By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
Among the many kinds of physical pain that can throw you off kilter and affect your quality-of-life, back pain is right at the top.
You undoubtedly have had it, perhaps a result of even just bending down to pick up a piece of paper. Many times, back pain is of the short-term variety, lasting days to a few weeks, and often resolving by itself.
About 80 percent of adults experience back pain at some point in their lives, and about 20 percent develop the long lasting kind – we call it chronic – that goes on for more than three months.
There is nothing new about back pain. It’s not a modern affliction by any means. Humans have been suffering for eons; recorded evidence of back woes go back to 1,500 BC in Egypt. Hippocrates (460 BC-370 BC) was the first to use a term for low back pain.
Today, according to the National Institute of Neurological Disorders and Stroke, low back pain is considered the third “most burdensome” condition in terms of mortality or poor health after heart disease and chronic obstructive pulmonary disease. Back pain is the #1 cause of disability in the United States for people under the age of forty-five.
Common causes include injury, spinal misalignments, and age-related wear-and-tear degeneration of spinal discs and structures.
I’ve had my share of back pain, plus pain in other body parts, as a memento of wrestling throughout high school and college. Now in my 60s, I’m still dealing with pain issues.
With conventional doctors, pain medication is typically the first treatment of choice for chronic back pain, followed often by surgery. My opinion is that these approaches should come into play only after less intrusive methods don’t work. Pain medications are associated with multiple side effects; back surgery is fraught with risks and common failures.
As a cardiologist, I obviously have focused my clinical attention on cardiovascular problems. But many heart patients also have pain problems, and pain generates stress, and stress is bad for the heart. So I often tried to help patients with their pain problems by referring them to integrative physicians and health professionals who could address those issues.
One such doctor is Martin Gallagher, M.D., D.C., a rare breed of physician, based in Jeannette, PA, just southeast of Pittsburgh, who is a highly experienced chiropractor, and who obtained a family doctor medical degree in mid-life. On top of that, he is certified in nutritional medicine, medical acupuncture, and prolotherapy, the latter referring to a technique in which joints are injected in a way that can uniquely trigger a healing process and stronger joints. Dr. Gallagher brings more healing tools to the table than practically any doctor I know. Like me, he is a strong believer in utilizing pharmaceutical and surgical options only after safer and more natural approaches haven’t worked. He has treated me for hip, shoulder, and back pain.
“Most people have very little knowledge about their spine,” he says, referring of course to the flexible, bony column that runs down the backside from the skull to the tailbone and protects the nervous system “wiring” operating the entire body.
“Yet the evidence is becoming clear that much of the pain and suffering we experience in our lives may be due to spinal neglect and misalignments (also known as subluxations).
“Many individuals suffer a lifetime with undiagnosed misalignments, some actually resulting from trauma during the birthing process, others from accidents, and still others from just the daily stresses of life. Misalignments can pinch or otherwise interfere with important nerves coming out of the spine, from the neck down to the lower back, so there’s big potential for many disturbances in the body. Chronic organ dysfunction and a host of unresolved symptoms can result until such disturbances are identified and corrected through proper adjustment. One such example is a non-cardiovascular chest pain, often misdiagnosed as a heart problem.”
Dr. Gallagher feels strongly that anyone with back pain should consult with an experienced chiropractor first.
I agree. For many decades, chiropractic was shunned by mainstream medicine, but in recent years, the practice has been repeatedly validated by research as an effective and cost-effective treatment for many problems, including low back pain. Even the Journal of the American Medical Association suggests that chiropractic and other conservative approaches be tried first. According to a 2012 study in the journal Spine, individuals whose first visit for a back injury was to a chiropractor had lower odds of needing surgery. Among a sample of 174 workers with occupational back injuries and pain, 42.7 percent of them who first saw a surgeon had surgery, in contrast to only 1.5 percent of those who saw a chiropractor.
Here are some highlights from a conversation I had with Dr. Gallagher, in which he shared his clinical perspective on back pain; if you are dealing with a back problem, they may be helpful to you as you decide how to proceed with treatment:
Dr. Gallagher: Patients often get trapped on a conventional medicine treadmill. The fundamental problem is that conventionally trained medical doctors look for the lesion – the hot spot, so to speak − that’s causing back pain. They’ll start you off with an anti-inflammatory drug, plus-or-minus physical therapy. These strategies don’t fix the underlying cause because most back problems are mechanical. There’s a misalignment. The medication turns down the intensity of the pain, but the effect will wear off, and the pain will return, and in the process you’ll likely be dealing with medication side effects and damage to the body. If those methods don’t work, surgery is often suggested, and it may indeed be an effective option.
Dr. Sinatra: Surgeries are not only risky, but can fail too. There are something like 700,000 such surgeries done in the U.S. every year, I understand, and many versions of surgery, and some of them have less than impressive success rates.
Dr. Gallagher: This is true. Patients need to do their homework carefully before having back surgery, and certainly are well advised to try less invasive methods first and to understand the cause of the pain problem. When patients don’t respond to medication and physical therapy, they’ll often get sent to orthopedic surgeons or neurosurgeons who prescribe MRIs or CAT scans. We know that there are plenty of false positives from these scans that lead to diagnosing herniated disks as a cause of the back pain when the disks aren’t really the problem. Then come the operations and, in turn, long-term disability and long-term medication.
Dr. Sinatra: This is well-known. We really need a more cost-effective paradigm.
Dr. Gallagher: Absolutely. We need to start with the concept that structure affects function. If your spine isn’t properly aligned, whether in the neck or at the base, you have mechanical stress on the nerves coming out. Your body tells you something is wrong through either pain or loss of function somewhere. At the base of the spine, you may have pain and/or leg and foot pain. So the first attempt should be to evaluate a person’s spine to find out where the joints are locked or not moving properly, and then receive a series of adjustments that may be 10-12-15 minute manipulations to unlock your back. For a lot of people that’s the end of the story. No further problem.
Dr. Sinatra: What about people who have taken that route and not had success? They’ll say they have had chiropractic adjustments, physical therapy, and the painkillers. And they still have pain.
Dr. Gallagher: I’ve encountered this many times. There could be disturbances in the meridian system in the lower back that interrupts the flow of energy through the spine. In such cases, I apply medical acupuncture at the base as well as to the ear. Such an approach is being used in the military to block back and leg pain among servicemen who have returned from combat situations. I’ve also encountered patients who have unsuccessfully tried trigger point therapy, massage, reiki, and anti-inflammatory nutritional supplements such as curcumin and fish oil. Such resistant cases may involve loose spinal joints as a result of damage or tears in the adjacent soft tissue. Here is where prolotherapy, also called regenerative injection therapy, may be helpful. We draw some blood and then separate it into platelet rich plasma. The plasma has growth factors that contribute to a fortification of the soft tissue. We safely inject your own natural growth factors into the injured area to promote tendon, ligament, and cartilage growth. This approach is often effective for helping spinal stenosis.
Dr. Sinatra: In my cardiology practice, eating an anti-inflammatory diet and taking targeted supplements has been a major part of getting patients healthy again. How useful are these strategies in your approach to pain?
Dr. Gallagher: Chronic inflammation is the basis for most diseases and a lot of people have pain that is referred pain from chronic inflammation. So I routinely recommend minimizing the sugar and processed food that makes up much of the standard American diet. And yes, I also recommend anti-inflammatory supplements, such as omega-3 fatty acids, curcumin, and ginger. I also use the homeopathic remedies arnica and Traumeel for mild to moderate pain. You can use them orally or topically applied to a sore or injured area of your body. You can rub it over the areas as often as needed.
Dr. Sinatra: I am a great proponent of Earthing, that is, using the Earth’s own natural, gentle energy to overcome many pain problems. What has been your experience with Earthing?
Dr. Gallagher: Decreased inflammation and improved sleep, which in turn help with pain and an improvement in focus and concentration. I’ve seen some pretty miraculous things occur. We all need to reconnect to the Earth’s healing energy by walking outside barefoot when possible, or using conductive grounding products indoors while we sleep, work on a computer, or relax reading a book or watching TV. So I look at this as a critical component of wellness. We get Vitamin D from the sun. We also need ‘Vitamin G’ from the Earth, and in today’s world, unless you are living in the Bahamas and you’ve got your feet in the water all day – you’ve got to get grounded. Simple things like this, and eating better can make a big difference.
The Bottom Line – Dr. Sinatra’s Recommendation
Clearly, before you go the painkiller route, or surgery, consider alternative avenues for your back pain or any pain issue. Try to find an experienced holistic chiropractor who is knowledgeable about nutrition and diet.
If you live in the Pittsburgh area, or otherwise may be interested in Dr. Gallagher’s services, visit his website at http://www.vitamincoach.com/
- National Institute of Neurological Disorders and Stroke. Low back pain fact sheet. Published online at http://www.ninds.nih.gov/disorders/backpain/detail_backpain.htm
- U.S. National Library of Medicine. Medications for Back Pain. Published online at http://www.nlm.nih.gov/medlineplus/ency/article/007486.htm
- University of Maryland Medical Center. Complications of spine surgery. Published online at http://umm.edu/programs/spine/health/guides/complications-of-spine-surgery
- Goodman DM, et al. Low Back Pain. JAMA. 2013;309(16):1738. Published online at http://jama.jamanetwork.com/article.aspx?articleid=1681414#PREVENTION
- Keeney BJ, et al. Early Predictors of Lumbar Spine Surgery after Occupational Back Injury: Results from a Prospective Study of Workers in Washington State. Spine. 2013; 38(11): 953–964. Published online at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4258106/
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