The scientific and medical consensus on low back pain is in: it’s complicated. It is also one of the most common ailments in the world. At any given moment, there are about 31 million Americans that suffer from back pain and half of Americans report having low back pain within the last year. It is the number one cause of disability and missed work worldwide1. There are many different causes of back pain, from congenital to neurological to mechanical, and effective treatment depends on the correct diagnosis from a skilled practitioner. At ORM, the majority of low back pain patients have suffered for months or years.
What causes low back pain?
The most common causes of low back pain are2:
- Sprain/strain of the ligaments/muscles
- Arthritis of the facet joints
- Degenerative disc disease
All 3 of these are effectively treated with prolotherapy and/or platelet rich plasma injections3. Any 3 of these conditions can lead to the sense of one’s back “going out”, and most people have some combination of all 3. Repetitive minor (or major) sprains to the ligaments accumulate over time, causing the connections between the vertebrae to become unstable, which alone causes pain but also contributes to the development of osteoarthritis4, which is also effectively treated with prolotherapy5. The common thread through these 3 top conditions is the degeneration or damage of structural tissue, which is exactly what regenerative injection therapies address. The use of ultrasound imaging during treatment provides a superior level of precision when performing the injections, ensuring the appropriate tissue targets are being treated.
Studies affirm prolotherapy effectiveness for low back pain
- PRP injections into the facet joints and surrounding muscular/ligament attachments decreases the pain of chronic back pain by as much as 55%6.
- 80% of patients had “good” or “excellent” pain relief from PRP facet injections after 3 months7.
- Of 145 patients with low back pain, 89% had an improvement in pain of 50% or better with dextrose prolotherapy8.
The way regenerative injections work is through the stimulation of the body’s healing cascade via growth factor release in specific locations where the injections are placed. The low back is a complex network of joints (every vertebrae has 6 joints), tendons, and ligaments that can all be injured and subsequently healed with regenerative injection therapy. All those times that you “tweak” your back doing chores, that you pick something up and feel a “zing”, or feel “achy” after playing with the kids or grandkids can be signs of minor injuries accumulating to the point of causing major pain and disability.
The multifidus muscles are also commonly targeted if there is evidence of them shrinking on MRI and/or US. PRP injections into the multifidus muscles have been shown to significantly reduce low back pain and reverse the muscular atrophy associated with chronic pain9.
An ideal combination of treatments for low back pain
Conventional treatment recommendations may include ice, rest, and NSAIDs, which we generally do not recommend for most patients because they are purely symptomatic relievers that can hinder your body’s healing response and prolong recovery10. Additional treatment such as physical therapy, chiropractic manipulation, and acupuncture are all excellent options, especially in combination with regenerative injection therapy. These are the top therapies we refer patients for during a treatment series. For example, an ideal marriage of all these therapies is for a patient to receive a chiropractic manipulation in the 1-5 days prior to injection, then do physical therapy in the month between injections and use acupuncture as a pain reliever.
Anecdotally, we routinely see autologous adipose tissue grafts injected into the lower back structures have a similar benefit in more severe cases. There are fewer scientific trials for adipose grafts in low back pain, but the mechanism remains the same. Both Dr. Oltman and Dr. Peterson have treated patients that have previously had spinal fusions and had success in reducing pain by treating all the dysfunctional tissue surrounding the fused vertebrae.
Back pain can be tricky and every person is different. There isn’t one therapy that works for every person every time. However, we know that prolotherapy, PRP, and adipose grafts should be considered for most patients given the prevalence of damaged tissue that adds up over time. The evidence will continue to evolve and as it does you can rely on Oregon Regenerative Medicine to continue to be the leader in helping you feel your best.
- Back Pain Facts and Statistics. (n.d.). American Chiropractic Association. Retrieved July 15, 2020, from https://www.acatoday.org/Patients/What-is-Chiropractic/Back-Pain-Facts-and-Statistics
- Back Pain Symptoms & Causes. (n.d.). Mayo Clinic. Retrieved July 15, 2020, from https://www.mayoclinic.org/diseases-conditions/back-pain/symptoms-causes/syc-20369906
- Mohammed S, Yu J. Platelet-rich plasma injections: an emerging therapy for chronic discogenic low back pain. J Spine Surg. 2018;4(1):115-122. doi:10.21037/jss.2018.03.04
- Kitanaka S, Takatori R, Arai Y, et al.Facet Joint Osteoarthritis Affects Spinal Segmental Motion in Degenerative Spondylolisthesis. Clinical Spine Surgery. Oct 2018, pp. E386-E390(5). doi: 10.1097/BSD.0000000000000674
- Hauser RA, Lackner JB, Steilen-Matias D, Harris DK. A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain. Clin Med Insights Arthritis Musculoskelet Disord. 2016;9:139-159. Published 2016 Jul 7. doi:10.4137/CMAMD.S39160
- Darrow M, Shaw B, Schmidt N, Li X & Boeger G| Tsai-Ching Hsu (Reviewing editor) (2019) Treatment of unresolved lower back pain with platelet-rich plasma injections, Cogent Medicine, 6:1, DOI: 10.1080/2331205X.2019.1581449
- Wu J, Du Z, Lv Y, et al. A New Technique for the Treatment of Lumbar Facet Joint Syndrome Using Intra-articular Injection with Autologous Platelet Rich Plasma. Pain Physician. 2016;19(8):617-625.
- Hauser R, Hauser M. Dextrose Prolotherapy for Unresolved Low Back Pain: A Retrospective Case Series Study. Journal of Prolotherapy. 2009;1(3):145-155. Retrieved July 15, 2020, from https://www.caringmedical.com/prolotherapy-results/unresolved-low-back-pain/
- Hussein M, Hussein T. Effect of autologous platelet leukocyte rich plasma injections on atrophied lumbar multifidus muscle in low back pain patients with monosegmental degenerative disc disease. SICOT J. 2016;2:12. Published 2016 Mar 22. doi:10.1051/sicotj/2016002
- Paoloni JA, Milne C, Orchard J, et al Non-steroidal anti-inflammatory drugs in sports medicine: guidelines for practical but sensible use. British Journal of Sports Medicine 2009;43:863-865. doi: 10.1136/bjsm.2009.059980