New Advances In Treating Low Back Pain



LivaFortis looks at some of the latest treatments for chronic back pain

Facts About Low Back Pain


  • In the United States alone, there were 33,821,043 cases of chronic lower back pain in 2017.


  • According to a Statista survey from 2017 that shows chronic back pain statistics, more than half of the people with neck or back problems have been dealing with these issues for over 5 years.


  • Based on back pain stats, the majority of patients (60% to 80%) who have had an episode of acute lower back pain will experience similar symptoms within two years.


  • Back pain lasting for at least three months is generally defined as chronic.




People are spending thousands of dollars trying to find relief from low back pain

The Costs Of Chronic Low Back Pain


Americans often miss work because of back pain. Actually, this health problem is among the most common causes of work absences. According to statistics, 264 million workdays are lost every year due to back pain.


When it comes to dealing with this challenging condition, when we see numbers as disturbing as these, it is no wonder that there are so many people who still are looking for a solution to their debilitating disorder. Fortunately the healthcare industry has been quick to respond with many new treatment offerings that all compete for consumers attention - and for their wallets.


The low back pain industry is worth $100 billion dollars and companies have been promising solutions to us for decades. Unfortunately, many of these promises have not come to fruition, leaving consumers frustrated, disappointed, and with empty pocket books. Even worse than that, sometimes consumers are left to deal with the fall out of addiction.



Despite numerous products being available, many of them leave low back pain sufferers disappointed.


Disappointing Deliverables


Traditionally treatment options have focused on surgery, medication, bed rest, or spinal injections. While these treatment options do have some effects in helping to relieve chronic low back pain, many are expensive and offer no real long term solutions to patients.


Indeed, one study on spinal fusion in chronic low back pain patients showed that “Lumbar fusion surgery in patients with chronic low-back pain does not appear to offer any major benefit in outcomes over conservative rehabilitation programs incorporating physical activity and cognitive–behavioral therapy. Patients undergoing lumbar fusion may have a slightly lower but clinically unimportant decrease in disability scores in exchange for an increased risk of complications, higher medical costs and no difference in quality of life at 2 years after surgery. “


These bitterly disappointing results have led to more and more people trying to find a solution to this ongoing problem. This has led to a glute of products on the market, many of which are not clinically proven or have much scientific basis at all. With so many new solutions on the market, we thought that it would be interesting to break down what some of these new treatments do, what their benefits are, what concerns there might be with the treatments, and their overall effectiveness when used to treat chronic low back pain. Here are our reviews on some of the most popular new treatments for chronic low back pain.



Does Dry Needling work for low back pain?

Dry Needling


What is it?

Dry needling is a technique that is used by physical therapists to treat pain and some movement impairment issues. The process of dry needling is where a physical therapist takes a “dry” needle (a needle that doesn’t contain medication) and inserts it through your skin into your muscle. The needle stimulates the trigger points in the muscle and connective tissues which allows the physical therapist to reach areas that are not accessible when they use manual manipulation therapies, such as massage. Dry needling is also sometimes called “trigger point dry needling” or “intramuscular manual therapy”.


There is data to suggest that dry needling can be an effective treatment for low back pain.


Pros:

Dry needling is useful for treating sports injuries, as well as muscle pain and stiffness as stimulating the trigger points can improve flexibility and increase your range of motion. Dry needling often provides some fairly instant relief for chronic low back pain. In many cases patients felt that their mobility increased immediately and that they felt less pain within 24 hours. Typically, it can take a few treatment sessions (2-3 weeks) to feel more lasting effects.


Cons:

Temporary pain during dry needling occurs in about 60-70% of treatments. Existing symptoms can sometimes actually get worse after treatment (less than 3% of patients); but this is not necessarily a “bad” sign.


When it comes to price, the cost of dry needling can range from $35-$85 per session, and it is often not covered by insurance. Fortunately only a few sessions are typically needed.



Some acupuncturists think dry needling should be left to those trained in acupuncture.


Effectiveness for Low Back Pain:


So, does it work for chronic low back pain? When it comes to the data on treating low back pain it does look as if there are some proven benefits to this treatment. Studies have shown that dry needling is “more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only.” Indeed, some international clinical guidelines have agreed that dry needling could be an effective add on therapy for treating low back pain.



