Many chronic back pain sufferers have to live with the frustration of having a slew of tests done, and undergoing spinal treatments that do not alleviate their suffering. However, new studies indicate that the cause of their symptoms, which manifest on their backs, might not actually originate there. Moreover, some of the methods employed to treat these conditions may actually aggravate the ailment.
Recent studies indicate that back pain in many cases does not stem from any defect of the spine itself; but from strain on the spine as consequence of sacroiliac joint dysfunction. The sacroiliac, or SI joint connects the spine to the pelvis, and when the cartilage at that location wears thin, often as a consequence of aging, obesity, multiple pregnancies or trauma, among other causes, this can cause lower back pain to develop in many patients. In addition, a Danish study has found that the cause of back pain in some cases can be bacterial infection by Propionibacterium acnes, also known as P. acnes.
In many cases, SI joint dysfunction is overlooked as a potential diagnosis because most spinal surgeons are not trained to look at it as the root cause of the pain. This leads to them subjecting patients to unnecessary testing, and in some cases, unnecessary and ineffective treatments. Indeed, spinal fusion, which is often the surgical option wrongly prescribed for chronic back pain can actually put increased strain on the sacroiliac joint. One study indicated that as many as 50% of cases in which spinal fusion failed to alleviate the patient’s back pain were actually due to sacroiliac joint dysfunction. In the case of herniated disks, it has been found that the pain, and the damage to the spine itself, can be caused from a localized P. acnes infection, and the pain subsides after the appropriate course of antibiotics.
It is estimated that anywhere from 20% to as much as 40% of misdiagnosed chronic back pain cases originate in the sacroiliac joint, with one study placing the total rate of incidence of SI joint dysfunction versus herniated disks at 20% to 25%. Treatments for SI joint dysfunction have traditionally included icing, physiotherapy, orthopedic braces, and in the most severe cases, fusion of the joint. Because the area in question presents difficult access to surgery, some treatments, such as radiofrequency ablation, are limited to pain management. However, a new, less invasive surgical alternative has recently been developed. DIANA (Distraction Interference Arthrodesis, Neurovascular Anticipating) surgery affords patients a faster recovery than fusion, allowing them to walk with crutches soon after the procedure, and to fully recover after a few weeks with relatively little pain and discomfort.
In the case of herniated disks. The study conducted by University of Southern Denmark, Odense researchers linking P. acnes to back pain, though promising, is very small; but hopefully will lead to further exploration of the matter. As for repairing the damage done to the disks, an experimental treatment is being developed that uses stem cells to regenerate injured tissue.
Some of the treatments for chronic back pain are still being developed, and the ones that have already proven effective are not available at all locations; but it is heartening that a better understanding of the root causes of the ailment will prevent misdiagnosis and wrongly prescribed treatments. Spinal pain has baffled many doctors in the past, and now it is evident that it was because in some cases they were not looking in the right place for the cause.
By Milton Ruiz
By Milton Ruiz