This website is operated by NYMMA, a nonprofit organization dedicated to improving and advancing information about compassionate care treatments available through New York’s Compassionate Care Act.  The website is purely educational and aims to help individuals make informed decisions about compassionate care treatments.

Alternative Back Pain Treatment

Alternative back pain relief is available through New York’s Compassionate Care Program and can significantly relieve chronic back pain.

Restore your activity level

With alternative back pain treatment you can decrease your pain, increase your activity and get more done.

How to get a medical card

The process starts by seeing a qualified physician to certify you for the program.  Once you obtain a medical card you can receive alternative treatments from a dispensary to treat a qualifying condition such as chronic back pain.

Chronic Back Pain Causes

Chronic back pain often affects the lower back but also includes pain in the mid-back or the neck. There are several causes of back pain, the most common being muscular or nerve related back pain. The latter is commonly caused by herniated discs and may be referred to as sciatica when pain travels down the leg. 

Qualifying for Alternative Treatment

When conventional treatments with pain relieving medications don’t work, you may qualify for compassionate care treatment. Back pain treatment under the supervision of a qualified physician can help to lower painkillers and improve mobility and quality of life.

About the author: Dr. Michael Morgenstern is a double board certified neurologist and expert on alternative treatments available through the NY Compassionate Care Program. He is founder of NYMMA and has helped hundreds of patients with compassionate care treatments in Manhattan, Queens and Long Island. This website is part of a non-profit, the NYMMA that is set up to educate you about compassionate care treatments. It does not provide any services or products. Click here to learn more about our organization or feel free to contact us by email or phone.

 

The NYMMA is a 501(c)(3) nonprofit organization dedicated to improving and advancing compassionate care treatment in New York. NYMMAs aims to:

• Increase awareness about compassionate care treatments
• Publish content to inform patients about the benefits and risks of compassionate care
• Educate physicians about the best practices for compassionate care
• Collaborate with other groups to create publications that help patients, physicians and organizations to navigate complex rules and regulations related to compassionate care

 

Contact Us: We can be reached by phone, text or email.

Phone: (646) 598-4571

Email: info@ny-compassionate-care.com

Lower Back Pain Symptoms, Causes & Treatment

by Michael Morgenstern, MD

Lower Back pain is extremely common and almost everyone experiences it at some time in their lives. Usually lasting a few days or a few weeks, low back pain usually resolves on its own, but in up to 25% of adults, it may become chronic and persist longer than 3 months.

Epidemiology. Prevalence, Risk

Low back pain can be debilitating, limiting common actives like walking, bending, climbing stairs, carrying, running and other forms of exercise. It is an extremely common complaint affecting around 20% to 50% of adults, according to population surveys.

The risk of developing lower back pain is associated with several demographic factors, work conditions and health related factors. Being female, older, and a lower level of education are all associated with lower back pain. Various types of work that are physically laborious, like construction, are associated with low back pain. At the other extreme, sedentary work is also implicated, as is non-physical work that that is psychologically taxing or dissatisfying. This may relate to anxiety, depression, and stress that may increase the severity or perception of low back pain. Other health related risk factors include smoking, and obesity, which may increase the weight or strain on an already sore back.

Common Symptoms of Lower Back Pain

Lower Back pain may be experienced as painful sharp, dull, aching, numbing or shooting sensations, worsened by bending over or other activity. Pain may limit activity, flexibility, and range of motion. It may also include painful muscle spasms or pain that spread down one or both legs.

Back Pain Flags

Back pain associated with one or more of the following should be evaluated immediately and may be associated with a more serious underlying condition:

• Trauma (eg. Falling, Car Accident)
• Physical Weakness (eg. Weak leg or foot)
• Fever
• Bowel or bladder dysfunction (can’t go, can’t stop going or incontinence)

Patients with back pain associated with one of the following should also see a physician urgently:

• Sudden severe pain
• Numbness or tingling
• Unintentional Weight loss
• History of Cancer
• History of Osteoporosis
• Steroid use
• Immunocompromised Condition (eg. HIV)
• Using immunosuppressive medications
• New back pain in individual over 50 years old

Causes of Low Back Pain

In most cases, the cause of back pain remains a mystery. Usually, this “nonspecific” pain isn’t accompanied by any serious symptoms, is caused by muscle or ligament strain, starts improving within days, and is completely resolved in a few weeks. Rarely (up to 1% of cases), the cause is a more serious medical condition and is often associated with one of the “Back Pain Flags.”

