Chronic Back Pain Breakthroughs

Ouch, that aching back! If you’ve ever moaned in agony from back pain, rest assured—albeit uncomfortably—that you’re not alone. About eight in ten Americans will suffer from it at some point in their lives. After colds, it’s the No. 1 cause of missed work. It’s a major drain on the American economy, costing more than $90 billion a year in medical bills. Yet a cure for the common backache is as elusive as ever.

Part of the problem is the complexity of the spine, a miraculous structure of bone and cartilage that surrounds nerves linking the brain to the rest of the body. The lower back, called the lumbar region, bears most of a person’s weight on five vertebrae separated by disks that work like shock absorbers to provide cushioning and flexibility. Muscles and ligaments supply further support. But over time, the effects of aging decrease bone mass and muscle elasticity, and contribute to disk degeneration, leaving the lower back vulnerable to injury—and millions of people susceptible to pain.

Back pain can originate from many sources, and treatments are just as varied, from conservative approaches like exercises and massage, to more risky prescription medications and surgery. Unfortunately for many patients, these choices often provide only temporary relief, and some have debilitating side effects.

But the search for a magic bullet continues, and we may be closer than ever. Doctors and scientists are reporting success with these new and coming-soon treatments that can ease back pain for some sufferers while offering hope to all.

The “Pain Pacemaker”: Blocking Back Pain to the Brain

Barbara Sweeney’s back hurt for 20 years. The 63-year-old hospice chaplain from Silver Spring, Maryland, had been on an agonizing odyssey of doctors’ visits and treatments. Painkillers, physical therapy, epidural shots, even methadone: Sweeney had tried them all, getting little relief. In 2000 neurosurgeons diagnosed her condition as stenosis, a narrowing of the spinal canal, which pinches the nerves.

Over the next five years, she underwent two spinal fusions to relieve the stress on her back nerves. But instead of lasting improvement, Sweeney experienced new pains, and her doctors were mystified.

Then, in the fall of 2006, she heard about a “pain pacemaker,” an implantable device introduced by Medtronic in 1969 and modeled after its heart pacemaker. Over the years, the company had refined the device, formally known as a neurostimulator, by making it increasingly smaller and longer lasting. One of its latest models, the RestoreAdvanced neurostimulator, can operate for nine years with a battery recharge only once every four to six weeks. The size of a pocket watch, the device works by sending mild electrical impulses along the spinal cord, blocking pain signals to the brain. “We’re still not sure why stimulating nerves provides relief, just that it does,” says Richard Kuntz, MD, president of Medtronic Neuromodulation in Minneapolis.

With her options dwindling, Sweeney scheduled a pacemaker implantation. After the surgery, “the relief was immediate,” Sweeney says. “The pain was gone.”

Since then, she has thrown away her cane. She now sleeps through the night, and in the spring, she started a water exercise class. “I feel like a new woman,” she says. “I’m finally able to do things I couldn’t do for years.” She pauses, carefully patting a gentle swelling in her lower back. “This little device,” she says, smiling broadly, “turned out to be a miracle.”

The support belt that decreases back pain
The Lumbar Wrap: Daily Therapy Decreased Back Pain

Infrared rays were discovered in 1800, but it took another two centuries to figure out how to harness their power to reduce back pain. The Lumbar Wrap, created by Canadian inventor Lawrence Gordon of IR Wraps, resembles the black support belts worn by people who frequently lift heavy loads.

The device uses low-level infrared energy—the same type of heat used to warm food in restaurants—to improve blood circulation and promote healing. In a small study in 2006, researchers at the Rothbart Pain Management Clinic in Ontario found that the Lumbar Wrap reduced painful symptoms by half.

The 39 adults in the study, who had suffered lower back pain for more than six years, found relief with daily therapy over the course of seven weeks, and reported decreasing pain levels when turning and bending in different directions. Gordon invented the belt after hurting his own back while training horses, and says other back pain sufferers have felt better wearing the belt while sleeping or doing daily activities.

One potential side effect: Prolonged use can cause a relatively harmless browning of the skin. And at $2,335, the Lumbar Wrap isn’t cheap.

Gordon is trying to get his invention approved as a medical device in Canada and the United States, in the hope that it will become more widely available, through doctors, chiropractors and pain clinics.

Less-Invasive Back Pain Surgery with More Relief

Scientists estimate that about 7 million cases of lower back pain are caused by strain or injury to spinal disks, often striking weekend warriors who overdo it when exercising or tackling home improvement projects. In the past, treating disk-related pain involved physical therapy or epidural steroid injections to reduce inflammation. For serious cases of herniated, or “slipped,” disks, patients resorted to surgery, despite the hazards of infection and no guarantee of a cure.

While some patients will still need surgery, doctors have been developing less invasive methods to reduce painful disk pressure on adjacent nerve roots. One of the most advanced decompression techniques, percutaneous diskectomy, involves removing a small amount of tissue from the disk nucleus through a tiny puncture in the skin. Some compare it to releasing air from a bulging tire. Doctors can choose from several recently introduced probes. The Stryker Dekompressor scoops out disk material through a needle, creating a space that draws the disk back to its normal alignment. The ArthroCare SpineWand sends out an electrical charge that creates a highly focused plasma field to vaporize and extract tissue.

With either instrument, the procedure lasts less than an hour, and patients can go home with only a small bandage over the needle insertion site. Best of all, at least two-thirds of appropriately selected patients experience positive results.

