If you have chronic low back pain, you are not alone. Up to 85% of adults will experience back pain, including low back pain, at some point in their lives. 2% to 10% of those who experience low back pain still report pain after 3 months, which makes it a chronic condition.
Nearly everyone at some point has back pain that interferes with work, routine daily activities, or recreation. Americans spend at least $50 billion each year on low back pain, the most common cause of job-related disability and a leading contributor to missed work. Back pain is the second most common neurological ailment in the United States — only headache is more common. Fortunately, most occurrences of low back pain go away within a few days. Others take much longer to resolve or lead to more serious conditions.
Low back pain also affects a significant proportion of younger working individuals, 35 to 45 years of age. An important study has correlated macroscopic and microscopic intervertebral disc alterations starting in the second decade of life with oxidative stress.
Job satisfaction remains a strong predictive factor for the identification of individuals with acute back pain who will develop chronic pain. Patients with infected vertebral osteomyelitis may have an increase in their erythrocyte sedimentation rate during the first 2 weeks of antibiotic therapy without requiring surgical intervention. MRI enhancement of migrated disc fragments identifies individuals who are likely to resolve sciatica without surgical intervention. As many as 25% of individuals with low back pain are symptomatic at 12 months, in contradistinction to the belief of resolution of pain in 2 months.
Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is mechanical in nature — the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and/or range of motion, or an inability to stand straight. Occasionally, pain felt in one part of the body may “radiate” from a disorder or injury elsewhere in the body. Some acute pain syndromes can become more serious if left untreated.
Chronic back pain is measured by duration — pain that persists for more than 3 months is considered chronic. It is often progressive and the cause can be difficult to determine.
What causes lower back pain?
As people age, bone strength and muscle elasticity and tone tend to decrease. The discs begin to lose fluid and flexibility, which decreases their ability to cushion the vertebrae.
Pain can occur when, for example, someone lifts something too heavy or overstretches, causing a sprain, strain, or spasm in one of the muscles or ligaments in the back. If the spine becomes overly strained or compressed, a disc may rupture or bulge outward. This rupture may put pressure on one of the more than 50 nerves rooted to the spinal cord that control body movements and transmit signals from the body to the brain. When these nerve roots become compressed or irritated, back pain results.
Low back pain may reflect nerve or muscle irritation or bone lesions. Most low back pain follows injury or trauma to the back, but pain may also be caused by degenerative conditions such as arthritis or disc disease, osteoporosis or other bone diseases, viral infections, irritation to joints and discs, or congenital abnormalities in the spine. Obesity, smoking, weight gain during pregnancy, stress, poor physical condition, posture inappropriate for the activity being performed, and poor sleeping position also may contribute to low back pain. Additionally, scar tissue created when the injured back heals itself does not have the strength or flexibility of normal tissue. Buildup of scar tissue from repeated injuries eventually weakens the back and can lead to more serious injury.
Occasionally, low back pain may indicate a more serious medical problem. Pain accompanied by fever or loss of bowel or bladder control, pain when coughing, and progressive weakness in the legs may indicate a pinched nerve or other serious condition. People with diabetes may have severe back pain or pain radiating down the leg related to neuropathy. People with these symptoms should contact a doctor immediately to help prevent permanent damage.
There are many causes of low back pain. Sprains, strains, muscle spasm, fractures, arthritis and degenerative disc disorders are among the causes of low back pain. Sometimes low back pain may be experienced as a result of referred pain from inside the abdomen. Rarely are intra-abdominal causes considered. Degenerative disc disease is common, costly, debilitating, and one of the most complex conditions to manage.
Back pain is a leading cause of doctors’ visits and disability. Nearly 80% of all Americans will suffer from back pain at least once in their life – whether it’s muscular, the joints, the discs or the spine itself. Back pain is not a disease in and of itself, but a sign of a more serious condition. (Think “check engine” light in your car.) It is often times a chronic and progressive disorder that gets worse with time; be that a sudden injury or something that has developed over time. If you try and cover up or just plain ignore the pain, the condition will likely worsen until it becomes permanent and spread to other areas of the body.
