Ask the Doctors: Holistic approach helpful for lower back pain

Dear Doctors:

I suffer from chronic back pain, and my doctor told me that the only treatment available is pain medication. Is that because the problem is with my lower back? Are there any other treatment options for this kind of chronic pain?

Dear Reader:

Chronic pain is a debilitating condition that affects more than 50 million adults in the United States. When someone experiences ongoing pain for three or more months, it falls into the category of chronic pain. The pain can range from mild to severe, and takes many forms — stiffness, tightness or aching, or sensations of throbbing, burning, stabbing, shooting, tingling or stinging.

People tend to focus on the physical sensations when talking about chronic pain, but the effects are often more widespread. Individuals living with chronic pain often struggle with sleep, can lose strength and stamina, may withdraw from normal daily activities, experience low mood or depression and often battle feelings of hopelessness.

The lower back problems you are grappling with are a common cause of chronic pain. We ask a lot from this area of the body, and we don't always treat it with care. The lower back is where the spine joins the pelvis, and it often bears the brunt of heavy lifting. If the back and stomach muscles aren't properly aligned and engaged or are tasked with more weight or torque than they can handle, all the structures get stressed. This includes the vertebrae and discs that make up the spine, and the connective tissues holding everything together. Injury, inflammation and misalignment, as well as degenerative conditions such as arthritis, can contribute to chronic lower back pain.

When it comes to treatment, pain medications can be helpful. These include nonsteroidal anti-inflammatories, muscle relaxants and nerve pain medications. The goal is to find the minimum dose needed to manage pain. Cortisone injections, which ease inflammation, can help short-term pain. However, due to potential side effects, such as changes to blood sugar control, high blood pressure, changes to mood, fluid retention and weight gain, they are not suitable for long-term use.

Alternative treatments such as acupuncture, chiropractic adjustment, massage, biofeedback and electrical nerve stimulation can be effective. Lifestyle changes are important as well. Both the mattress on your bed and your sleep positions can contribute to lower back pain. Poor posture and poor technique when lifting even light objects can also stress the back.

Physical therapy can be an important part of managing lower back pain. This typically includes exercises to strengthen the core, stretching and flexibility, and postural awareness. In some areas, these approaches are collected into a single program known as a "back school." It's a targeted training and education program overseen by teams of therapists who specialize in the lower back.

Chronic pain is mentally and emotionally taxing. Practices that focus on mindfulness, such as tai chi, yoga, meditation and deep breathing, can also be helpful. And as with all areas of health, diet is important. A diet of lean proteins, fresh fruit and produce, and limited sugars and processed foods helps to lower inflammation.

A good friend has Parkinson's disease. She has mentioned trying probiotics to her doctor, but he doesn't seem interested in the idea. My friend worries she might alienate him if she gets help from another doctor. Is there guidance about using probiotics with PD?

Dear Doctors: Dear Reader:

Parkinson's is a neurological disease that results in a gradual loss of the ability to produce smooth, sustained and controlled movement. It's a progressive disease, which means symptoms grow more pronounced over time.

Parkinson's is caused by a decrease in the production of dopamine, a chemical messenger in the brain. The resulting changes to brain chemistry adversely affect strength, balance, movement, coordination, endurance, bowel function and blood pressure control. The disease often also takes a toll on mood, emotions, sleep and cognition.

There is no cure for Parkinson's disease at this time. Treatment focuses on medications to increase dopamine production. In some cases, a surgical treatment known as deep brain stimulation can ease symptoms. Supportive care is also important. This includes physical, occupational and speech therapy, exercise, mental health care and attention to diet.

Now, thanks to a growing understanding of how gut microbes influence the brain, researchers are exploring a role for probiotics in managing Parkinson's disease. Known as the gut-brain connection, it's a two-way communication between the central nervous system and the gastrointestinal system. It has been found to affect digestion, immune function, mood and cognition, and is suspected to play a role in neurological diseases.

Several studies have found that certain strains and combinations of probiotics can ease some of the nonmotor symptoms of Parkinson's disease. These include constipation and other gastrointestinal problems, disrupted sleep, anxiety and fatigue. The research is certainly promising; however, it has not yet made the transition from the research phase to therapeutic treatment. Each study used a unique blend of probiotics, none of which are commercially available. In order to add probiotics to the treatment regimen of someone living with Parkinson's, both the patient and the doctor must be willing to experiment.

Although your question focuses on probiotics, you have touched on an important topic. That is, shared decision-making in health care. It's just as it sounds — a collaborative approach between patient and doctor. It's a departure from the days when patients were expected to have a passive role in their medical care.

Your friend would begin by being clear with her doctor about her interest in taking probiotics. Rather than just mentioning them, it is important for her to state that she wants to have an in-depth discussion about the pros and cons. If her doctor isn't interested in pursuing the issue, she can indicate that she will seek a second opinion. This is a common practice in medicine and should not affect her relationship with her doctor.

If your friend does add probiotics to her treatment regimen, it is important to let all her doctors know. Probiotics can sometimes cause side effects, such as diarrhea. To provide optimal care, her doctors need to know about all the medications and supplements she is taking.

Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.