Back pain is one of the most common types of chronic pain in the United States. Most people will experience some form of back pain in their lifetime.
Some forms of pain will go away on their own with time and the body’s natural healing processes. When pain persists, however, it can be detrimental.
Finding the right treatment option for back pain depends on a proper diagnosis. The complex nature of the back and spine impacts every aspect of treatment as it is happening. Surgery is an option when minimally invasive treatments fail to provide relief. However, the potential risks with surgery may be enough to turn away patients.
Anatomy of the Back
Spinal issues are most commonly associated with back pain. The spine is made up of vertebrae, bony segments of varying sizes that are stacked on top of one another. Located between each vertebra are vertebral discs. These act as a cushion between the bony parts of the spine, preventing them from rubbing against one another. Vertebral discs also play an important role in spinal support and stability.
Outside of the spine itself are an intricate network of muscles, tendons, and ligaments which protect the spine. They also provide support, stability, and mobility.
The bony part of the spine serves as protection for the spinal cord. The spinal cord contains nerve tissue and is an integral part of all movement as it sends signals from the brain to the rest of the body. The spinal cord is connected to nerves that are susceptible to damage. Nerve damage can lead to significant issues long- and short-term.
Any of the aforementioned aspects of the spine can become damaged or injured. In some cases, it is more than one specific part of the spine that is damaged and causing pain. The causes of pain or discomfort in the back can be varied, but generally, the causes stem from:
- Degeneration: tissues degrade naturally over time. This can apply to vertebral discs, tendons, ligaments, and muscles.
- Injury: a sudden traumatic injury can result in misalignment of this intricate network, as well as cause trauma and stress to the spine.
- Overuse: consistently repeating certain motions over time can lead to more rapid degeneration.
Most of the conditions associated with back pain can be traced back to these general causes. The diagnosis of back pain leads to receiving proper treatment.
Common conditions related to back pain can include:
- Bulging/ruptured/herniated discs
- Vertebral fracture
- Ligament or muscle tears
- Bone spurs
- Nerve damage or pinched nerves
A patient seeking medical advice for back pain must receive a proper diagnosis. Each diagnosis comes with a different treatment plan that satisfies the patient’s specific needs. The first step to treating or managing pain is finding out the root cause of it.
Diagnosis of Back Pain
It is generally recommended that an individual visit the doctor if back pain begins to impact daily life. This may include interruption of sleep or the inability to perform normal tasks due to discomfort.
Diagnosis typically follows a path that begins with a minimally invasive assessment, but for greater accuracy doctors will often employ the aid of certain imaging techniques. The process of receiving an accurate diagnosis generally involves:
- Examination: doctors will look at a patient’s range of motion and test their abilities to perform certain tasks. During this, they will ask the patient to describe the pain they are feeling and inquire about the location. This form of testing does not typically lead to a diagnosis for back pain, as many conditions could be occurring. This is typically done to narrow down further diagnostic testing.
- MRI imaging: Magnetic Resonance Imaging (MRI) is used to create a picture of the soft tissues. This includes muscles, ligaments, and tendons, so if the pain is caused by a tear or deterioration in any of these, an MRI can demonstrate an accurate picture of what is going on. CT scans are also used in some cases for a picture of soft tissue.
- X-ray: this form of imaging is used to determine the bone structure. If back pain is being caused by a bone spur or herniated disc, this will show up on an X-ray.
Treatment of Back Pain
Once diagnostic methods have established the source of pain, doctors will create a treatment plan specific to each patient. Some of the factors that may influence a treatment plan include family history, age, activity level, profession, and the severity of injury or degeneration.
Acute pain is more common than chronic pain. Acute pain refers to pain that occurs for a shorter period, under 3-6 months, but goes away over time. Chronic pain refers to pain which persists for a long time and does not improve or go away.
Each treatment method varies, but the general format for treating back pain is a sort of timeline which goes as follows:
- Rest: doctors initially will suggest that a patient rest and avoid strenuous activity. In the case of muscle or ligament tears, the injury is often capable of healing itself. Rest is recommended to instigate healing if the cause of the pain can be healed on its own.
