SAN FRANCISCO (KCBS RADIO) – People suffering from lower back pain who feel like treatments don’t do too much for their ailment are probably right, according to a new study. This week, Dr. Prasad Shirvalkar of UCSF joined KCBS Radio’s “As Prescribed” to discuss the findings.
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Specifically, the study published last month in the BMJ Evidence-Based Medicine journal found that current evidence shows that only one in 10 non-surgical and non-interventional treatments for low back pain are efficacious, “providing only small analgesic effects beyond placebo.”
“When I was reading the study, it reinforced, I think, intuition of what a lot of practicing pain management docs find, which is chronic low back pain is really hard to treat well for most people,” said Shirvalkar.
With nearly one-in-four Americans experiencing back pain, that indicates that a lot of patients and doctors are left frustrated by it. However, there is some hope, and Shirvalkar has some insight on where progress is needed most to help make back pain less of a mystery.
“There’s certain drugs that work really well for certain people. And right now, the state of the art is trial and error,” he explained. At first, non-invasive treatments are tried, followed by things like injections and nerve blocks. If those treatments don’t work, things like spinal cord stimulation could be considered.
Lumping patients who suffer from lower back pain into one group can make things more difficult due to this variety in responses to treatment. So, Shirvalkar said one goal that could improve outcomes is to work on more personalized medicine, tailored to each patient.
“The reality is, if you have low back pain for a long time, one of the real difficult things is, it’s hard to know where it’s coming from,” Shirvalkar added.
Imaging like an MRI or your CAT scan can help, but he said imaging also doesn’t always correlate with someone’s symptoms.
“I think what really needs to be studied is one, what is happening to joints and to bone structure when arthritis develops,” he said. “Fundamentally, what are the early processes before arthritis fully sets in and can we essentially identify them using imaging? So that brings me to we need better scans or better really algorithm technology.”
Aging can also make back pain worse for some, or trigger new back pain for other patients. This often manifests as chronic back pain, which is particularly difficult to treat.
“It becomes kind of ingrained in our spinal circuits and our brain circuits, and it changes the wiring in our nervous system, actually,” said Shirvalkar.
That’s why he thinks that research into our nerves might finally reveal more about why this back pain occurs and what we can so about it. He said there’s currently a “knowledge gap” regarding what happens to nerves when someone has acute back pain versus chronic back pain.
“There are circuits that change in the spinal cord, circuits that changed in the brain. And I think understanding how this kind of maladaptive rewiring happens will help us hopefully to undo it or try to reverse it,” Shirvalkar explained. Understanding this would be a “holy grail” for the treatment and prevention of the pain, he said.
As for what people can do today, Shirvalkar recommended exercise, with some notes. He said that strengthening muscles should help stabilize a person’s spine, allowing it to work less and that aerobic activities such as running should help promote bone growth. However, he said that people should work with a trainer to make sure their form is correct and that they don’t get injured.
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