Back Pain

Whether or Not Weather Prompts Chronic Pain

cmaynard — Thu, 01 Oct 2009 10:21:05 -0700

October 2, 2009
by: Sylvia Marten

As Chicago (the home base of Spine-health) deals with some chilly weather this week, and other cities also come to terms with the end of summer, an old, unanswered question comes to mind:

Do changes in the weather bring on changes in [url:137,type=|term|,content=|chronic pain|]?

A quick run through the Spine-health Pain Forums finds patients commenting on how the onset of fall has already led to increased pain:

One member starts a very similar discussion after noticing [url:26085,type=|node|,content=|seasonal changes and increased pain levels|]
Another member describes how [url:26516,type=|node|,content=|hot to cold weather changes are agony|]
This member jokes about [url:25621,type=|node|,content=|using WD-40 on her joints and spine|] with the fall changes.

While chronic pain sufferers are quick to note how weather changes affect their symptoms, medical professionals are not so certain about the relationship.

Medical View of Chronic Pain and Weather

Surprisingly, there is scant scientific research and evidence linking seasonal changes to pain. Of course, this development goes against the grain of theories that suggest drops in barometric pressure lead to increased joint inflammation or even propose that patients with chronic joint pain can predict changes in the weather (i.e. temperature drops, rain, etc.) based on how their joints are feeling.

While many medical professionals may be hesitant to confirm such statements as truths, what is generally agreed upon is that patients do see their doctors about symptoms related to weather changes.

For example:

Modulating factors like cold, damp weather, "stress", and overexertion have been noted by patients whose symptoms of [url:147,type=|term|,content=|fibromyalgia|] (generalized pain, stiffness, fatigue, non-restorative sleep) recently worsened
Patients with [url:136,type=|term|,content=|osteoarthritis|] have noted swelling and warmth in one or more joints particularly during weather changes that may be related to cooling of the air and drops in barometric pressure.

Even if the scientific relationship between the weather and chronic pain is not fully understood, what is known is that patients may try different non-surgical treatments to alleviate their symptoms.

Counterbalancing the Cold with Some Heat

Known for decreasing stiffness, increasing blood circulation and promoting the healing process, [url:167,type=|term|,content=|heat therapy|] may be a potential ally for patients with chronic pain during the fall and winter.

For patients whose joints may feel painful, sore or stiff with the onset of recent cold weather, consider these suggestions:

Apply a hot pack, warm towel or heating pad to the painful area. Simply doing this for 20 minutes at a time may be enough for temporary pain relief.
Utilize heat wraps. Available in most grocery stores/pharmacies, heat wraps can provide warmth for joint-related back pain and other symptoms for up to 8 hours at a time.
Try water therapy. Some patients may experience pain relief by swimming in an indoor, heated pool a few times per week, or utilizing a whirlpool, perhaps at a local community center or health club. Taking a hot shower may be an alternative solution for other patients.
Stay active rather than hibernating. A lot of people limit their activities in the winter because of the cold weather. Such immobility is not good for the spine and joints. Rather, maintaining a regular exercise program promotes a healthy spine.

While the new season may bring added stress to some chronic pain sufferers, keeping these tips in mind and having a positive outlook (after all, the fall does bring wonderful scenery and football) may help patients minimize pain.

More on this Topic:

[url:671,type=|node|,content=|Understanding Osteoarthritis of the Spine|]
[url:656,type=|node|,content=|Treatment Options for Facet Joint Pain|]
[url:700,type=|node|,content=|Fibromyalgia Overview|]
[url:851,type=|node|,content=|Alternative Treatments for Fibromyalgia|]
[url:1662,type=|node|,content=|Benefits of Heat Therapy for Lower Back Pain|]
[url:2004,type=|node|,content=|Modern Theories of Chronic Pain|]

Feeling and Looking Older Because of Chronic Pain

cmaynard — Wed, 23 Sep 2009 06:42:30 -0700

September 23, 2009
by: Sylvia Marten

The study in the September issue of the Journal of the American Geriatric Society noted that chronic pain patients (aged 50-59) looked similar to healthy patients who were two to three decades older. Furthermore, the study found that the chronic pain sufferers also functioned as if they were much older, specifically in terms of four types of physical activities:

Walking/jogging
Climbing stairs
Using the upper extremities
Performing everyday activities like bathing, dressing and eating.

Chronic Pain Study: Methodology and Other Findings

Researchers at the University of California in San Francisco analyzed data from slightly more than 18,500 participants (aged 50 and older) who took part in the 2004 Health and Retirement Study, which examined functioning across the aforementioned physical activities.

Notable findings included the following:

24 percent of patients had pain across all four physical abilities, with higher functional limitations present in those patients than in painless subjects.
Only 9 percent of patients (aged 50-59) who suffered from chronic pain were able to jog a mile, in comparison to 37 percent of patients in the same age group without any pain.
50 percent of chronic pain sufferers (aged 50-59) were able to walk a few blocks without difficulty; however, 91 percent of same-aged subjects without any pain walked a few blocks without complications (Sources: Journal of the American Geriatric Society, UPI).

Providing some statistical evidence to the devastating effects of chronic pain, this study confirms what many chronic sufferers already feel on a daily basis.

Chronic Back Pain Sufferers Relate to Study Findings

A quick troll through our Pain Forums finds many personal accounts of younger patients explaining how their chronic pain makes them feel much older.

One 28-year-old, [url:21642,type=|node|,content=|new member with chronic back pain|] over the last five years feels as if she’s 82!
A 24-year-old [url:13930,type=|node|,content=|member with a cervical herniated disc|] complains of feeling 40 years older.
In response to the previous member, a chronic pain sufferer who is roughly 50 years old details looking older than his or her mother, who is 20 years older; thus supporting the study’s findings.

With chronic back pain and neck pain exerting such physical and mental tolls, it is important for patients to stay active through exercise and physical therapy (in addition to other pain management techniques) to prevent functional problems and preserve their abilities to perform certain physical activities as they age.

For more information on dealing with chronic pain that lasts more than three to six months, see our Health Center on [url:137,type=|term|,content=|chronic pain|].

More Information:

[url:2204,type=|node|]
[url:2000,type=|node|]
[url:2205,type=|node|]
[url:1081,type=|node|]
[url:2004,type=|node|]
[url:1080,type=|node|]

"Off-Label" Drug Confusion Can Impact Back Pain Patients

cmaynard — Wed, 26 Aug 2009 14:09:18 -0700

August 27, 2009
by: Sylvia Marten

A significant minority of physicians incorrectly identified the use of certain drugs as having been approved by the U.S. Food and Drug Administration (FDA), according to a national survey that reiterates the importance of patients understanding "on-label" versus "off-label" drug use.

When the safety and effectiveness of a drug has been demonstrated in studies, pharmaceutical manufacturers seek FDA approval, which includes getting approval of a label that describes indications of use, dosage and method of administration. If the drug and its label are approved by the FDA, doctors may prescribe it to the general population.

When the drug is prescribed for uses that are clearly listed on its label and have been approved by the FDA, such usages are described as “on-label.”
When the drug is prescribed for usage that is not described on its label and has not been approved by the FDA (which doctors may legally do for various reasons), its use is described as “off-label.”

Here’s a prime example in relation to patients dealing with [url:145,type=|term|,content=|back pain|]:

While the brand name drug Neurontin (gabapentin) has been approved by the FDA for “on-label” use among adult patients with post-herpetic neuralgia, it is commonly prescribed “off-label” to patients who have been diagnosed with chronic back pain or chronic low back pain.
In other words, while the Neurontin label does not indicate usage for back pain, it is still prescribed “off-label” for this condition.

With this understood, a University of Chicago-led survey of nearly 1200 physicians (specifically 599 primary care physicians and 600 physiatrists from around the country) revealed some confusion about the “on-label” and “off-label” usage of select drugs among 22 drug-indication pairs.

So What Did the Survey Reveal?

More [url:169,type=|term|,content=|Pain Medication|] Info

[url:1916,type=|node|,content=|Muscle Relaxants|]

[url:1917,type=|node|,content=|NSAIDs|]

[url:1924,type=|node|,content=|Pain Killer Addition|]

Physicians correctly identified the FDA-approved status of just slightly more than half (55%) of the drugs in the survey. Especially of interest, physicians who had previously prescribed drugs for “off-label” uses were more likely to respond incorrectly in the survey that such uses of the drug had been approved by the FDA.

Here are just a few drugs whose “on-label” usage created confusion in the survey:

Lorazepam. This drug has not been approved to treat chronic anxiety, yet 26% of the surveyed physicians thought it had been approved for this purpose, with 33% of those incorrect physicians having previously prescribed the drug for this reason.
Seroquel (quetiapine). This drug has not been approved by the FDA for treatment of dementia with agitation, yet 13% of the surveyed physicians thought that it has been approved for this purpose, with 19% of those misinformed physicians having previously prescribed Seroquel to treat such dementia.

Also of interest is the fact that some doctors were prescribing Seroquel for dementia at a time of the study (2007-2008) when the FDA had advised that quetiapine not be prescribed for dementia.

Patient Considerations with "Off-Label" Drug Usage

With these findings in mind, why should patients -- especially those with back pain, [url:149,type=|term|,content=|neck pain|], and other pain related to the spine -- care?

Here are a few reasons:

Doctors may prescribe drugs for “off-label” usages for many purposes that are quite relevant, specifically when back pain and/or neck pain has not responded to other approved treatments.
As seen in both the Lorazepam and Seroquel examples, physicians are not always right when prescribing drugs as "on-label."
As evident in the Seroquel example, doctors may unknowingly prescribe drugs for “off-label” purposes at times when the FDA has already advised against such actions.
For any patient who is prescribed a drug, it is important to confirm if the specific usage is “on-label” or “off-label.” If the drug is being prescribed “off-label,” it is particularly crucial to get an understanding of the risks and benefits of such usage.
Patients should do their homework and check out recommended drugs and their approved indications and uses on reputable sites like the FDA, Medline Plus and the [url:169,type=|term|,content=|Pain Medications|] section of Spine-health, in addition to speaking with their doctor.

For more information, see the resources below.

Source: Therapeutics Daily

Update (September 2, 2009): In related news, the world's largest drug maker Pfizer has been penalized a staggering $2.3 billion as part of a record settlement for alleged violations of federal drug rules, including marketing painkiller Bextra and three other drugs for "off-label" purposes that were not approved by the FDA. According to the allegations, Pfizer personnel created false doctor requests for pain reliever Bextra, anti-psychotic Geodon, antibiotic Zyvox, and anti-epletic Lyrica in order to provide doctors with unsolicited information about unapproved uses of these drugs. While it is legal for doctors to prescribe medications for "off-label" purposes, drug manufacturers may not market those drugs for reasons not approved by the FDA, something that Pfizer would hopefully be aware of now. Source: Associated Press

Is Child Back Pain from Backpacks Overhyped?

cmaynard — Thu, 20 Aug 2009 05:49:32 -0700

August 21, 2009
by: Sylvia Marten

As youngsters across the country return to school, I’ve noticed a lot of online stories the past couple of weeks stressing the importance of parents equipping their children with adequate backpacks to avoid [url:145,type=|term|,content=|back pain|] this school year.

As just one example, a recent McClatchy article noted a Consumer Reports study detailing how sixth graders at three New York schools were carrying far too much weight in their backpacks – 17.2 percent of their body weights on average, with some children carrying more than 30 pounds – and emphasized the importance of safety when choosing and using backpacks.

While child safety should always be of utmost consideration, it’s also safe to say that the idea of backpacks being dangerous to the health and wellness of school children is a slightly overblown point at a timely moment in the calendar year.

Still, as a parent whose children started school today, and as a former sufferer of back pain due to using inadequate work luggage when frequently traveling, I can take the current hype for what it is, separate the useful tips from the self-serving ones, and share some personal experiences that I think are worth mentioning to other parents.

In my case, I developed back pain and [url:149,type=|term|,content=|neck pain|] while in tow with a briefcase that strapped over one shoulder on many business trips. By making a switch to a two-strap, black leather backpack that still passed as professional and also balanced the weight on my shoulders and back, as opposed to using the one-strap briefcase that placed uneven weight on my spine and strained the muscles in order to compensate, my back pain quickly improved to the point where the pain rarely occurs today.

With my personal anecdote in my mind, it is important for not only school children but all people who carry extra weight on their backs at some point of the day to find a backpack that is comfortable. While a lot of backpacks nowadays are equipped with enough features to make your head spin, here are five key components that I look for when purchasing a storage item that meets the travel and back needs of my children and myself:

Dual straps. As stated earlier, a backpack with two wide straps allows for more even weight distribution rather than placing unneeded stress on one side of the back.
Padding. A good backpack should have some thick padding on the straps and between the back and the backpack, thus making carrying books and other supplies a more comfortable experience for the user and a less stressful process on the back.
Abdominal Straps. Notice a theme here. Many backpacks come equipped with straps that go around the abdomen to provide even more balanced weight distribution. Unfortunately, many people do not utilize the abdominal straps or even know that they exist on their backpacks. Oftentimes, these straps are already fastened together at the bottom of the backpack when purchased. While easy to overlook, abdominal straps are an underrated feature worth using.
Compartments. A good backpack features several compartments for different types of items, like sharp or pointy objects that can be packed farther away from the back, thus reducing the likelihood of direct trauma to the spine.
Flexibility. All backpacks that are worth their weight allow for the user to adjust them to their specifications (as each person’s spine is unique in its own ways). In other words, the backpack must allow for flexibility and maximum comfort for the child, teen or an adult user.

Other Considerations with Backpacks

Medical experts offer their advice on what makes an ideal backpack for a child. Some of the major points include:

Carrying no more than 5-15% of the student’s body weight. That means, if your child is 100 pounds, he or she should carry no more than 5 to 15 pounds of materials in the backpack.
Hanging no more than 4 inches below the waistline. The farther the backpack sags, the more pressure that is exerted on the spine. Make sure that the backpack is snug with the back to reduce the weight-bearing load.
Appropriately sized with the student’s weight. How many times have we seen little kids with oversized backpacks? While the scene of a kindergartner swimming in his or her backpack on the first day of school may make a cute picture, it’s not good for the back. Bigger equals more weight, so make sure that the backpack is of an appropriate size for your child, even if it means saying "no" to that cool but oversized "Sponge Bob" backpack and going with something less trendy.

In addition to these helpful tips, parents can be proactive in watching how much weight is in their child's backpack.

Some things that have worked well with my children have included:

Teaching them how to pack books in their backpacks. What may be lost on a young child is the importance of putting the heaviest objects in first as opposed to spreading them out, which creates more work and stress for the back.
Observing how they wear their backpacks. Emphasize that your kids utilize both shoulder straps when wearing their backpacks.
Ensuring that they are bringing home what is absolutely necessary and leaving behind items (shoes for gym class, etc.) that can stay in their lockers. Of course, this point runs the risk of children forgetting important books, but teaching them what must come home versus what can stay behind should take care of such concerns.
Having them clean out their backpacks before the start of each school week. Like a purse or gym bag, a backpack may be a repository for items that are forgotten about and add extra weight when carried. Get rid of such excess baggage.

Of course, if your children are complaining about back pain from a backpack, take care of the situation as soon as possible. Examine how they pack their items and what they are packing, and consider if a smaller backpack may be better. Speak to a teacher if your children are being expected to bring home most of their books. Consider alternatives like luggage on wheels (if allowed in your child's school).

If the back pain persists, it may indicate an injury or other underlying condition that warrants a discussion with your pediatrician or an orthopedist.

In short, backpacks should be the least of children and parent worries during the school year. By following these tips throughout this post, you can reduce the minimal likelihood of your children experiencing back pain from backpacks and move on to more important things like finishing those last minute science experiments, getting your kids to those many school-related extracurricular activities that account for most of your weeknights, and of course making sure their homework is done every night.

Wishing your children the best success in the 2009-2010 academic year.

Sincerely,

Sylvia Marten

President, Spine-health

More on This Topic

[url:676,type=|node|]
[url:741,type=|node|]
[url:982,type=|node|]
[url:1111,type=|node
Watch Your Back
[url:1041,type=|node|]

Vertebroplasty Benefits Questioned in Recent Studies

cmaynard — Wed, 12 Aug 2009 08:59:45 -0700

August 13, 2009
by: Sylvia Marten

Recent studies have questioned the minimally-invasive spine surgery [url:1064,type=|term|,content=|vertebroplasty|], specifically noting that there was no apparent benefit from the procedure as compared to a simulated treatment that mimicked a vertebroplasty but lacked one key element.

Led by researchers from the Mayo Clinic, one study compared function and pain in patients who had [url:6027,type=|node|,content=|vertebroplasty surgery|] and a placebo group who had their backs numbed but did not receive an injection of the bone cement.

More specifically:

131 patients were randomly assigned to either a vertebroplasty or the simulated procedure in eight medical centers in the United States, United Kingdom and Australia
68 patients were treated with vertebroplasty
63 patients were given the simulated treatment.

According to the study’s findings as published in the New England Journal of Medicine, there was no difference between the treatments after one month: both groups experienced significant and similar reductions in disability and pain, making it impossible to declare a better treatment, and calling into question, at least according to some, the benefit of vertebroplasty.

While one researcher noted that the study isn’t saying that vertebroplasty is ineffective, it does raise the argument of whether the improvements are actually the result of sedation, local anesthesia or other factors as opposed to the injection of bone cement.

Other Research on Vertebroplasty Supports Mayo Study

The findings of the Mayo-led study coincided with the results of a separate study by the Australian government. In this study that was also recently published in the The New England Journal of Medicine:

78 patients with 1 or 2 unhealed vertebral fractures of less than 12 months in duration participated in the multi-centered study
38 of those patients underwent vertebroplasty
40 patients were placed in the control group.

The primary outcome of overall pain (on a scale of 1-10) was measured at 1 week and 3 and 6 months. According to the findings, both groups of patients experienced significant but similar improvements in pain; in other words, once again there was no major difference establishing one of the two treatments as being more beneficial.

Update: On Thursday, October 16, 2009, the North American Spine Society (NASS) issued a response to these two randomized controlled trials. After reviewing the studies, the NASS noted how it was not looking to discredit these studies or the integrity of their authors, but was rather interested in exploring the disconnect between the findings of these two studies and previous findings on vertebroplasty. Read the NASS response below:

Newly Released Vertebroplasty RCTs: A Tale of Two Trials.

