Oh My Aching Back

Relief is just a piece of plastic away

Keeping abreast of new therapies is a challenge for patients and providers alike. When the new treatments are applied to old, troublesome problems, all of us are pleased. Such is the case with victims of chronic back pain.

Old physician aphorism: "There's nothing lower than low back pain."

"Cures" for patients with chronic back pain have been infrequent, thus we've had lots of methods for relieving the discomfort. Some of the methods do work - good physical therapy and appropriate stretching / manipulation - but most are simply stop-gaps, something to do while you hope the pain goes away. Mainstream physicians have been very happy to shift the burden of chronic back treatment to those who practice outside the mainstream, so to speak.

Two easily diagnosed causes of back pain are vertebral collapse (usually due to osteoporosis and mostly in women) and degenerative or traumatic disc disease. Physicians are now using some pretty fancy techniques to relieve those problems by approaching their specific causes. In the case of the osteoporotic collapse, the cure may be with glue!

In this situation, vertebral bodies simply collapse as a result of softening. Restoration of them has not been deemed possible until some bright person came up with an idea: How about injecting the collapsed vertebrae with a thick glue? (Such a material has been available for years, and has a proven safety record.) As with a lot of new things, the first doctors to do this had to have a lot of courage, and their courage (and their patients' as well) was rewarded with fairly impressive results. Many patients (two-thirds or more) get good to excellent relief of their pain through this "stabilization" as the glue hardens inside the soft bone.

(This does nothing for the osteoporosis which has to be treated with medication, diet, calcium and exercise, but we all agree that exercise is a lot easier when one doesn't hurt.)

A couple of new things can be used to help patients with degenerated or traumatized intervertebral discs, those small cushions between the bones of the spine. Perhaps the neatest thing about this field of orthopedics and pain management is the ability of practitioners to identify the disc as the cause of the pain. Short story: Inject the area with a local anesthetic and see if the pain goes away. If it does, then proceed to deal with the disc.

In one curative technique, the disc is encircled by a device which essentially destroys the pain sensing nerves in the area. "No nerves, no pain" is the concept, and it's getting a lot of attention. In another method, the old beat-up disc is extracted and replaced by a new plastic one. This works best for someone in whom the original disc has flattened out like a crepe! Descriptions of this procedure refer to it as "minimally invasive". Right.

Physicians in Europe have been replacing discs longer than we have here in the US. Their reports on the procedure are quite enthusiastic, and we hope that we'll have the same success here.

Time is a great evaluator of "new" in medicine, and we haven't been using these back-pain relievers for very long. But -- so far (keep your fingers crossed and say a little prayer) so good. Perhaps new doctors of the future won't tend to run and hide from patients with low back pain.