Expert: Dr. Victor Dolan, DC, DACBSP - 6/21/2008

Question
I have had lower back pain for the last nine years and I am now really struggling and finding it very difficult to cope. The pain is very low down and central, always in the same spot, occurs when i go to sleep, in any position, lying down, in a chair, i have tried everything. i can sit for long periods, walk miles but when i stand still for any length of time it occurs. Tried Chiropractor, physio, acupuncture, but normally after two sessions they tell me they cant do anything, physio 2 weeks ago listened to my history and told me he couldn't do anything and see the doctor. I have been seeing doctors for the past nine years and still waiting for a diagnosis. Have tried injections into the spine , spinal manipulation under anaesthesia, tens and many more. Dihydracodeine is now not working and i am on fentanyl patches but am worried that when my body gets used to them, what next? Had all types of tests several years ago (clear) and just had an Xray and MRI, both came back, normal but with the usual wear and tear. I go through periods of muscle spasms, sometimes 20 or so a night but haven't had much for a while now. I had a fall more than nine years ago when i damaged the ligaments and tendons in my ankle very badly, (in plaster for 3 weeks but took far, far longer to recover) don't know if there is a connection because my back pain didn't flair up until 4 months later. I am literally begging somebody to help me with a diagnosis, the lack of sleep affects all aspects of my life and my family, and the pain has been getting worse. I am crying as i am writing this because i don't know what i can do next and how much longer i can cope. Please help

Answer
Low Back Pain, chronic sprain/ strain, vertebral subluxation complex, herniated disc, degenerative joint disease, mysofascitis, muscle spasm.

Hello Jess,

Sorry to hear of your nine year fight with lower back pain.

MRI of the lumbar, thoracic spine; Abdominal/pelvic Ultrasound and/or CT and/ or MRI are also tests to be considered.  Paraspinal and lower extremity EMG/ncv must also be considered. Vascular and GI examination should be considered.  It does sound as if you have had a complete battery of tests, and no very significant medical pathology has been found.  Medical pathology, medical lesions, cancers, tumors, organic metabolic dysfunctions have been ruled out, by your subjective history.  Given that the big bad medical pathologies have been ruled out; I commend you on trying natural, alternative approaches to your problem.

Chiropractic usually does well in these instances.  Many times patients will go to many different medical doctors and many different medical pharmaceuticals, many medical procedures,,, sometimes all of those medical approaches fail, but, in America, Allopathic Medical Care has many different treatment options, and Americans will keep on trying, keep on trying, keep on trying in the Allopathic Medical arena.

Natural health approaches also have many different approaches, disciplines and practitioners.  I applaud that you tried the Spinal Manipulation Under Anesthesia.  I am a proctor to certify Doctors in that skill.  Protocol calls for a trial of conservative, conscious, in-office chiropractic.  The conscious chiropractic treatment (spinal adjustment- the 'clicks', 'cracks', and 'creaks' that laypeople talk about when they talk about chiropractic) should not aggravate the complaint, and either help minimally or  do little to nothing with the complaint.  With no contra-indications to adjustment and manipulation, deeper manipulation can take place under anesthesia. The daily (usually a minimum of three consecutive days ambulatory in a hospital or ambulatory facility) MUA is followed by two weeks of daily in office adjustment and therapy, 3- 4 weeks of every other day treatment (stretching, massage, manipulation, adjustment, therapy), 3- 4 weeks of twice a week treatment, 3- 4 weeks of once a week treatment, and then re-evaluation and treatment as necessary.  In this aspect, Chiropractic Spinal MUA is very similar to any other medical/ physiotherapeutic procedure and rehabilitation protocol. I applaud your perseverance in going to the Doctor of Chiropractic for such intensive care over four or more months.  People are used to taking a pill EVERY day for the REST of their lives, - people are used to seeing the physical therapist 3X per week for 4, 5, 6 months; people are used to wearing braces on their tooth bones for years;
but sometimes people balk at seeing the chiropractor at the same schedule as these other disciplines.

Usually spinal MUA is VERY successful for acute or chronic lower back (or neck) pain of neuro-musculo-skeletal origin.  

Again, given that there is no medical pathology, I would continue to investigate safe, conservative, non-invasive, natural, alternative answers to my complaint.  Chiropractic- perhaps by a different Doctor with different techniques- - perhaps spinal decompression therapy could be helpful.  Nutritional approaches to provide an anti-inflammatory lifestyle (hence anti-pain) may be helpful.  Acupuncture may be helpful.  Try not to become dependant upon medications with their side-effects.

A website for Doctors of Chiropractic with very comprehensive low back pain approaches would be: http://www.lifechangingcare.com , perhaps you could see if there is a Doctor close to you through this website.

A handout I use in my Staten Island Chiropractic office on Low Back
pain may be helpful:
    +++++++++++++++++++++++++++++++++++++++++++++++++++

Lower  Back  Pain  (LBP):          Low  Back  Pain  can be caused by many different things.  Big, BAD, catastrophic things like a tumor or a cancer can cause low back pain (only a proper exam by a licensed doctor, like your Doctor of Chiropractic, or your family Doctor of Medicine, can evaluate your signs and symptoms, and perhaps refer for testing).  Big, bad things like a Herniated Disc, sciatica, possible fracture or dislocation can cause LBP (again, best evaluated by your DC or MD, and perhaps referral).  Bad things, like  - Sprains, Strains, contusion, or Vertebral Subluxation Complex (all very efficiently diagnosed and treated by your Doctor Of Chiropractic.  LBP can come from a motor vehicle accident, sport injury, slip, trip, fall, arthritis, lifting improperly, or even bad posture in standing, sitting or sleeping.  All of these things often have a Lumbar (Low Back) Vertebral Subluxation involved.

              Vertebral   Subluxation   Complex    (a.k.a.  ‘subluxation’)
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.

This is a serious condition identified by its five parts:

    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve system dysfunction can cause symptoms elsewhere in the body.

    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The resulting scar tissue changes muscle tone, requiring repeated spinal adjustments.

    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation. Discs can bulge, herniate, tear, or degenerate. Other soft tissues may suffer permanent damage.

    Pathophysiology:
         Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term nerve dysfunction can cause other systems of the body to malfunction.

The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.
         Automobile accidents, improper lifting, improper posture, alcohol, emotional stress, chemical imbalances, and long periods of sitting can cause the Vertebral Subluxation Complex.
          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.  Subluxation- a neuro/skeletal/muscular- mechanical-  problem requires a mechanical   correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.
   +++++++++++++++++++++++++++++++++++++++++++++++++++

I hope this helps, I hope it is encouraging.  I know you have fought a long time.  IF  your  tests  are old,,, it may be time for new MRIs CTs, Xrays.  Follow the different natural approaches as long as the medical pathologies have been ruled out.

As always, this article is for discussin, conversation, information and education.  Proper evaluation DX, RX, TX, PX can only be given by a treating health professional in person.

Thank you for the question, This Staten Island chiropractor wishes you good luck, and good health naturally !

Dr. Victor Dolan, DC
http://www.DocDolan.net
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com  (email newsletter)