Arthritis Causing Lower Back Pain

Just like the joints in your knees allow them to bend, joints in your spine allow it to twist, turn, and bend and can be affected by osteoarthritis when cartilage breaks down from wear and tear. Osteoarthritis often impinges on the facet joints in the lower part of the spine where the back is most flexible and can cause back pain that is worse with activity and at the end of the day, and better with rest. Arthritis tends to get worse with age and is often experienced in other joints besides the back, such as the hip, knees, and fingers. Osteoarthritis can also contribute to other causes of back pain such as radiculopathy or spinal stenosis resulting from bone growths around joints, known as osteophytes, caused by increased friction between bones.

Scoliosis  as a Cause of Low Back Pain

Anything that puts additional strain on the back can cause pain. An increased curve of the back in any direction, such as scoliosis (sideways curve) or hyperkyphosis (forward curve), can cause back pain by increasing pressure on the back’s joints, muscles, ligaments, discs or nerves.

Stress Can Worsen Low Back Pain

Stress makes just about everything worse. We know that stress related to anxiety and depression makes pain feel more intense and individuals will often experience worsening pain symptoms during times of increased stress.

Radiculopathy as a Cause of Lower Back Pain

The spinal cord travels through the spine with nerves branching off to the rest of the body. When the roots of one of these nerves are damaged by injury to the spine, a herniated disc or another cause, back pain, traditionally described as a sharp, burning or shooting pain spreading down the leg, may develop but any type of pain may result. Most of the time, the lower lumbar roots (L4, L5) or a nerve root of the sciatic nerve (S1) are affected, the latter commonly results in pain known as “sciatica.”

Spinal Stenosis as a Cause of Lower Back Pain

The spinal cord and nerves travel through a tunnel in the middle of the spine known as the spinal canal. Narrowing of this canal may occur in a painful condition known as spinal stenosis if the spine is misaligned or develops arthritis, or if the ligaments holding the spine together thicken. Movements that make the canal wider, like bending forward or flexing the spine (as when pushing a shopping cart or sitting), can actually improve the pain caused by spinal stenosis.

Ankylosing Spondylitis: An Inflammatory Cause of Lower Back Pain

Ankylosing Spondylitis is a common inflammatory cause of back pain that affects the areas where tendons and ligaments connect to bones. It is common in men under 30 and affected individuals report morning stiffness and back pain that improves with exercise and is worse in the evening. Ankylosing Spondylitis runs in families and is associated with the HLA-B27 gene. Apart from back pain, some individuals with spondylitis may experience red eyes, psoriasis or inflammatory bowel disease related to inflammation.

More Serious Causes of Low Back Pain

Almost 99% of the time back pain isn’t life threatening or related to a serious medical condition, and an otherwise healthy individual suffering with back pain should have little cause for concern. However, there are times when a more serious cause is present.

Spinal Cord Compression Causing Back Pain

One of the first symptoms of spinal cord compression is pain, but anything that interferes with the spinal cord or one of the roots coming out of it can cause partial paralysis, weakness, or loss of sensation. The lower end of the spinal cord is known as the “cauda equina” because of the way it narrows and then gives off many small branches, resembling a horse’s tail. Bowel and bladder dysfunction is associated with compression here but compression can also be caused by many other things, the most likely of which include new or worsening severely herniated disks, trauma or spinal cord injury, ankylosing spondylitis, blood collections or hematomas, infection, tumor or metastatic cancer.

Infection as Cause of Low Back Pain

Back pain can also be caused by an osteomyelitis infection in the spine or an epidural abscess around the spine. Symptoms usually progress from localized back pain to pain radiating down one or both legs and subsequent weakness or decreased sensation. Fever or malaise may also accompany these symptoms, forming the classic “triad” of back pain, fever and neurological deficit that are characteristic of spinal epidural abscess and osteomyelitis. Both of these conditions are more likely in older or immunocompromised individuals and following recent spinal procedures, including a lumbar puncture, epidural, and injections. It is also more common in individuals who have another infection or are susceptible to developing bacteremia, a blood-borne bacterial infection. These infections can develop after any procedure and individuals with a history of IV drug use, which can introduce bacteria into the blood that can spread to the spine, are particularly vulnerable. Other areas around the spine can also be infected, like the discs, but the spine and epidural space are most commonly affected.

