What Doctors Don't Tell YouKeep moving. While bed rest is the traditional recommendation for back sufferers, the latest research shows that movement is the key to preventing trauma from turning into chronic pain. Try to keep moving, within the limits of your level of pain. Investigate gentle exercises such a t’ai chi (a form of qigong). In one randomised controlled study, six weeks of t’ai chi significantly reduced the intensity of pain suffered by a group with chronic low back pain, compared with those given routine care. Pain was especially improved during the last week (Alt Ther Health Med, 1998; 4: 90-1). T’ai chi has only 20 movements which can be taught over a period of eight weeks. Yoga and Alexander Technique may also be beneficial.
Take supplements. The most important supplements for the treatment of chronic pain are the B-complex and C vitamins. The spine is surrounded by the watery cerebrospinal fluid, which, in healthy individuals, contains a higher concentration of these water soluble vitamins than is commonly found in the blood (Am J Clin Nutr, 1992; 56: 559-64). A combination of thiamine (B1), vitamin B6 and vitamin B12 has been shown to significantly improve symptoms for those complaining of severe pain (Neurosci Lett, 1988; 95: 192-7; Klin Wochenschr, 1990; 68: 116-20). In a study of back pain sufferers, this combination (100 mg B1, 200 mg B6 and 0.2 mg B12, each three times daily) was used over six months. Only 32 per cent of those taking the vitamins suffered relapses in back pain, compared to 60 per cent receiving the placebo (Ann NY Acad Sci, 1990, 585: 540-2).
Adequate vitamin C intake is necessary to maintain the integrity of spinal discs (Med Ann DC, 1964; 33: 274). Deficiency in copper and selenium may also be contributory factors in chronic pain; 90 to 100 mcg of selenium alone or in addition to 20 IU vitamin E, taken daily, has been shown to improve musculoskeletal complaints (NZ J Med, 1981; 93: 289-92)
Consider hydrotherapy. Spa treatment has been shown to improve the range of movement and intensity of pain (Aust J Physiother, 1995; 41: 205-8). In one study when patients were randomly assigned to either spa treatment or a control group, the spa group showed improvement of pain and mobility as well as a reduction in drug use.
Spa treatment included a mixture of mineral baths, warm mud applications and high pressure showers, six days a week for three weeks.
Hypnotherapy. Pain management through hypnosis may also be an effective way of dealing with back pain for which no physical cause can be found (Pain, 1995; 60: 39-47). Hypnosis works by relieving stress and promoting relaxation. However, behavioural modifications can also be incorporated into each session.
Reduce caffeine. In one small study, back pain sufferers consumed more than twice the amount of caffeine daily than non sufferers. Caffeine consumption among men was 86 per cent greater than among women (Arch Phys Med Rehabil, 1997; 78: 61-3).
Quit smoking. Smoking may make the condition worse. While it is unlikely that smoking causes back pain, its known debilitating effect on the vascular system may make the condition worse in some individuals (Spine, 1993; 18: 35-40) particularly among men. Male smokers have a higher frequency of invertebral disc problems than female smokers, and both female and male smokers were found to have back pains more frequently than non smokers (Scand J Rehab Med, 1996; 28: 33-8).
Herbal help. Devil’s claw (Harpagophytum procumbens DC) has been shown to be more effective than long term drug treatment. It does not cure back pain, but acts as a supportive measure in reducing pain of different intensities in the back and legs (De Candolle Erfahrungsheilkunde, 1997; 46: 330-5). When applied on the skin, capsaicin, an alkaloid present in hot peppers, can block pain impulses (Pain, 1990; 41: 61-9; J Am Acad Dermatol, 1989; 21: 265-70).
Maryon Stewart
Hyla Cass MD