Conditions that may cause low back pain include:
Bulging disc (also called protruding, herniated, or ruptured disc). The intervertebral discs are under constant pressure. As discs degenerate and weaken, cartilage can bulge or be pushed into the space containing the spinal cord or a nerve root, causing pain. Studies have shown that most herniated discs occur in the lower, lumbar portion of the spinal column.
A much more serious complication of a ruptured disc is cauda equina syndrome, which occurs when disc material is pushed into the spinal canal and compresses the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.
Sciatica is a condition in which a herniated or ruptured disc presses on the sciatic nerve, the large nerve that extends down the spinal column to its exit point in the pelvis and carries nerve fibers to the leg. This compression causes shock-like or burning low back pain combined with pain through the buttocks and down one leg to below the knee, occasionally reaching the foot. In the most extreme cases, when the nerve is pinched between the disc and an adjacent bone, the symptoms involve not pain but numbness and some loss of motor control over the leg due to interruption of nerve signaling. The condition may also be caused by a tumor, cyst, metastatic disease, or degeneration of the sciatic nerve root.
Spinal degeneration from disc wear and tear can lead to a narrowing of the spinal canal. A person with spinal degeneration may experience stiffness in the back upon awakening or may feel pain after walking or standing for a long time.
Spinal stenosis related to congenital narrowing of the bony canal predisposes some people to pain related to disc disease.
Osteoporosis is a metabolic bone disease marked by progressive decrease in bone density and strength. Fracture of brittle, porous bones in the spine and hips results when the body fails to produce new bone and/or absorbs too much existing bone. Women are four times more likely than men to develop osteoporosis. Caucasian women of northern European heritage are at the highest risk of developing the condition.
Skeletal irregularities produce strain on the vertebrae and supporting muscles, tendons, ligaments, and tissues supported by spinal column. These irregularities include scoliosis, a curving of the spine to the side; kyphosis, in which the normal curve of the upper back is severely rounded; lordosis, an abnormally accentuated arch in the lower back; back extension, a bending backward of the spine; and back flexion, in which the spine bends forward.
Fibromyalgia is a chronic disorder characterized by widespread musculoskeletal pain, fatigue, and multiple “tender points,” particularly in the neck, spine, shoulders, and hips. Additional symptoms may include sleep disturbances, morning stiffness, and anxiety.
Spondylitis refers to chronic back pain and stiffness caused by a severe infection to or inflammation of the spinal joints. Other painful inflammations in the lower back include osteomyelitis (infection in the bones of the spine) and sacroiliitis (inflammation in the sacroiliac joints).
Lumbar spine stenosis most commonly affects the middle-aged and elderly. Entrapment of the cauda equina roots by hypertrophy of the osseous and soft tissue structures surrounding the lumbar spinal canal is often associated with incapacitating pain in the back and lower extremities, difficulty ambulating, leg paresthesias and weakness and, in severe cases, bowel or bladder disturbances. The characteristic syndrome associated with lumbar stenosis is termed neurogenic intermittent claudication. This condition must be differentiated from true claudication, which is caused by atherosclerosis of the pelvofemoral vessels. Although many conditions may be associated with lumbar canal stenosis, in most cases the cause is unknown. Imaging of the lumbar spine with CT or MRI imaging often demonstrates narrowing of the lumbar canal with compression of the cauda equina nerve roots by thickened posterior vertebral elements, facet joints, marginal osteophytes or soft tissue structures such as the ligamentum flavum or herniated discs.
How is back pain treated in the conventional medical system?
Most low back pain can be treated without surgery. Treatment involves using analgesics, reducing inflammation, restoring proper function and strength to the back, and preventing recurrence of the injury.