Considerations:


Dry needling is not available in every state, in fact, only 30 states allow it, while the other 20 states actually prohibit this practice. There has been a bit of a debate over who should be allowed to practice dry needling. Physical therapists believe that it is it’s own treatment, while acupuncturists insist that PTs have just given acupuncture a different name, and that they are not trained in this technique.


One acupuncturist stated that “Dry needling is acupuncture and physical therapists are practicing it without a license and putting patients at risk. Dry needling uses trigger points, 90 percent of which are acupuncture points. In many states, where dry needling is now allowed, little or no extra training is required for physical therapists to perform it on patients.” Physical therapists dispute this, stating that dry needling is part of modern western medicine principles and that it is supported by research. If you are thinking of trying out this treatment, check with your local state laws and make sure that whoever you use is actually qualified to be practicing.




Do electrical stimulators work for chronic back pain?

Electrical Stimulators


What Are They?


Electrical stimulators are also known as spinal cord stimulators. Spinal cord stimulation is a procedure that sends low-level electrical signals to the spinal cord in order to block pain signals from reaching the brain. In this treatment, a needle implants a small device into the body, close to the spinal cord. A second device, known as a pulse generator (sort of like a battery), is then implanted in the upper buttock of the patient. The impulses generated by the device mask pain signals traveling to the brain.


Newer pulse generators can be recharged through the skin, while some that do not require recharging have to be replaced after a period of time. Patients can turn the current on and off, or adjust the intensity of the signals. Some provide a tingling sensation, while others do not.



Spinal cord stimulation is an expensive and risky treatment for low back pain.


Pros:


When it comes to safety, spinal cord stimulation is generally considered to be a safe procedure. Potential risks are those that generally go along with any type of surgical procedure.


As far as cost is concerned, because the science behind spinal cord stimulators is sound, traditional Medicare is willing and able to cover both the procedure and the hardware for those who qualify for this treatment.


Cons:

Recovery time: As with any surgery—even a minimally invasive one—the initial recovery period following spinal cord stimulation implantation can be painful. Generally patients can resume light activities after about two to three weeks, but it can take six to eight weeks for a full recovery.


Cost: Without insurance, spinal cord stimulation surgery can be very expensive. A small study published in 2009 found that the average cost to implant an SCS device in the U.S. was between $33,000 and $58,000.


Side effects: These can include feelings of jolting or shocking, hematomas, epidural hemorrhaging, paralysis, infection, device malfunction or migration, loss of pain relief, or pain at the implant site.


Effectiveness for low back pain:

Although spinal cord stimulation is often 50-60% effective in reducing pain, the underlying condition is left unresolved. Patients may need to work with other healthcare specialists to treat the underlying causes of their condition. Pain relief is not guaranteed with this surgery, although success rates are improving with newer forms of this technology. Published studies of spinal cord stimulation show good to excellent long-term relief in 50 to 80% of patients suffering from chronic pain.



Do TENS Units help with low back pain?

TENS (Transcutaneous Electrical Nerve Stimulators)


What Is It?


A TENS unit is a battery-operated device that delivers small electrical impulses through special electrodes to reduce pain. The electrodes are attached to the skin via adhesive pads, so it is non-invasive. With TENS treatments, electrical impulses flood the nervous system, reducing its ability to transmit pain signals to the brain and spinal cord. They also stimulate the body’s production of natural pain killers, known as endorphins (our feel good hormones).

TENS treatment has been used to treat thing such as:

  • Labor pain

  • Joint pain

  • Sports injuries

  • Multiple sclerosis

  • Diabetic neuropathy

  • Fibromyalgia

  • Arthritis

  • Back and neck pain



TENS units seem to have some benefits for low back pain but they are very short lived.

Pros:


Because the electrodes are attached to the surface of the skin, it is non-invasive (you don’t need surgery).


The units are small and portable, making them easy to take with you. You can clip it onto your belt or put it in your pocket if you are at work.


Has been shown to reduce the use of pain medications.


You can purchase the units without a prescription and many are very affordable. Their price ranges from less than $100 to some more expensive ones that can cost more than $500.



TENS units do not treat the underlying causes of low back pain.


Cons:


If you want your insurance to pay for it you will need to get a prescription from your healthcare provider.


Safety: TENS is generally pretty safe, but it does have some risks associated with its use. If the electrical current is too high, or if the electrodes are placed on the wrong part of the body, the skin can get burned or irritated.


