You can hardly find a person 40 years of age in our new society who has never had back pain! We have come to accept it as part of growing older and sitting most of the day (and then injuring ourselves at some point when we over exert our weakened state). However, back pain is usually preventable, and if you are afflicted by it, it is treatable. In fact, back pain should not just be ignored or endured without investigation, since it can be a medically important symptom that needs a proper diagnosis.
I have outlined back pain into 4 main categories to make my point….
- A. Most common – non-severe back problems: The most common causes of back pain which most doctors recognize quickly since they are the most common are:
- vertebral dysfunctions especially facet joint and early stage disc related problems
- musculo-ligamentous strain or mild injuries
- spondylosis, a degenerative ostheoarthritis of the spine
- sacroiliac dysfunction, or pain in the SI joint usually due to pelvis misalignment issues
People who come to our clinic commonly have these condition. Most of the diagnostic shortcuts will bring us to these three pathologies first.
- B. Progressive structural back problems: Next are the conditions are more difficult to diagnose, since they initially look like the first group A. All of these would require special tests like Xray or MRI and expert evaluation. They are:
- spondylolisthesis, the displacement of the vertebra
- ankylosing spondylitis, an autoimmune process in the spine
- significant trauma to back, disc herniation
All of these conditions can start as a regular back pain resembling muscular strain or disc related problem and eventually progress to more advanced structural pathology diagnosed too late for early intervention. To make it more complicated, some patients have show degeneration or disc pathology under imaging, which can hide or distract the best diagnosis and real source of pain.
- C. Medically urgent back problems: Next are conditions which are red flags to a doctor, and are medically urgent. They are often discovered by an obvious history. But, the doctor needs to investigate a further, since back pain here is usually a secondary issue caused by a serious more underlying problem. They indicate the need for immediate treatment. Red flag symptoms include a sudden intense or constant pain, with history of cancer, and/or elevated temperature, a recent significant trauma or weight loss, neurological deficit (lose of sensation, or numbness/tingle, or muscle weakness), a recent bladder or bowel dysfunction. The doctor pays attention to a patient’s medications too, especially drugs like anticoagulants or corticosteroids, as well as potential drug or alcohol abuse. Another red flag warranting further investigation here is if the problem does not improve over time.
Serious back pain disorders that are usually recognized by most doctors show as an acute and severe back pain. These include:
- ruptured aortic aneurysm, retroperitoneal hemorrhage due to anticoagulants
- cauda equina compression
- severe acute infections of vertebra, or pelvic inflammatory disease
- D. Indirect causes of back pain: Lastly, there are a cluster of conditions that do not affect the back directly, but still can be associated with back pain. Again, they are often misdiagnosed and treated incorrectly. Conditions like depression, diabetes, accumulation of some drugs or toxins, anemia, hormonal digestion imbalances all can cause metabolic changes in the body that express themselves as physical tenderness in the back. We have discussed this before in previous blogs where conditions like fibromyalgia and other referred pain phenomena may be expressed through bioactive zones. These zones were discovered by oriental practitioners and now are common acupuncture points located throughout of the body. In these situations, typical painkillers may be not effective to address the root of the problem. Here, additional measures need to be investigated to diagnose and treat the roots of the problem. Acupuncture can address these metabolic-type back pain conditions because it is a holistic practice. For instance, an acupuncturist will select points on arms and legs to address other imbalances which address the indirect nature of back pain. Acupuncture initiates small, incremental and self-sustaining effects in metabolic and organ function through relaxing the body’s flight or fight responses. On the other hand, a drug approach, although more dramatic and effective in the short term, usually has side effects and creates a dependency which is not sustainable without the drug. Acupuncture works by supporting the body’s inherent healing systems to create balance (known medically as homeostasis), whereas drug therapy often creates imbalances that still need to be addressed later.
Summary: The back pain problems that are most responsive to acupuncture are the first and last groups (A and D). – the common early stages of physical stress and wear and tear on the muscles and sinews and also the indirect type of back pain caused by stress or metabolic imbalances.
For the other two back problems which need a doctor’s attention (B, C above), acupuncture and massage and other supportive practices complement what the medical system does. Acupuncture may not change the development of these problems, but indeed, may decrease pain and improve a client’s function and comfort level considerably.