Dr. Jacob Teitelbaum's Column
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Monday, September 29th, 2008:
Relief from Back Pain
by Jacob Teitelbaum MD
One of the most common chronic pain conditions is back pain, which affects an estimated 36 million Americans.1 It is the price we pay for being an upright species. Fortunately, it is also very treatable.
In understanding back pain, it is helpful to understand the anatomy of the spine. The spine is made up of a column of bones called the vertebrae. From top to bottom, these are divided into four sections:
1. The seven neck/Cervical vertebrae (C1-C7)
2. The 12 upper back /thoracic vertebrae (T1-T12)
3. The five lower back/lumbar vertebrae (L1-L5)
4. The sacrum plus the tailbone (Coccyx) at the bottom of the spine
The bones/vertebrae of the spinal column are held together by tendons, ligaments, and muscles. Between each of the vertebra are shock absorbers called "discs." These flexible pads of cartilage contain liquid. If this liquid leaks out, it can trigger inflammation and swelling, which pinches on the nerve roots causing pain.
The spinal cord itself is a critical bundle of nerve cells that are inside the spinal column and protected by it. At each of the vertebrae, nerve roots come out of the front carrying information from the brain to the body. At each level, nerve roots enter the back of the spinal column, bringing information from the body to the brain. Compression of, or damage to, these nerve roots causes pain and loss of sensation.
It's always good to start with the basics. For example, in one study people with low back pain who slept on a medium firm mattress had less back pain than those who slept on a firm mattress.2 Distraction and relaxation, such as listening to relaxing music for one half hour daily for three weeks, also reduced back pain by 40%.3
In disc disease, the nerve is being pinched as it comes out of the spine. As the vertebrae and discs (the building blocks that make up the spine) develop wear and tear, the disc, which acts as a shock absorber between the vertebrae, sometimes ruptures and the fluid inside of the disc leaks out. As noted above, this disc fluid can cause inflammation and swelling that can compress the nerve as it enters or leaves the spine, causing pain. MRIs and x-rays are poor indicators of whether the pain is coming from disc disease (vs. tight muscles or muscle spasm pinching the nerve) as almost everyone shows normal "wear and tear" on their back x-rays.
Until recently, over 70% of back pain from disc disease could be eliminated without surgery by simply giving six intravenous injections of an old gout medicine called colchicine. Given intravenously (IV), this medicine gets into the disc space and turns off the inflammation and swelling. Relief usually occurs by the 5th to 6th dose. If used in the proper dose, it is very safe, with the main risk being rare and severe allergic reactions (similar to the risk with penicillin) and a nasty skin burn if it leaks out of the IV (the medication has to stay in the vein, not anywhere else). This can usually be easily avoided by making sure the IV is flowing well. Two studies with over 1,000 patients (one study being placebo controlled) have shown the same 70% relief rate that I and others who use it in practice have found.4,5 Only one study (conducted with 14 long-term workman's compensation patients who had failed all other treatments, where no treatment was likely to help) did not show benefit.
Unfortunately, the FDA recently forbade the continuing production of this very safe (when used in the proper dose) medication because there have been a few deaths from overdose when used improperly in very high dosing (usually in hospitals or in one clinic where it had been improperly made). To put it in perspective, Ibuprofen (arthritis) family medications cause more deaths every eight hours than this medication has caused from overdosing in 20 years (with no deaths or serious long term toxicities when used appropriately).
Unfortunately, the main problem with the use of IV colchicine in disc disease is that it is too inexpensive. It costs $3 per dose for six doses, with the main cost being that of starting the IV. Because there is no money to be made, and it is used in Holistic practices, there is no one to stand up for it. When Vioxx killed or caused heart attacks or strokes in an estimated 139,000 Americans, the FDA committee was stacked with "experts" on the drug company payroll, so the FDA allowed thousands of Americans to die before they were forced to remove Vioxx from the market (the members of the FDA review committee not on the drug company's payroll voted overwhelmingly to remove Vioxx immediately, but those on the drug company payroll voted unanimously to keep it on the market—so it stayed). Colchicine is off patent with no one to stand up for it (or you) so only God knows how many people will die from unnecessary back surgery because of the FDA's actions. It is clearly time that natural remedies and medications used in Holistic practice be removed from FDA authority and put under the regulation of experts in these therapies who are not hostile to natural remedies and respect your right to have access to these safe therapies. Otherwise, if it comes down to your living or the drug companies making a buck, sad to say it but you're in trouble! The good thing is that with health care reform on the table, we have the possibility to heal the health care system in the next few years.
