I Have Back Pain – Now What? An Interview with Lee Hazen, DC

By Mike Bundrant

I’ve mentioned in previous issues of Healthy Times how impressed I am with doctors who are not only experts in their chosen field, but also personable and open minded.  In communicating with such professionals I always learn something new and never feel “less than”.  In my opinion one such medical professional is Dr. Lee Hazen, who practices chiropractic in Wildomar. 

Not only have I personally benefited from Dr. Hazen’s advice on prior occasions, but I also appreciate how clearly he communicates in this interview the options that are available for people in pain…across the entire spectrum of health care.  If you or someone you know is experiencing chronic back pain, I urge you this interview in it’s entirety.  Enjoy…..

HT:  Let’s say that I discover that I have chronic neck or back pain.  As average consumer, what are my options and what might I expect?

Dr. Hazen:  We can break this down into basically two forms of care.  The first is allopathic care, which includes: medical doctors, doctors of osteopathy, and physiatrists (which are medical doctors who prescribe physical medicine).  Within this realm you have medical doctors who will prescribe either surgical or non-surgical intervention for back treatment.

If a person goes to their general practitioner for treatment of severe neck or back pain, arm pain or leg pain (which we call sciatica) he might be referred to a surgeon or neurosurgeon for a consultation.  If a person is deemed a surgical candidate, then he would have a number of surgical options available to him.  These may include a minor surgery for removing the disk pressure called “micro-disc-ectomy”.

Some cases may be referred to orthopedic surgeons, who do procedures more along the lines of spinal stabilization and fusion.  It’s just a matter of how much needs to be done based on factors such as the age of the patient and level of degeneration.

Surgery will give you either a positive or a negative outcome.  Right now it is running about 50/50. The 50% who have positive outcomes typically experience pain relief immediately.  People who have negative outcomes often end up getting additional surgeries and it is really miserable for those people.

Even those people who have positive surgical outcomes can experience unfortunate consequences.  Often times surgeons don’t give their patients post-surgical education about spinal rehabilitation, that might prevent the  person from visiting the surgical table again.  Patients often don’t learn to care for their spine.  After the spinal disc surgery the space between the bones where the disc has undergone removal no longer moves well due to scar tissue build up. When the patient returns to the same activities of daily living, the mechanical stresses move to the next disc level creating another herniated (ruptured) disc, and a repeat surgery. So, you can have an initial positive surgical result that is followed by negative consequences down the road.
 
Let’s say you go to your doctor and you don't need surgery.  At that point you might be given a choice of treatment.  One of those choices involves drugs, and there are three major drug types.  One type is a pain reliever. Another is a muscle relaxant. The third would be an anti-inflammatory.  Those three are used either singly or in conjunction to help reduce pain.  We’ve known for years that statistics show that pain relievers and anti-inflammatory drugs can be effective, but the muscle relaxants show very little clinical efficacy in chronic pain. They just keep some people off their feet.

The three drugs can produce some unwanted side effects, as you can imagine.  These can include addiction, loss of effectiveness over time, internal organ damage and secondary injury due to the “relief factor”.  People get feeling better then go out and really hurt themselves.

Another non-surgical approach involves spinal injections.  We know that spinal injections (epidural steroids, anti-inflammatories, cortizone cocktails and trigger point injections are effective in about 50% of the people who receive them. Those that get relief can receive up to 3 injections in a single site. Injections can have long term side effects – they can close down the small capillaries that feed the area.  So, you can lose some of your circulation where it is needed most.

The upside to injections is that they may work when other types of therapies fail.
 
Physical therapy is another non-surgical option. Physical therapists are masters of passive and active modalities.  Passive modalities include things like range of motion joint movements, hot and cold packs or electrical stimulation.  Active exercise is also used where they will get in there and try to rehabilitate – strengthen and stretch and use mobilization…..using long, gentle stretching and pressure.  Mobilization can be helpful…..but most passive modalities have limited effectiveness. They are kind of a temporary “feel better” and an expensive one!

There is a new approach in physical medicine that has really caught on in the last five years called Decompression Therapy.  Decompression Therapy typically utilizes a machine with a rope and pulley system. You lay on your back – and the machine pulls your lower back and pelvis away from your upper back, or your neck from the shoulders.

The idea here is to decompress the spine and take pressure off the disks and nerves.  The problem with these machines is that there is no directed pressure relief to the specific disc area.  It pulls the whole spine generically.  Often there is no follow up rehabilitation with these.  Another downside is that they tend to be pretty expensive to use.

So, those are some conventional, non-surgical treatments that are widely available.
 
HT:  Ok.  That's’ all pretty clear.  Now what about complementary or alternative therapies for back problems?

Dr. Hazen:  These are defined as treatments that are not typically taught in medical schools nor available in most hospitals.  These include chiropractic manipulation, acupuncture, massage therapy, exercise physiology and holistic medicine.