- Physical therapy: the general goals of physical therapy are to strengthen muscles and improve range of motion. In the case of back pain, physical therapy also seeks to correct bad posture which may negatively impact an injury and its ability to heal.
- Injections: many forms of injections can be used on the spine to treat pain. The type of injection a doctor may recommend is dependent on the type of injury and its location. One of the most popular forms of injection for chronic pain is corticosteroid injections, which work by delivering a high dose of anti-inflammatory properties into the pain source. This helps patients in the short-term with pain management but has been proven to damage tissue over time.
When back pain persists even after attempting minimally invasive treatment options, doctors will often turn to a surgical option.
Surgery for Back Pain
There are many forms of spinal and back surgeries that doctors may consider for treating back pain. Due to the complex nature of the spine, each surgery and its risks should be explained to provide patients with as much information as possible.
Being aware of what will happen during surgery is important for determining a recovery plan. Most surgeries are elective and it is up to the patient to decide if they would like to pursue it.
Some of the most common types of surgery include:
- Spinal fusion: this form of surgery involves removing a vertebral disc which could be causing pain and fusing two vertebrae.
- Discectomy: herniated or bulging discs can contribute to pain. Discectomy is the removal of parts of a vertebral disc that are abnormal and could be causing pain or discomfort.
- Laminectomy: enlarging the spinal canal by removing vertebral bone (lamina) can relieve some pressure which the spinal column faces.
- Artificial discs: replacing discs with artificial substitutes could relieve pain and pressure on the spine. This is generally a less invasive form of surgery that seeks to relieve pain before needing spinal fusion surgery.
All surgeries come with a general set of risks. The most common risks include:
- Blood clots
What Happens After Surgery?
Some surgeries are minimally invasive and have a short recovery period. Others, like spinal fusion, are highly invasive and can take months to over a year to fully recover from. For this reason, a doctor’s recovery plan will be different for each patient.
Generally, it is recommended that patients often rest and take prescription medication to manage pain levels.
Surgery can be a life-altering procedure. In many cases, surgery fails to treat pain in the long term. The uncertainty that surgery may not improve pain leads to many patients seeking alternative therapies before and after undergoing surgery.
Regenerative Medicine’s Role in Managing Back Pain
Regenerative medicine involves taking a patient’s own healing cells, concentrating them, and using them to treat injury. These include platelet-rich plasma (PRP) and cell-based therapies. Both forms of therapy are minimally invasive and have a low risk of rejection as the doctor uses a patient’s own cells.
The two types of regenerative therapy that CELLAXYS offers are:
Also known as stem cell therapies, this treatment takes a patient’s own cells or “autologous” tissues and reinjects them into the injury site. Based on your condition, the doctor may recommend you one of the two types of cell-based therapies:
- Minimally Manipulated Adipose Tissue (MMAT) Transplant. This procedure is super effective in treating back pain after surgery. MMAT takes healthy cells from your adipose (fat) cells, concentrates them, and reinjects them into your injury site. The doctor can perform MMAT in multiple locations in the same procedure if needed.
- Bone Marrow Concentrate (BMAC). This procedure harvests highly concentrated cells from your bone marrow and returns them to the injury site.
Injecting healthy cells can improve the recovery timeline by healing an injury or degeneration quicker than it would without. Both cell-based therapies are performed within 1.5 to 2 hours and are outpatient procedures, meaning you can go home right after the process.
Platelet-Rich Plasma (PRP) Therapy
PRP therapy takes a patient’s own blood to separate platelets from the plasma. These platelets are then processed and reinjected into the patient’s injury site to promote healing. Platelets contain 10 Growth Factors and proteins to boost healing and send chemical signals to attract healthy cells from the blood.
They also produce fibrin, a sticky web-like structure that supports the growth of healthy tissues in the injury site. A high number of platelets in injured areas shortens the healing time and promotes speedy recovery.
PRP is a popular treatment for several spine, sports, and orthopedic injuries. It takes 45 minutes to complete and is an outpatient procedure like cell-based therapies.
Some patients experience pain relief with cell-based therapies and PRP in a few days. Though regenerative medicine can help back pain, it may be even more important as a treatment aid after back surgery.