Although ice and heat (the use of cold and hot compresses) have never been scientifically proven to quickly resolve low back injury, compresses may help reduce pain and inflammation and allow greater mobility for some individuals. As soon as possible following trauma, apply a cold pack or a cold compress (such as a bag of ice or bag of frozen vegetables wrapped in a towel) to the tender spot several times a day for up to 20 minutes. After 2 to 3 days of cold treatment, apply heat (such as a heating lamp or hot pad) for brief periods to relax muscles and increase blood flow. Warm baths may also help relax muscles. Sleeping on a heating pad can cause burns and lead to additional tissue damage.
Bed rest — 1–2 days at most. A 1996 Finnish study found that persons who continued their activities without bed rest following onset of low back pain appeared to have better back flexibility than those who rested in bed for a week. Other studies suggest that bed rest alone may make back pain worse and can lead to secondary complications such as depression, decreased muscle tone, and blood clots in the legs. Resume activities as soon as possible. At night or during rest, should lie on one side, with a pillow between the knees (some doctors suggest resting on the back and putting a pillow beneath the knees).
Exercise may be the most effective way to speed recovery from low back pain and help strengthen back and abdominal muscles. Maintaining and building muscle strength is particularly important for persons with skeletal irregularities. Gentle exercises can help keep muscles moving and speed the recovery process. A routine of back-healthy activities may include stretching exercises, swimming, walking, and movement therapy to improve coordination and develop proper posture and muscle balance. Yoga is another way to gently stretch muscles and ease pain. Any mild discomfort felt at the start of these exercises should disappear as muscles become stronger. But if pain is more than mild and lasts more than 15 minutes during exercise, stop exercising and contact a doctor to get an evaluation of the cause and get a recommended treatment plan.
Medications are most often used to treat acute and chronic low back pain. Effective pain relief may involve a combination of prescription drugs and over-the-counter remedies. Medications include: Over-the-counter analgesics, Counter-irritants applied topically to the skin, Topical analgesics, Anticonvulsants, some antidepressants, Opioids such as codeine, oxycodone, hydrocodone, and morphine are often prescribed to manage severe acute and chronic back pain but should be used only for a short period of time and under a physician’s supervision. Chronic use of these drugs is detrimental to the person with back pain, adding to depression and even increasing pain.
Other approaches include: Spinal manipulation, Acupuncture, Biofeedback, Interventional therapy with nerve blocks, with injections of local anesthetics, steroids, or narcotics into affected soft tissues, joints, or nerve roots to more complex nerve blocks and spinal cord stimulation. Others are: Traction, Transcutaneous electrical nerve stimulation (TENS), or Ultrasound. Surgical approaches include: Discectomy, Foraminotomy, IntraDiscal Electrothermal Therapy, Nucleoplasty, Radiofrequency lesioning, Spinal fusion, Spinal laminectomy, rhizotomy, cordotomy, and dorsal root entry zone operation, or DREZ.
PEMFs in the management of back pain
Except in the face of severe, potentially disabling and destructive back pain conditions, PEMFs should be considered before any procedural or surgical intervention.
So you might ask, is there evidence to support the use of PEMFs for back pain? Below are 2 articles regarding the use of PEMFs for back pain. The 1st is using a very low intensity PEMF system.
Back pain and whiplash syndrome are very common involving tremendous costs and extensive medical effort. In two prospective randomized studies, patients with either lumbar radiculopathy in the segments L5/S1 or the whiplash syndrome were investigated. They excluded patients with prolapsed intervertebral discs, systemic neurological diseases, epilepsy, and pregnancy. A total of 100 patients with lumbar radiculopathy and 92 with the whiplash syndrome were studied. Both groups (magnetic field treatment and controls) received standard medication consisting of diclofenac and tizanidine, while the magnetic field was only applied in group 1, twice a day, for a period of two weeks. In patients suffering from radiculopathy, the average time until pain relief and painless walking was 8 days in the magnetic field group, and 12 days in controls (p < 0.04). In patients with the whiplash syndrome, pain was measured on a ten-point scale. Pain in the head was on average 4.6 before and 2.1 after treatment in those receiving magnetic field treatment, and 4.2/3.5 in controls. Neck pain was on average 6.3/1.9 as opposed to 5.3/4.6, and pain in the shoulder/arm was 2.4/0.8 as opposed to 2.8/2.2 (p < 0.03 for all regions). So, they concluded, that PEMFs appear to have a considerable and statistically significant potential for reducing pain in cases of lumbar radiculopathy and the whiplash syndrome.
