I went to the Pain Doc and all I got was this back brace?!?
Low back pain is a VERY common problem – the 2nd most common reason for visits to the physician in industrialized nations. In any given year, anywhere from 15-45% of a given population will experience an episode of low back pain (LBP) with increasing frequency as we age. Most cases of LBP are brief and resolve within 1-2 weeks spontaneously without interventions. There is a smaller subset of this population, however, for whom symptoms do not resolve quickly. Some studies suggest this can be anywhere from 10-33% of patients who can have persistent pain after the first year. In these people, recovery can take a prolonged time period, and their medical care costs contribute to a majority of spending on this medical condition. This subset also tends to encompass a large portion of individuals who are on disability.
Historically, it was thought that putting patients on short term narcotics while they sought interventional therapy was a good option. However newer studies show that even a short course of narcotics – as short as 7 days! – can significantly increase the risk for patients developing dependency. So, we are left searching for other options. With this in mind, lumbar supports could be a viable option for care while patients progress through physical therapy, interventions, and for immediate pain control. Classically it was believed that use of lumbar supports would result in atrophy, or weakening, of core muscles, however, in one recent study has shown that using lumbar support for 6 weeks actually showed an increase in core muscle strengthening.
This prospective study showed that using a lumbar support (with semi-rigid support and a cinching mechanism) allowed enough range of motion to prevent core muscle atrophy. By allowing reasonable flexibility, but restricting trunk range of motion in flexion-extension and lateral bending movements, it prevents discomfort in low back pain. The compression aspect of the cinching mechanism also allows for a stretch of the erector spinae muscles which is effective in alleviating myogenic pain (muscular pain). Also limitation of movement on the lumbar spine could limit motion of facet joints which also provides pain relief.
This study demonstrates two key benefits of back braces in the interventional pain clinic. First back braces can decrease pain immediately and allows the patient, to determine if the level of relief is sufficient to warrant the expense of purchasing the brace while still in clinic. The second major advantage is having a non-narcotic therapeutic option that allows patients the opportunity to address their pain control needs while they progress through the different steps of therapy without side effects associated with narcotics. Often times when patients present to an interventional pain physician they will be on the first step of their journey – which could entail a series of diagnostic blocks before a rhizotomy which could take several weeks. In the interim a back brace can help reduce pain significantly. Also, after finishing therapeutic treatment, patients can experience flareups. Having access to a back brace at home again diminishes their pain level and makes them less likely to require urgent therapy in an emergency department or to require follow up with their interventional pain physician.
Bottom line, back braces are USEFUL! I have often recommended them for patients and my own family members. While maybe not the most fashionable, they can aid to getting you – and your back – back in business.
-Dr. Mike Martinez