Pain relief: Sadly, pain relief is only experienced while the device is in use. Because it doesn’t treat the underlying cause of the pain, as soon as you stop using the device, the pain will return. This means that you have to use the device a lot if you are a chronic pain sufferer. This brings us to our next point.


Tolerance build up: Over time, patients can build up a tolerance to the TENS current, decreasing its effectiveness over time. Some units try to alternate different frequencies, but it can be hard for people to know which units will work and which won’t. This can lead to consumers spending more money on units that are ineffective. Not all units are made equal and there is very little regulation around these devices to guarantee effectiveness.



TENS units are not safe for everyone.


Considerations:


People who should not use TENS units:

  • Pregnant women: Pregnant women should avoid using TENS in the abdominal and pelvic regions.

  • People with epilepsy: Applying electrodes to the head or neck of people with epilepsy may induce seizures.

  • People with heart problems.

  • People with a pacemaker or another type of electrical or metal implant.


Effectiveness For Low Back Pain:


New guidelines released by the American Academy of Neurology (AAN) state that transcutaneous electric nerve stimulation, commonly known as TENS, is not effective at treating chronic low back pain. After the literature review, the researchers concluded that “TENS is not an effective way to treat chronic pain”.


When it comes to reviewing the data, two trials that involved more than 400 patients found that TENS did not improve back-specific function status. Other research showed that there was no decrease in use of other medical services when people used a TENS unit. A large meta analysis study could not find any evidence to support the use of TENS in treating chronic low back pain. This is why all international guidelines for the treatment of low back pain strongly recommend against using these devices to treat chronic low back pain.


Digital physical therapy is a growing trend in treating low back pain.


Digital Physical Therapy


What Is It?


Digital health has been making great strides in the past few years. From wearable devices and at home ECGs, to telehealth services and smart watches. It is no wonder then, that the physical therapy field has also started to investigate ways to bring their services into the homes of clients, digitally.


Many countries are experiencing provider shortages across all specialties, and the US is no exception. There are a great many clients in need of physical therapy that are unable to access services because they live in remote areas, often without a licensed practitioner nearby. When it comes to reasons why clients can’t access much needed physical therapy services, there are a range of reasons. Sometimes client are unable to get to appointments due to time constraints, sometimes they can’t take time off work, and other times they don’t have the transportation to get to a provider, especially one that is in network with their insurance provider.



Digital PT makes PT more accessible for patients.


These barriers to treatment have prompted those in the physical therapy industry to start trying to find ways to reach their clients in the comfort of their own homes. Some practices have been offering video home exercises to clients through different apps, while others in Canada and New Zealand have been doing online intake appointments and even doing assessments digitally.


Physical therapy is a treatment that is recommended by the international guidelines on treatment for low back pain, so it is important that patients are able to access these treatments.


Pros:


Patients are seen in the comfort of their own home

Travel costs are eliminated

Patients can see therapists at their convenience

Patients don't need to arrange for caregiver services

No need to take time off work

No lengthy waiting room times

PTs are able to see clients in their home environment, learning more about their clients

Clients can take more ownership of their treatment and recovery

High success rates in treating conditions



Not all insurance plans reimburse for digital health.

Cons:


Not all companies/countries offer these services

Not all insurance plans cover telehealth services

Technology can be unreliable (slow bandwidth for streaming services)

Not all clients are comfortable using technology

Not all PTs are trained in digital PT technology

Not all insurance plans cover physical therapy

Not all patients have insurance, which makes physical therapy very expensive. The average cost of receiving physical therapy without health insurance is now $75 to $150 per session. The actual price you pay depends on the type and severity of the injury. The standard out-of-pocket fee for a single evaluation assessment is $150.



Research supports using digital physical therapy for low back pain.


Effectiveness For Low Back Pain:


While this is a relatively new area of treatment, there is a growing body of data to support this practice. One study in Germany found that patients who received digital physical therapy services reported a 33.3% reduction in pain, whereas the control group only reported a 14.3% reduction in pain. The study also found that high-risk patients who had a telehealth consultation demonstrated larger decreases in pain intensity (−43.5%) compared to the control group (−14.3%).


