical treatment by decreasing the inflammation, and then improving the back muscle’s strength and flexibility.

The inflammation can be reduced by using an anti-inflammatory such as Ibuprofen or other NSAIDs, or even CBD oil. Physical therapy or chiropractic care then is used to help regain muscle strength and spine flexibility. Occasionally, spine injections can be used to help further reduce the pain. Often, these measures are effective in reducing the symptoms of back pain and allowing patients to regain a pain-free life.

Treatment for back pain caused by nerve compression also can be treated with non-surgical measures such medications and physical therapy/chiropractic care. Although these can be helpful, epidural injections or nerve injections sometimes are needed to help relieve the nerve pain. These epidural injections can be repeated if the patient needs further pain relief.

If non-surgical treatment such as therapy, medications, and injections fail to relieve back pain caused by arthritis or nerve compression, then surgical treatment can be considered.

Over the past few years, there have been significant advancements in surgical management of back pain caused either by arthritis or nerve compression, namely, outpatient spine surgery. This is vastly better than traditional surgical treatment, which often required prolonged hospital stays and, hence, a prolonged recovery.

Additional benefits of outpatient spine surgery are shorter surgical time and less tissue dissection leading to less post-surgery pain. Due to the significant decrease of surgical pain, patients often do not require prolonged hospital stays and can return home the day of surgery to begin their recovery.

The surgery for arthritic back pain is called a fusion. In this procedure, the adjacent diseased vertebral bodies are joined together to prevent movement and pain. This procedure usually requires internal devices to hold the vertebral bodies together until they unite. Patients then can resume their therapy or chiropractic care after surgery to help strengthen the back muscles.

Most of these patients can resume their normal activities within a few months after surgery. Tiger Woods is the most famous recent patient who had a spinal fusion and was able to resume to his normal activities — playing golf — at a high level.

The other cause of back and leg pain can be nerve compression. If non-surgical treatment (therapy, medications, chiropractic care) fail to relieve symptoms, then a surgical procedure called a decompression often is used to remove the pressure on the nerves. This procedure also can be done in an outpatient setting. In this procedure, any bone spurs or disc herniation that is causing nerve compression is removed from the nerves, thereby relieving the back and/or leg pain. As with the spinal fusion, the patient will resume therapy to strengthen the spine muscles and can resume normal activities within a few weeks.

However, as we all grow into adulthood we have less and less of these stems cells, therefore we have less and less ability to repair injuries and the aging process.

The excitement about stem cells rests in the belief that since they have the ability to form any kind of cells we could use them to repair any damaged cells in the body. For example, for patients with damage to the heart muscle, stems theoretically could be injected into the heart to repair the damage and allow the heart to function normally.

The same idea exists for any disease process such as brain disease, spinal cord injury and even arthritis in the knee, hip and shoulder.

Despite this, there are many concerns about stems cells. One of the main concerns is whether these cells could become tumors because of their ability to differentiate into any kinds of cells once reintroduced into the body. One possible solution to this problem is to have the stem cells differentiate to the desired cells type before they are used.

One main unknown about stem cells is how they are triggered to start growing into different cells and what ultimately stops them from growing. We do not know if that by simply injecting the cells into a damaged body part will cause them to grow and to perform repair. It is also not known if the cells need other substances within the body to help them grow and replace the damaged cells.

Currently, the use of stem cells is not FDA-approved for use within the United States in clinical practice unless in a research setting. Therefore, most stem cell treatments being currently advertised on TV or on the internet do not have official FDA sanction unless it being used in an approved research study.

And, even in those approved studies, the FDA has restricted how the stem cells can be used. The cells are approved to removed or harvested from the patient, purified and re-inserted in to the patient. The stems are not allowed to be expanded, that is being grown, before injected back into the patient.

These guidelines by the FDA make it difficult to perform clinical research in the U.S. on the amount of stem cells that will be needed for a given condition. Therefore, no one is certain that even if stems cells can treat a condition how many cells are needed.

Patients who want to use stems cells to treat a medical condition are best served by finding an accredited research project treating their conditions, since it is not always possible some patients who can afford the cost of stem cell treatment are travelling overseas to have their treatment done.

So although stem cells hold great future promise there are many current unknowns that will limit their application in treating diseases.

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