The dreaded back pain
Question
Dr Pearce
I recently saw on A Current Affair a story relating to
a medical procedure known as the Blomberg technique. I believe this technique
was pioneered in the USA and assume it was named after the person who developed
it.
Basically, the technique involved some kind of solution (I
think the programme mentioned a steroid) being injected into the lower back of
the patient, and relieving chronic lower-back pain.
Several persons interviewed here in Australia had the
procedure performed by a Sydney doctor. All stated it was a
“miracle”, and that their chronic pain was dramatically reduced, if
not relieved completely.
One patient had fallen off her horse and severely injured her
lower back and another had a ruptured disc.
The NSW doctor said he could not understand why this
technique had not yet been widely accepted and practised in Australia.
Do you have any knowledge or comment on this procedure, and
are you aware of any SA practitioner who uses the technique? Also, is there any
literature available on the subject?
Regards
Simon Keir
Major Crash Unit
Blomberg and others published, in the Scandinavian Journal
of Primary Health Care (v. 11, p. 83-90, 1993), an article titled Manual
therapy with steroid injections in low-back pain. Improvement of quality of
life in a controlled trial with four months’ follow-up.
The conclusion was that: “Manual treatment with steroid
injections was superior to conventional treatment in minimizing mental and
somatic symptoms and increasing quality of life, in parallel with other
measures of improvement.”
The techniques were reported on A Current Affair on
June 9, 2003, in a piece called Back pain relief: a remedy that really
works.
The use of cortisone injections has generally been accepted as
a safe technique when used properly. The type of injections, how they are given
and what other treatments are used also influence the outcome, and some
authorities believe further research is still needed to warrant the use of some
of the techniques discussed.
Research is still being conducted around the world, and in
Adelaide, with injections, implants and other ways of treating back pain.
Despite the implied criticism in the ACA report – that Australia is behind
in its treatments – most options are available in Adelaide.
Back pain affects us all at some time. It can force us into
time off work and/or cost time and money in treatment. It is renowned for its
association with worker compensation claims; and “bludger’s
back” is a common thought about anyone who complains of, or reports in
sick with, a back problem. Stories of sexual activity causing back pain, and
accusations of “shagger’s back”, are as much compliments as they
are slurs.
But, somewhere, amid all the stories, is the reality of coping
with the pain. Simple treatments sometimes make a difference and, other times,
new surgery is the answer.
Slight discomfort sometimes indicates the beginning of a
serious complaint. In other cases, pain that feels like the worst someone has
ever experienced is simply muscle spasm that needs a little care and will
settle.
It can be difficult to know when to seek help for back pain,
which comes in so many types. But, rather than the type of pain, it is how long
one has suffered it – and whether it has eased – that advice is more
often base upon.
However, if there appears to be nerve compression, or
symptoms such as leg weakness, numbness around one’s genitals or
difficulty passing or controlling the passage of urine, urgent medical
attention is needed. These symptoms might be from serious spinal-cord pressure
or compression, and require an operation to relieve the nerve pressure before
permanent damage is caused.
The spine is made up of the vertebra or bones, which surround
the spinal cord. At each level, nerves come out of the spinal cord and go to
the various muscles or organs so a connection exists between the body and the
brain.
The neck region is made up of seven bones known as the
cervical region. Coming out between these bones are eight lots of nerves. The
first, C1, is between the skull and the first cervical vertebra.
In the chest region, known as the thoracic or dorsal spine,
is where the ribs attach to the vertebra. In this region are 12 sets of nerves;
and the abbreviations refer to the level of the nerve or disc between two bones
(eg T7 nerve or T9-10 disc).
The lower back, or lumbar region, has five vertebrae sitting
on the sacrum, which is one piece. Therefore, in this region, the abbreviations
refer to the nerve or region, such as L5-S1, which means the region between the
fifth lumbar spine and the sacrum.
Because of wear and tear, the bones usually show changes on
x-rays. These are known as degenerative changes, but are also called
spondylosis. They are more common with age of previous injuries to the spine.
The pain associated with spondylosis is not related to the
nerve but to the bones rubbing at the joints between the vertebrae. As this
process is like any other arthritis, it can be helped by exercise,
physiotherapy and medication (anti-inflammatory or analgesia). Surgery is
sometimes considered but not usually helpful because the wear and tear
continues and the adjacent joints take the extra strain and themselves become
sore.
A nerve compression in the neck is called brachialgia and in
the lumbar region sciatica. Despite the severity of pain, most nerve root
injuries will settle by themselves in four to eight weeks. Treatment is best to
control the pain and do no further harm. When the pain becomes more chronic,
surgery might be needed, and various investigations will suggest the exact
cause of the pain and the treatments likely to work.
A plain x-ray will show some of the causes, but CT is the
usual choice to discover if there is actual pressure on a nerve or disc
prolapse that might need to be helped with surgery. Rarely these days will
surgery be considered without an MRI (magnetic resonance imaging) scan, which
gives the most precise view of the anatomy ready for treatment.
Surgery is designed to stabilize the bones and ligaments that
are pressing on nerves, or other structures causing pain. It (surgery) is
considered the last resort for back pain, unless there is serious nerve or
spinal-cord damage in need of treatment. The success of surgery depends on the
right operation and the treatment of problems that will benefit from the
surgery.
Adelaide has some of the top specialists working with the most
advanced back surgery in the world. Websites such as
www.spine.com.au offer a local
perspective, while the American Orthopedic Association can be found at
www.spine-surgery.com and
www.orthospine.com.
The operations are designed to cut away any material that is
pressing on the nerve or make the bone and structure of the spine stable. This
is so neither the spinal cord nor the nerves will be damaged by movement or
pressure from the bones, disc or ligaments.
Folklore about back injuries might be plentiful, but extremely
good advances in treatment also abound. Anyone with concerns should seek
treatment early. In Adelaide, we have access to some of the best surgery in the
world, so one can expect good advice. But, sometimes, the best treatment is
simple, and needs time and ongoing exercise programmes that get frustrating. If
in doubt, get advice.
