What to do about chronic back pain?

Mar 4, 2022

Many Americans experience pain in one form or another, but the most common type of pain is low back pain. It is the single leading cause of disability globally and seems to get worse over time. Standard medical treatments often involve drugs, procedures, or surgery which all have risks and may not improve overall pain levels. Back pain can even be linked to an epidemic of opioid related deaths in the United States from the large amount of pain prescriptions used to treat back pain. This may seem hopeless, but there are many options that can address the root causes of pain and lead to a longer and more fulfilling life.

We have more and more evidence that back pain is directly related to lifestyle factors, even in ways you might not expect. Smoking and high cholesterol are both linked to chronic low back pain. Scientists have shown that atherosclerosis, or fat buildup, in the arteries around the spine starves the blood supply leading to arthritis and degeneration. The same buildups can pinch nerves and cause shooting pain down someone’s leg. This means that for many, back pain is fully preventable and likely reversible by healthy habits. In the same way that we reverse heart disease with a whole food plant based dietary pattern, stress management, and exercise - blood flow and healing can be restored to our aching spines.

Like many other lifestyle related diseases, a key intermediary for back pain is inflammation. Targeting inflammation with proper lifestyle allows for diet and exercise to be a first line treatment for chronic back pain and a tool to move away from hazardous medications.

Not all foods or exercises are created equal when it comes to chronic pain, some can help short and long term while waiting for healing. Take a few examples:

Turmeric, a spice used across the globe but best recognized in curries, is a potent anti-inflammatory that can undo some of the brain changes caused by opiates that lead to a heightened sensation of pain.
Polyphenols are found in a variety of plants from berries to cocoa powder, nuts, seeds, olives and even coffee. These can reduce pain by cleaning up free radicals and help to reverse morphine induced hyperalgesia and tolerance.
Ginger can be used in dietary doses to treat a variety of ailments including migraines, osteoarthritis (often a part of the problem with low back pain) and muscle pain form exercise
Aerobic exercise, resistance training, and yoga are all shown to reduce low back pain. Some is better than none, but the best relief can be achieved by regular exercise and can be augmented by working with a physical or occupational therapist.

Some options that are effective to treat pain might sound downright wacky, like taping a cabbage leaf to your knee or low back to alleviate pain. In a well-designed study, it was shown to be as effective as Voltaren gel, a pain medication that can be applied to the skin.

As with any lifestyle related disease, chronic back pain that develops over decades typically does not vanish in days by adding a little ginger to someone’s diet. Amazing and rapid results are possible with intensive changes and gradual improvement is certainly possible with moderate changes. In my experience, making one or two positive changes has the potential to snowball into a whole new way of approaching exercise and food, improving back pain in the process.

Jeremy Clay, MD, MPH, DipABLM

Schedule your next appointment, 707-467-4327

Resources:

Leino-Arjas P, Kauppila L, Kaila-Kangas L, Shiri R, Heistaro S, Heliövaara M. Serum lipids in relation to sciatica among Finns. Atherosclerosis. 2008;197(1):43-49. doi:10.1016/j.atherosclerosis.2007.07.035

Vodovotz Y, Barnard N, Hu FB, et al. Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit. Front Med (Lausanne). 2020;7:585744. Published 2020 Dec 22. doi:10.3389/fmed.2020.585744

De Gregori M, Muscoli C, Schatman ME, et al. Combining pain therapy with lifestyle: the role of personalized nutrition and nutritional supplements according to the SIMPAR Feed Your Destiny approach. J Pain Res. 2016;9:1179-1189. Published 2016 Dec 8. doi:10.2147/JPR.S115068

Maghbooli M, Golipour F, Moghimi esfandabadi A, Yousefi M. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine. Phytother Res. 2014;28(3):412-5.

o Bartels EM, Folmer VN, Bliddal H, Altman RD, Juhl C, Tarp S, Zhang W, Christensen R. Efficacy and safety of ginger in osteoarthritis patients: a meta-analysis of randomized placebo-controlled trials. Osteoarthritis Cartilage. 2015 Jan;23(1):13-21.

Bliddal H, Rosetzsky A, Schlichting P, Weidner MS, Andersen LA, Ibfelt HH, Christensen K, Jensen ON, Barslev J. A randomized, placebo-controlled, cross-over study of ginger extracts and ibuprofen in osteoarthritis. Osteoarthritis Cartilage. 2000 Jan;8(1):9-12.

Drozdov VN, Kim VA, Tkachenko EV, Varvanina GG. Influence of a specific ginger combination on gastropathy conditions in patients with osteoarthritis of the knee or hip. J Altern Complement Med. 2012 Jun;18(6):583-8.

Altman RD, Marcussen KC. Effects of a ginger extract on knee pain in patients with osteoarthritis. Arthritis Rheum. 2001 Nov;44(11):2531-8.

Haghighi M, Khalvat A, Toliyat T, Jallaei S. Comparing the Effects of ginger (Zingiber officinale) extract and ibuprofen On patients with osteoarthritis. Arch Iranian Med 2005; 8 (4): 267 – 271.

Ambrose KR, Golightly YM. Physical exercise as non-pharmacological treatment of chronic pain: Why and when. Best Pract Res Clin Rheumatol. 2015 Feb;29(1):120-30. doi: 10.1016/j.berh.2015.04.022. Epub 2015 May 23. PMID: 26267006; PMCID: PMC4534717.

Wewege MA, Booth J, Parmenter BJ. Aerobic vs. resistance exercise for chronic non-specific low back pain: A systematic review and meta-analysis. J Back Musculoskelet Rehabil. 2018;31(5):889-899. doi: 10.3233/BMR-170920. PMID: 29889056.

Lauche R, Gräf N, Cramer H, Al-Abtah J, Dobos G, Saha FJ. Efficacy of Cabbage Leaf Wraps in the Treatment of Symptomatic Osteoarthritis of the Knee: A Randomized Controlled Trial. Clin J Pain. 2016;32(11):961-971. doi:10.1097/AJP.0000000000000352