Of the alternative therapies for back pain, chiropractic care is definitely the “top dog”. It is proven both safe and effective through many double blind, randomized trial research studies that compare it to traditional forms of treatment.
 
Chiropractic is a rather ecclectic profession.  There is a lot of variation in the style of treatment.  We have doctors that utilize very gentle or “non-force” treatments all the way to the old “rack ‘em and crack ‘em” style treatments….and everything in between.  

The chiropractic profession has spent some time and money to study it’s various forms of treatment to know which work the best – even through grants from the National Institute of Health.
 
Of the various therapies, the one that is proven most effective – giving the best outcomes in the shortest time frame – is Distraction Manipulation, otherwise known the Cox Technique, otherwise known as Flexion Distraction. The positive effects of the Cox Technique are similar to the decompression machines in that you are taking pressure off herniated disks by mechanically pulling that herniated disk material away from the nerves. The major difference between the Cox technique and the decompression machines is that it is the doctors’ hand that can specifically target the bad disc and direct the right amount of decompression that the patient can tolerate safely. Also the doctor can move the disc and joint through the full normal ranges of motion, not just traction.  The combination of the specificity of the Cox Technique, which allows to work that one joint that is most inflamed through its natural range of motion and decompression, combined with patient education, exercise rehabilitation with follow up treatment, seems to be the most effective way to care for most spinal problems.  
 
That, plus the fact that this treatment is commonly less than half the expense of decompression machines makes it a nice way to go….

 

The next most proven chiropractic technique is diversified technique.  Many Americans who have been to a chiropractor have had diversified techniques done. This is the gentle, “crack-pop, lay on your side, lay on your stomach, lay on your back” kind of chiropractic.

Beyond these, most of the techniques become less proven and of course then you can get into some of the techniques which are just a bunch of balderdash.
 
 
 
A bit more on chiropractors.  They are licensed to do physiotherapy  including both active and passive modalities.  They also prescribe spinal rehabilitation exercises with postural education…often times people are hurting because they are in terrible shape, have terrible posture, or both. So often education is what is needed most.  

HT:  Beyond chiropractic, what kinds of treatment might you recommend?

Dr. Hazen:  Massage is one form of treatment I’d recommend.  You have many techniques such as shiatsu, hot rock, myofascial and deep tissue. Of course, there is the common “fluff and buff” massage that is light and makes you feel good for a bit, but doesn’t have any lasting effect.  But if you have a well-skilled massage therapist, they can do wonders to help heal. Chiropractors, like myself, often employ massage therapists.

Exercise – let’s talk about that. There are passive and active exercises. Passive exercises are very gentle and typically for people who have been injured. Active exercise is for rehabilitation and strengthening – this is what we do when we’re out of shape and need to get back the gym…we’re giving our body some needed rehab.  This includes core strengthening and functional strengthening.  We need to make sure we maintain these actively. Active exercise also may include Pilates or Alexander Technique….both of which are wonderful.

Acupuncture is another kind of alternative treatment that works on the electrical meridians in the body.  It involves using small, hair-like needles.  I’ve had it done myself and found it to be almost painless- occasionally you feel a little jab that is no big deal.  This is a fascinating field that is not well understood.  There have been some very interesting studies that have been done with it that show it may be functional in changing the electrical system (nervous system) in the body to help in healing.

So, those are some of the alternative forms of treatment available.  What therapy an individual chooses largely depends on their family culture....on what is acceptable in their world……in other words, who the “real” doctor is and who is the witch doctor?

The perception of alternative medicine is changing.  Those of us who practice it are beginning to crack the egg in terms the prejudice that has affected us for so long. Allopathic doctors (M.D.’s) more and more are sending their patients to alternative practitioners like myself because they are finding out that alternative therapy is effective and provides healing options that their patient’s wouldn’t otherwise have.

HT:  You don’t seem to paint a very optimistic picture of conventional surgery. Is there ever a time when it is the best option available?

Dr. Hazen:  Great question.  Yes, absolutely.  Surgical intervention is required in some cases, such as when cancer is involved.  There are cases when the disk is ruptured in such a fashion that it has created nerve damage by its presence and that disk just has to be removed.  There are other cases that involve spinal infection where there is no choice but surgical intervention.

It is still interesting to note that on the whole only 2% of people with back pain are true candidates for surgery.  98% have other options available to them that have better clinical outcomes.  I would even share with you that the number of annual spinal surgeries is dictated more by the number of spinal surgeons in a given geographical area than by the actual needs of the patient!  That is proven and I can share the documentation with you if you want.

That said, 60% of MDs have made a referral to an alternative care professional. 38% have done so in the preceeding month. This is usually done because patients requested the referrals or because conventional treatments have failed.
 
So there are doctors that are sending patients to alternative care. It’s growing in leaps and bounds. Interestingly, the United States health care system is in such disarray people are finding out that by the time they pay their co-payments for conventional care they could have paid cash for alternative care and gotten equal to, if not better results.