Compression Fracture Causing Back Pain

The spine is made up of 33 interlocking bones known as vertebra and like other bones in the body, they can break or fracture. Osteoporosis and chronic steroid use result in brittle bones that break under ordinary pressure or suffer compression leading to a compression fracture. In contrast to common fractures, a fall, accident or physical trauma isn’t required to incur a compression fracture. It can often just happen incidentally during routine activity.

Other Causes of Back Pain

Pain can be referred, meaning pain in one area like the chest can be felt somewhere else such as the arm. Similarly, pain in the back can result from an arthritic hip, an abdominal aortic aneurism, kidney stones, pancreatitis and shingles and other areas and causes. Most of these medical causes have their own characteristic signs, symptoms and risk factors.

Diagnosis of Lower Back Pain

Since the overwhelming majority of back pain is self-limited and with an unknown cause, most back pain can be treated conservatively without first identifying an exact cause. Over the counter medications and non-pharmacological treatments like heat or massage can be used.

Your doctor will examine the back and ask questions to help identify the location, cause or source of the pain and to ensure the absence of “red flags” that would suggest something serious. If a red flag is present, the doctor may order urgent imaging like an MRI, CT scan and other testing. Otherwise, ordering an MRI may have limited value. The fact is that imaging of the spine rarely looks normal. More than half of individuals without back pain will show disc herniation, spinal stenosis or signs of facet osteoarthritis on imaging. Therefore, even if an individual has low back pain and an MRI shows a herniated disc, the cause of pain may not be definitively established. The utility of imaging is much more valuable when it comes to ruling out serious pathology like cord compression, infection, metastatic disease or a compression fracture.

Diagnostic Test Overview

One of the following tests may be ordered by your provider:

X-ray. May reveal compression fractures, broken bones, misalignment of the spine and signs of osteoarthritis such as a bone growth.

MRI. Can show herniated disc, infections of the spine or surrounding tissue, tumors, metastatic disease.

CT Scan. Like an MRI, can show herniated discs and infections of the spine. This scan is useful in cases where an MRI is contraindicated, such as individuals with a pacemaker and those who cannot tolerate an MRI.

Blood tests. Can show signs of inflammation, infection or other disease.

Bone Scan. May reveal compression fractures, tumors or metastatic disease.

Nerve Conduction Velocity Test (NCV) or Electromyogram (EMG). A test of nerve signaling that can show evidence of radiculopathy, nerve damage or evidence of muscle disease.

Treatment of Lower Back Pain

Most back pain gets better on its own in 4 – 6 weeks, even without medication. It is generally recommended to remain active but within sensible limits. If back pain does not improve or worsens after this period, a follow up with imaging or further lab work may be warranted. When pain continues past 4 weeks, it is considered subacute and considered to be chronic pain when it lasts longer than 12 weeks. Treatment includes modifying activity, medication, non-medicinal interventions and surgery

Modifying Activity for Back Pain Treatment

In general, remaining moderately active is advised and will help maintain back muscle strength and prevent spasms. Bedrest should be avoided, but some activities should be restricted to avoid further back injury, including prolonged standing, sitting, twisting or heavy lifting. High impact sporting activities should also be avoided but light exercise like walking, stationary cycling, low-impact aerobics, and swimming are recommended. Going to work can help most individuals maintain moderate activities helpful to recovery but if potentially injurious activities cannot be avoided because you have a job that exclusively requires heavy lifting say, time off may be necessary.

Ideal Sleeping Position for Back Pain

Many individuals experience increased pain at night but the proper position can help. For some individuals, this means lying with the upper body elevated and knees flexed with a pillow underneath. Another position many find comfortable is to lie on their side with their upper knee bent or both knees flexed with a pillow between them.

