Cure My Low Back Pain

posted by editor on Feb 7

You are aware that there are various means to address low back pain. As alternatives may differ substantially, this suggests that there are a variety of paths to the same endpoint, some duplicative of others, some complementary or synergistic.

Clinicians unaccustomed to frequent engagement in pain management often apply increasingly more or stronger variations of an inadequately efficient intervention, increasing undesired side effects without increased pain resolution.

Instead, the treatment plan should acknowledge the presence of abnormalities, dysfunction and/or diseases and apply a treatment plan founded upon a reasonable model. If the assessment and model are sufficiently congruent you may expect to reasonably address the pain.

In the following model, your pain exists as an entity in the brain. As such, given your pain precipitated by injury, dysfunction or disease, the treatment plan may need to address all the following elements.

• wounds
• concurrent injuries (acute, cumulative, degenerative) and osseous disorders
• organ diseases
• iatrogenic contribution (e.g., past surgery)
• psychological contributors
• behavioral contributors (e.g., smoking, malnutrition, etc.)
• external factors (e.g., work)
• current treatments with undesirable side effects

Pain management is then a treatment plan that is multi-factorial and directed at all eight layers of the assessment model. Moreover, the specific interventions applied should address different portals/pathways. By analogy, presume you were asked to create a flavorful dish of food, and you initially apply a substantial amount of cayenne pepper. If the outcome is that cayenne pepper is insufficiently flavorful, then more cayenne would also be insufficient. You would need an alternative, complementary spice to add to the mix, providing a complementary flavor via an alternative source (i.e., portal, pathway).

In the example of acute lumbar pain in an otherwise healthy young man, how do we apply the model? A comprehensive pain evaluation would include:

• Description of the pain.
• History of the onset of the pain, frequency, intensity and exacerbating and
alleviating factors.
• General medical history.
• Current symptoms related to all other body systems.
• Medications, supplements and other interventions presently used, regularly and
at lesser frequencies.
• Spiritual/other beliefs, particularly about health and responsibility for health.
• Family medical history.
• Work, non-vocational and recreational activities.
• Support system data (family, friends, etc.).
• Physical examination
• Assessment – Pain, related to multiple factors.
• Plan (interventions)

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Discussion

The brain interprets signals acutely as well as develops recurring pain signal loops if receiving adverse stimulation too long. The patient may also develop some psychopathology if required to live with pain of significant intensity too frequently or for a prolonged period.

As such, in developing the pain treatment plan you must rank order probable factors contributing to the pain by acuity, relative need for intervention and estimated percentage of contribution to pain regarding:

• wounds
• concurrent injuries (acute, cumulative, degenerative) and bone/joint/musculo-
ligamentous disorders
• organ diseases
• iatrogenic residuals (e.g., past surgery)
• pain signal pathways to brain
• brain/psychopathology/psychological contributors
• behavioral contributors (e.g., smoking, malnutrition, etc.)
• external factors (e.g., work, play)
• current treatments with undesirable side effects

You subsequently develop a multiple element plan based upon the preferences of the patient, available resources and within the framework of that allowed by the organization, state laws and insurance systems to which you may be obligated.

Treatment Alternatives

1. wound repair, surgery
2. prescription medications
3. homeopathic medications
4. naturopathic medications
5. herbs
6. cannabis
7. acupuncture
8. acupressure
9. electroacupuncture
10. electrical stimulation (various forms)
11. chiropractic, physical therapy, massage
12. light therapy (infrared, laser)
13. hypnosis
14. psychotherapy
15. distraction (mental)
16. heat
17. ice
18. dietary adjustments (see foods and anti-inflammatory effects)
19. spiritualism
20. weight control, exercise, stretching)
21. treatment of co-morbidities
22. other behavioral adjustments (e.g., stop smoking)
23. cease activities that exacerbate symptoms

As a Table A, cross treatment alternatives with pain factors to treat. As a Table B, cross treatment alternatives with options within the alternatives.

Tables A & B jointly reflect the treatment alternatives and option subsets available to address pain contributors associated with identified factors. Numerous challenges to their application include:

• Collection and interpretation of information during the diagnostic process.
• Acknowledgement of contributing factors.
• Understanding and recognition of alternative treatment options.
• Access to and affordability of treatment options.
• Willingness and ability of patient to participate in the relevant treatment
alternatives and option subsets.

Patients and non-pain specialists should recognize the complexity of many of these cases, acknowledging the efforts of those willing to fully participate in considering alternative pain management pathways. It is also important to recognize that the patient has a significant role in healing him/herself.