Back Pain Treatments Can Be Tailor-Made

When it comes to back pain, there are alternatives to surgery and medications.

Dr. Scott Fishman runs the pain-management program at the University of California, Davis School of Medicine. He says that by the time some patients get to him, their back pain is so severe, it radiates down their leg and limits their activities. Many can barely walk. They can't shop for groceries, go to family outings, exercise or even work.

"This is the collateral damage of pain," says Dr. Fishman. "Pain is a noxious stimuli that affects all parts of our lives. When we get stopped in our tracks because of the pain we have, we become 'de-conditioned' both physically and emotionally. It becomes a vicious cycle and a downward spiral."

Fishman warns that long periods of pain deserve medical attention.

"We all get back aches. That's universal. But most pain, even the most severe pain, goes away in a few days," Fishman says. "If the pain lingers — shooting down your legs, arms getting electrical 'zingers' — you should tell your doctor and get it examined."

Years ago, doctors recommended that patients go to bed and stay there in order to heal. That's absolutely not the recommendation today. In fact, not moving at all could be the worst medicine. Fishman likens the process to the need to get up and move after surgery.

"The sooner we get people up and moving, the sooner they are able to resolve and get discharged from the hospital. The same for back pain," he says. "In order for the joints to clean out toxins, feed themselves and regenerate, they need movement to get nutritious fluids in and out of them."

Fishman says that people often tend to overdo it — or underdo it. People exercise too much and stress their bodies even more. Or they don't move at all.

The key is to "engage in modest, persistent activity," Fishman says. "That may mean just walking a little bit every hour while you're having a back-pain episode, just making sure you're not sitting in a chair or lying down for long periods of time."

The first step toward making movement tolerable, Fishman says, is taking over-the-counter medications such as aspirin or ibuprofen. These medications work by diluting the power of the nerve pathway to the brain. For most patients, a couple of days of medication and movement makes the pain goes away.

But for chronic pain sufferers, there can be difficulties sifting through appropriate medications.

"Most people have a view that drugs, since they are over-the-counter, are nontoxic, with no side effects," Fishman says. "In fact, that's not the case. These drugs come with a whole range of side effects, particularly if taken in greater than recommended doses or taken for long periods of time."

For example, aspirin and ibuprofen can cause stomach ulcers, increase bleeding and damage kidneys. This can be especially problematic for patients on blood-thinning medications. Tylenol can adversely affect the liver. This, too, can be problematic for patients on other medications that affect the liver, as well as patients who drink large amounts of alcohol.

Morphine-like prescription drugs may be an option for some patients. Vicodin, percocet and oxycontin are all morphine-derived medications. They are the "gold standard" of pain relief, Fishman says, because they're potent and effective.

There are alternatives for those who don't like the idea of being on medication every day. Patients can learn psychological techniques, much like those used by athletes. These powerful psychological tools are not new; Buddhists have relied on them for centuries.

Patients can harness their brainpower to get "really robust effects on their pain and general health that are lasting and can be used most of their lives and may even mean they rarely have to go to the hospital or see the doctor," says Fishman.

The Mind Body Medical Institute outside of Boston is run by cardiologist and Harvard professor Herbert Benson. For more than three decades, Benson has helped patients harness their body's innate capacity to heal itself.

"Stress does not cause pain, but it can exacerbate it and make it worse," Benson says. "Much of chronic pain is 'remembered' pain. It's the constant firing of brain cells leading to a memory of pain that lasts, even though the bodily symptoms causing the pain are no longer there. The pain is residing because of the neurological connections in the brain itself."

Benson uses what he calls the 'relaxation response' to change the brain's perceptions of what it is experiencing, and help erase the memory of pain. In order to do this, a person has to break the train of everyday thought. To do that,Benson says, two steps are necessary.

First is repetition. Patients repeat a word, sound, prayer, phrase or movement, such as yoga or tai chi. In Benson's experience, most patients use a prayer they are comfortable with and believe in, such as "The Lord is My Shepherd." Other patients choose general words, such as "peace" "love" or "gentle."

Benson then walks patients through the relaxation process. He asks them to sit up, close their eyes, relax all their muscles, loosen their clothing, shrug their shoulders and roll their head and neck around. Then, he asks them to sit at ease without movement and focus on breathing. With each outgoing breath, patients repeat their special word or phrase silently to themselves, letting it drain out with each breathe. They should repeat this for ten to twenty minutes every day.

Often, practicing this relaxation technique regularly will deliver the intended results.

"Long-term bodily changes occur." Benson says. "Pain becomes less bothersome, and if stress is exacerbating the pain, then this approach can work in the long term and can relieve the pain entirely."

This is often true with tension headaches, and sometimes with back pain.

Benson says that scores of techniques can evoke the relaxation response — meditation, repetitive prayer, yoga, Tai Chi and Chi Gong.

"Every patient is different," he says. "So we try to tailor-make the method of evoking relaxation to the belief of that patient."

The relaxation response is a physiologic state characterized by decreased metabolism, decreased heart rate, decreased rate of breathing, lower blood pressure and specific changes in brain waves, including the liberation of a substance called nitric oxide, a chemical that relaxes blood vessels. This is a discrete physiologic package that's opposite of the "stress" package called the "fight or flight" response.

Often the pain is still there, Benson says, but relaxation-response techniques help patients live with the pain and return to normal activities. For some patients, he says, the pain disappears completely.

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