Friday, November 13, 2015
Back Pain Patients Seek Pain Relief First, Mobility Second
“There has long been a debate in the medical community over striking the right balance between pain relief and physical function,” said the study’s lead author, Dr. John Markman, director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery in Rochester, N.Y.
“While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief,” Markman said in a university news release.
The study’s authors focused on nearly 270 patients who had trouble standing and walking and suffered from chronic back pain associated with lumbar spinal stenosis. The participants were asked to choose between a therapy that reduced their pain and one that would enable them to stand and walk. Nearly 80% of the patients said they would rather have relief from their pain than greater mobility, the study published recently in Neurology found.
“Even the patients who could not stand long enough to pick up a letter from their mailbox or wash the dishes after dinner chose pain relief,” said Markman.
The authors pointed out patients are playing a greater role in setting new standards for pain relief, demanding new medications that are both safe and effective.
“This study convincingly demonstrates the need to prioritize pain relief because that is what patients want,” Markman said.
After 39 years of treating patients with low back pain I don’t need a study to tell me what patients want. All you have to do is listen to them – what a concept!
However, pain and mobility go hand-in-hand. Pain creates protective muscle spasm in the low back that reduces mobility. I think conventional medicine makes a mistake in trying to target one objective over the other. It is typical the the tunnel vision in health care that seeks to isolate health factors and treat them without regard for the whole body.
Effective treatment of the low back first requires that any injury reflexes be restored. Second, you must address inflammation, not just pain. Pain is just one aspect of inflammation. Third, any structural misalignment need to be corrected (spinal manipulation). Fourth, the neurological circuits instituting protective spasm need to be reduced. Finally, any adaptive gait mechanisms need to be corrected.
Note that spinal manipulation is not performed until inflammation has been addressed. Additionally, protective spasm and gait mechanisms are checked after manipulation. This sequence makes manipulation easier for the patient and they will more likely “hold their adjustment”.
We measure both pain and mobility, and typically some improvement in both is noted immediately. However, using nutritional supplementation to reduce inflammation naturally, in lieu of drugs, takes a few days to be effective. This helps me judge which therapy is having the greatest benefit. Of course, the lack of side effects is nice as well.
The Bottom Line:
Low back pain and mobility are intimately related. Effective treatment addresses both and the true healer listens to their patients.
Source: September 21, 2015 National Institutes of Health –