“The relief is instantaneous,” says Netsere Tesfayohannes, MD, director of the Interventional Pain Management Center at Georgetown University Hospital in Washington, D.C. “You know right away whether the treatment has worked.”

Flexible Fusion for Greater Movement

Each year, some 200,000 Americans with degenerative disk disease undergo spinal fusion surgery. The procedure stabilizes the vertebrae with metal rods and screws to allow a bone graft to fuse the vertebrae together. It can provide dramatic and long-term relief. But there’s a price. Spinal fusions limit a patient’s range of motion and can require follow-up surgery to alleviate stress on the vertebrae adjacent to the fused area.

But a new process called the Dynesys Dynamic Stabilization System uses bendable materials to provide support and greater movement. The system consists of flexible plastic tubing that surrounds a cord and spacers. During the surgery, doctors attach the device to both sides of the affected vertebrae. “The goal is to restore stability while preserving motion,” says Reginald Davis, MD, head of neurosurgery at Greater Baltimore Medical Center, who’s performed the surgery more than 200 times. “I’ve had success with patients from 21 to 75.”

The Dynesys system was approved for spinal fusion by the FDA in 2004, but in Europe, where the system has been on the market for a dozen years, it’s most commonly used to provide flexible stabilization of the vertebrae without bone fusion. Dr. Davis has joined a study involving 400 U.S. patients to determine its effectiveness for this use. He hopes the study will show the system’s ability to restore natural movement—without the need for follow-up surgery. “In Europe,” says Dr. Davis, “the new mantra for treating back pain is, Refuse to fuse.”

When a Patient’s Stem Cells Hold the Cure

Many therapies for degenerative disks treat only the symptoms, not the cause of the back pain. But at England’s University of Manchester, Stephen Richardson, MD, has proposed a radical and promising approach: using the patient’s own stem cells to create a healthy back. Developed in conjunction with German biotechnology company Arthro Kinetics and an English medical charity called the Spinal Foundation, Dr. Richardson’s therapy uses bone marrow cells to regenerate damaged intervertebral disks. Doctors would extract and mix the cells with a special gel that’s based on a type of human collagen and then implant the substance during minimally invasive surgery. The stem cells should then produce new disk tissue with the same properties as the original, but without the damage.

“It’s completely safe because we’re using the patient’s own stem cells,” says Dr. Richardson, who is a researcher in the University of Manchester School of Medicine’s division of regenerative medicine. “The patient could go home the same day of the procedure.”

Researchers hope to start clinical trials after two years and bring a product to market within five years (though others think it will take longer). Dr. Richardson believes the stem cell technique “will revolutionize the treatment of lower back pain” by addressing both cause and symptoms with one therapy, rather than consigning sufferers to a lifetime of pain-killers and physiotherapy.

“What we envision is a one-stop shop for treatment,” he says. “You’d come in, get these cells implanted into your spine, and end up with regenerated new tissue. And that would be it, for life.”

Bone Growth Drug Targets Back Pain

Many elderly people experience back pain from osteoporosis and serious bone fractures. But what if frail bones could grow stronger — as strong as new bone? That’s the idea behind site-directed bone growth (SDBG). A patient with diseased or damaged vertebrae undergoes a minimally invasive outpatient procedure and receives an anabolic drug to accelerate natural bone growth at precise locations. The strengthened bone, in turn, lessens the back pain.

“The novel idea is to target new bone to specific sites,” says Agnès Vignery, PhD, a professor of orthopedic surgery at Yale University Medical School who developed SDBG with clinicians at Unigene Laboratories in Fairfield, New Jersey. “Most drugs affect the whole body. But our treatment increases bone mass just where it’s needed.”

Already, investigators have demonstrated success with SDBG in experiments involving mice and rats. In 2005 the Unigene team filed for patents, with plans to start clinical trials involving humans in the next two years. And though Vignery refuses to speculate how soon the therapy may be ready for people, she’s excited about SDBG’s potential to remedy a wide array of ailments.

Finding Back Support in a New Mattress

If all else fails or involves too many needles for your liking, consider getting yourself a better bed. A study by researchers at Oklahoma State University found that simply getting rid of a worn-out mattress could significantly reduce back pain and stiffness. A scientific team led by Bert Jacobson, EdD, reports that people who suffered from back pain experienced relief by switching to a new mattress, and that the relief continued long after acquiring the new bed.

“Most people treat their mattresses like a rented mule,” observes Jacobson, head of the School of Educational Studies. “They’ll sleep on a bed long after the support has given out. We found a positive relationship between a new mattress and lower back comfort.”

In the 2006 study, Jacobson’s team examined 59 men and women of all ages for four weeks with their old mattress, and four more weeks with new ones. Then the researchers analyzed the participants’ daily assessment of their back discomfort, spine stiffness, sleep comfort and sleep quality. The subjects reported improvements in each area when they’d slept on new, medium-firm mattresses. Those who entered the study reporting the highest levels of back pain experienced the greatest improvement.

While it sounds like cheerleading from bedding companies—and the study was partly sponsored by a trade group, the International Sleep Products Association—Jacobson points out that the research was approved by a university review board and insists that the findings stand up to scrutiny.

“Here’s a possibility for relief without taking drugs, having surgery or getting manipulated,” says Jacobson. “And all you need to do is trade in your old bed.” That’s the kind of painless treatment that anyone can take lying down.