What Do These Findings Reveal about Vertebroplasty?

A lot of opinions have been formed in the week since the release of the results from these first two studies to examine the effect of vertebroplasty. Some doctors have said that these independent studies reveal that vertebroplasty is not beneficial and should be performed only in clinical research trials designed to continue studying its effectiveness.

Other doctors have raised concerns about the vertebroplasty research, including the lack of willing participants, small patient sizes and a flaw in the study that allowed patients to crossover from one treatment to the other. Others have cited the need for more research beyond two trials.

Of course, the issue is an important one for several reasons:

An estimated 100,000 vertebroplasty procedures were performed last year in the United States, according to a Wall Street Journal story. While the risks of vertebroplasty (specifically, leaking bone cement leading to soft tissue damage, nerve pain and compression, pulmonary embolism, respiratory or cardiac failure, and/or even death) are extremely small, it would make no sense to expose patients to such risks if the benefits of the surgery did not outweigh them.
With 250,000 vertebral fractures diagnosed each year, it’s vital that patients are receiving and paying for care that is actually beneficial; the same goes for doctors in terms of performing and paying for vertebroplasty. According to the Wall Street Journal story, vertebroplasty can cost anywhere from $2,000 to $5,000.
Amidst the debate on health care reform, legislators will certainly be interested in the actual benefits of vertebroplasty (which is covered by Medicare) as they go back and forth on legislation. According to a doctor at Dartmouth in a Forbes article, Medicare paid for 40,000 vertebroplasty procedures last year at a price of roughly $3,000 each.

More Information:

[url:1614,type=|node|]
[url:930,type=|node|,content=|When Is Back Pain a Fracture?|]
[url:699,type=|node|,content=|Definitive Guide to Osteoporosis Fractures|]
[url:926,type=|node|,content=|What You Need to Know about Osteoporosis|]
[url:934,type=|node|,content=|4 Proven Steps to Prevent Osteoporosis Fractures|]
[url:15644,type=|node|,content=|Conservative Treatments for Osteoporosis and Surgery for Vertebral Fractures|]

New Study Highlights Antidepressant Use for Back Pain and Sleep Problems

cmaynard — Tue, 04 Aug 2009 07:17:12 -0700

August 3, 2009
by: Sylvia Marten

Since insomnia and depression may often occur in conjunction with chronic pain, low doses of sedating antidepressants may be prescribed to help patients sleep and receive some pain relief.

With this in mind, a recent study details the prevalent use of antidepressants in the United States, especially for patients with [url:145,type=|term|,content=|back pain|] and sleeping problems.

According to a study of nearly 50,000 children and adults in the Archives of General Psychiatry, the number of Americans using antidepressants doubled in the last decade, to approximately 27 million in 2005 (the last year in which data was available).

A USA Today story notes how doctors have become more comfortable prescribing antidepressants for back pain and sleep problems since newer drugs are much safer and have fewer side effects.

As just a few examples, doctors may prescribe antidepressants like Escitalopram (Lexapro), Duloxetine (Cymbalta), Desvenlafaxine (Pristiq), Trazodone (Desyrel), Amitriptyline (Elavil) and Doxepin (Sinequan) for sleeping problems because they are non-addictive, have low side effects, and include pain relieving properties that are absent in their predecessors, the hypnotic class of medications.

However, to some medical professionals in the story, the use of antidepressants is a bit alarming and at least warrants more mental health training for doctors.

As just one example that raises some concern, the new study notes how the percentage of children using antidepressants rose from 1.4 percent in 1996 to 2.6 percent in 2005. The USA Today story added that antidepressant use by children did drop 10 percent in 2005 following an FDA “black box” warning from the year before about the suicidal risks in children using antidepressants.

Important Considerations with Antidepressants and Pain Medications

Whether or not Americans have become too dependent on antidepressants and other pills is subject to debate; what must be noted is that any patient who plans on taking antidepressants for depression, chronic back pain, insomnia or other problems should be fully aware of the side effects involved and only do so under the guidance of a trusted medical professional.

Learn more about depression and insomnia stemming from chronic pain, and examine other methods besides antidepressants to address such problems, in the following resources:

[url:804,type=|node|,content=|Chronic Pain and Depression|]
[url:830,type=|node|,content=|Definitive Depression Guide|]
[url:17137,type=|node|,content=|Antidepressants as Sleep Aids|]
[url:1318,type=|node|,content=|Chronic Pain and Insomnia: Breaking the Cycle|]
[url:1081,type=|node|,content=|Chronic Pain Management|]
[url:1080,type=|node|,content=|11 Chronic Pain Control Techniques|].

The Latest Chiropractic Debate

cmaynard — Mon, 27 Jul 2009 08:57:17 -0700

July 30, 2009
by: Sylvia Marten

While [url:1621,type=|node|,content=|chiropractic treatment|] of the spine may have been considered unproven at one point in time, that opinion has been dispelled more recently as nearly 9 percent of Americans now seek chiropractic care each year, according to the National Center for Complementary and Alternative Medicine.

While chiropractic treatment has gained acceptance in the mainstream as a valid form of health care, there is now a growing debate among [url:1624,type=|node|,content=|chiropractors|], specifically as a result of those who claim that chiropractic offers holistic treatment for much more than [url:145,type=|term|,content=|back pain|] and other symptoms associated with the spine.

Since its inception, chiropractic has held as a central tenant that the anatomical relationship between the spine and nervous system is vital to a person’s health.

Traditionally, chiropractic care has been used to treat musculoskeletal conditions, specifically via non-surgical and drug-free means. Chiropractors have based their practice on the idea of manipulating the spine through a series of short-lever, arm thrusts with the goal of reducing subluxation (the altered position of the vertebra and subsequent loss of function as a result of the vertebra being mispositioned in comparison to the other vertebrae) and providing relief for:

Upper and lower back pain
[url:149,type=|term|,content=|Neck pain|]
[url:998,type=|node|,content=|Sciatica|]
Muscle strains
Arthritic pain
Other conditions of the spine.

The acceptance of [url:1620,type=|node|,content=|chiropractic manipulation|] has naturally coincided with strong evidence to its effectiveness in improving function and reducing symptoms of acute and chronic back pain.

With its evolution, chiropractic treatment has expanded and incorporated the use of massage, exercise programs and physical modalities like heat/ice therapy, electrical stimulation, ultrasound and X-ray to help diagnose and treat back pain.

A Holistic Approach to Chiropractic Care

More recently, some chiropractors have provided chiropractic care for not only back pain but acid reflux, digestive disorders, ear infections, asthma, allegories, colic and much more.

These chiropractors promote chiropractic treatment as holistic, using words like “hygiene” and “wellness,” noting how the spine is directly related to all conditions, and using the concept of “subluxation” as a basis of their arguments.

Such chiropractors say that they don’t want to pigeonhole chiropractic in terms of its treatment abilities but rather aim to provide patients with a more well-rounded understanding of its many applications.

Other chiropractors disagree, saying that there is not any evidence at this point to suggest that chiropractic care is an effective treatment for symptoms beyond back pain and opining that it should thus be primarily used for treatment of spinal conditions.

So just as chiropractic has become more integrated with other health care practices, the battle is not over as it continually seeks to define itself, this time as a holistic approach.

Source: Chicago Tribune

More Chiropractic Resources for Patients

The most recent debate on chiropractic care should not confuse or sway patients interested in exploring this treatment in more detail.

Learn more about chiropractic care by checking out the following resources:

[url:1636,type=|node|,content=|How to Select the Best Chiropractor|]
[url:1635,type=|node|,content=|How to Choose a Chiropractic Clinic|]
[url:1633,type=|node|,content=|What to Expect at the First Chiropractic Consultation|]
[url:15655,type=|node|,content=|Questions to Ask Your Chiropractor|]
[url:15656,type=|node|,content=|Chiropractic Treatment Program Guidelines|]
[url:1647,type=|node|,content=|Chiropractic Treatment of the Joints|]

Effectiveness of Sciatica Treatment, Herniated Disc Surgeries Compared in Recent Study

cmaynard — Wed, 15 Jul 2009 09:27:47 -0700

July 15, 2009
by: Sylvia Marten

View Sciatica Videos

Examining the effectiveness of conventional microdiscectomy and tubular disectomy surgeries for treatment of [url:996,type=|node|,content=|sciatica symptoms|] resulting from a [url:885,type=|node|,content=|herniated disc|], a recent study found and opined that the minimally invasive, tubular surgery did not result in better outcomes for patients despite such claims in the past.

[url:1584,type=|node|,content=|conventional microdiscectomy|]. The most commonly performed surgery for patients with sciatic leg pain from disc herniation, [url:5991,type=|node|,content=|microdiscectomy|] (also known as lumbar decompression surgery) entails the removal of a small portion of the bone over the nerve root and/or disc material under the nerve root to relieve neural impingement and provide more room to heal.
[url:6025,type=|node|,content=|tubular discectomy|]. Introduced in 1997, tubular discectomy involves a similar procedure to the one described above, with the exception that it is performed through a tubular device. This type of herniated disc surgery has been described as producing less tissue damage and resulting in a faster rate of recovery, the latter point serving as the basis of examination for the Sciatica Micro-Endoscopic Discectomy trial.

Performed by researchers in the Netherlands, this trial involved 328 patients (ages 18 to 70 years) who:

had persistent leg pain from lumbar herniated discs for more than 8 weeks
were hospitalized in 7 general hospitals in the Netherlands from January 2005 to October 2006
were randomized to either a tubular discectomy (approximately 167 patients) or conventional microdiscectomy (161 patients).

A blind follow up was conducted a year later, with functional ability, pain and a self-view of recovery assessed via a series of questionnaires and surveys.

Findings on Microdiscectomy and Tubular Discectomy

According to the study, conventional microdiscectomy produced more favorable results than tubular discectomy after one year for:

functionality. The mean score on the Roland-Morris Disability Questionnaire (RDQ), which has a 0-23 score range with higher scores indicative of worse functional status, was 3.4 for conventional microdiscectomy and 4.7 for tubular discectomy.
leg pain. On the visual analog scale, the 1-year mean difference was in favor of conventional microdiscectomy (with scores of 4.2 mm for leg pain and 3.5 mm for [url:145,type=|term|,content=|back pain|]).
self-reports of recovery. 120 of 151 patients (79%) who had conventional microdiscectomy reported good recovery a year later while 107 of 156 of patients (69%) who had tubular discectomy reported good recovery a year after the minimally-invasive procedure.

It should be known that this randomized control trial by no means knocks the validity of tubular disectomy as a minimally-invasive procedure for herniated discs; rather, it challenges certain claims like it increasing the rates of recovery.

Source: JAMA

More on This Topic

[url:1001,type=|node|,content=|Sciatic Nerve Anatomy and Sciatica Symptoms|]
[url:1016,type=|node|,content=|The Truth about Sciatica|]
[url:715,type=|node|,content=|Lumbar Herniated Disc|]
[url:884,type=|node|,content=|Treatment Options for a Lumbar Herniated Disc|]
[url:9574,type=|node|,content=|Surgery Options for a Herniated Disc|]
[url:18207,type=|node|,content=|Lower Back Pain after Surgery|]
[url:7996,type=|node|,content=|Sciatica Treatments|]

What Back Pain Patients Should Know about Stop-Smoking Drugs Chantix and Zyban

cmaynard — Tue, 07 Jul 2009 11:43:47 -0700

July 8, 2009
by: Sylvia Marten

The U.S. Food and Drug Administration (FDA) just announced that a black box warning will be carried on two popular, “stop-smoking” drugs – varenicline (Chantix) and buproprion (Zyban, Wellbutrin) – following a report detailing some very significant side effects with their use.

According to the FDA’s adverse event reporting system, use of these two drugs has been linked with serious changes in behavior, including:

depression
agitation
hostility
thoughts of suicide.

More specifically, the report linked:

98 suicides and 188 attempted suicides to use of varenicline
14 suicides and 17 attempted suicides to buproprion use.

While noting the importance of getting people to quit smoking, the FDA added that it simply wants closer monitoring of these two drugs.

Consequently, the FDA is going to ask the manufacturers of Chantix and Zyban – Pfizer and GlaxoSmithKline, respectively – to conduct clinical trials examining behavioral changes with usage of these drugs.

Smoking has long been linked to causing back pain and is often a reason why surgeons may not want to perform spinal surgery on certain patients.

Since smoking can slow down the recovery time after back surgery, many patients may have to quit smoking prior to surgery.

If you have recently quit smoking in wake of a scheduled back surgery, or have stopped smoking following back surgery, it’s important that you know the risks of stop-smoking drugs, as the above information about Chantix and Zyban demonstrates.

And if you have used any of these stop-smoking drugs and noticed changes in your behavior similar to the symptoms listed above, get in touch with your doctor as soon as possible.

More on This Topic

[url:6767,type=|node|,content=|Chantix Helps Quit Smoking|]

[url:738,type=|node|,content=|Does Smoking Cause Low Back Pain?|]

[url:6679,type=|node|,content=|Quitting Smoking: A Must for People with Back Pain|]

[url:6742,type=|node|,content=|Ways to Quit Smoking|]

[url:6741,type=|node|,content=|Why It Is So Hard to Quit Smoking?|]

[url:6724,type=|node|,content=|Quitting Smoking before a Spinal Fusion|]

Pain Killers Scrutinized after Shocking Death of Michael Jackson

cmaynard — Wed, 01 Jul 2009 11:55:00 -0700

July 1, 2009
by: Sylvia Marten

It’s been nearly a week since pop singer Michael Jackson’s sudden death from cardiac arrest, and questions still remain as to what led to his death.

According to various news reports, Jackson was addicted to the narcotic pain killer Demerol for more than 20 years and also received daily doses of another pain killer, Oxycontin. According to an unnamed senior law enforcement official in an ABC News report, Los Angeles police were told that Jackson did in fact receive a Demerol injection an hour before his death.

A lawyer for Jackson’s physician, Dr. Conrad Murray, has said that his client did not prescribe Jackson with any of these pain killers, but many medical experts think that Demerol and possibly other drugs played a role in the death.

Whether this is true or not, Jackson’s death provides a sad but absolutely necessary forum to talk about pain killer addiction.

While pain killers like Vicodin, OxyContin, Norco and Hydrocodone are typically prescribed to treat pain, what is often forgotten or not known with patients is that pain killers cause changes in the brain’s chemistry that are not under their control.

More specifically, the brain increases the number of receptors in response to the specific pain killer, and its nerve cells stop functioning. Since the body is receiving opiate pain killers, it stops producing endorphins (the body’s natural pain killers). Consequential degeneration of the nerve cells often auses a physical dependency for these opiates.

What is also not known by many patients is that taking pain killers over a long period of time may actually increase a person’s sensitivity to pain, possibly causing them to up their doses, become addicted and put their health in serious danger.

An overdose of pain killers can lead to respiratory arrest (when breathing slows and stops). Low blood oxygen may then cause the heart to quiver and not circulate blood, and lead to cardiac arrest (when the heart stops circulating blood).

Pain killer addiction is a very real problem in the United States. It has been estimated that more than 4.7 million Americans (roughly 2% of the U.S. population) are dependent on prescription pain killers.

Learn more about pain killer addiction and treatment in the following resources:

[url:808,type=|node|,content=|Pain Medications|]
[url:6639,type=|node|,content=|How Pain Killers Sometimes Increase Chronic Pain|]
[url:1924,type=|node|,content=|Pain Killer Addiction Treatment|].

In related news, Jackson’s death comes at a time when the European Medicines Agency (EMEA) wants a specific pain killer off the market and the U.S. Food and Drug Administration (FDA) is considering major changes to the use of one pain reliever.

The EMEA has said that the pain killer dextropropoxyphene (known as propoxyphene in the United States) should be withdrawn from the European market because a “significant” number of patients have allegedly been overdosing and dying from it (although the EMEA did not provide a specific number of casualties, according to a Wall Street Journal story).

Propoxyphene (e.g. Darvocet) has been used in the United States to treat mild to moderate pain since the late 1950s. It is marketed today by many drug manufacturers, and the FDA is reportedly considering whether to withdraw this pain killer.

For back pain patients who use or are considering taking a pain medication, especially medications with addiction potential, it is essential to understand and carefully monitor the use of that medicine. Do the upfront research to understand the medication options for your particular type of back or neck pain, and work closely with your medical professional to watch for side effects and risks of dependency. Some medicines are safe for short term use, but become potential dangers when used longer than indicated or in combination with other drugs.

Update: The FDA announced on July 8 that it would not withdraw Darvocet, Darvon and other pain killers with propoxyphene from the market despite calls from one consumer group to remove them. The FDA added that it would require a boxed warning of propoxyphene overdose risks and force manufacturers to study the fatality rates from overdoses.

9 Quick Back Pain Tips for Airplane Rides

cmaynard — Fri, 26 Jun 2009 08:22:42 -0700

June 26, 2009
by: Sylvia Marten

Looking forward to that much-awaited summer vacation but worried about dealing with chronic lower back pain, especially on a long flight?

If so, follow these lower back pain management tips -- courtesy of Spine-health’s continuing series on dealing with [url:145,type=|term|,content=|back pain|] on summer vacation -- to make your trip as painless, comfortable and stress-free as possible.

Let’s get started with some things you can do prior to your flight.

Utilize Your Doctor

As Haglandc of the Spine-health forum wonderfully points out, your doctor is one of your best advocates when preparing for a vacation. Here’s why.

A doctor may be able to provide a letter about your [url:896,type=|node|,content=|lower back pain|] to the airline and flight crew, which may then make accommodations for your needs. In the case of one forum member, that meant getting upgraded to business class, allowed to lay on the floor and rest during long flights, provided with a bunch of blankets for cushions, and afforded the opportunity to get up and walk around when others remained in their seats.
A doctor may provide you with prescription drugs like narcotics or muscle relaxants to help make the plane ride easier on your lower back pain. If this is the case, be sure to keep all of your prescription drugs in their original bottles (for airport security reasons) and bring a doctor’s note with you that specifies the medications you are on and the medical necessity.