Heat to Treat Low Back Pain

Applying heat to the lower back with a heating pad can help to relieve back pain. Less evidence exists for the efficacy of cooling packs.

Over-the-counter Low Back Pain Medications

Over the counter medications like Acetaminophen (Tylenol), Ibuprofen (Advil) and Naproxen (Aleve) can be used to relieve low back pain. Tylenol is considered to be the safest of the group but for some may not offer the same benefits as the NSAIDS—Ibuprofen or Naproxen. As with all treatments, it is always best to consult with your physician before starting an over-the-counter treatment to ensure that you have no contraindication to a particular medication. For example, a physician may recommend that patients with heart disease take Tylenol for pain and avoid ibuprofen. When over-the-counter medication is used for pain, it is better to take that medication consistently (i.e. 3 times a day for 5 days or as prescribed) rather than take it as needed when pain is intolerable. Consulting with a physician is useful as they may prescribe a higher dose of an NSAID like Naproxen than the regular dose advised on an over the counter drug.

Prescription Lower Back Pain Medications

When pain isn’t relieved by over the counter medication, there are many different prescription medications for back pain. Though many of these are reserved for chronic pain lasting more than 3 months, they are sometimes used in the subacute period between 4 and 12 weeks or earlier. These medications include different forms of antidepressants, muscle relaxants, and anti-seizure medications. They should only rarely include opioids, which must always come with close monitoring.

Physical Therapy for Low Back Pain

Medication treats pain but fails to improve the root cause of back pain. On the other hand, physical therapy can reduce pain and strengthen muscles, relieving pressure from joints, tendons, nerves and other areas where pain is triggered. Physical therapists can also guide a patient to do strengthening or stretching exercises to loosen tightened muscles and ease spasm. They can provide massage and spinal manipulation, as well as apply TENS machines to reduce pain.

While physical therapy can sometimes cause short-term pain during exercise, pain medication timed appropriately can help individuals get the most out of therapy. For example, knowing that a particular medication takes an hour to start working, you might take a dose one hour prior to initiating a therapy session, allowing you to do exercises that would otherwise be limited by pain.

Interventional Pain Management for Back Pain

Chronic pain can also improve with interventional pain procedures, including trigger point injections, epidural steroid injections, facet joint injections, and radiofrequency nerve ablation. Depending on the cause of pain and other factors, some of these procedures may work better than others.

Surgery for Lower Back Pain

At times surgery is unavoidable, such as when there is a spinal cord compression or nerve root compression that could cause permanent weakness, or when an infection does not respond to antibiotic therapy. Elective surgery is also used to treat pain when there is a high level of confidence that a particular disc herniation is responsible for an individual’s symptoms. Other times, bone may need to be reinforced or fused to maintain the spine’s stability.

Alternative Compassionate Care Treatment for Chronic Lower Back Pain

There are many conventional treatments available for chronic low back pain. When traditional medications don’t work and pain persists despite an adequate trial of these treatments, compassionate care treatments available through New York’s Compassionate Care Act can help to relieve pain. Part of the reason this treatment works so well is that it fights pain in many different ways simultaneously. For example, it has some anti-inflammatory actions similar to NSAIDS, it can also slow down nerves that feel pain like an anti-seizure drug does, but it also reduces the anxiety and depression that magnify pain.

About the author: Dr. Michael Morgenstern is a double board certified neurologist and expert on alternative treatments available through the NY Compassionate Care Program. He is founder of NYMMA and has helped hundreds of patients with compassionate care treatments in Manhattan, Queens and Long Island. This website is part of a non-profit, the NYMMA that is set up to educate you about compassionate care treatments. It does not provide any services or products. Click here to learn more about our organization or feel free to contact us by email or phone.

 

The NYMMA is a 501(c)(3) nonprofit organization dedicated to improving and advancing compassionate care treatment in New York. NYMMAs aims to:

• Increase awareness about compassionate care treatments
• Publish content to inform patients about the benefits and risks of compassionate care
• Educate physicians about the best practices for compassionate care
• Collaborate with other groups to create publications that help patients, physicians and organizations to navigate complex rules and regulations related to compassionate care

 

Contact Us: We can be reached by phone, text or email.

Phone: (646) 598-4571

Email: info@ny-compassionate-care.com