In this study the PEMF used was the MRS 2000. The polarity was switched every 2 minutes, with the cushion being applied each time for 16 minutes and the whole-body mat for 8 minutes. Extended use is feasible and may actually often should produce better results than studied in this care project. I will often recommend up to an hour 3 times a day at the beginning, gradually tapering down in time to at least 30 minutes twice a day. Also I would use the highest intensity possible with the pillow applicator to the lower back.
In another randomized controlled clinical trial, they evaluated the effect of a PEMF system in the management of patients with discogenic lumbar radiculopathy. Radiculopathy refers to a set of conditions in which one or more nerves is affected and does not work properly (a neuropathy). The emphasis is on the nerve root. This can result in pain (radicular pain), weakness, numbness, or difficulty controlling specific muscles. In a radiculopathy, the problem occurs at or near the root of the nerve, along the spine. However, the pain or other symptoms often radiate to the part of the body served by that nerve. For example, a nerve root impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot or sciatica. The radicular pain that results from a radiculopathy should not be confused with referred pain, which is different both in mechanism and clinical features.
Forty patients suffering from lumbar radiculopathy due to lumbar disc prolapse were randomly assigned to one of two groups: a study group that included 20 patients who received PEMF therapy and a control group that included 20 patients who received placebo treatment. Both groups were evaluated at baseline and after 3 weeks by using a visual analogue pain scale (VAS) (0-10), objective electrical somatosensory evoked potentials (SSEPs) for selected dermatomes and a questionnaire using a Modified Oswestry Low Back Pain Disability scale (OSW). Findings were compared before and after treatment. Significant differences were observed between both groups before and after application of PEMF therapy relative to overall pain, Oswestry Low Back Pain, personal care, lifting, walking, sitting, sleeping, social life and employment. Even more importantly, were the objective measures of improvements in tissue pain related brain sensation perceived effects, the SSEPs. The actual statistical significance values are: VAS (P=0.024), total OSW (P<0.001), and other domains of OSW score (pain intensity [P=0.009], personal care [P=0.01], lifting [P<0.001], walking [P<0.001], sitting [P<0.001], standing [P<0.001], sleeping [P<0.001], social life [P<0.001] and employment [P=0.003]). Other significant differences were observed between both groups relative to SSEP latency and amplitude of the evaluated dermatomes on the right side (P=0.022 and P=0.001, respectively), and left side latency and amplitude (P=0.016 and P=0.002, respectively).
The authors concluded that PEMF therapy is an effective method for the conservative treatment of lumbar radiculopathy caused by lumbar disc prolapse. In addition to improvement of clinically observed radicular symptoms, PEMF also seems effective in reducing nerve root compression as evidenced by improvement of SSEP parameters after treatment.
I can tell you that in my clinical practice, I have treated hundreds of patients with low back pain, very successfully, just using PEMFs. The challenge in medicine, is that most of the treatments for pain do not remove the cause. They simply help you with the symptoms. Often, the pain, even after “definitive” surgery comes back. This is due to the fact that we can’t always identify the actual pain generator. The x-ray may indicate that there is a herniated disc or pressure on a nerve, that is, radiculopathy, but these may not actually be causing the pain. They may eventually, but at the moment they may not be the true cause. So, it makes much more sense to treat these kinds of problems conservatively with something that will reduce the pain and help the local tissues decrease swelling, improve circulation, and so on, without the risk of a more harmful intervention.
