An Integrative, Non-Pharmacological Pain Management Approach In Severe Lumbar Spine Degeneration: A Case Report.

Introduction: Chronic low back pain (CLBP), or low back pain lasting greater than 12 weeks, is a prevalent condition that profoundly impacts the quality of life in affected individuals. Traditional treatments - such as physical therapy, medications, injections, minimally invasive procedures, and surgery - often prove ineffective in a considerable number of cases, particularly when utilized as singular modalities. Given the complex biopsychosocial nature of CLBP, a multi-modality approach tailored to each patients' unique needs is essential. This case report presents a comprehensive approach designed to address the intricate aspects of CLBP, emphasizing the advantages of individualized therapeutic strategies.

Case presentation: We present a physically active 68-year-old Latin male with persistent CLBP. His medical history includes a healthy BMI, hypercholesterolemia controlled with a statin medication, and a previous meniscal repair of the left knee. Initial magnetic resonance imaging (MRI) findings revealed severe multilevel degenerative disc disease and lumbar facet arthropathy, with lower lumbar foraminal and central canal stenosis. Despite undergoing numerous prior treatments with over the counter and prescription analgesics, physical therapy, epidural steroid injections, and radiofrequency ablations, his pain disrupted his ability to perform activities of daily living, professional tasks, and recreational pursuits. Due to the multiple structural abnormalities identified on imaging and the severity of his pain, a complex neurosurgical intervention was offered. In collaboration with the patient, we formulated a personalized treatment plan that effectively addressed his individual goals such as avoidance of neurosurgery, pain relief, and improved function. The integrated interventions provided within the acupuncture practice included personalized acupuncture to promote innate healing, use of an inversion table for spinal decompression, and lifestyle modifications to support his overall biopsychosocial health. Additionally, we supported multi-disciplinary treatments such as chiropractic adjustments to improve spinal alignment, physical therapy to address biomechanics, and ozone therapy and platelet-rich plasma injections to facilitate structural repair. Formal standardized assessment tools, such as the Visual Analog Scale for pain intensity, were not used to measure treatment progress or outcomes. Instead, we prioritized evaluating his ability to perform personal and professional tasks, which were deemed more critical to the patient. After four months of treatments, the patient reported significant symptom resolution, improved function and performance at work, as well as enhanced quality of life despite potential degenerative progression identified on follow-up imaging.

Discussion: Current literature regarding the management of CLBP highlights the efficacy of a methodical multi-disciplinary approach that includes aspects of medical, psychological, physical, and interventional approaches. Numerous organizational clinical practice guidelines exist to assist care teams in managing CLBP. However, the absence of a standardized approach coupled with the limited capacity of many health systems to support various treatment options, poses significant challenges for both providers and patients. This case report aims to address the advantages of an individualized approach to help navigate the complexity of CLBP management, particularly when pharmacological or surgical therapies are not preferred. Through this approach, we highlight the importance of individualized assessments and open dialogue to set mutually agreed upon treatment goals and protocols to enhance patient satisfaction and outcomes. Our report highlights the need for further longitudinal studies to assess the efficacy of long-term treatments for CLBP even in cases where radiographic findings indicate worsening spinal degeneration. It also implores for further clinical trials to investigate non-pharmacological and non-surgical management options for CLBP. Additionally, we call to action for enhancement of clinical practice guidelines to develop systematic tools for broadening multidisciplinary referrals to improve care.