The Disease of the Century: Low Back Pain
Excerpt from Stopping Pain Book
Back pain has been labeled the disease of the century, surpassing obesity and diabetes. There’re more chronic diseases than ever. It’s estimated that half of 65-year-olds can’t get up from the floor with one or two hands — It’s worth pausing to let that sink in. Pain and physical disability reduce peoples social functioning, mental health, and diminish quality of life. The economic impact consumes health and social care resources. Elderly patients with chronic diseases exercise less, fall more, and are frailer; they suffer from depression, cognitive impairment, and poor sleep. Despite spending trillions on pain and antidepressant medications annually, modern healthcare cannot address pain, and many suffer needlessly, often until death. Nothing seems to change, despite the last three American presidents, Obama, Trump, and Biden, having implemented policies to combat chronic diseases. Even billionaire entrepreneurs like Bill Gates and Elon Musk suffer from chronic diseases despite their vast resources.
Millions Suffer Worldwide from Chronic Diseases
Low back pain (LBP) is common affecting 1 in 13 people worldwide. According to the Fit for Work Europe study, 100 million European working-class citizens have chronic musculoskeletal pain. Data from the 2016 United States Bone and Joint Initiative suggest that 50% of Americans have chronic musculoskeletal conditions.
We’ve surrendered to living with chronic illnesses: arthritis, back pain, degenerative disc disease, sciatica, knee pain, hip pain, frozen shoulder, migraines, and TMJ, to name a few. If those stats are alarming, it’s likely because one of the worst parts of having chronic pain is the isolation that it brings. We’ll arrive there one day: a fact of being human. When you receive a chronic disease diagnosis, the reality of how life will change sets in; it’s normal to feel like your world is shrinking around you. But there are more people than you know who understand just how you feel. Living with chronic illness or chronic pain means facing some unique challenges, not least of which is the confusion and isolation that comes with being “differently abled.”
A lot of Side Effects
Besides non-pharmacological approaches, musculoskeletal pain disorders are traditionally managed with drugs to reduce pain and inflammation. However, the frequent association with adverse effects, sometimes life-threatening, is often not worth the risk. Tylenol use can affect the intestines, heart, liver, and kidneys. Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with many adverse events affecting the gastrointestinal, cardiovascular, and renal systems. High dosages of corticosteroids are associated with many adverse events, such as hypertension, hyperglycemia, hyperlipidemia, weight gain, glaucoma, cataracts, gastrointestinal toxicity, osteoporosis, myopathy, avascular necrosis, immunosuppression, impaired wound healing, mood disorders, memory deficit, and even psychosis. Opioids, used either alone or in combination with Tylenol and NSAIDs, cause a variety of side effects, including overdose and death.
WHO Low Back Pain Practice Guidelines
The World Health Organization (WHO) recently unveiled its inaugural guideline for the nonsurgical management of low back pain (LBP). The critical point of the WHO Guidelines is to enhance treatment outcomes for chronic primary LBP in primary and community care settings, excluding interventions applied in more advanced healthcare settings or the workplace. LBP is defined by the WHO as pain lasting over three months, located between the 12th rib and gluteal folds, not linked to a specific disease or structural abnormality. The WHO recommendations focus on five classes of interventions – patient education, physical, psychological, pharmacological, and multicomponent approaches, with 24 specific recommendations derived using the WHO Handbook for Guideline Development and the GRADE methodology. Notably, most recommendations are based on “low” to “very low” certainty evidence, emphasizing a cautious approach to treatment selection. The WHO guidelines represent a step forward to managing chronic LBP, but it shows just how limited, even in the 21st century, we are in treating chronic back pain. In reality, most patients don’t benefit from these standard treatments.
Limited Options and the Health Authorities
There are not many options for patients suffering from LBP. Most patients are offered anti-inflammatory medication, pain medications, physical therapy, and surgery. For conditions with LBP it’s essential to treat the mind, body, and spirit. Often, alternative therapies are the only thing that might reverse the course of chronic diseases, rather than just masking the pain with medications. Countries like France are taking away alternative and complementary medicine, which will dramatically affect patients with LBP. I’ve written about this in my previous Substack article called Nurturing Democracy. If these kinds of measures succeed in taking away the various modes of alternative therapies, patients will be left with nothing other than pain medications and surgery; and surgeries are no better than chance at alleviating back pain.
Polypharmacy and Pharmaceutical Companies
The Hippocratic oath says, “Do no harm,” however, this is paradoxical because most treatments involve pain and suffering; therefore, we must constantly evaluate the risk-benefit ratio. Patients are seldom satisfied with doing nothing and reveal everything if we listen. The doctor-patient relationship is unique — it’s a meeting of confidence and conscience. The patient wishes to stop the pain and return to normal function without side effects. Modern medicine simply masks the symptoms with pharmaceuticals rather than treating the cause; even worse, the response to side effects is to take more medicines to counteract the side effects of those other medicines. Pharmaceutical companies have taken advantage of this situation by creating numerous drugs in our daily lives. Pharmaceutical companies focus on new drug production; they allocate vast sums of money to research with the hope of beneficial financial returns; they excel in creating voluminous documents that adapt perfectly to the requests of government health authorities. These expensive studies always reach the ultimate cost of an FDA-approved drug. Market forces push for profits, leading to less time for interaction between the patient and the healthcare provider. Consequently, the costs associated with our healthcare system have become exorbitant, and in the end, it’s the patient who pays.
The recurring problem is polypharmacy — the patient is taking too many medications. Most drugs are unnecessary, particularly when considering the biological terrain and can be removed if we treat the disease’s cause. A nation concerned about the health and vitality of its population should react and invest more in this sector. In addition to the financial problems, there are also medical concerns regarding the long-term side effects of these drugs. Particularly for the elderly, who often take multiple medications, the side effects of these drugs remain unknown. A world freed from polypharmacy would be a real added value.
Getting Closer to Clinical Reality — Percutaneous Hydrotomy
Medicine is the art and the science of fostering physical, psychological, and spiritual health. In percutaneous hydrotomy, the healthcare provider is interested in the biological manifestations of the pain and the energy needed to heal the lesion. Nobel laureate Albert Szent Gyorgyi says, “healing is the art of moving energy.” Too many healthcare practitioners need to remember this.
The front-line general practitioner must become an artisan and work with their hands rather than a pen or a computer. This is called general interventional medicine (it already exists in cardiology and radiology). We aim to expand medications to treat chronic pain, allergies, hives, eczema, etc. In these diseases that spread over time, the healthcare provider must find and treat the causes. Few things in life are as real as chronic pain; the answer is closer to a world with fewer drugs — this is precisely what percutaneous hydrotomy attempts to address.
In percutaneous hydrotomy, our focus extends beyond merely addressing symptoms and the names of the diseases. Instead, we prioritize the underlying biochemical problems of the pain that give rise to pain and injury. For example, osteoarthritis is primarily a biological phenomenon involving destructive degeneration, resulting in functional impotence. The goal of the consultation in percutaneous hydrotomy is to learn that the treatment will eliminate pain and medications. The patient is a wealth of information; the truth always comes from them.
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