We’ve got our eyes on new techniques for back pain relief
Back pain relief is the elusive golden ring for more than half of adults who report having back pain for five years or longer. Once the back pain becomes chronic, it is much more difficult to treat. At New Jersey Brain and Spine, our physicians are continuously researching new and innovative ways to treat chronic back pain while continuing to refine and improve the proven standbys.
As always, our practice aims to treat pain conservatively and non-invasively first, and we continue to refine and improve tried-and-true therapies. Because our clinic is on the cutting-edge of neurovascular and spine care, we are continuously investigating innovative treatments.
While none of the non-opiate alternatives we’re watching are home runs, so to speak, for alleviating pain entirely, they do offer a “double” or a “triple.” They may offer chronic back pain patients a modicum of relief.
Use your brain to relieve back pain
Today, augmented reality offers digitally enhanced treatment for lower back pain relief, especially when paired with cognitive behavioral therapy (CBT). In late 2021, the FDA approved a prescription-use immersive virtual reality system that, through a headset and controller similar to those used in video games plus a breathing amplifier, assist with deep relaxation and awareness-building exercises aid in back pain relief.
Cognitive behavioral therapy is a type of psychotherapy that helps people recognize specific thoughts and behaviors and modify them to become more positive. One study has shown that 58% of patients with chronic back pain saw functional improvement after six months of practicing CBT.
Minimally invasive approaches for lower back pain relief
Radiofrequency ablation, known as RFA, is an emerging treatment for chronic low back pain using heat to interrupt pain signals in the nerves of the spine. Studies have shown this treatment is efficacious for short-term relief for lumbar facet joint and sacroiliac joint pain.
Neuromodulation, or micro-current stimulation, also offers a safe and affordable means to suppress pain. Because pain really is a perception, neuromodulation is a way to modify the pain feedback loop to the brain. (This principle is not new and goes back to something called the gate theory of pain in the 1960s.)
You may be familiar with transcutaneous electrical nerve stimulation (TENS), a neuromodulation therapy. TENS works by applying one or more topical skin patches containing electrodes to the lower back, then running a very low current for a short while to attempt to block pain signals traveling between back and brain. It is used in various forms today, and frequencies are typically modified to fine-tune to the individual patient.
A more invasive advancement in neuromodulation involves hair-like electrodes placed into the superficial paraspinal muscles (the outermost layer of muscle closest to the skin) to a depth of about 3 cm. A 30-minute treatment may provide some relief for low back pain and the three muscle groups that support the back (paraspinal muscles).
Burst stimulation also shows promise: it addresses multiple dimensions of pain, including somatic pain as well as emotional and psychological effects. In addition, dorsal root ganglion (DRG) stimulation therapy, while still in development, shows promising signs of targeting only the specific nerves in the spine associated with pain in a specific area of the.
Implants are increasingly a source of hope
In 2021, surgeons implanted the first device that uses neurostimulation (electrical pulses) on key nerves and muscles responsible for stabilizing the lower back. For people seeking chronic lower back pain relief, this is a hopeful sign. The implant blocks pain signals from the nerve root at the vertebral level. It is especially beneficial whose back pain stems from a degenerative multifidus muscle, and it may potentially restore functionality.
This is next-level neuromodulation. Implanted electrodes at the spinal nerve root level connect to a pacemaker-like implantable unit. The purpose, again, is to attempt to block pain transmission to the brain.
Back in the 1980s, these treatments were only for radiating pain in a leg (sciatica, for example). However, advances in software and hardware have resulted in some reduction in chronic axial low back pain. The electrical frequencies can be varied and the strength of stimulation can be modified to impart pain relief on the paraspinal muscles as well as the nerve root level. High frequencies are being used now in place of low-frequency stimulation, which was the original approach years ago.
Peripheral nerve stimulation (PNS) and spinal cord stimulation have been around for a while. While these aren’t new treatments, they are continuously being fine-tuned and improved.
For back pain relief, watch your posture
There are two methodologies that are seeing a resurgence because they offer gentle means to relieve stress and ease lower back pain. Both are more postural exercise programs, almost philosophies, of how we carry ourselves and interact physically with our environment. But what’s old is new again, as these treatments, developed more than 100 years ago, teach people how to use posture and balance to perform daily functions more efficiently, with the least wear and tear the body’s mechanics.
This program focuses how to relieve and prevent tension in the body that can manifest into chronic back pain and sore neck and shoulders. It aims to change incorrect movements and postures to improve balance, muscle support, and coordination.
Focusing on awareness, this method encourages mindfulness in movement and in other aspects of life. This somatic education improves flexibility and efficient movement to enhance coordination, thinking, emotion regulation, and problem-solving.
Another age-old practice, yoga, improves flexibility and helps gently stretch and strengthen muscles that support the back and spine. Pilates originally found devotees among ballet dancers as the best way to recover from injuries and prevent new ones. It has now become mainstream for strengthening the lower abdominal muscles, lower back, hips, and buttocks to provide enhanced muscular control of the back.
Stem cell therapy? It’s still under the microscope
The relatively new field of regenerative medicine or biologics, such as stem cell therapy or tissue engineering, has yet to widely prove its efficacy. Recent studies published in Journal of American Medical Association have shown limited benefit to various orthobiologic treatments, such as platelet rich plasma injections. However, there is a considerable amount of ongoing research in ways that different types of orthobiologic treatments could help relieve low back pain.
Amongst regenerative medicine providers, the opinion is that most studies are limited by poor methodology, so there is hope. Many providers who offer regenerative medicine treatments may not be using correct platelet concentrations or volumes that could effect more positive clinical outcomes.
Ongoing research will eventually result in more effective regenerative treatment options, and these may end up being the best option to produce future treatments that can reverse or stall chronic tissue decay.
Best ways to avoid lower back pain
Of course, the best way to avoid chronic low back pain is to stretch and protect your spine every day. We can’t stress enough the importance of maintaining a regular exercise program, proper ergonomics when sitting at a desk, and avoiding prolonged sitting, especially the “couch slouch.”
Learn more about New Jersey Brain and Spine’s Comprehensive Spine Center or contact us online.