While PEMFs can be especially dramatic in acute back pain, they are actually most often used for chronic back pain. Most people with acute back pain resolved their pain problems in a short time. Those patients who had PEMF systems for other reasons and used them for their acute back pain got over their back pain much faster. People often become more desperate in managing their chronic back pain and therefore resort to more “desperate measures.”
I have even had a number of patients who have what are called “failed backs”. These individuals have had multiple procedures to their backs and still have severe or even worse pain than when they had before the procedures. In this situation, pulsed magnetic field therapy is a rescue treatment and can make a huge difference in their ability to function. While it may not be able to completely eliminate the pain, a severe pain may become a mild pain, which is much more tolerable.
I learned as a physician, decades ago, that if the patients came to see me I could only recommend them approaches that I had learned and experienced. I would almost never recommend them approaches I knew very little about, such as chiropractic, acupuncture, bodywork, etc. after all, these seem to be less “scientific” and less medically credible. So, as a result but most other doctors, patients would end up going down the path of inappropriate, expensive, and often disastrous medical approaches that were unwarranted, if I had only known about other technologies. Unfortunately, most of these other technologies or outside the house of medicine, and are often not covered by insurance. As a result most doctors, myself included at the time, did not ever consider these other options. The other unfortunate situation is that, if I make my living doing a particular procedure, then that is what I’m going to do. So it starts become very obvious, that the individual will be responsible for their own health destiny. Because I was frustrated with the options I had available to me, having seen firsthand many times, the consequences of inappropriate and unnecessary procedures, when considering other options that were available outside the medical sphere, I obtained training in some of these other disciplines to better understand the value they might have. This is one of the reasons I began to work with magnetic therapies. I began to see their potential very early, seeing as well, that they had very low risk. It took about 20 years of practice to finally get to this point. As a result, I want to see other people benefit from my experience, without having to wait as many years, and having to learn the hard way.
Which systems to consider
Any PEMF systems offered on drpawluk.com may have value in the treatment of low back pain. The bigger the person, the deeper the problem, the longer it’s been there, would suggest the need for a stronger higher intensity PEMF system. That’s not to say that weaker PEMF systems won’t work. The whiplash article above shows that people can still get significant benefits from a low intensity system. In my experience, results typically occur faster and are more sustainable using higher intensity systems. Higher intensity systems such as Parmeds, MAS, PEMF 120 allow both local and systemic treatment, therefore serving multiple potential needs. If budget or need demands a local system instead of a whole-body unit, consider the following: the SOTA for a known very local problem, the Almag, which allows treatment for more extended periods of time, and the system is portable enough to be plugged into outlets at work or home. The EarthPulse system can be plugged in to the wall or it can be put into a car. FlexPulse is completely battery-operated and is portable and allows complete flexibility in use.
I need to often remind people that when you own a PEMF system, you do not have to restrict your treatments to the problem you may have originally bought it for. You may be able to use it for other parts of your body that need help, or other members of the family, including pets, who also may need help. So therefore the system our general utility systems for general health maintenance and treatment of a wide range of conditions in the body. There is no value that may be placed on pain relief and good health. So, the most important reason to select a PEMF system should be its most likely benefit for you. You do not need to wait to become a statistic, that is, a failed back, to begin using PEMF therapy. You may contact us to help you to make a better decision as to which system would be most likely to be beneficial for you.
Thuile C and Walzlb, M. Evaluation of electromagnetic fields in the treatment of pain in patients with lumbar radiculopathy or the whiplash syndrome. NeuroRehabilitation 17 (2002) 63-67, 63.
Omar AS, Awadalla MA, El-Latif MA. Evaluation of pulsed electromagnetic field therapy in the management of patients with discogenic lumbar radiculopathy. Int J Rheum Dis. 2012 Oct;15(5): 101-8.