Back pain is the fifth most common healthcare complaint. Eight out of ten Americans will suffer from back pain in their lives. Low back pain is self-limiting in many cases. Chronic back pain is defined as ‘pain that persists for more than 3 months’. Low back pain is responsible for missed work days and a loss of income, not to mention an overall painful, unhealthy daily life.
The most common causes of low back pain are myofascial pain (muscles and tendons), facet joint pain (small joints in our spine), bone pain, root nerve pain (sciatica) and discogenic pain (pain arising from the intervertebral disc).
The treatment of low back pain can be complex since all the above can cause low back pain individually or in combination. History, physical exams, and x-rays can help determine the most likely source of pain. Traditional conservative treatment can include the use of nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, or a short course of opioids, in combination with non-pharmacological strategies such as physical therapy, acupuncture, etc. The sooner low back pain is resolved the greater the chance of it not becoming chronic low back pain.
If there is significant pressure on a nerve from spinal stenosis, ruptured discs, or other structures, surgery may be required. There is usually a significant amount of leg pain associated with this condition. Muscular-skeletal pain can respond to medications (NSAIDs, steroids), heat/cold, physical therapy, and regenerative therapies. Facet pain can respond to injections with steroids, PRP (platelet rich plasma) or radiofrequency ablation.
Discogenic pain is considered one of the major causes of low back pain. It is caused by the degeneration of the intervertebral disc. The causes of intervertebral disc degeneration include genetic, nutritional and mechanical influences. As the disc deteriorates, it can result in abnormalities of other parts of the spine such as the endplates, facet joints syndrome, disc herniation, spondylolisthesis, and spinal stenosis. Repair and arrest of the disc degeneration in the early stages are important to prevent more serious issues.
The supply of nutrients and oxygen to the disc is tenuous, making treatment difficult. Consequently, over the last decade or so there has been an attempt to find ways to heal the disc before it is too late. Mesenchymal stem cell (stem cells) have been used with mixed results. Both adipose and bone marrow-derived stem cell has been used. In order to improve results, they have been expanded or cultured to increase the number of cells, and have also been supplemented with hyaluronic acid, among other things.
One of the challenges is that harvested stem cells are not used to the environment of the disc. The disc is known to be a low oxygen environment with high loading forces, while the harvested stem cell are not. The goal is for the stem cell to heal the disc by decreasing the inflammatory environment, decreasing the degeneration of the disc, increasing the elasticity of the disc, and increasing water content. However, if the newly placed stem cell does not survive, the entire process breaks down.
We have two ways to help stem cells survive in the disc. One is to prepare stem cells to survive in a low oxygen environment before placing them in the disc. The other means is to improve the environment of the disc during the injection of stem cells by using hyperbaric oxygen therapy. The benefits of hyperbaric oxygen therapy consist of increasing the oxygen content in the disc area, decreasing inflammation, stimulating and mobilizing stem cells, and most importantly, helping mesenchymal stem cell survive.
At New Life Medical Group, we can combine stem cell therapy with hyperbaric oxygen therapy along with targeted nutrition to treat low back pain related to the disc and other causes. These protocols have been effective in helping patients with low back pain.
Kenneth A. Pettine et all, International Orthopaedics, (2017) 41:2097-2103
Byval’tsev VA, et all Zh Vopr Neirokhir Im N N Burdenko 2008 Oct-dec,(4):30-5