A second study found that an app digitalizing multidisciplinary rehabilitation for the self-management of LBP reduced user-reported pain levels significantly and further research found that not only did patients’ experience of pain decrease, but their interest in surgery also decreased.


As the evidence continues to build it looks as if this is a very effective treatment for chronic low back pain.



LivaFortis looks at using sEMG sensors for low back pain.


sEMG Sensors


What Is It?


Surface Electromyographic Sensors (sEMG) is a non-invasive technique where electrodes are placed on your skin to measure the electrical activity in your muscles. So what does that mean, exactly? The sEMG readings can measure the activity in your muscles, as well as how your muscles are being used. It is basically an inside view of how your muscles are working when you do certain things like exercising or standing or walking.


sEMG can provide you and your doctor with specific information about nerve or muscle injuries that other testing cannot see. It can also determine the exact location of injuries and give some indication of whether the damage is reversible or not. sEMG can also see which muscles are being used/overused and determine what kind of balances/imbalances the body is using. With this information, you can learn to re-balance out your muscles to prevent overuse or injury.



SEMG sensors can help detect muscle fatigue and prevent injury.


sEMG is of particular use in sports medicine and rehabilitative medicine. Using sEMG data healthcare providers are often able to see the underlying cause of low back pain, and treat it more effectively. Physical therapists are able to see if patients are engaging their muscles properly during rehabilitative exercises. Doctors can see if the rehabilitation program is working effectively, and make necessary adjustments to the treatment plan.



SEMG sensors can see if rehabilitation programs are working.


Pros:


sEmg sensors can tell you which muscles are being activated during certain exercises and movements

sEMG sensors are non-invasive and much cheaper than MRIs.

sEMG sensors can show which muscles are getting fatigued, which is key to both injury prevention, and over compensation of other muscles.

sEMG sensors are a wonderful diagnostic tool to see issues with the muscles that help support the spine.

Treatment plans can be tailor made for individuals and are more effective.

EMG testing is typically covered by health insurance. For patients with health insurance, there may be a copay of $10-$50 or coinsurance of about 10%-50%



sEMG sensors are a wonderful diagnostic tool to see issues with the muscles that help support the spine

Cons:


sEMG machines are expensive - they can cost from $9000 - $20,000.

The data is hard to interpret and many PTs are not trained in reading and interpreting the data to make clinical recommendations.

Electrodes are hard to place.

Must often be done in a clinic setting.

For patients without insurance, the test typically costs between $150 and $500 per extremity, depending on the health care provider.

A patient may need to schedule a follow-up visit with a primary-care doctor to discuss the results. Research shows that an office visit for an uninsured patient is approximately $199. Patients who are covered by health insurance can face a copay of $10 -$50.


Effectiveness For Low Back Pain:


Research on chronic low back pain shows a correlation with delays in core muscle activation. This leaves the spine vulnerable to injury and pain with any initiation of movement. Thus, a good place to start with managing back pain is to restore muscle control and balance.


What does the science say? While sEMG is relatively new, more conservative healthcare players, like health insurance providers, would like to see more research being done on its applications for treating chronic low back pain, specifically. Fortunately the research that has already been done on the subject looks extremely promising.


In one study, using EMG biofeedback to train the lumbar (back) muscles in static postures (like standing) was associated with significant improvements in certain measures of chronic low back pain for up to 2.5 years after the study.


Research has also shown that correcting muscle imbalances in CLBP subjects have been reported to result in decreased pain, with gains lasting up to four years post-treatment, while the addition of SEMG biofeedback to a traditional exercise program for CLBP subjects resulted in a significant increase in lumbar strength measures. It seems as if addressing the root cause of the condition can provide long lasting results to those who suffer from chronic low back pain.


How does it measure up to other treatments? Well, further research of sEMG found that the biofeedback was “superior to cognitive behavioral counseling (including relaxation without biofeedback) and medical “treatment as usual” in outcome measures of pain, functional interference, and affective distress”.


Conclusions:


The use of new innovative technologies for chronic low back pain is only at its initial stage, but many scientists believe that this process is unstoppable, as it is happening in all the other areas of medicine and beyond. Obviously it will be important to continue with research and clinical studies to continue to prove their effectiveness. Not only will these technologies provide new treatment options for those who suffer terribly from low back pain, but knowledge will continue to grow and allow for the optimization of some of these treatments, as well as spurring on ideas for the development of new ones.