“Although it feels better temporarily, it immediately returns to the same heavy, dull ache or sharp pain.” Patients at a small Japanese clinic say this often, and it is the starting point for an unusual theory about where chronic low back pain begins.
One clinic’s theory
The Dejel Treatment Clinic in Iwaki City, Fukushima Prefecture, practises what it calls En-Raku medicine. Its practitioner argues that chasing the sore spot with massage, electrical stimulation and stretching is a blind spot. In his view the trouble starts higher up, in what he calls the lower brain.
He lays out a sequence. The atlas, the first cervical vertebra, shifts slightly or becomes inflamed. The inflammation spreads to the medulla oblongata. The vagus nerve, which originates there, works less well. Blood flow from the back to the lower back drops, the muscles lose nutrients and oxygen, and they turn brittle. Then the body cannot cope with even minor daily loads, and acute flare-ups keep coming.
The clinic says long-standing cases can go further, with inflammation and compression reaching the lumbar spinal cord, and with fatigue, insomnia and stomach trouble alongside the pain. It admits its own limits. Many of the concepts are particular to En-Raku medicine, it says, and the medical terms it uses were not diagnosed by the clinic, so readers should take them as “it is considered that” rather than settled fact. This is early, unproven thinking, and patients should treat it that way.
What the broader research says
Studies point in a more conventional direction. A review in PLOS Medicine, led by Manuela Loureiro Ferreira of the George Institute for Global Health in Australia, looked at 20 studies with 14,884 participants. Six single therapies, among them yoga, cognitive behavioral therapy and self-management support, could cut health care costs and improve outcomes compared with usual care. Two combined approaches, workplace advice with graded activity and diet plus physical activity, were more cost-effective too, at a willingness-to-pay threshold of £20,000. All the studies came from high-income countries.
Medication carries its own risk. A study from Columbia University and NYU Grossman School of Medicine followed 399,500 Medicaid adults. Those who started treatment for a new bout of back pain with opioids above 50 milligrams of morphine equivalent per day had a 147 percent higher relative risk of later opioid use disorder or overdose. Nonpharmacologic therapies were linked to lower risk. “We urge caution when opioids are prescribed, minimizing dose and duration,” said Lisa Doan of NYU Langone.
Then there are people whose jobs hurt their backs. At the University of Florida, researchers enrolled 127 landscape and nursery workers and 21 supervisors from 16 companies. Tailored exercise videos and text reminders led to less pain anxiety and better physical function. Kim Dunleavy, who leads the project, said workers “often regard pain as part of the job.”
The encouraging part is that cheap, simple care appears to work. Early findings suggest that exercise, yoga and psychological support help people recover. Anyone with persistent back pain should talk to a doctor before choosing a path, especially if there are red flags such as fever, unexplained weight loss or trouble with feeling or movement.
A 30-second habit
Physical therapist Karena Wu recommends a dynamic side stretch to keep the lower back mobile. Stand with feet hip-width apart and hips facing forward, left arm down. Reach the right arm to the ceiling, then lean the head and torso slowly to the left, bending at the waist. Hold for 30 seconds, then switch sides.
Sources
- The Blind Spot of Low Back Pain Treatment: Why Treating Only the Lower Back Does Not Lead to 'True Improvement'｜やすのり
- Low back pain
- Initial Treatment for Lower Back Pain Is Associated with Subsequent Risk of Opioid Use Disorder and Overdose
- As Florida landscape workers face chronic back pain, a new study aims to improve lives and prevent job loss
- Non-drug and non-surgical low back pain treatments are highly cost-effective options
- A Physical Therapist’s 30-Second Fitness Snack To Avoid Low Back Pain
Photo: Sasun Bughdaryan / Unsplash (Unsplash License)
