A sharp twinge. A deep ache. A relentless, stabbing pain.
Back pain takes many forms, yet nearly any severe incarnation of it is going to be debilitating.
Just ask Sandy Teller, who says pain that started in his back and ran down his legs took a major toll on his day-to-day life.
"It was hellish pain," said the New York City-based marketing and public relations consultant. "I had a cane. I couldn't walk around the block, couldn't go out, had trouble sleeping, and life was pretty bleak."
Teller had a spinal fusion operation in 2002 to improve his condition. The procedure worked for his back pain, but he says the pain in his upper legs continued.
When a second spinal fusion failed to remedy the problem, he started looking at other solutions.
His search led him to Norman Marcus, a doctor who says that the source of many people's back pain may not lie in their spines but in their muscles.
Rather than scalpels or drugs, the approach used by Marcus involves a series of slender needles.
It is an approach that is not currently accepted by many in the field of back pain management, but Teller swears by it.
And Marcus says thousands of other patients he has treated share Teller's story.
Treating Muscles to Release the Pain
Teller is not alone in his pain. The Mayo Foundation for Medical Education and Research estimates that four out of five adults have at least one bout of back pain sometime in their lives.
Beneath the skin, the back is actually a complex network of muscle and nerves, stretched across a bony frame.
Its solid design and central location make it a central player in nearly every move you make -- including everything from lifting a stack of books to getting out of bed in the morning.
Because of this, there are a host of movements that can result in injury to the back.
Fortunately, most sufferers will get over their back pain in a few weeks, but 1 percent to 2 percent will eventually resort to surgery, most often to fuse together the bones of the spine or to remove a problem disk.
Marcus, who helped establish the first pain center in New York City at Montefiore Hospital and two others, says in many cases spinal treatment is missing the real problem -- the muscles of the back.
Marcus says he first detects problem areas using an electronic device that stimulates one muscle at a time, allowing him to locate trouble spots.
Once he locates the troubled muscle, he pierces it with a needle.
"That muscle can restore its normal length and normal function," he said. "This is a treatment that does not use steroids or cortisone. The treatment is actually the needle breaking up the 'knots' in the muscle."
Marcus says the treatment is followed by a series of exercises designed to rehabilitate the treated muscles.
Some Doctors Skeptical
Not every expert in the field of pain management is convinced of the efficacy of Marcus' treatment strategy.
"Trigger point injections are done by just about any physical medicine and rehabilitation doctor in the country," said Dr. Andrew Haig, associate professor of physical medicine and rehabilitation and orthopedic surgery at the University of Michigan in Ann Arbor, Mich.
"But they are shown not to make a long-term difference for pain when performed on their own. Simple stretching exercises are likely as effective in most cases, and the idea of multiple repeated injections is sketchy, though financially rewarding," Haig said.
Haig says Marcus has not published any findings on his technique in any of the major journals -- a point echoed by others.
"I have reviewed the literature extensively on this subject," said Dennis Maiman, a neurosurgeon at the Medical College of Wisconsin in Milwaukee.
Maiman says that he has seen "absolutely no evidence of efficacy in treatment" of lower back pain.
Other doctors say that while they have seen little evidence that confirms the validity of Marcus' approach, his methods hold promise for future directions in treatment.
"Intuitively, it sounds reasonable, but of course that's been true of many abandoned treatments," said Dr. Richard Deyo, professor of medicine and of health services at the University of Washington Harborview Medical Center in Seattle.
"I guess the question will be: How does this compare to 'trigger point' injections as conventionally used, to saline injections, to oral muscle relaxants, or to exercise interventions?" Deyo said.
"I know of Dr. Marcus' work and think it has a good chance of providing another nonsurgical treatment option for patients with intractable pain," said Bill McCarberg, founder of the Chronic Pain Management Program for Kaiser Permanente and assistant clinical professor in the department of family practice at the University of California, San Diego, School of Medicine.
"As with any therapy, which is not mainstream, his work needs randomized trials to prove benefit. Without this data, the theory and outcomes reported by individual patients remains speculative," McCarberg said.
One Pleased Patient
Teller, however, says there is nothing speculative about his recovery from pain.
"The thing about pain is that it really defines your life and changes you in ways you can't even think of," Teller said. "He gave me my life back. Gave me my life back -- and my wife's, too. I can take a walk now, without a cane, and no pills! So I'm grateful."
And Marcus says the results he sees in his patients speak for themselves.
"We're really for everything that works, and the belief is that if we would incorporate muscles into all of our approaches, including surgery, that everybody's results would get better," Marcus said. "I think if more physicians would begin to look at muscles and begin to make these diagnoses and consider treatment for primary muscle pain, we will see a huge benefit in our patient population."
For more information on Marcus' work, check out his website.