Contact the Airline

Generally speaking, it usually cannot hurt to contact the airline a couple of weeks prior to the flight and let them know of your back pain. In the case of one forum member, speaking with the airline prior to flight made boarding much easier.

With a letter provided by a physical therapist, this passenger was allowed to bring on his [url:1940,type=|node|,content=|Transcutaneous Electrical Nerve Stimulation|] (TENS) unit, a portable, pocket-sized device that blocks pain signals by sending electrical impulses to certain parts of the body, and go through security without have to take it off.

You may be surprised that the airline may be able to make accommodations for your back pain, especially when you give them a decent notice of your condition. As just a couple of examples, the airline may be able to:

Provide you with medical attention (if necessary) via wheelchair assistance and early boarding
Have airline personnel carry your luggage for you and/or lift it into the overhead bin for you
Accommodate you with special shuttles and elevator platforms for boarding
Allow non-medical assistants to accompany you through security and boarding.

Put More Thought into Scheduling Your Flight

Take into account how you can make your flight less stressful on your back rather than rushing to book tickets by:

Exploring the possibility of taking a flight when there will be less people on board and more room for you to lie down across seats.
Contacting the airline prior to scheduling a flight and let them know of your back pain. They may be able to provide you with more insight on when flights tend to be very crowded and much lighter.
Trying to limit the down time between in-flight connections or layovers, if applicable.

Now that you’ve done some work prior to your flight, here’s what you can do to curtail back pain during it.

Bring Over-the-Counter Pain Medication

Utilize over-the-counter pain medication like acetaminophen (e.g. Tylenol) or [url:1917,type=|node|,content=|NSAIDS|] ibuprofen (Advil, Motrin and Nuprin) or naproxen (Aleve), to provide back pain relief on your flight.

Take your pain medication one hour before your flight to give it time to get into your system.
Carry your pain medications together in a clear plastic bag and have them on you at all times, in case you need to resort to them during the flight.
Inform flight attendants that you are on medication. This way they can monitor you if necessary.

Provide Support to Your Back While in the Air

For lower back pain, providing support behind your lower back, often with a back roll or even a couple of pillows (which a flight attendant may be more than willing to give you), is a good way to prevent slouching that may lead to back pain and to keep your spine straight.

One forum member talked about how he brings a neck pillow on board to help with his [url:912,type=|node|,content=|neck pain|].
Back braces, tube-shaped pillows with microfibers inside and other materials providing support are common companions of passengers with back pain and can be purchased inexpensively at many stores.

Watch How You Are Sitting

Airplane rides can be a bit tight and uncomfortable at times, especially if you’re not in a luxury class.

If your legs are not positioned at a right angle when you sit in an airplane seat, ask for something (pillows, blankets) to prop up your feet and keep your knees at a right angle. Doing so keeps stress off the lower back.
If you have long legs, request an exit row or bulkhead seat, which generally has more leg room.

Get Up, Move & Stretch as much as possible

Staying stationary for prolonged periods of time stresses the spine and can make back pain much worse.

See if there is room at the back of plane to do some quick stretching, which can provide more flexibility to the back and ease stiffness. Just be sure not to get up and move when there are jerking movements.

Alternate between Heat and Ice

Stock up on inexpensive heating options like ThermaCare heat wraps or warm gel packs and apply them while in the air.
Bring an empty hot water bottle and ask the flight attendant to fill it up during your flight.
Carry a small gel pack on the plane and have the flight attendant store it in the fridge when you are not using it.
Have a Ziploc bag on hand and ask the attendant to fill it up with ice that you can apply to your back.

Of course, do not apply heat or ice directly to the skin and be sure to check in with the airline to see what items are acceptable to carry on.

Relax and Try to Get Some Rest

A long flight provides plenty of time to [url:1080,type=|node|,content=|relax|], with just some suggestions including:

Getting comfortable via a back or neck support, sitting properly or reclining your seat, and maybe even taking some pain medication prior to your flight
Breathing slowly (inhale deeply, count to five, exhale slowly and repeat 10 times) to relax your muscles and nerves
Listening to some soothing music on an iPod
Bringing a novel or some other reading materials that can stimulate your mind and divert your attention away from your back pain
Staring out at the clouds and scenery (if you have a window seat) and letting your mind drift
Thinking about your vacation destination and how long you’ve waited for this day.

Hopefully these tips will help and even spark some more ideas as you prepare to deal with your back pain on a vacation plane ride.

Thanks again to those forum members who provided ideas with how they’ve dealt with back pain on airplane rides in the past.

Feel free to provide us with any other tips that you feel may be helpful to others, and be sure to check in at the Spine-health blog for future tips on dealing with back pain during summer vacation.

Happy travels to you.

More On This Topic:

[url:6713,type=|node|,content=|5 Tips for Flying Back Pain Free|]
[url:22230,type=|node|,content=|Effective Tips for Curtailing Back Pain on Plane Rides|]
[url:22226,type=|node|,content=|Top 7 Back Pain Treatments for Summer Vacation Car Rides|]

Top 7 Back Pain Treatments for Summer Vacation Car Rides

cmaynard — Wed, 17 Jun 2009 08:06:30 -0700

June 17, 2009
by: Sylvia Marten

Well, it’s that wonderful time of year when school is letting out, the weather is getting beautiful and the days are much longer and brighter. For most people, the summer is an ideal time to get away from the grind of the 9-to-5 and take a vacation with family.

With money tighter and the economy what it is, more families vacationing this summer may decide to travel by car, which may not present the most ideal situation for people dealing with a history of lower back pain.

Still, [url:896,type=|node|,content=|lower back pain|] doesn’t have to throw a wrench in your summer travels. In fact, if you keep the following tips in mind, you may very well make your trip a comfortable one.

In the first installment of Spine-health’s summer series of tips for limiting back pain on vacation, we examine how you can “have the back” of your back during that long car ride to the destination of your dreams.

1. Cover Your Bases by Getting Comfortable Immediately.

Whether you’re going to be driving or sitting in a car on your vacation trip, chances are you’ll be in the vehicle for extended periods, likely hours at a time. While this may sound extremely basic, make sure you’re comfortable from the get go.

Unfortunately, not all cars include built-in lumbar support or other ergonomic features. With that said, here are some tips for making your car more ergonomically-friendly for your back.

If your car seat provides little back support, roll up a towel, pillow or back support and place it between your lower back and seat for some more support. There are many different types of cushions and pillows (including but not limited to ones for sciatica, the [url:149,type=|term|,content=|neck|], lumbar spine, bottom and full body) that you can also purchase to alleviate your back pain.
Don’t sit on your wallet, cell phone or anything else that may throw your spine out of whack.
Reduce reaching (which places more stress on the lumbar spine, neck, shoulder and wrists) by sitting as close to the steering wheel as possible without compromising your safety.
Sit up straight with your knees slightly higher than your hips, and keep your chin pulled in.
Since staying still is bad for your back, don’t just pick a position and stay in it. Rather, adjust your seat and make slight adjustments to your position every 15-20 minutes.
Perhaps you’ll be renting a car for your vacation. If so, seek a car that provides lumbar support, is high enough for you to see past other vehicles without having to cringe your back and neck, and allows an easy way to get in and out without having to do much bending.

2. Bring a Small Cooler & Stack an Ice Pack.

Chances are you’ll already be bringing a small cooler with little snacks and beverages for yourself or the kids as you begin your vacation trek in the family car, so you might as well store a small ice pack in there as well.

[url:1664,type=|node|,content=|Applying ice|] to where you’re experiencing back pain – most often for no more than 20 minutes – is typically a good way to curtail any pain.

As most back pain is accompanied by inflammation, ice therapy can slow back swelling, numb sore tissues, slow the nerve impulses in the affected area, and decrease tissue damage.

Just remember that you should never apply ice directly to the back, but should rather keep it in a towel or another protective barrier to avoid ice burn.

3. Alternate Ice with Heat Therapy via These Inexpensive Means.

Alternating ice and heat is often an effective way to combat back pain, so be sure to bring something that can provide some warmth to your back.

Since lower back pain typically develops from strains and over-exertions that place tension in the muscles and soft tissues around the lower spine, hence leading to a lack of proper circulation and the transmission of pain signals to the brain, [url:1662,type=|node|,content=|heat therapy|] may reduce such signal calling and decrease stiffness by stretching the soft tissues around the spine.

Here are just a few options for how you can “light a fire” under your back during your summer vacation car ride.

Right before you leave, fill up a hot water bottle that you can place on your back. Be sure to refill your water bottle when you make bathroom breaks at rest stops.
While you’re preparing for your vacation by buying new clothes and snacks, be on the lookout for a heating pad with a car adapter that can simply plug into your vehicle’s cigarette lighter.
If you have leather seats with heating power, turn this function on for a few minutes at a time.
Gear up with other less expensive heating options, like warm gel packs and heat wraps. As an example, something like a ThermaCare heat wrap can be used to deliver low level heat to your back for several hours.

As you can see, there are plenty of affordable ways to provide heat therapy to your lower back pain. Just remember, that like ice packs, you should never apply heat directly to your skin.

4. Make Rest Stops So Much More – Utilize the Open Space for Back Exercises.

While this may seem counterintuitive, exercise is often a good treatment for lower back pain. Specifically, active [url:1183,type=|node|,content=|back exercises|] keep discs, muscles, ligaments and joints healthy by distributing nutrients into the disc space and soft tissues in the back.

Now if you have been to one rest stop, you’ve likely been to them all. In addition to providing lovely facilities to use the rest room and being stocked full of vending machines where you can get some of the oldest coffee in the world, rest areas are typically known for having plenty of flowing, green space.

After taking care of business at the rest stop, be sure to utilize its open space by making it a point to do some back exercises, including stretching and working on your hamstrings (FYI: you should stretch your hamstrings twice a day when dealing with low back pain).

Even walking around a bit is a good way to stretch out the muscles.

Here are just some [url:1246,type=|node|,content=|lower back pain exercises|] that may work for you (with that said, a physical therapist or spine professional can provide you with more back exercises).

If you have done back exercises in the past to curtail lower back pain, you’ll want to keep your routine, even when going on vacation, which is all about breaking routines.

Make it a point to spend a couple of minutes doing back exercises at a rest stop before getting back on the road with the Joads, and be sure to get to a stop every couple of hours.

5. Make Good Use of the Back Seat (if available).

If your back pain is proving unbearable and the back seat is available, use it to lie down and rest.

Simply lie down in the back seat (obviously when the car is parked and not moving) with your knees slightly bent. Put a blanket on the seat and rest a pillow under your head.

In simple terms, try to get as comfortable as possible and adjust your positioning when necessary.

6. Substitute Your Pain Medications with Tylenol, Ibuprofen or Naproxen.

Taking your pain medications is not advisable when driving. With that in mind, you can always alternate with over-the-counter pain relievers like Tylenol, ibuprofen (Advil, Motrin and Nuprin) or naproxen (Aleve).

These [url:1917,type=|node|, content=|NSAIDs or non-steroidal anti-inflammatory drugs|] are often effective in limiting inflammation associated with back pain and typically don't produce the gastrointestinal side effects of aspirin.

7. Sit Back, Relax and Rest.

There’s a reason why passenger seats recline. And there’s usually no better time to catch up on some sleep than during a long car ride.

If your lower back pain is nagging, taking a nap may be an effective way to limit the pain.

While sleeping in a car may be difficult for some people, most people are able to adapt and find a good way to nap and get some much needed refreshment and back pain relief.

Here are some general tips for doing so.

Recline the passenger seat in a position that is most comfortable to you.
Depending on how you feel and what you prefer, you may want to use a comfortable pillow to rest your head on and a back brace to support your back.
Throw on a pair of headphones, simply stare out the window at the wonderful scenery passing by, and drift off into your own place of contentment.

Well, hopefully you find these tips helpful as you treat back pain during your summer vacation car ride.

If you have any tips that you would like to add, feel free to let us know in the “Comments” section.

With that said, be on the lookout for next week’s tip on dealing with back pain on plane rides to your summer vacation hot spot.

Latest SPORT Data Supports Back Surgery for Degenerative Spondylolisthesis

cmaynard — Thu, 11 Jun 2009 12:36:10 -0700

June 11, 2009
by: Sylvia Marten

Spine-Health has blogged in the past about the Spine Patient Outcomes Research Trial (SPORT), including one study concluding that [url:6608,type=|node|,content=|back surgery was better for patients with degenerative spondylolisthesis|].

Well, SPORT just recently released the latest data on this study. Its verdict? The newest data supported this earlier conclusion, finding that back pain relief was more prevalent four years later for those patients who voluntarily had lumbar laminectomy surgery as opposed to those who voluntarily passed on this surgery.

Here’s a quick summary of these latest SPORT findings:

Identical Approach, Longer-Elapsed Time Frame, More Crossover, Similar Results.

To recap, there were two cohorts in this study: 304 patients in a randomized cohort (meaning that they were randomly chosen either to have or not have laminectomy surgery to treat their [url:6000,type=|node|,content=|spondylolisthesis|] and [url:152,type=|term|,content=|spinal stenosis|]) and 303 patients in an observational cohort (meaning that these patients voluntarily chose to have or not have this surgery).

It should be known that 66 percent of those patients who were randomly chosen to have surgery did so within four years and that 97 percent of those patients who chose surgery also had a laminectomy in that time period.

More telling were the latest findings that 54 percent of those people who were randomized not to have surgery ended up having surgery within four years and that 33 percent of those who voluntarily passed on surgery eventually had it. For more than a half and approximately a third of these specific patients, not having surgery apparently wasn’t as beneficial in terms of providing back pain relief.

Adding more intrigue to this study were the responses of those patients who voluntarily had surgery for their back pain. This group of patients reported improvements of 15.3 points for bodily pain and 18.9 points for physical function, and decreases of 14.3 points on the Oswestry Disability Index, signifying that gains experienced two years after back surgery were still maintained four years later.

At the end of the day, these latest findings confirm how laminectomy surgery may have wonderful results for people dealing with spondylolisthesis. Still, one must not rush to assume that surgery is always better than not having surgery when addressing spondylolisthesis associated with spinal stenosis. It should be noted that non-surgical treatments may adequately alleviate back pain for others, as very well may have been the case for the 70 percent of the observational patients who initially passed on and still did not have surgery four years later.

As each patient’s case is unique in itself, it ultimately comes down to the patient and his or her doctor examining their options and making a decision that they are most comfortable with and feel is the best course of action at the time.

Source: The Journal of Bone and Joint Surgery

More on This Topic:

[url:144,type=|term|]

[url:6000,type=|node|]

[url:1056,type=|node|]

[url:152,type=|term|]

[url:1581,type=|node|]

[url:18465,type=|node|]

Back Pain Remedies, According to Consumer Reports

Tue, 28 Apr 2009 07:58:51 -0700

April 28th, 2009

Back Pain Treatment Survey

Back pain is one of the most common injuries among adults, affecting about 80% of Americans. [url:896,type=|node|,content=|Low Back Pain|] is a condition that can disrupt many aspects of life: sleep, maintaining a healthy weight and sex life, among others. While some people only experience pain for a few days or a week, it can plague others for a year or more.

The Consumer Reports Health Ratings Center recently surveyed more than 14,000 subscribers, all of whom had suffered from low back pain and sought [url:2229,type=|node|,content=|non-surgical treatments|].

Many people chose to see their primary-care physician for help with back pain. While this may be able to rule out any serious underlying disease, most survey subjects reported disappointment with how the doctor could help, however, primary-care physicians can write prescriptions and give referrals for other treatments.

Survey participants tried an average of five to six different treatment options over the course of a year. They were then asked to rate a comprehensive list of remedies.

Hands-on treatments such as chiropractic, massage therapy and physical therapy were rated as very helpful.
Spinal injections were rated just below hands-on treatments, with 51% of respondents finding them very helpful.
Prescription medications were reportedly taken by one-third of respondents, with ratings ranging from beneficial (45%) to very helpful (22%).
58% of participants wished they had done more back-strengthening exercises to help prevent injury.

Posted by: Stephanie

More resources:

[url:140,type=|term|,content=|Lower Back Pain Health Center|]
[url:896,type=|node|,content=|Lower Back Pain Symptoms and Treatment|]
[url:906,type=|node|,content=|Understanding Low Back Pain|]

Original Back Pain Remedies Article Courtesy of Consumer Reports.

Chronic Low Back Pain Incidence Rising: Obesity, Depression Among Suspected Causes

Ben Parr — Thu, 19 Feb 2009 10:36:48 -0800

February 19th, 2009

A recent study conducted at the University of North Carolina found that the incidence of chronic [url:140,type=|term|,content=|low back pain|] among North Carolina residents increased more than 5% from 1992 to 2006, doubling the group’s incidence of this condition in 14 years. The study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

In both 1992 and 2006, surveys were conducted via telephone to individuals 21 years or older; the same definition of [url:137,type=|term|,content=|chronic|] low back pain and similar questions were used in both instances. Survey questions focused on issues related to chronic low back pain, including levels of impairment and types of medical care received. Results reported an increase of 3.9% to 10.2% rate of chronic low back pain from 1992 (based on 4,400 respondents) to 2006 (5,300 respondents).

The findings also suggested that diverse groups, including men and women of all ages and black and white races suffer equally from the effects of this condition. The exact cause of the increase in this population remains unclear, but researchers suggested that it may be due to [url:1308,type=|node|,content=|obesity|], [url:819,type=|node|,content=|depression|], or increased awareness of the condition of low back pain. They also suspect that a similar trend may be occurring in many other states.

Increasing numbers of cases, along with the rising costs of treatment, are calling for an evaluation of the effectiveness of current [url:896,type=|node|,content=|treatment options for chronic low back pain|].

By: Spine-health staff writer

Sources:

Freburger JK, Holmes GM, Agans RP, et al. The rising prevalence of chronic low back pain. Arch Intern Med. 2009;169(3):251-258.

Additional Reading:

[url:1080,type=|node|]

[url:894,type=|node|]

[url:821,type=|node|]

Watch Your Back!

Ben Parr — Mon, 21 Jul 2008 07:07:25 -0700

July 21, 2008
by: Sylvia Marten

Do you sit in front of a computer nearly every day? Then you need to watch this important video to learn helpful [url:1092,type=|node|,content=|ergonomic tips|] to protect your back!

Get the Flash Player to see this player.

Also share and favorite this video on YouTube

Additional Reading

[url:1092,type=|node|]

[url:1106,type=|node|]

[url:1099,type=|node|]

[url:1111,type=|node|]

5 Tips for Flying Back Pain Free

Greg — Wed, 12 Mar 2008 18:11:03 -0700

March 12, 2008
by: Stephanie

With spring break around the corner, and travel season looming, many people with chronic back pain aren't looking forward to vacation; they're worried about how to manage the pain associated with a long flight.

Forum member Tallguy, who is preparing for a grueling 12 hour flight from Taiwan to the US, recently asked for advice on how to fly comfortably despite back pain caused by [url:714,type=|node|,content=|disc degeneration|]. Several members responded with suggestions to help minimize his back pain and make his trip more tolerable.

Move.
Get up and walk and stretch as frequently as possible. Go to the back of the plane and do back bends, etc. Consider bringing a doctor's note and alert the flight crew prior to boarding that you have a back condition and will need to move about more often than normal passengers.
Smart Flight Scheduling.
Try to book a flight for a time of day when the plane is likely to be on the empty side. If there are any empty rows, ask to be moved to one so you can lie down across the seats. This will help keep pressure off of your back.
Posture Perfect.
Bring a back roll or ask for extra pillows to put behind your back to keep your spine straight and prevent slouching. This will alleviate pain and pressure. If you are on the shorter side, bring something to prop up your feet to keep your knees at a right angle.
Bring the Heat and Chill.
Bring gel packs that can be frozen or heated (or bring one of each). These are great for treating swelling, sore muscles, back pain and even headaches. Be sure to have the physician's note about your back condition handy in case airport security has issues with the gel pack in your carry-on luggage; medically necessary items over the 3 oz. limit are permitted through the security checkpoint.
Pain Medication.
OTC pain killers like acetaminophen and NSAIDs, or prescription drugs like narcotics or muscle relaxants, can help "take the edge" off during and after the flight. (Read more about [url:1915,type=|node|,content=|back pain medication|]). Again, a letter from your doctor stating your need for any prescribed pain medications will help with possible airport security issues; and always be sure to keep medications in their original bottles.

Using a combination of the tips above should make travel as easy on your back as possible. Happy trails!

Posted by: Stephanie

Read more:

[url:1107,type=|node|,content=|Pain Free Travel Tips|]
[url:1112,type=|node|,content=|Traveling Doesn't Have to be a Pain in the Neck|]
[url:6663,type=|node|,content=|29 Best Travel Tips for your Aching Back|]

Back Pain and Holiday Blues: 18 Tips to Reduce Your Holiday Stress

spine-health — Fri, 07 Dec 2007 13:00:24 -0800

December 7, 2007
by: Sylvia Marten

Ah yes, the holidays are upon us once again, and with them the holiday blues. Not everyone is in festive spirits, especially those of us with chronic pain. Often, chronic back pain leads to [url:138,type=|term|,content=|depression|], and alternately depression can worsen physical pain. The added anxiety and stress of all the holiday planning and expectations can intensify feelings of sadness. Travel blues may factor into the equation too - vacation blues catch us off guard as we're taken away from our normal routines and pain management support like special [url:158,type=|term|,content=|ergonomic chairs|] and [url:161,type=|term|,content=|mattresses|]. Even if it's just a temporary bout of the holiday blues, that doesn't mean you have to simply accept it. Here are some things you can do to reduce your holiday stress.

Talk with friends on the phone, or over coffee.
Talk with other people who suffer from back pain or chronic pain on the Spine-Health.com forums:

See your family doctor or psychiatrist - you may have a physiological disorder that requires antidepressants.
Improve your diet and exercise regularly, at least on non-party days. Don't stress about weight gain at the big family gathering or work holiday party. Having food you enjoy and chatting with friends releases endorphines. Live a little! On other days, make sure that you eat in moderation and get at least a half hour of cardiovascular exercise, even if that means nothing more than taking a walk. If you have difficulty with certain types of exercises due to back or neck pain, try these [url:1183,type=|node|,content=|exercise tips for people with back pain|].
Seek sunshine - the real thing is best, but if it's dark and dreary outside, spend a few extra dollars and get yourself some full spectrum lighting.
Set realistic goals and don't be the ultimate people-pleaser. Decide what's important and don't overextend yourself.
Plan a small gathering of friends or neighbors such as a dinner or wine party.
Read these Spine-Health.com articles:

[url:1079,type=|node|]
[url:6615,type=|node|]
[url:1081,type=|node|]

Make sure your plans move you toward your goal, and celebrate even minor achievements.
Cook, buy yourself some new music and/or new books to have on hand. (no depressing music!)
Go to a museum or concert.
Plan a short trip to a place you enjoy, either by yourself or with a good friend, and don't forget to take along these [url:1107,type=|node|,content=|pain-free travel tips|].
Rent movies from your local movie store or an online DVD rental company.
Hug somebody! This is no joke, hugging has positive and real physical benefits. The BBC even published the results of a study stating that hugs increase oxytocin and reduce blood pressure in women.
Meditate. According to researchers at James Cook University in North Queensland, Australia, meditation offers similar mood benefits to running or other physical exercise. If your pain restricts you from strenuous exercise, consider meditation. Don't know how? You can learn to meditate.
Go ergonomic. If you're at home, it makes sense to have [url:158,type=|term|,content=|ergonomic seating|] available. If you're going to sit and watch TV, eat dinner or pay bills, do everything you can to reduce your pain by giving your back the proper support. [url:170,type=|term|,content=|Pain management|] is a key component in managing depression during the holidays as well as throughout the year.
[url:1927,type=|node|,content=|Get enough sleep|]. Yes, you have to get to the store, wrap those gifts, bake that cake, etc...but sleep deprivation is a big contributor to depression. Be disciplined - go to bed and get 6 to 8 hours of sleep! If you have difficulty sleeping due to chronic pain, you might want to check out our articles on the [url:1315,type=|node|,content=|best mattresses for back pain|].
Clean up the house and get organized. A clean space can make you feel better about any other holiday projects you have going on.

BONUS "BEAT THE HOLIDAY BLUES" TIP:

Honor your own feelings. While nobody wants to feel depressed, recognizing your sadness can mean that something isn't working in your life the way that you would like it to. If it's something you want to change, hey, it's almost time for those New Year's resolutions, right? Pay attention to what your body is telling you, and if necessary, seek the help you need.

How to Prevent Osteoporosis with a Once-a-Year Injection

spine-health — Tue, 04 Dec 2007 13:58:39 -0800

December 4, 2007
by: Sylvia Marten

The need to take a once-a-day or even once-a-month osteoporosis medication may soon be eliminated. Recent studies indicate that a once-a-year osteoporosis injection of zoledronic acid like Reclast® can prevent spine fractures and hip fractures from [url:141,type=|term|]. In a 3-year study conducted by the manufacturer of Reclast®, Novartis, it was determined that there was a 70% reduction of spine fractures and 40% reduction of hip fractures in a group of 7,736 postmenopausal women.

Reclast® - now approved by the FDA - is a [url:699,type=|node|,content=|bisphosphonate|], a class of drugs that is used to treat [url:141,type=|term|,content=|osteoporosis|]; a class that also includes medications such as Boniva, Fosamax and Actonel. According to the FDA, more than half of postmenopausal women on daily or weekly biphosphonates will discontinue osteoporosis treatment after one year, leading to a higher risk of fractures. Given as a 15-minute infusion, the Reclast® (zoledronic acid) injection for osteoporosis has the benefit of long-lasting protection.

Reclast® was originally used in the treatment of metastatic bone cancer and was found to have positive impact on bone density, reducing the degenerative effects of [url:141,type=|term|,content=|osteoporosis|].

Osteoporosis is a degenerative bone disease in which one's bone density is reduced over time. It is a silent disease, and most sufferers of osteoporosis do not know that the condition exists until they experience a [url:930,type=|node|,content=|spinal fracture|] or hip fracture. Postmenopausal women are at the [url:699,type=|node|,content=|highest risk for osteoporosis|], but osteoporosis can affect anyone, especially individuals over the age of 40 and those who do not have enough calcium in their diets.

Some physicians noted a minor risk of atrial fibrillation, a potentially dangerous cardiac rhythm disorder, when taking zoledronic acid intravenously. However, in the 3-year study, there was not a significant increase in mortality or morbidity. It is always a good idea to discuss any [url:922,type=|node|,content=|osteoporosis medication|] risks with your physician prior to treatment.

Source: Novartis Pharmaceuticals, Inc.

Additional Reading:

[url:930,type=|node|]

[url:934,type=|node|]

[url:926,type=|node|]

[url:6021,type=|node|]

[url:6027,type=|node|]

Resources:

Novartis Reclast Website

ABC News: Experts Speak Out: Once-a-Year Injection for Osteoporosis

Health24.com: Once a Year Jab vs. Osteoporosis

Associated Content: Once-a-Year Injection to Replace Traditional Osteoporosis Drugs

National Osteoporosis Foundation

FDA Bisphosphonate Safety Review

read more

Top 12 Tips for Buying a New Mattress

Thu, 18 Oct 2007 12:12:59 -0700

October 18, 2007
by: Sylvia Marten

Any [url:1325,type=|node|,content=|mattress|] that helps you sleep comfortably and wake up feeling refreshed, without pain and stiffness, is the best mattress for you. There is no single mattress that works for all people. You should choose the mattress that provides adequate support and meets your standards for comfort and allows you to get a good night's [url:161,type=|term|,content=|sleep|].

That being said, there are a ton of advertising claims being made by mattress companies and it's hard to choose which is right for you. To help you get started, here are some things to keep in mind when buying a new mattress:

Research online before going shopping. Two helpful resources that provide information (but don't sell mattresses) are the Spine-health.com Sleep Health Center and Better Sleep websites.
Talk to your doctor. If you have a health condition, talk to your doctor or physical therapist about what he or she recommends. Keep in mind that doctors are not sleep experts, but they know your medical condition and symptoms and will probably have some good advice from that point of view.
Firm mattresses aren't always better for your back. Think twice before buying a hard or firm mattress. There is a difference between firm support and firm feel. You want firm support with a comfortable feel (comfortable will be defined by your personal preference. Research has shown that the [url:1310,type=|node|,content=|best mattress for low back pain|] is a medium firm mattress rather than a firm mattress.
Pillow tops aren't for everyone. Very light-weight people don't need big thick pillow top mattresses because they don't weigh enough to compress the foam to even touch the underlying coils/support system. On the flip side, larger/heavier people do tend to feel more comfortable with a little extra cushion to help buffer thems from the coils.
Adjustable beds are a great option, especially if you find you are more comfortable sitting in a recliner than lying down. They allow you to elevate your head and knees slightly to relieve pressure on the lower back. You can also create the same effect using pillows rather than an adjustable bed.
Ask about money-back guarantees. If you think you'll like a memory foam mattress but aren't quite sure, try the Tempurpedic brand as they typically offer a 30-day money-back guarantee. If you don't like it within the first 30 days, you're probably not going to change your mind so send it back.
Ask about "comfort guarantees" BEFORE you buy. Many states still allow retailers to give what's called a comfort guarantee. Ask for it BEFORE you buy, and be sure you understand the details – if you're required to pay shipping, if it includes a money-back guarantee or exchange, time frames, etc.
Check the warranty. A good mattress will have a minimum of a 10 year FULL replacement or NON prorated warranty.
Protect your investment. Always get some kind of water proof mattress protector. Stains will void your warranty.
Take it for a test drive. When shopping for a mattress, try to lie on the mattress for at least 10 to 15 minutes. Don't feel self conscious or let the sales person hurry you along – it's a big purchase, and if you don't try it for at least 10 minutes you're not going to get a real feel for it. That being, said it's at all uncomfortable you can rule that one out pretty much right away.
Check out all the options and variations. Give yourself a comfort test if the salesperson doesn't offer you one. Ask to try a firm, a plush, and a pillowtop in the same brand quality and price point of each other. Lay on each one for 10-15 minutes. When you find the most comfortable one ask to see more of that kind.
Shop at a real mattress store, not a furniture store or department store. The salespeople at a mattress store usually have more training on the whole subject of sleep. Try to find a store that carries several major brands, such as Sealy, Serta, Simmons, and Tempurpedic. Remember it's your mattress, your back, and your money, so it's worth the time to research it and get the best that you can. That being said you don't have to spend a fortune either – mattresses are often on sale, and the price, frames and delivery fees are often negotiable.

Sources:

[url:1315,type=|node|,content=|Choosing the Best Mattress for Low Back Pain|]
Sleep Discussion Board

Posted by: Stephanie

Unusual Office Chair Solutions

Mon, 08 Oct 2007 18:29:35 -0700

October 8, 2007
by: Sylvia Marten

Many people feel very uncomfortable in their office chair. And there are lots of good office chair reviews if you're looking for a new option. But what if the problem is not your specific [url:1106,type=|node|,content=|office chair|] but the fact that you're sitting on one at all? If this may be true for you, then here are some office chair alternatives to consider.

Stand up desk

For people who really feel uncomfortable sitting at a desk all day, one solution is not to sit – but rather stand up and work. Just get a desk that is a comfortable height for you to work at while standing.

Other guidelines:

Put your foot up on a footrail or some type of footrest so you can put rest one foot higher than the other and easily shift your body weight from one leg to the other.
Use some type of seat as well. Using a stool affords you the most options, as you can sit fully or just sit partially by leaning forward while sitting with your weight distributed between your seat and your foot on the floor.

A side benefit that some people find from working standing up is that they feel more energized and are more productive working while standing up. My first boss told me to stand up when making important phone calls because then you sound more positive and motivated. Also, if you're someone who likes to move around a lot (aka you fidget when sitting still), then standing up while working makes it easier to pace while doing certain tasks, such as talking on the phone.

Add a podium

If working full time at a stand up desk isn't for you, consider adding a podium, lectern or stand up desk in your work area and just do certain tasks while standing, like reading or talking on the phone. This way you can move between your regular desk and your standup area and get some variety in your positions during the workday.

Walking desk

[url:6601,type=|node|,content=|We've talked about walking desks/treadmill desks|] before. The idea is that you walk very slowly on a treadmill while working standing up. Personally I'm not a big fan of this idea – I like to keep the workout and the work separate. But I can see how this idea would make sense in certain situations, and some people say it works for them.

Exercise ball

The main benefit here is that [url:1706,type=|node|,content=|sitting on an exercise ball|] is active – your body is constantly making minor adjustments to remain balanced on the ball - and this requires your core body muscles, your abs and large lower back muscles, to work to hold the body upright and balanced on the ball. And because there is not back as on an office chair, it's hard to slump or slouch, which encourages good posture.

Until your core muscles get strong enough to support you and sitting on the exercise ball feels comfortable, it is often a good idea to not have the ball fully inflated so that it is more stable, and start out by sitting on it for only a little while at a time (e.g. 10 to 20 minutes) and gradually work up to several hours at a time. You can buy a ball with sand at the bottom of it if you're concerned about it rolling away every time you stand up (a good idea for people who get up a lot at work).

Other factors to note: This is one of the least expensive office chair options, usually around 15 - $30. However, many people find that they also sit in a regular office chair for at least part of the day.

Balance stool

A balance stool the same general idea as an exercise ball – forcing you to sit with good posture (as you're not able to slump or slouch) and many versions, such as the Swopper, encourage active sitting as they bounce up and down and side to side, making your core muscles work in order to stay balanced on it. Compared to the exercise ball, a balance stool looks slightly less unconventional and stays in one place.

Most balance stools are in the price range of $200 - $700. Ikea offers a similar option that is similar but less expensive at around $50.

Kneeling chair

A kneeling chair is actually a bit of a misnomer, because you're not really kneeling while on the chair, just sitting while angled forward with some of your bodyweight supported by your shins. Your shins provide stability, but the body is still sitting, not kneeling. The design of the chair is intended to:

Reduce some of the strain placed on the lower back when sitting in conventional, right angle office chairs – the idea is that sitting while tilted forward slightly places the spine in a more neutral position.
Encourage good posture by sliding the hips forward so that your weight is distributed between your pelvis and knees/shins, which reduces spinal compression, and therefore reduces the stress and tension in the lower back and leg muscles.

The result is an office chair that makes sitting in the proper position feel comfortable and effortless. As with all chairs, be sure to get one that allows you to adjust the height and angle. Some versions are on casters, if you need to move around, and some have a bit of lumbar back support for when you want to lean back a little.

Recliner

Many people with back pain feel much more comfortable sitting in a reclining position than sitting upright. In a survey on Spine-health.com, we found that 72% of people with back pain felt less pain when lying down or reclining (N = 1368). If you are one of these people and have the option, then working while sitting in a recliner, with feet propped up on an ottoman or attached footrest, then using some type of laptop stand with your recliner may be a good option.

For the inexpensive route, you can use a lap desk – a wood or other type of solid top and beanbag cushion on the bottom – and work on it with your laptop and a wireless mouse.

If you're working for longer periods, then I would recommend using a laptop stand that lets you use a separate keyboard and ergonomically positioned wireless mouse. There is a huge variety of recliners and laptop stands – some very elaborate ones, and there's bound to be a setup that will suit your needs.

Personally, I think sitting in a recliner would be way too comfortable and relaxing – I'm pretty sure I'd be dozing within minutes. Standing or active sitting are definitely better options for me.

Final thoughts

No matter what you choose, there is nothing better than getting up regularly during the day to stretch and walk around. If price is an issue, remember that all the above options are available for much less via Craigslist and EBay, as a lot of people seem to buy these new but end up reselling them without using them much.

Of course this is not a comprehensive list, just a few ideas to get you thinking about alternatives. Have you found something that works well for you? Please let us know. (No sales pitches please.)

More reading:

OSH Answers – Working in a Sitting Position – Alternatives
[url:6660,type=|node|,content=|Is Your Job Aging You? Computer Users Beware|]
[url:1106,type=|node|,content=|Reducing Back Pain While Sitting in Office Chairs|]
Stand Up Desk – CNN Money Magazine

Is Your Pain Medication Prescribed Off-Label?

Mon, 01 Oct 2007 14:46:35 -0700

October 1, 2007
by: Sylvia Marten

Experts estimate that 21% of prescriptions for common drugs are written for off-label uses. According to a study on Off-Label Prescribing published in the Archives of Internal Medicine, three-fourths of those prescriptions were for off-label uses that lacked scientific support. What's going on?

First, let's talk about what we mean by on "label" drugs. In the U. S. , the FDA requires that drug makers submit, test and get approval from the FDA for specific uses of their product before the product can ever be marketed. To obtain approval, pharmaceutical manufacturers must submit extensive study data demonstrating safety and effectiveness, a process which usually takes several years and millions of dollars. When a product is approved by the FDA, a specific "label" for that product is approved too. The label must include the product's approved indications, dosage and method of administration, and use in specific populations.

So, what is "off-label"? After the FDA approves a drug for its specific use, physicians can prescribe the product for uses not covered by the approved label. This is "off-label" use. Off-label uses include:a drug prescribed to patients with conditions not listed on the approved label; departure from the approved drug dosage, method of administration, or patient population; and unapproved product combinations, such as using two different drugs to treat a single condition. This practice is perfectly legal but it lacks any kind of oversight.

"Off-label" drugs for back pain. Among the types of drugs commonly prescribed off-label, most common were heart drugs and anti-convulsants (indicated for seizures). For example, gabapentin, brand name Neurontin, had one of the highest proportions of off-label use among specific medications, namely for neuropathic pain (it is only indicated for use in controlling epileptic seizures and in pain from post-herpetic neuralgia). Neurontin also happens to be a quite commonly prescribed drug for people diagnosed with chronic back pain or chronic low back pain. This of course means the drug is being prescribed off-label in the back pain patient population.

Patients should always consider carefully all medications that are prescribed to them. It is fair for patients to ask their doctors whether a prescription is on or off-label, and this can be easily and more thoroughly researched on reliable health information websites that address medications, such as MedlinePlus, the FDA, or condition-specific sites. If off-label, it is important to know whether there is sufficient data to support its use or if the practitioner's decision is based on anecdotal evidence. The patient should weigh off-label recommendations against the alternatives with his/her practitioner, and ultimately decide if he/she is comfortable with an off-label drug for the specific health issue being addressed. It is important for patients to keep in mind that a drug prescribed off-label to them is a drug that has not been approved by the FDA for some element of their specific health situation.

Is "off-label" drug prescribing good or bad? There isn't a clear cut answer. Anecdotally, many of my colleagues and personal circle of friends have experienced off-label drug use with positive results. For example, our children have been prescribed albuterol for various severe pulmonary episodes (not asthma, for which it's indicated) with much success. The Spine-health.com message boards are full of stories of people taking medications off-label for back pain or [url:887,type=|node|,content=|leg pain|] as prescribed by their doctors, with many experiencing much needed pain relief not possible with approved drugs. So, off-label use can be positive in that it expands access to important health benefits that may not be possible with alternatives. On the flip side, concerns and warning bells should go off with respect to safety and the long-term impact of a drug use that has not been extensively studied.

The study authors cited several reasons as to why the high percentage of off-label prescribing is occurring, with some reasons being legitimate and others not. The practice itself raises issues that require addressing, including a better/faster process for getting legitimate additional uses for a drug indicated, but also for ensuring patient safety for patients dutifully following an off-label treatment protocol as prescribed by physicians they trust.

Posted by: Sylvia

Additional reading:

[url:1921,type=|node|]
[url:1948,type=|node|]
[url:808,type=|node|]

29 Best Travel Tips for Your Aching Back

Thu, 20 Sep 2007 16:17:09 -0700

September 20, 2007
by: Stephanie

Traveling is hard on our joints, muscles and nerves for two main reasons: 1) it requires us to use our bodies in ways they're not used to, such as hoisting luggage over our heads into the bin and yanking it off the moving baggage claim, and 2) it requires us to sit still for long periods, often in a cramped space. No wonder people with back pain and other types of pain avoid travel whenever possible. To help you have as pleasant a trip as possible, here are a number of things others have tried and found to work well:

Be Smart About Luggage

Lift luggage in stages. Move slowly when lifting your luggage and break the action into smaller parts. For example, when lifting a bag into an overhead bin, it can first be lifted to the arm of the seat, then to the top of the seatback, and then into the bin in separate motions.
Never twist while lifting. Never, never, never. This is a common cause of injury to the low back. Pivot with your feet so that your whole body moves instead of just twisting your back. Nuff said.
Better yet, avoid lifting. Ask a flight attendant for help. If you explain you have back condition, you will be surprised how helpful the airline staff will often be. If your bags are small and light, it will be less of a burden to ask someone to do this for you.
Ship ahead. This is my favorite solution for luggage – just mail your stuff on to your destination ahead of time. This way you avoid luggage entirely and can carry just one small bag onboard with you. No schlepping. No hassle. No pain.
Pack light. Use 2 or 3 smaller bags rather than one large/heavy bag, especially if you will have to lift the bags in/out of car trunks, off airport baggage carousels, into and out of overhead bins, etc.
Use a backpack. Do not sling a bag over one shoulder (unless it is a very light handbag). Use a good quality lightweight backpack – and wear it using both straps. The generally recommended maximum weight of a backpack is 10 - 15% of your body weight – less if you have a painful back. Using backpack has the added advantage of leaving your hands free to hold onto handrails on escalators, stairs, the boarding ramp, etc.

Plan Ahead for Medication

Get a prescription. If there's any chance you would run out while you're traveling, get a prescription from your doctor and bring this with you so that you can buy more when required. Remember that in foreign countries the medication that you usually take may have a completely different name.
Keep your medication with you. This may be completely obvious, but it's worth saying anyway. Make sure you keep all your medication with you in flight - do not check it in with luggage. Don't just bring the medication you think you'll need for the flight, as you and your luggage may get separated indefinitely, or your flight could get seriously delayed or be worse than expected.
Bring an OTC backup. As a backup, bring acetaminophen (such as Tylenol) and ibuprofen (such as Advil, Motrin or Nuprin). Just in case your pain medications run out, these two can be taken together and have a powerful pain relieving effect. And neither requires a prescription. Of course, check with your doctor before doing this.
Keep meds in their containers. Don't put different medications into the same containers. Keep each type of medication in its prescription bottle. In some situations, you could be detained in security for traveling with pills that aren't in separate labeled containers.

Use Easy Pain Relief Tactics

Ice is key. There are many ways to make sure you have access to ice/cold to numb the lower back when traveling. The simplest is to bring extra ziploc bags and whenever you need to, ask a flight attendant to fill it with ice for you. Place it between your lower back and the seat. Leave it on for 20 minutes to numb the lower back, repeat as needed. You can also use the cold packs that you crack to get cold. If security will let you, bring a small gel ice pack on the airplane, flight attendants will keep in fridge for you.
Heat is too. There are also disposable, portable hot packs that heat up after you open them, so you can bring them on your travels and open and apply them as needed. Commercial heat wraps, such as ThermaCare, incorporate heating units across the low back area of the band. Such types of heat wraps last for several hours, making them ideal to provide back comfort during lengthy travel. If you want to bring gel heating packs, first check with your airline to see if they're allowed past security.
OTC pain patch. Consider using a non-prescription pain patch, (such as the Bengay Pain Patch). It may reduce your need for pain medications. Of course, check with your doctor before using this.
TENS units. For some people, a TENS unit can reduce pain. Get a letter from your physicians or physical therapist explaining your condition and the need for the TENS unit and what it is, as this may be needed to help you through security or to provide information to the flight crew.
Consider muscle relaxants. Consider talking with your doctor about muscle relaxants that you can take before a plane trip – they may be helpful if you have a long plane ride ahead of you.

Proactively Manage the Airline Service

Get an aisle seat. Ask for an aisle seat out of medical necessity (stress medical necessity). It is easier to get into and out of an aisle seat, and allows you to get up and move around the cabin more easily. Since back pain can't be seen, traveling with a letter from your doctor that explains your condition will help you get accommodations such as an aisle seat.
Get wheelchair assistance. Make sure the airline knows you are handicapped so they will wheel you around with a wheelchair. You won't have to carry your bags, walk to the gate, or stand while waiting in line at security. It is best to do this when you make the reservation. You just need to ask for wheelchair assistance to the plane door. Even if it is supposed to be just a short walk to the gate, remember that gates can change, there may be a lot of standing in line when going through security, and other issues may arise that would make a wheelchair worthwhile.
Ask for a row of seats. If the airplane isn't full, when booking see if you can get the last row of seats (which usually no one else wants). Then you can pull up the seat arms and lie down.
Recline. For many back conditions, sitting in a slightly reclined position is least stressful on the back. If this is the case, remember to check that your seat will recline when making your reservation and getting a seat assignment. Some seats in exit rows or at the back of the plane to not allow you to recline.
Stretch key muscles. Sitting for extended periods can cause stiffness and tension in the hamstrings (the muscles in the back of the thighs) and hip flexor muscles, which in turn puts added stress on the low back. Ask your doctor for a few safe hamstring and hip stretches you can do while traveling.
Preboard. When they call for pre-boarding for people who need assitance, that's you. Make sure the gate agent knows you will need to pre-board. Conversely, if sitting for a moment longer than necessary will be unbearable, then board very last. If you do this, make sure your carryon can fit beneath your seat, because if you board last the overhead bins might already be full.
Consider a handicapped parking sticker. If you will be parking at the airport but have trouble walking very far, you can ask your doctor to fill out an application for a handicapped parking sticker to be able to park nearest the airport entrance.
Avoid getting bumped. Due to overbooking, a practice that seems common lately, getting a seat assignment in advance can reduce the risk of getting 'bumped'. If no seat assignment is given when you buy your airline tickets online, call the airline to get seat assignment immediately. If you arrive at the ticket counter without seat assignment on an overbooked flight, you probably will get bumped off the flight and forced to take a later flight - which can be several hours or even one or two days later.

Sit with support

Fix the seat. Place a small rolled-up airline pillow, blanket, or a towel or lumbar pillow between your back and the seat to support the natural inward curve of your lower back. You may also use commercial low back supports if you prefer. Supporting the curve in your low back is especially important with many airplane seats, as they are often worn out and force your lower back to an unnatural, stressful position. If the bottom of the seat is concave from too much use, place a folded blanket on the seat.
Use your feet. Bottom-up leverage from your feet is also required to support your low back. While seated, your knees should be bent at a right angle. If your seat is too high, place your feet on something that can act as a firm footrest - like a book or box - to keep your knees at a right angle and avoid stressing the low back.

General advice

Bring a letter. Get a letter from your physician explaining your condition, medications and treatment requirements. This can come in handy in many ways -- when requesting an aisle seat, wheelchair assistance, getting your medications through security, if you need medical care while traveling, etc.
Drink water. Water circulates healing nutrients and oxygen throughout the body. Drink water frequently to help keep your pain at bay and keep your body nourished.
Get up and move. Sitting in one position for extended periods of time stiffens the back muscles, which can put stress on the spine. Get up and stretch and move around every 20 to 30 minutes if possible. Movement stimulates blood flow, and blood brings important nutrients and oxygen to your back, reducing stiff muscles, helping curb inflammation. Movement also helps prevent blood clots from forming in the leg (called deep vein thrombosis), which is one of the most dangerous risks of sitting still for long periods.
Wear slip on shoes. Wear good, comfortable supportive shoes if you will be walking distances through airports, train stations, etc. Slip on shoes are the best, because its easy to get them on and off (without having to bend over) when going through security.

I also advocate diversion to help keep the pain at bay, especially if traveling will be stressful for you. One option is to treat yourself to something special – a great new book or movie – during the flight. Another option is to do something for someone else (write a letter to an elderly relative or neighbor, write down memories of your children, etc.) to focus your mind elsewhere.

Happy travels!

Posted by: Stephanie

More Resources:

Transportation Safety Administration, Travelers with Disabilities and Medical Conditions - Air Travel
Tips while traveling abroad – US Department of State
Health information you should know before traveling abroad, including insurance, Medicaid and Medicare information, and bringing prescription medication and getting medication abroad
American Family Physician Medical Advice for Commercial Air Travelers http://www.aafp.org/afp/990901ap/801.html

Lumbar Artificial Disc Replacement Not Covered In People Over 60

Mon, 27 Aug 2007 12:00:42 -0700

August 27, 2007
by: Sylvia Marten

Medicare has decided it will not pay for lumbar artificial disc replacements in people over 60 years of age. The reasoning for the CMS' (The Centers for Medicare and Medicaid Services) decision is the lack of data on using such devices in the 60+ population, according to Scott Boden, MD, a Spine-health.com Medical Advisor.

This August 2007 decision affects the Prodisc-L (made by Synthes), approved by the FDA in August 2006. The first lumbar artificial disc approved by the FDA in 2004, the Charite disc (made by DePuy Spine, a Johnson & Johnson company), was already covered by a similar decision made by CMS in May 2006.

Both the Prodisc and Charite disc FDA IDE clinical studies tested patients between the ages of 18 and 60. Based on the age limitations in these studies and in Medtronic’s Maverick lumbar disc study, CMS says it “is convinced that the indications for LADR will exclude the over age 60 population, and that these age limitations are not specific to one manufacturer’s disc implant.”

What about people under age 60 with pain and disability from lumbar degenerative disc disease, the prevalent and severe condition the artificial disc was designed to treat? It’s still left up to individual insurance companies to decide. The CMS acknowledged “some evidence does exist for patients age 60 and under” to benefit from artificial disk technology. However, it believes the ProDisc clinical trial design created more uncertainty in benefits and thus would not come forth with a statement supporting artificial disc replacement in the under age 60 population.

For those of you interested, the exact wording of the decision is below.

The original CMS decision about Lumbar Artificial Disc Replacement was made on May 16, 2006, and was specific to the Charite Disc, the only lumbar artificial disk available at the time:

“LADR with the Charite^TM lumbar artificial disc is not reasonable and necessary for the Medicare population over 60 years of age; therefore, LADR with the Charite^TM lumbar artificial disc is non-covered for Medicare beneficiaries over 60 years of age. For Medicare beneficiaries 60 years of age and younger, there is no national coverage determination, leaving such determinations to continue to be made by the local contractors. Medicare coverage under the investigational device exemption (IDE) for other lumbar artificial discs in eligible clinical trials is not impacted.”

On August 14, 2007, the CMS issued the following in its decision memo:

“The Centers for Medicare and Medicaid Services (CMS) has determined that LADR is not reasonable and necessary for the Medicare population over sixty years of age. Therefore, Section 150.10 of the Medicare National Coverage Determination (NCD) Manual is amended to reflect the change from non-coverage for LADR with a specific implant to non-coverage for the LADR procedure for the Medicare population over sixty years of age. For Medicare beneficiaries sixty years of age and under, there is no national coverage determination, leaving such determinations to be made on a local basis.”

Further reading:

CMS decision memo for Lumbar Artificial Disc Replacement
[url:1734,type=|node|]

Posted by: Sylvia

Question: Are You Depressed or Just Feeling Down?

spine-health — Wed, 22 Aug 2007 18:42:59 -0700

Everyone feels down once in awhile, and for many of us enduring stressful times in our lives, it can truly feel overwhelming. But how do you know if you’re clinically depressed and should see a professional for help? Clinical depression goes beyond what would be considered normal sadness or feeling bleak.

Take this questionnaire and put a check next to each statement that is true for you:

___ I have a predominant mood that is depressed, sad, blue, hopeless, low, or irritable, which may include periodic crying spells
___ I have a lack of appetite, even for my favorite foods, or significant weight loss, or conversely increased appetite or weight gain
___ I have a sleep problem of either too much sleep (hypersomnia), or too little sleep (hyposomnia)
___ I feel agitated (restless) or sluggish (low energy or fatigue)
___ I have lost interest or pleasure in usual activities
___ I have decreased sex drive
___ I feel worthless and/or very guilty
___ I have problems with concentration or remembering things
___ I have thoughts of death, suicide, or wishing to be dead

If you put checks next to at least 5 of the above statements and the symptoms have occurred daily for two weeks or more, you are considered clinically depressed.

Based on what we’ve learned from Spine-health.com’s [url:2192,type=|node|,content=|back pain community|], I would add that chronic back pain and any type of chronic pain that seems unresponsive to treatments is also a cause (and/or a symptom) of depression.

If this is the case for you, please find professional help promptly. There are a wide range of anti-depressant medications available that have helped a lot of people and many types of therapy that can also help. Visit the National Alliance on Mental Illness to learn more about treatment options.

Posted by: Stephanie

Sources:

[url:819,type=|node|]
American Psychiatric Association. In: Diagnostic and Statistical Manual of Mental Disorders. 4th Ed. Washington, DC.1994

Also see:

[url:830,type=|node|]

How and When to Get a Second Opinion Before Surgery

spine-health — Wed, 15 Aug 2007 16:39:46 -0700

August 15, 2007
by: Peter

It is often said that no one should have spine surgery unless they receive a second opinion from another surgeon. On the surface, this would sound like good old common sense, as two opinions are better than one. However, there is a trap in this line of thinking. When a patient sees a physician for a second opinion, this next opinion has a tendency to always sound smarter than the first opinion. This is a well-recognized phenomenon, but in reality the second opinion may not be the best one.

When should you get another opinion?

Certainly if you are not comfortable with the first physician, then seeing another surgeon for an opinion is a good idea.
If a surgeon cannot answer questions about the rationale for a proposed procedure or is vague on the surgical plan, another opinion is a good idea.
If you suspect that the initial referrals was made on the basis of economic interests rather than who is best suited for your surgery, go for another opinion. (Referring physicians favor local surgeons who will do the surgery in a local facility, especially if they are in a multispeciality clinic. This is not saying that these physicians are not capable but that there is a possibility that the first referral one receives may not be the best.)
Another time it is good to get a second opinion is if the initial [url:165,type=|term|,content=|back surgery|] did not work and another surgery is being proposed. This is especially true if it involves fusing further segments of the spine. Often, if the initial fusion surgery does not work, further surgery will not be helpful. Only in very specific circumstances (i.e. pseudoathrosis) is further surgery likely to be beneficial.
There are times when a surgeon will ask a patient to get a confirmatory opinion prior to proceeding with surgery. In these cases it is best to let the treating surgeon pick the second opinion as they are best able to determine whose opinion they would value.

Otherwise, picking a surgeon for a second opinion is often difficult. As previously stated, the goal is to get an opinion from a respected, experienced and ethical surgeon. While it is not perfect, word of mouth is probably still the best measure as to who could be helpful in the second opinion process. This is, however, still a relatively arbitrary process.

The best thing for a patient seeking another opinion is to keep an open mind. You need to be as judgmental about the second opinion as for the first, and need to grill the second physician even further than the first. Beware of surgeons toting unrealistic expectations or who are overly dependent on “cutting edge” technologies. Focus on their experience with your specific type of back surgery and what the surgeon's past outcomes with that surgery are. What are the alternatives to a proposed procedure, and what is the expected natural history of the patients condition if they do not have the procedure? What are the risks and possible complications of the procedure, and if it doesn’t work, what would be the subsequent plan? Read all [url:6634,type=|node|,content=|38 Questions to Ask Your Surgeon Before Having Surgery|].

Remember, the worst thing to do is assume the second opinion is automatically going to be better than the first. Keeping an open mind will prevent you from falling into this trap. And if you’re still not sure, ...get a third opinion.

Posted by: Peter Ullrich, MD

10 Best Laptop Setups

spine-health — Mon, 13 Aug 2007 18:53:07 -0700

August 13, 2007
by: Stephanie

In this day and age many people use their laptop as their primary computer, so it’s important to have it setup correctly in order to avoid back pain, neck pain, and other musculoskeletal injuries or strains. The problem is that laptop computers are designed with portability in mind rather than sound ergonomic principles. Basically, if the screen is at the right height then keyboard is too high, and if the keyboard is in the right position, then the screen is too close and too low.And laptop touchpads and trackballs are never very user friendly. Given these challenges, here are 10 simple tips for the best laptop setups:

Use a large screen. Get a laptop with the largest screen possible for your needs to avoid the stressful posture that results from straining to see the text on a small screen. Many laptops offer large screens (15" plus), but these can be difficult to use while on the go. There are a number of smaller notebook and ultra-portable laptops on the market, and while a smaller screen (12.1") can be useful in mobile settings, make sure that you’re able to read the screen characters and easily use the keyboard (the smaller the laptop, the smaller the keyboard). If you find yourself straining to see your screen, increase the font size.
Place the screen at eye level. Ideally, set your laptop height and screen angle so you can easily view the screen without bending or rotating your neck, and put it about an arm’s length in front of you. To do this, you will usually need to elevate the laptop a few inches above your desk, which you can do by placing it on a stable support surface such as a laptop stand or on a thick book.
Don’t slouch. Despite the name “laptop”, you want to avoid propping your laptop on top of your lap as this requires you to slouch down to see the screen.If you have to work on your lap, such as while you’re on the train, at least put the laptop on top of your computer bag or briefcase so you can raise it up slightly.
Use a separate keyboard. When using the laptop for extended periods, use an external, full-sized keyboard with your laptop and position it at a height that allows your shoulders and arms to be in a relaxed position, with your elbows at a 90° angle when typing. Ideally, place the separate keyboard on a keyboard tray beneath your desk surface to help ensure that your wrists stay in a neutral (flat) position.
Use a separate mouse. Be kind to your wrists by using an independent mouse rather than the mouse that’s incorporated into your laptop keyboard. Ideally, place the mouse on an adjustable-position mouse platform so you can keep it near your body and keep your wrist flat while using it.
Recline slightly. If you can’t use a separate keyboard and mouse, an alternative is to find a chair that allows you to recline slightly. This will allow you to position the laptop keyboard and mouse with the least strain on your neck. Angle the screen slightly upward so that you can view the screen without having to bend your neck too far down.
Prop up your feet. If you have to raise your chair so that your arms and wrists are positioned comfortably, check to see how your legs are angled. Your knees should be at about the level of your hips. If your hips are too high, you need to put a footrest or small box under your feet to prop them up and keep excess strain off your lower back.
Make your chair work for you. The type of [url:1106,type=|node|,content=|office chair|] you use is critical.Basically, any office chair that is fully adjustable and has lumbar support will work, but you need to be sure to set it up correctly.Follow this diagram on how to [url:1106,type=|node|,content=|set up your office chair|].
Take a break. Take brief breaks every half hour, at the very least taking your eyes off the screen and letting them rest on something in the distance, and doing some simple stretches while at your desk, such as stretching your neck, shoulders, arms and legs. Every one or two hours, leave your desk to walk around to get your blood flowing and move your muscles. Downloadable Stretch Break™ software reminds you to stretch and gives you stretching ideas.
Travel light. Be careful when carrying your laptop around. The power supply cord, spare battery and other accessories in your laptop bag may add a lot of weight. If you carry your laptop to work and home again, get duplicate power cords and other peripheral components to leave in each place so that you don’t have to carry everything back and forth. Carry your bag across your lower back in a messenger bag style, or use a backpack with dual padded shoulder straps (and avoid draping the bag over just one shoulder). If your laptop and components weigh more than 10 lbs, a roll-along carrier is the best choice.

I realize that not all of the above tips will always be practical, but if you use your laptop daily, paying attention to how you set it up will go a long way to easing back pain and strain on your joints and muscles.

Posted by: Stephanie

Additional reading

[url:1106,type=|node|,content=|Reducing Back Pain while Sitting in Office Chairs|]
Laptop Computer Ergonomic Tips

14 Natural Pain Relievers

Thu, 09 Aug 2007 14:41:12 -0700

August 9, 2007
by: Stephanie

Many who live with chronic back pain would really love to be less dependent on painkillers to manage their pain. But how? Natural pain relievers may be the answer. Here’s a list that might help – each of these won’t be for everyone, but any number of these natural pain relievers might help you be able to rely less on pain medications and feel more in control of your life.

Release your inner endorphins. These natural chemicals block pain signals from reaching your brain. Endorphins are the body's natural pain relievers, and they can be as strong as many of the strongest pain relievers. Endorphins also help alleviate anxiety, stress and depression -- conditions that often accompany and exacerbate chronic pain. The body produces endorphins during aerobic exercise. A “runner’s high” is not just for those running long distances -- any activity that gets your blood pumping for a sustained period will release pain relieving endorphins into your system.
Find good company. Those who have regular contact with others dealing with similar forms of chronic pain find that their pain becomes more manageable. An online group that is both active and supportive is best. Members of the Spine-health.com Back Pain and Chronic Pain discussion forums say that it is quite simply “free therapy”.
Eat cookies. Research shows that eating sweet foods like cookies, chocolate or ice cream, helps reduce the sensation of pain.
Or just bake the cookies. Enjoying a smell that is both sweet and pleasant has been shown to reduce the [url:6637,type=|node|,content=|perception of pain|].
Feel the heat. Applying some form of heat -- a hot water bottle, gel-filled pad heated in the microwave, electric heating pad, or hot bath -- can go a long way in easing your pain. [url:1662,type=|node|,content=|Benefits of heat|] are twofold: it increases the flow of healing oxygen and nutrients to the damaged area, and it suppresses pain signals being sent to your brain. Some find that wearing a heat wrap, such as Thermacare heat wrap, is best because it releases a low level heat for several hours and can be worn under clothes so you remain mobile.
Cool it with ice. Ahh, how this cools down inflamed and sore tissues. Back pain almost always comes with some level of inflammation, and ice is the best natural way to reduce it. [url:1664,type=|node|,content=|Ice|] also helps by acting as a local anesthetic, and by slowing the nerve impulses, which in turn interrupts the pain-spasm reactions between the nerves in the affected area.
Loosen up. Almost everyone can benefit from [url:1186,type=|node|,content=|stretching the soft tissues|] - the muscles, ligaments and tendons - in and around the spine. Your back is designed for movement, and if your motion is limited it can make your back pain worse. If you suffer from chronic back pain, you may find it takes weeks or months of stretching to loosen up your spine and soft tissues, but you will find that meaningful and sustained pain relief will follow the increase in motion.
Enjoy the outdoors. People who got the recommended daily 400 to 800 IU of vitamin D experienced less pain than those who didn’t, according to a Boston University study of 221 men and women with [url:969,type=|term|,content=|knee osteoarthritis|]. Researchers surmised that Vitamin D helps relieve pain by aiding in the absorption of calcium, which is needed for bone growth and repair. Other research shows vitamin D may directly help soothe pain. 93% of 150 people with unexplained sources of pain were recently found to be deficient in Vitamin D levels, according to recent research at the University of Minnesota. About 15 minutes of sun exposure on your face and hands a day is enough to get your daily dose of D, or a 200-IU supplement of Vitamin D and as much calcium as is found in two glasses of milk.
Imagine yourself to a better place. Guided imagery allows you to hear and internalize therapeutic suggestions that help you feel better. In one study of 28 women with osteoarthritis pain, half of the women listened to a 10- to 15-minute recorded script twice daily that guided them through muscle relaxation techniques. On average, women in the guided imagery group reported that their pain eased by 18% and that their mobility improved by 13%; vs. those in the control group who experienced a 16% worsening of pain and a 2% decrease in mobility. Guided imagery can be learned with a practitioner or on your own using audiotapes or CDs.
Change your inner thinking. Hypnosis involves influencing the subconscious mind in order to change your inner thinking, thereby enabling you to change the way you view pain and assisting in the your body’s healing process. The human body has an infinite capacity for healing, and this is just one technique that many find helpful.
Meditate twice daily. Easy to learn and immediate results make this one of my favorite paths to natural pain relief. Meditation comes in a huge variety of forms --some complex, some simple. My personal favorite is just to find a sound that is pleasing to you but has no particular meaning (my sound is “som”), close your eyes, sit (or lie) still and comfortably, and repeat the sound in your mind. When your thoughts wander, notice that they have wandered and return to your sound. If you feel your pain, notice the pain and return to your sound. Start with a few minutes, and gradually lengthen to thirty minutes. You will find yourself refreshed and reinvigorated, with less pain overall. Meditation can also help reduce the depression, anxiety, stress and sleeping problems that often accompany chronic pain.
Realign your energy flow.The mechanism of action for the ancient Chinese healing technique of acupucture is still not completely understood, but it has been proven in medical trials to reduce certain types of chronic pain, including [url:1358,type=|node|,content=|back pain|]. The American Association of Oriental Medicine has a list of trained acupuncturists. P.S. the needles are super-thin and not painful.
Get enough restorative sleep. Getting enough sleep is critical to managing the pain and healing, so it’s important to employ a variety of [url:1927,type=|node|,content=|sleep aids|] to help you get a healthy amount of sleep. Regular exercise that physically exhausts the body is the best way to promote deep sleep. Visualization, meditation, and other psychological techniques can also help you get to sleep and stay asleep. And don’t forget the power of naps.
Enjoy a massage. In my book, nothing beats a good [url:1287,type=|node|,content=|therapeutic massage|]. It gets the blood flowing, which helps nourish and heal the body, and releases endorphins, which release powerful pain relieving substances in the body (see first point on the list).

Any more thoughts on natural pain relievers? Please share what has worked for you!

Posted by: Stephanie

Sources:

Also see: [url:830,type=|node|]

New Hope for Smokers with Back Pain

Wed, 08 Aug 2007 15:15:12 -0700

August 8, 2007
by: Sylvia Marten

There’s a unique drug now on the market for smokers trying to quit - Chantix (manufactured and distributed by Pfizer). It was actually approved by the FDA in May 2006 and given priority FDA review because of its significant potential benefit to public health.

Chantix, a prescription drug indicated for smoking cessation, is different because it acts on the brain in two ways: by providing some nicotine effects to ease withdrawal symptoms and by blocking the effects of nicotine from cigarettes if patients resume smoking.

According to the Centers for Disease Control and Prevention (CDC), an estimated 44.5 million adults in the United States smoke cigarettes and more than 8.6 million of them have at least one serious illness caused by smoking. In particular, smokers are nearly 3 times as likely to develop chronic low back pain as non-smokers.

According to a user survey conducted on Spine-health.com, about 30% of the chronic back pain population self reports having a smoking addiction. Couple this with the fact that about 80% of those same people are candidates for [url:165,type=|term|,content=|back surgery|] – and we have trouble. Smokers are at higher risk for healing problems after fusion surgery, which means that potentially the chronic back pain problem and the smoking addiction will remain after surgery if smokers with back pain don’t quit.

It is common for back surgeons to ask their patients to quit smoking prior to surgery and commit to not smoking for at least three months after surgery (and hopefully longer, from an overall health standpoint). In recent months, we have heard anecdotally from some of our physician members that they have seen great results using Chantix with their back pain patients. Other smoking cessation aids include: [url:6745,type=|node|,content=|Zyban|] (pill), Nicotrol (nasal spray), Nicorette (gum), Nicoderm CQ (patches), Habitrol (patches), Commit (lozenges), and counseling and support groups.If you are a smoker with back pain, you should consider talking to your doctor about smoking cessation aids – to help you quit smoking and to ease your back pain.

Posted by: Sylvia

More reading:

Chantix patient information sheet at FDA
[url:1826,type=|node|,content=|Healing after spine fusion surgery|]
Varenicline (Chantix) shows greater continuous smoking abstinence

New Research on Interlaminar Epidural Steroid Injections for Back Pain and Sciatica

Fri, 03 Aug 2007 14:50:58 -0700

August 3, 2007
by: Sylvia Marten

It should be noted that interlaminar epidural injections are different than transforaminal epidural steroid injections (also called spinal nerve blocks) and that transforaminal epidural steroid injections have been shown to be effective for sciatica in clinical trials.

The effectiveness of lumbar interlaminar [url:6010,type=|node|,content=|epidural steroid injections|] for treatment of lower back pain and sciatica continues to be a hotly debated topic.

Some physicians view epidural steroid injections as an important pain relief treatment option for many patients with severe lower back pain that radiates down the leg. They would argue that, while it doesn’t work for everyone, an epidural steroid injection is one of the only non-surgical options that can provide almost immediate pain relief for severe sciatica. Others view the recent reviews as evidence that interlaminar injections should not be performed.

As always, the devil is in the details, and significant details are left out of the clinical trial reviews. Most notably:

The injection protocol in the studies cited do not include the use of fluoroscopy or x-ray to verify proper placement of the medication, despite the fact that fluoroscopic guidance is an important factor in the success of the procedure and is routinely used today.
Most of the studies do not classify patients according to diagnosis and tend to 'lump' different types sources of pain together.

"These methodological flaws are considerable and make it difficult to impossible to draw conclusions from the studies. More clinical studies are needed to properly define the role of epidural steroid injections in low back pain and in sciatica" states Ray Baker, MD, a pain management physician in Bellevue Washington and Medical Advisor for Spine-health.com.

Until more definitive and reliable research is available, patients are advised to make sure that they:

Enlist the services of professionals with extensive experience in doing epidural steroid injections
Always use fluoroscopy to ensure accurate placement
Follow the generally accepted guidelines of limiting the number of [url:168,type=|term|,content=|injections|] to a maximum of three within any one-year period

Sources:

American Academy of Neurology
[url:168,type=|term|]

56 Things to Do While Recovering from Surgery

Wed, 01 Aug 2007 21:43:11 -0700

August 1, 2007
by: Stephanie

About to undergo surgery? With a little planning, you can make the most of your recovery period. Here is a list of ideas– compiled largely from ideas and contributions from the Spine-health.com Message Board to help get you started. This list was written specifically for people having [url:165,type=|term|,content=|back surgery|], but most of the ideas are applicable to recovery from most types of surgery.

Pure entertainment

Download music (legally) from the Internet; fill up your ipod from itunes

Randomly explore the internet; see what the rest of the world is searching for using Google Trends

Play games that can be played by yourself. There's an amazing variety of games now available – here's a great list. Develops thinking skills, pattern recognition, etc.

Read (or listen to) the classics: To Kill a Mocking Bird, A Catcher in the Rye, The Grapes of Wrath, The Old Man and the Sea , The Great Gatsby, The Call of the Wild, War and Peace. These books are almost always available from your library, and often on sale at the large book stores.

Listen to books on CD. Sometimes it's easier to listen to a book than to read, very relaxing.

Have your kids read to you

Play classic board games with your kids – Monopoly, Scrabble…

Rent a season of a TV series that you had always wanted to see. Entourage is hilarious. Or rent an old series, like Cheers or The Dick Van Dyke Show.

Download books from, e.g. from www.netlibrary.com

Do crossword puzzles or Sudoko puzzles or print up some kakuro, which are number versions of crossword puzzles

Play the guitar (or learn to), or ask someone to play an instrument or sing for you.

Watch old movies. This is great if you are feeling fuzzy from the pain medications – the classic old movies are slow-moving, so it's easy to follow the plot

On a budget? Rent movies from the library instead of from the video store – it's usually a fraction of the price and you can keep the movie for a week.

Enjoy Xbox or Nintendo, Gameboy, Sony PSP, or any handheld electronic games

Some like the handheld game of Simon – it's not too difficult, so good if the pain medications are affecting your concentration

Read the entire Harry Potter series (no these books are not just for kids, the stories and characters are riveting!)

If you prefer, read the original magical book series, The Narnia Chronicles by C.S. Lewis

For the women - give yourself a manicure, a facial, look through magazines to find a new hair style you'd like to try

Read the entire New York Times – that will take at least a half a day!

Emotional care

Go sit out on your deck or porch for awhile each day and get some fresh air

Get free therapy online and make friends with other people who are in similar situations on the Spine-health.com Discussion Forum: "...finding this site and spending time here was a great help during recuperation - both in regard to having something to do but also for learning and understanding about our surgeries and recovery, and also being able to help and assist others here - that's why I am still active here 7 months after surgery."

Start a Carepage – an online diary that allows you to chronicle your recovery and automatically notifies your network of friends and family each time you update it.

E-mail a loved one who is having difficulty empathizing with your condition and invite him or her to view the Message Board so they can see what you and others in your condition have to go through

Talk with others real time who are laid up in similar situations in an online Chat Room

Read and comment on blogs that deal with recovery from surgery; or start your own blog!

Connect with an old friend who you've lost touch with. Try sending him or her a card or letter via old fashioned mail.

Learn to meditate and practice practice practice. Meditation is great for reducing stress and producing an overall feeling of calm and well being, all of which contributes to healing.

Productive time

Scrapbooking and putting all those old pictures in an album. Use … to create online photo albums of all your digital prints

Plan ahead for your next vacation - research and plan it online.

Become on expert on a specific subject – rent documentaries, read books, and use Google Scholar to do free online research on a certain subject. Ancient Greece? Bird watching? History of golf? Research and learn all about whatever interests you.

Sort out pile of mail, bills, catalogues etc., that has been piling up on kitchen counter since before your surgery.

Put your financials online with Quickbooks or a similar financial management program.

Make some gifts the old fashioned way – knit or crochet a baby blanket for someone who's expecting a baby soon, needlepoint something to decorate the baby's nursery, or make advance holiday gifts.

Learn the almost-lost art of lace making

Learn to write left handed (or right handed, if you're a lefty) to exercise a new part of your brain

Inventory all the stuff you want to get rid of around the house and garage, and sell it on E-Bay

Get started on that novel you've always wanted to write

Make a Honey-do (or handyman) list for all those odd jobs that need to get done around the house

Help build the online encyclopedia Wikipedia by editing or starting any topic where you have expertise

Learn origami and create beautiful origami gift boxes or figures

Learn calligraphy and make your handwritten notes gorgeous! This is especially valuable if you have horrible handwriting like mine…

Create list of recipes that are easy to prepare that you can make once you're up and around but still recovering. Here's a list of spine-friendly recipes

Feeling better by doing good

Every day write a short thank you (or love note) to the person who is caring for you and put it in the same place for them to find each day.

Write thank you notes to everyone in the hospital who was helpful to you
Pray in your own way.

E-mail thank you notes to all the websites you found especially helpful (hint, hint!) … makes all the hard work worth it J

Read online verses from the bible about healing and related topics

Anytime you reach out to help someone else in need, you will feel better. Less lonely. Less depressed. Volunteer with an organization that allows you to call and talk to people who are lonely (such as people in nursing homes or people confined to their house).

If you don't yet have a cause that you're passionate about, research one online (start here) and make a plan to start donating your time and energy to something you care about once you can get around

Be an excellent host or hostess – send out invitations to your friends and family, schedule visits, greet your visitors enthusiastically even when you're in pain, and encourage them to talk about themselves and their lives. It will go a long way to help take your mind off your situation, and will make it a pleasant visit all around.

Getting mobile again

If you can't walk much yet, have someone drive you to Wal-Mart or Target and ride one of the rascal scooters.

Just walk walk walk. Try to gradually work up to 10,000 steps a day

Wear a pedometer to encourage you to walk whenever possible

[url:1195,type=|node|,content=|Get comfortable shoes|] for walking that are easy to get on and off. Crocs are a favorite – they're lightweight, slip on so you don't have to bend over to get them on or off, and have some traction to help avoid slipping.

[url:1199,type=|node|,content=|Walk on a treadmill|] and set a progressive goal (e.g. go for 2 minutes longer each day) that is OK'd by your doctor. Chart your progress each day so you have a visual confirmation of how far you've come!

[url:1284,type=|node|,content=|Sign up for a water therapy|] - it's very gentle on your back, as the water supports you while you exercise and prevents any jarring motion.

Of course, check with your doctor first before doing any of the above.Many of these ideas do require a laptop and Internet access. If you don't have a laptop, you can buy an inexpensive one (starting at $600) or try to borrow one from a friend or family member. Wireless internet access is a good idea so you can access the Internet from your bed, a recliner, or wherever you're most comfortable.Any more ideas? Please add your comments!

Posted by: Stephanie

Laser Disc Decompression for Spinal Stenosis: Does it Work?

Mon, 30 Jul 2007 15:46:34 -0700

July 30, 2007
by: Peter

[url:5998,type=|node|,content=||]
[url:5998,type=|node|,content=||] [url:5998,type=|node|,content=|See the Spinal Stenosis
Interactive Video|]

As a practicing spine surgeon, I am often asked by patients if their [url:1580,type=|node|,content=|disc decompression surgery|] can be done with a laser. There is a perception by the general population that lasers are a modern, almost futuristic, up and coming technology. The reality is that lasers have been around for a long time and are almost completely useless when it comes to spine surgery.

[url:17599,type=|node|,content=|A laser|] is a focused beam of light that can be used for cutting soft tissue. In eye surgery, they are definitely useful and have changed corrective eye procedures drastically. In the spine, electrocautery is much more practical for cutting soft tissue. Lasers can cut disc tissue, but it is far easier and more reliable to mechanically grab the disc fragment and remove it from compressing the nerve. Also, since discs lie right next to the nerve root, one risks the chance of damaging the nerve root with the laser. Lasers cannot cut bone so they cannot be used to decompress patients with [url:152,type=|term|,content=|spinal stenosis|].

It seems to me that the most practical use for lasers in spine surgery is for marketing. Like most businesses, spine surgery is very competitive, and having an edge in marketing can make a practice standout. I knew a spine surgeon who would tell his patients he could use a laser to do their surgery. He would cut the skin with a scalpel, then bring in a laser to cut the subcutaneous fat, then go back to electrocautery. However, since the laser was so slow, he would only use it for about thirty seconds before he went back to electrocautery. The laser performed no useful function during the surgery, but helped him for marketing purposes.

Spine-health.com has thousands of pages of information, all of which have been peer reviewed by a medical advisory board of prominent spine physicians. However, there is not one article on laser surgery as it is not an accepted spine procedure. At the major spine meetings and in the major spine journals there is a paucity of (if any) peer reviewed articles documenting any use of lasers in spine surgery.

So, if mainstream spine surgery is not interested in lasers, and lasers are primarily only useful as a good marketing tool, why do patients remain so interested in lasers? Perception plays a central role, and many patients perceive lasers to be a useful technology. Lasers are often perceived as an effective surgical approach for spine surgery because of two reasons: placebo response, and the tendency to always think the second opinion sounds more knowledgeable.

Placebo response: Patients with pain want to get better, and if they undergo an invasive procedure, they will try to get better if at all possible. The placebo response in patients with chronic pain can be as high as 70%, even if the procedure was a complete sham and did not address their spine pathology. However, in patients with true pathology the response doesn’t last very long. I recently operated on an elderly woman who had a degenerative spondylolisthesis and severe lumbar spinal stenosis. She had initially seen a local surgeon who had recommended a posterior decompression, instrumentation and fusion (which is what she needed for correction of her condition). She went to a center that claimed a laser surgery would suffice. After the laser surgery, she felt better for a couple of weeks, but then realized her pain was about the same. This is the placebo response. When I saw her and offered her the surgery she should have had in the first place, the reason the laser surgery had failed became apparent. I could see that none of the bone around the nerve roots had been removed, as would be expected since a laser surgery would have limited exposure and limited ability to deal with the anatomic problem causing the pain.

We did perform the surgery that was needed and she has subsequently done very well, as would be expected since this is a reliable surgery. The previous laser surgery had been touted as a minimally invasive surgery, which is its main benefit, but the drawback is that it does not address the pathology of lumbar spinal stenosis – the laser surgery does not remove the bone that is pressing against the nerve root and causing the pain. Unfortunately, since her laser surgery was not covered by insurance, the patient was out the cash.

Second opinion. The other factor that allows lasers to be marketed for spine surgery is that almost any second opinion for surgery has a tendency to sound smarter than the first opinion. The above patient had seen another surgeon prior to going to having laser surgery, and the first surgeon had recommended the appropriate surgery for her condition (decompression, instrumentation and fusion). The surgeon who wanted to use the laser, however, probably sounded smarter since he gave the second opinion. I have frequently heard that nobody should have a spine surgery unless they get a second opinion. The danger is that the next opinion a patient obtains may or may not be any smarter that the first opinion, and it may be based more on marketing than on any sound medical science. This is not to say that patients shouldn’t get second opinions – I am very much in favor of the patient having as much information as possible prior to deciding on surgery. Just be aware of the natural tendency for the second opinion to sound better.

Posted by: Peter Ullrich, MD

Take Control of your Low Back Pain

Wed, 25 Jul 2007 16:57:36 -0700

July 25, 2007
by: Sylvia Marten

Unlike some health conditions that need to be resolved as soon as possible (such as a broken bone), most forms of low back pain actually don't need to be fixed. Low back pain usually just needs to be managed - through a combination of [url:170,type=|term|,content=|pain management|], specific types of exercise, nutrition and postural changes that protect the spine.

While some people with this condition are unlucky enough to develop debilitating back pain, for most of us the back pain from degenerative disc disease is just a signal that we need to adopt a healthier lifestyle to keep the symptoms in check.

The natural history of degenerative disc disease is a [url:137,type=|term|,content=|chronic|] low level of pain or discomfort with intermittent flare ups of pain. Managing this common type of back pain has two main objectives:

Manage your pain level. Keeping the pain to a tolerable level will help keep you active, which in turn will help minimize the pain and prevent it from getting worse. Common pain management techniques include ice packs, heating pads, over-the-counter or prescription pain medications, and possibly epidural steroid injections. Some people find alternative treatments quite helpful, such as chiropractic care, acupuncture, or massage therapy.
Personally, I think nothing beats a good neuromuscular massage. On mild days a heating pad on my low back at the end of the day feels soothing, and if I've overdone it exercising or roughhousing with the kids then an ice pack usually does the trick.

Stay healthy overall. Good overall health -- and the health of the muscles, ligaments and tendons that support your spine -- will go a long way to minimizing painful flare-ups. Exercise and physical fitness are critical, including stretching and building strength in the core trunk muscles that help support the spine. Aerobic exercise brings important nutrients to the discs in the low back. Modifying movements and posture minimize stress on the low back and help prevent injury, and eating well fortifies the body (including spinal discs) against degeneration. And of course avoid smoking and don't drink too much alcohol.

Like other chronic conditions (diabetes, asthma), with mechanical low back pain you can do a lot personally to help keep the severity of the condition in check. It is by no means a guarantee that the condition won't worsen -- some people can do everything right and their back pain still gets much worse. But for most of us, these lifestyle changes can go a long way to keeping the pain in check and, importantly, avoiding the need for extensive surgery.

Posted by: Stephanie

Additional resources:

[url:809,type=|node|,content=|Living with Degenerative Disc Disease|]
[url:830,type=|node|,content=|Depression Guide|]

The Basics of Back Pain and Spinal Anatomy

Fri, 20 Jul 2007 14:19:43 -0700

July 20, 2007
by: Stephanie

[url:946,type=|node|,content=|Spinal anatomy|] is a remarkably intricate structure of strong bones, flexible ligaments and tendons, extensive muscles and highly sensitive nerves and nerve roots. Without question, the composition and function of the spine is a marvel of nature, providing us with a unique combination of:

Structure to allow us to stand upright and move with precision
Protection for the spinal cord and nerve roots to safely relay messages to and from the brain and the rest of the body
Shock absorption accept jolts and stress as we move about
Flexibility, especially in the lower and upper spine, allowing us to bend and twist in a full variety of movements
Strength provided by the bones, discs, joints and supportive muscles and connective tissue

Once back pain starts, however, the many benefits of this intricate anatomical construct can quickly be lost. Here are the basics of anatomical causes of spine pain:

Neck Pain

The [url:1113,type=|term|,content=|cervical spine|] (neck) supports the weight of your head and protects the nerves that come from your brain to the rest of the body. This section of the spine has seven vertebral bodies (bones) that get smaller – and provide more rotation - as they get closer to the base of the skull.

Most episodes of acute neck pain are due to a muscle, ligament or tendon strain, which is usually caused by a sudden force (e.g. whiplash) or from straining the neck (e.g. sleeping in the wrong position). If you have [url:913,type=|node|,content=|neck pain|] that lasts longer than two weeks to three months, or with predominantly arm pain, numbness or tingling, there is often a specific anatomic abnormality causing the symptoms, such as a herniated disc, [url:152,type=|term|,content=|spinal stenosis|], etc.

Upper Back Pain
The 12 vertebral bodies in the upper back that are attached to the rib cage make up the thoracic spine (middle or upper back) are firmly attached to the rib cage at each level, providing a great deal of stability and structural support, protecting the heart, lungs and other important organs within the chest.

Because there is little motion in the upper spine, it is rare to have pain caused by a herniated or degenerated thoracic disc. More common causes of [url:1068,type=|node|,content=|upper back pain|] include irritation of the large back and shoulder muscles or joint dysfunction...

Lower Back Pain Because the lower back carries the most load with the least structural support, it is the most likely to wear down or suffer injury.

Most episodes of [url:896,type=|node|,content=|lower back pain|] are caused by muscle strain. Even though this doesn't sound like a serious injury, the pain can be severe. Strong abdominal muscles and back muscles are important to provide support for this area of the spine and avoid injury.

Pain at the bottom of the spine The iliac bones are part of the pelvis, and the sacrum is connected to this part of the pelvis by the sacroiliac joints. Pain can occur in the sacroiliac joints (where the sacrum connects to the pelvis), called [url:902,type=|node|,content=|sacroiliac joint dysfunction|], and in the coccyx (tailbone), called [url:890,type=|node|,content=|coccydynia|]. Both of these conditions are more common in women than men.

Posted by: Stephanie

Additional reading:

[url:5999,type=|node|]

Cyber Hugs: How Online Support Groups Help with Chronic Pain

Wed, 18 Jul 2007 19:29:21 -0700

July 18, 2007
by: Stephanie

If you're dealing with [url:137,type=|term|,content=|chronic pain|], you probably already know what a devastatingly lonely experience it can be. Even with the most supportive family and friends, you still feel alone, because they don't know – they can't know – what it's like to endure chronic pain each and every day of your life. And just so sick and tired of explaining yourself and having it affect all the most important relationships in your life.

This is where online support groups come in – an online discussion forum where people with the same kinds of pain are dealing with the same things your are. These groups provide you with a circle of friendship, support and camaraderie to help you through the worst and celebrate the good times as well. These people won't tell you its all in your head, they won't keep asking if you think you feel better yet, and they won't mind when you just need to vent.

Contrary to how many people view online chronic pain support forums, the people in these groups are not whiners and attention seekers. At least on Spine-health.com's back pain forums and chat rooms – we find people are almost universally constructive, supportive and at times downright hilarious.

So what are the main benefits of an participating in an online support community?

They validate your feelings – no, you're not crazy or imagining it!
They give you hope even in your deepest times of need
They spur you on to keep coping and looking for pain relief even after you're exhausted and want to give up
They help you with daily living problems. Should I get a shower seat? How do you arrange the pillows at night to get back support? What are recipes that are easy to prepare and nutritious?
They are available day or night. Up with intense pain at 2:00 am and feeling all alone? Log on and you'll have company – your online friends can help you get through the night.
And sometimes best of all, you get the satisfaction of helping others. You can reach out to others when they post questions, need an emotional lift, or just need to talk.

A good pain management program and other approaches can hopefully help you from a medical perspective. And if you're really depressed, take care to get help from a professional right away. (You can use this [url:819,type=|node|,content=|Symptoms of Depression|] checklist as a guide to see if you - or someone you care about - needs help.) And by all means don't forget to take good care of your emotional, spiritual and psychological health too by finding a good support group. You may have to visit a number of discussion boards and chat rooms to find one that suits you best, but I guarantee you it will be well worth it. If you prefer to meet in person, contact your local hospital or your pain management physician and they should be able to give you a list of local chronic pain support groups in your area.

You will be amazed at how many people suffer from the same pain and related challenges as you do, and how refreshing it is to meet others in such similar situations. Cyber hugs to all!

Posted by: Stephanie

Additional Resources:

American Pain Foundation Pain Resource Locator
Back Pain and Chronic Pain Discussion Forum
[url:830,type=|node|]

Think Carefully About your Surgeon's Recommendations

Mon, 16 Jul 2007 17:26:57 -0700

July 16, 2007
by: Peter

[url:1582,type=|node|,content=|Spinal fusion surgery|] for low back pain has gotten quite a bad reputation for delivering poor results. Because it is a painful, dangerous, and costly surgery, spine fusion should only be offered for the most severe symptoms and clearly defined pathology, but sadly this is not always the case.

Recently, I saw as a second opinion a young man who had been offered a three level fusion by another surgeon - a prominent academic surgeon at a medical school in a different area. This 19 year-old male was very debilitated with low back pain and bilateral [url:887,type=|node|,content=|leg pain|] that was made worse with activity. The young man was taking large doses of oral narcotics to control his pain and had already maximized his non-surgical treatments, including three epidural injections.

The only abnormalities that his MRI scan revealed were [url:1051,type=|node|,content=|congenital stenosis|] of his lumbar spine, made somewhat worse at L4-L5 by a slightly bulging disc. The surgeon recommended and booked this young man for a three level decompression, instrumentation and fusion and told him that "additional levels of the spine may need to be fused once they see what is going on during surgery".

This is truly an unbelievable opinion. The chance that a three level fusion would relieve the patient's pain is only about 50%, AND there is a 50% chance that the surgery would actually make his pain worse. Even if the surgery did provide pain relief, it would only be temporary until the next level of the spine wore out and started causing pain. The spine is meant to move and fusing three levels, especially in a 19 year old, completely alters the biomechanics of the spine. In the spine surgery world, the term "fusion disease" is used to describe the ongoing or worsening pain that follows a multilevel fusion.

This young man's scan and x-rays did not show any pathology that would warrant a fusion. The number one determining factor whether or not a fusion surgery will deliver the desired reduction in pain is a proper preoperative diagnosis that clearly identifies the [url:1470,type=|node|,content=|cause of the patient's pain|]. I can't stress this enough. Fusion surgery does work very well for discrete pathology. One (or maybe two) level severe [url:815,type=|node|,content=|degenerative disc disease|], [url:6000,type=|node|,content=|spondylolisthesis|], tumor, fracture or infection all can be successfully treated with a fusion that removes the motion at a painful motion segment. But this young man did not have any of these problems, so a fusion would be unlikely to help him. At the most, a one or two level [url:1581,type=|node|,content=|decompression surgery|] to treat the [url:1051,type=|node|,content=|spinal stenosis|] could have been considered to treat the pain.

There is no way to justify a reckless use of fusion surgery such as the recommendation that this man received, and it typifies what is wrong with fusion surgery today. At best, that surgeon does not understand what pathology is and is not amenable to a fusion procedure. At worst, he is motivated purely by a profit motive and does not care about the damage and pain he is inflicting on patients. Having a three-level fusion at age 19 would have severely damaged this patient's life forever.

It just takes a few unskilled and/or irresponsible surgeons to ruin a lot of people's lives. Patients should take all precautions to get educated about their options and understand exactly why the surgeon is doing the surgery, the risks and benefits, and their other options, before deciding on fusion surgery.

Posted by: Peter Ullrich, Jr., MD

31 Back Pain Tips Your Doctor Didn't Mention

Thu, 12 Jul 2007 19:25:11 -0700

July 12, 2007
by: Stephanie

Office Chair Ergonomics Video

Well, maybe you have a spectacular doctor who has all the time in the world to tell you how to care for your back. But just in case, we thought we’d compile a list of the most helpful tips that we’ve heard over the years – from doctors, physical therapists, nurses, and back pain patients. Some of these may seem contradictory – like using heat and ice – but the truth is that managing back pain is often a process of trial and error and most people have to try several options to see what works best for them.

Back Pain Remedies

Numb it. After activity-related discomfort, [url:1664,type=|node|,content=|ice|] acts as a local anesthetic by numbing the tissue, and reduces inflammation, which usually is a factor in low back pain. Make your own ice pack by freezing dishsoap in a plastic bag, or freeze water in a paper cup and get an ice massage.
Warm it up. [url:1662,type=|node|,content=|Heat|] helps blood circulate in the affected area of the low back, and blood brings healing nutrients. Some prefer moist heat - a hot bath or other form of moist heat.
Keep it warm. Some people feel more pain relief with continuous, low level heat, which is available with commercial [url:1668,type=|node|,content=|heat wraps|] (e.g. ThermaCare, and ACE).
Combine acetaminophen and ibuprofen. These have different mechanisms of action, and when combined, are more effective than either one alone. I like to stagger the doses (take ibuprofen, then 2 – 3 hours later acetaminophen).
Take the max dose. If you’re taking over the counter medications like Tylenol or ibuprofen, take the maximum dose to keep a therapeutic level of the medication in your bloodstream.
Use your brain. Employ powerful [url:1080,type=|node|,content=|relaxation and distraction techniques|] in order to make your brain ignore at least some of the pain signals it receives and help you feel more in control of your situation.
Get a massage. Nothing helps like a good [url:1287,type=|node|,content=|back massage|] to loosen up the muscles and get the blood flowing.

General Health

Get continuous sleep. Lack of deep, restorative sleep makes the pain worse, and pain makes it hard to sleep. If you need it, get professional help for sleep aids.
Treat your emotions. [url:819,type=|node|,content=|Depression and chronic back pain|] go hand in hand and each makes the other worse. Get professional help for the depression too.
Stop smoking. It causes back pain.
Avoid alcohol. It is a depressant and interrupts sleep cycles.
Avoid being tall. Tall people are at higher risk for developing back pain, so take extra care of your back if you are tall.
Check your gene pool. A lot of back pain runs in families, so if back pain runs in your family take extra care of your back.
Connect with others. Pain is lonely. Most people feel better when they can connect and share with others who are experiencing similar challenges.

Exercise

Stretch your hammies. Tight hamstring muscles put stress on the lower back. Stretch them every morning and evening.
Stay active. Don’t rest for more than a day or two when back pain is at its worst. Prolonged inactivity makes the pain worse.
Walk as much as possible. Carry a pedometer to know you’re walking 10,000 steps a day. A treadmill has less impact on the spine than walking on a sidewalk
Try an elliptical trainer. The tracks never touch the ground, so there is almost no impact on the spine.
Biking is good too. For people who feel better leaning forward, try an upright exercise bike. For those who feel better reclining, try a recumbent bike (with a lumbar back support)
Water therapy is gentle. The water provides buoyancy and mild resistance, but no impact or stress on the back.
Strengthen your core. Abdominal and back muscles need to be specifically targeted with strengthening exercise in order to support the spine.
Try a strengthening program. McKenzie therapy, Dynamic lumbar stabilization exercises, and most forms of exercise ball programs, tai chi, pilates, and yoga all focus on strengthening the core trunk muscles.

Posture and ergonomics

Look at your chair. If you’re reading this, chances are you spend a reasonable amount of time at your computer. Make sure the back of the [url:1092,type=|node|,content=|chair|] supports the inward curve of your lower back, your chest is open, arms on armrests, upper back is straight and your feet are flat on the floor.
Use a lumbar support (or rolled towel) for your [url:1106,type=|node|,content=|office chair|] and car.
Don’t slouch. Ever. It stresses the back.
Replace your office chair with an exercise ball. Sitting on the ball introduces an element of instability, and over time the muscles used to balance on the ball become stronger.
Pivot with your feet. Don’t twist while lifting. Instead, pivet with your feet to keep your low back from twisting.
Use pillows. Support your spine while sleeping by using [url:1329,type=|node|,content=|pillows|] to reduce stress. One very supportive position is to lie on your side in the fetal position with a pillow between your knees.
Avoid standing. At least for long periods of time. If you have to, make sure one leg is resting on a step or something a few inches off the ground, and switch feet every few minutes.
Push. If you have to move a heavy object, always push – don’t pull.
Get household help. Have someone else vacuum, load and unload the dishwasher, lift grocery bags and other household chores that require bending and place stress the low back. You can chip in with the chores that don’t stress your back.

I’m sure we missed some – anyone care to add to this list? Thanks!Obligatory disclaimer: always consult with a physician for your back and any health conditions.

Posted by: Stephanie

More reading:

[url:140,type=|term|]

Get Your Back Pain Diagnosis from a Physiatrist

Wed, 11 Jul 2007 12:33:21 -0700

July 11, 2007
by: Stephanie

Whenever someone with bad back pain asks me where to get help, I say I would start with a diagnosis from a [url:1720,type=|node|, content=|physiatrist|] who specializes in back pain. Here is why:

Most physiatrists can provide you with the broadest array of treatments for [url:140,type=|term|,content=|back pain|]:

Spinal injections (for diagnostic and therapeutic purposes)
Prescription pain medications and anti-inflammatories
Heat and ice and other pain modalities
Physical therapy
Education on ergonomics, posture, etc.

I like the general orientation of the physiatry, which is to provide enough pain relief to enable patients to make progress with rehabilitation – the best long term solution. (I’m not saying that practitioners in other specialties don’t have this focus, many do, but my impression is that physiatrists are most likely to have this focus.)
Most physiatrists have a strong surgical referral network. So if you really do need surgery, they would be able to refer you to a surgeon who they know has done a good job for other patients.
Many are part of an integrated clinic or network of clinicians to provide coordinated care, e.g. chiropractors, [url:170,type=|term|,content=|pain management|] specialists, physical therapists, psychologists who specialize in pain, etc. For complex cases, this is often the best way to go.

Again, let me repeat, I realize that clinicians in many [url:1969,type=|node|,content=|specialties|] have many of the above qualities, and I am not saying that every physiatrist is good at treating back pain. I am highlighting this specialty’s training and approach to treating back pain because, in general, this seems to be a medical specialty that many consumers don’t know about, and I would like those seeking back pain relief to know about this option.

Posted by: Stephanie

More reading:

[url:1720,type=|node|]

Does Pain Prefer Sweets?

Thu, 05 Jul 2007 13:00:26 -0700

July 5, 2007
by: Stephanie

For all of you with chronic pain who are thinking "yes, a pint of Ben & Jerry's really does help the pain", that's true - sweet tastes have been shown to increase pain tolerance, and now new research shows the same holds true for sweet smells. Quite simply, the perception of pain diminishes when one is smelling something sweet. ScienceBlogs explains the research:

"They started with three types of smells: sweet and pleasant (caramel), unsweet and pleasant (after shave), and unpleasant (civet musk, which I hear smells awful). The inclusion of both sweet and unsweet pleasant smells allowed Prescott and Wilkie to distinguish between the analgesic effects of the pleasantness of the smell from that of the sweetness (apparently these two properties had been confounded in previous studies). The smells were placed on the inside of a mask, which participants were told was used to measure their breathing rate so that they would have no knowledge of the experiment's purpose. Participants put on the mask, and then placed their hands into a vat of water at 5° Celsius (41° Fahrenheit) for up to 4 minutes. They did this in two trials, separated by 15 minutes, one trial with the smell and one without (they wore the mask for both). The key measure was how long participants kept their hand in the cold water. Prescott and Wilkie also asked them to rate how intense the pain was right after putting their hands in, thirty seconds later, and when they pulled their hands out of the water."

The results of the study show that specifically the sweet smell helped people tolerate the pain - and that group kept their hands in the water more than twice as long, on average, than the participants in the other two conditions, when the smell was present...The actual, subjective perception of pain did not differ across all three conditions, so it seems that the participants subjectively experienced the same levels of pain, but they were able to tolerate it better when the sweet and pleasant smell was present.

The researchers also hypothesized that the analgesic effects of sweet smells are likely the result of learned associations. Whatever the reason, you might want to try popping a few chocolate chip cookies into the oven, or whatever is sweet that you associate with good things, to make your pain more tolerable.

Posted by: Stephanie

Source: Prescott, J., & Wilkie, J. (2007). Pain tolerance selectively increased by sweet-smelling odor. Psychological Science, 18(4), 308-311.

More reading: [url:137,type=|term|,content=|Chronic Pain Health Hub|]

Lyrica Helps with Restorative Sleep

spine-health — Mon, 02 Jul 2007 14:26:41 -0700

July 2, 2007
by: Stephanie

Just read about an interesting study that showed that Lyrica (pregabalin) helped the participants get more restorative sleep, not just fall asleep faster. Thanks to Dr. Steven Poceta, a neurologist, who explains on his Revolution Health blog:

"Slow wave sleep is deep—hard to wake up from—it is highly conserved and the first to recover after sleep deprivation, and it is the stage in which growth hormone is secreted in children. Slow wave sleep seems to diminish as we age. In some ways, slow wave sleep is the “holy grail” of sleep disorders. Getting more of it is always better (more restorative), just like getting younger."

He also hypothesizes that Lyrica's ability to increase slow wave sleep may explain its effect on helping people with fibromyalgia pain.

As those with [url:137,type=|term|,content=|chronic back pain|] know all too well, the problem isn't just getting to sleep but staying asleep long enough to wake up restored and refreshed.

Let's hope that the scientific community continues to produce and refine agents that will help people with chronic pain get sleep in long enough stretches - true restorative sleep - in order to help them heal.

Posted by: Stephanie

Additional reading:

[url:1318,type=|node|]
[url:6629,type=|node|]

38 Questions to Ask Your Surgeon Before Having Back Surgery

Thu, 28 Jun 2007 18:02:14 -0700

June 28, 2007
by: Stephanie

Surgery Videos

This subject comes up a lot in our forums - "I'm considering surgery, what questions should I ask my surgeon?" From articles on Spine-health.com and contributions from our discussion forum members, we've compiled a list that you can print up and take with you to your consultation. Good luck!

Questions before you decide to have the surgery

What type of surgery are you recommending? Why?
What is the source of the pain that is being addressed? How do you know this? (Exploratory back surgery is not done).
Please explain the procedure - at a very high level/with some detail/in great detail. The amount of information depends on your personal preference – some want to know everything, some not so much! To actually see the surgery (animated – no gore) – view our [url:204,type=|term|,content=|Spine surgery animated videos|].
What are my non-surgical options?
What is the natural course of my condition if it is not surgically addressed?
What would you recommend if this were your friend/wife/sister/daughter etc…?
How long will the surgery take?
What are side effects, potential risks and complications?
Please explain the risks and how they relate to me personally. For example, chances of having a non fusion if you are overweight, a smoker, risks if have a grade 3 spondy, etc.
What if you get in there and see something different than you expected?
Do I need to donate my own blood? If yes, why? For most types of [url:165,type=|term|,content=|back surgery|], blood does not need to be donated ahead of time.
Do you perform the whole procedure? Will any students/other surgeons be doing any parts of the operation? If yes, who are they and what are their qualifications? Some surgeons only do a small part of the operation, others do the whole thing. If another surgeon is required, e.g. a vascular surgeon, their role is important and it would be good to know their qualifications..
Who else will assist you in the operation? What is their background and qualifications?
What are the long-term consequences of the proposed procedure? E.g. will the operation ever need to be re-done? If it is a fusion, will it lead to degeneration at other levels of the spine?)

Questions about the surgeon

How many times have you done this procedure? In general, when it comes to surgery "practice makes perfect", so more is better. (However, if the doctor is recommending something that is not often done, such as multi-level fusions, more would not necessarily be better.)
Are you board eligible or board certified? You can usually look on the wall and see a certificate.
Are you fellowship trained in spine surgery? This is more important if the surgery is a fusion, artificial disc replacement, or other more extensive procedure.
If I want to get a second opinion, who would you recommend? (Someone not in the same practice)
Statistically the success rate for this type of surgery is _%. What is your personal success rate, and how many of this type of surgery have you done?
Can I talk to other patients who have had a similar procedure?

Any defensiveness on the part of the surgeon when you ask these types of questions may be a red flag. A surgeon with good results and appropriate qualifications will not be threatened by these types of questions and will respect your attention to these matters.

Questions about what to expect after the surgery

What kind of pain should I expect after the surgery and for how long?
How long is the hospital stay?
May a family member spend the night with me in the hospital?
How do you manage the pain in the hospital?
Which pain medications will I be sent home with? What are possible side effects of these prescriptions? E.g. Constipation, drowsiness, etc.
Will you know before the surgery if I will need a backbrace afterwards? If so, will I be fitted for one before the surgery?
Who can I call if I have questions after the surgery? What is the process for communication?
How often will I see you after my surgery?
What symptoms would warrant a call to your office?
What symptoms would warrant immediate medical attention?
What limitations will I have after surgery and for how long?
How long will I be out of work? School? Whatever...
What kind of help will I need when I return home?
When can I drive again?
When can I resume normal (light) household chores?
What expectations do you have for my recovery?
When is it safe for my spouse and I to have sexual relations again?
How soon after the surgery can I start physical therapy?

Good luck with your decision and your recovery!

Posted by: Stephanie

More resources:

[url:1457,type=|node|,content=|Practical Advice for Recovering from Back Surgery|]
[url:1536,type=|node|,content=|Preventing Constipation after Back Surgery|]
[url:1547,type=|node|,content=|How to Select a Spine Surgeon|]
[url:6592,type=|node|,content=|How to help your surgeon help you|]
[url:6591,type=|node|,content=|Back Surgery Postop Recovery Tips|]
[url:6593,type=|node|,content=|Top 10 Reasons to Run from your Surgeon|]

Pain is Inevitable. Suffering is Optional.

spine-health — Tue, 26 Jun 2007 18:19:08 -0700

June 26, 2007
by: Stephanie

That sentiment, from The Dalai Lama, sums up the gist of a lot of our message board posts. Contrary to what many people think (at least from what surgeons tell me), message boards aren’t just for people hopped up on pain meds or whining. At least on our board, positive thinking is rampant – exactly the kind of support that helps people with back pain deal better and heal better…

Extracts from Spine-health’s discussion forum (minus the epidemic smilies):

Get educated, then keep pushing and don’t give up

Joe: “…My advice is to learn as much as you can about what is going on with you. The challenge can be when you’re loaded up with drugs it is hard to know what you need! But keep pushing and don't give up. There are answers, they might not come right away, but they will come."

Joe: “…The stages we are all in. bewilderment, denial, depression, anger, and finally acceptance. And when we reach the acceptance part we realize we need to educate ourselves and make the best out of what we have.”

When the pain is bad, focus on other things

Cleoscreations: "… My best coping mechanism is ignoring it! In other words, finding other things to do and think about. If it is so bad that I can't ignore it, then I make sure to do what it takes to feel better. Rest, massage, heat, ice, acupuncture. Try them all! I think living with chronic pain is trial and error.”

Dilauro: "For the past year, I've been going to a rehab theraputic pool twice a week and having seen other people that have problems, many worse, helps you get by."

Baileesmom: “I find that funny movies help, even though it hurts to laugh sometimes it is worth it.”

Krazigirl: "I'm with you on the silly movies and ice cream - sometimes when you want to just say screw the meds, screw the pain, forget the world - you just grab a pint of Ben & Jerry's, sit down in front of the TV, and lose yourself."

Don’t go it alone: ask for help if you need it

Manda: “It’s good for you to reach out here and talk about what you are feeling with others who have similar experiences and know that you are not alone in this... I know for me it helps to talk about it and feel my feelings with others who can hear me. I now see a therapist to help me with the emotional aspects of the physical pain as physical pain and emotional are very inter-related... all I can say is that after I have gone into some of my feelings the physical pain often subsides and I feel much better and much clearer.”

ErinM: "Just do the best you can do. That is all anyone can ask for… A good support system is a very helpful thing in this position. Don't be ashamed or too proud to ask for help when you need it.”

Baileesmom: “Your family just doesn't know what to say to make you feel better. Hopefully you can find support from the people that you meet here who understand EXACTLY where you are and can go along for the ride.”

Don: “Hopefully (your family) will give you the support that you need , but when ya need that little extra understanding , visit this site - we here know all too well what you’re going thru. I think this board is one of the best things that I have found for a place to go with understanding people that will listen and offer support as best as they can. It is not easy, but in this site u can get a lot of understanding that is very well needed. The chronic pain is the worst issue I have had to deal with. So just don't ever forget these three words, DONT GIVE UP, there is always someone here to listen to ya, so hang in there ok.”

Me: See, no whining? (Well, precious little). Seriously though, all doctors and clinicians treating chronic pain patients - please ask them if they're getting enough support, and if not give them some resources - online or off - that they can turn to for help. With support, they are likely to do much better.

Posted by: Stephanie

Chronic Back Pain and Wandering the Halls at 2:00 am

Tue, 26 Jun 2007 16:29:55 -0700

June 26, 2007
by: Stephanie

Two-thirds of Spine-health.com's visitors report having sleep problems, but ... so what? Spending the long nighttime hours wincing in pain while wandering from bed, to recliner, to couch, to simply roaming the house, and finally back to bed for one last short bit of sleep. That's the real story. Exhausting. