Our new colleague Robert Savala, MD has been a pain management expert in the Bay Area for 25 years.In the second of two articles, he discussed five strategies for treating low back pain (LBP)
When low back pain is severe and acute, supportive measures to control the pain such as medication, rest, chiropractic and physical therapy are the main treatment methods. However, despite adopting this “conservative treatment”, when the pain persists, we will turn to more and more aggressive treatments.
The fact that there are so many treatments for this situation reflects the fact that there is no single method that can reliably cure the problem.
Currently, we have five basic strategies for treating low back pain: 1) physical therapy/chiropractic and lifestyle changes, 2) medication, 3) injection, 4) “other” and 5) surgery.
When talking about physical therapy and chiropractic, I am concerned about the importance of how we move our body and how it affects our spine. Behavior changes, stretching, traction, core stabilization, weight control, and spinal manipulation are the foundation of spinal care. No matter what the next treatment is, it is essential to have well-trained professional guidance and support you to build strength and healthy habits.
Medications are used to reduce pain by reducing inflammation, blocking pain signals, and inhibiting overactive nerves. I have achieved some success in medicine, but many patients worry about long-term effects and adverse reactions. Some patients simply do not respond adequately to treatment.
Injection therapy basically relies on corticosteroids to relieve pain. Like cortisol (one of our body’s natural pain relievers), steroids are powerful anti-inflammatory drugs but have many side effects on soft tissues and bones. Most doctors agree that long-term use of these substances will cause a series of complications and limit their use.
The fourth area of pain management I call “other”. These forms of treatment have a limited role in care and are usually used when all other options have failed. Usually focused on reducing sensation, they include spinal cord stimulation, intrathecal infusion therapy, and other nerve ablation techniques designed to destroy nerve endings.
Many patients come to me, hoping to stop our fifth option: surgery. Of course, surgery plays an important role in the treatment of spinal stenosis and spinal instability-but in order to solve the pain of intervertebral discs, facet joints and sacroiliac joints, we do not actually repair these structures, but rely on removal of tissue and fusion spine. Many of us know that people who have undergone back surgery are not helpful and even make their condition worse. Serious concerns about surgery make it natural for many LBP patients to worry about these operations.
Let us now discuss the emerging role of regenerative medicine in the treatment of LBP.
Regenerative medicine technology is the only treatment that attempts to reduce pain by actually restoring the health of the target tissue. It seeks to stimulate the normalization of the tissue environment, the reduction of inflammation, and the reversal of tissue decomposition. I believe that back pain is particularly suitable for this treatment.
One of the biggest attractions of regenerative medicine is the relative safety of using “the body’s own pharmacy” to heal the intervertebral disc, and overcome one of the main obstacles to the healing of the intervertebral disc: due to poor blood flow of the intervertebral disc and hypoxic environment, the cascade degeneration leads to gradual collapse. In order to overcome this problem, we can directly inject these discs with growth factors mainly derived from platelets.
The platelets present in our blood are important for the formation of blood clots. Nature makes these platelets full of growth factors. Therefore, where there is damage and bleeding, as the clot degrades, thousands of different proteins are released to stimulate local tissue healing. To make platelet-rich plasma (PRP), we draw a person’s blood, concentrate it, extract platelets, and then use local anesthesia and mild sedation to inject a solution during outpatient surgery.
More and more evidences show the effectiveness of PRP in stabilizing the degradation process and promoting tissue repair. Importantly, these studies failed to find serious risks such as tumor formation or adverse systemic reactions. This makes sense, because the body’s own substances are used to help healing.
Recently, small studies have shown that even a single injection of intervertebral discs and facet joints can reduce pain within one month after injection. Most studies show that LBP will gradually decrease for at least 3 months. A 2017 study of patients receiving PRP in the intervertebral disc showed that during an average follow-up of 6.5 years, 70% of patients showed significant pain relief and functional improvement without any serious complications.
Unlike steroids-whose effects diminish over time and are associated with negative systemic reactions-the analgesic effect of PRP injection seems to improve within a few months.
Of course, determining the correct method of injection into the correct structure is critical to the success of the treatment. At Stone Clinic, we combine these procedures with physical therapy to consolidate the results, help people resume life activities, and help them become stronger, faster, and healthier. Because, as Joseph Pilates said, “You are only as old as your spine.”
The views expressed above are the author’s own.
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