Meanwhile, back to recovering from back pain (sorry about my rant, but I am tired of seeing people die so drug companies can get rich. On the other hand, my article Holding in Anger Can Make Back Pain Worse shows that if you hold in anger instead of expressing it, back pain gets worse. So I guess it is OK to rant occasionally ;-)Sciatica, or back pain in which the pain goes down the leg, is very common. It is simply disc disease from compression or irritation of the nerve from the foot as it enters the spine (although a tight muscle can also pinch the nerve). If you lie on the floor and lift the painful leg straight up without bending it (while keeping the other leg flat on the floor), it can stretch the nerve and worsen the pain. This is called the "straight leg raising test." Even with colchicine not currently available, there are many natural options so you can get relief without surgery.
What Else Can Help My Back Pain?
Willow bark was twice as effective as Motrin in a head on study, and Boswellia (Frankincense) is a good anti-inflammatory as well. I would take two tablets 3x a day of the "Pain Formula" by ITI or End Pain by Enzymatic Therapy, which contain both of these. Pain relief is significant at one week (and this was in people with severe chronic back pain) and optimized by six weeks. Then the dose can be lowered. The Pain Formula herbal mix can be taken with your other pain medications.
Simply taking vitamin D (2,000-4,000 units a day—or consider the Bone Health formula to add other helpful nutrients with the vitamin D) was shown in many studies to help back pain (see Vitamin D Can Help Back Pain). A new study showed Lipoic Acid 300 mg 2x day also decreased the need for pain medication in 71% of those with back pain after three months (see Lipoic Acid and Acetyl-L-Carnitine May Decrease Back Pain).
Because back pain often comes from arthritis of the spine joints (just like arthritis anywhere else—see Arthritis—A 6 Week Program to Help Heal Your Achy Joints), it is also reasonable to add glucosamine sulfate, 1,500 mg a day, and chondroitin sulfate 2,500 mg per day. Give this combination a 6 to 12 week trial. In one Russian study, 73% of those who took the chondroitin had less back pain and more mobility. As noted above, use only "low molecular weight" chondroitin (such as the one made by Enzymatic Therapy) as most others are poorly absorbed. These compounds may help to rebuild the cartilage tissue worn away by wear and tear.6
Medications can help back pain as well. I would begin with Lidoderm patches (Novocaine in a patch) which you can wear over the painful area 16 hours a day (though the box says 8 hours). It may help in ½ hour in some or take a week in others. It is very well tolerated without side effects. In severe cases, Lamictal® (lamotrigine, a seizure medicine that acts as a sodium channel blocker with some calcium channel blockade) was shown to be helpful. In one study with patients who had severe refractory neuropathic pain (especially disc pain) and had failed at least two other treatments, there was an average 70% drop in pain in 14 of 21 patients using this medication.7
What if It Is Not Disc Disease?
Most other back pain, unless it is coming from your chest or abdominal organs (which is rare and can be found by your internist) is muscular. Using the treatments in the chapter on myofascial pain in my book "Pain Free 1-2-3" (chapter 9—basically the "SHINE Protocol"), and also taking care of any underlying structural/ergonomic problems (see chapters 6 and 21) can routinely eliminate this pain. In addition, chiropractic can also be very helpful, as can many forms of bodywork and Prolotherapy.
Adapted with permission from “Pain Free 1-2-3” (McGraw Hill 2006). Scientific references in this article also from “Pain Free 1-2-3.”
Used with permission from Dr Jacob Teitelbaum's free newsletters-available at www.Vitality101.com
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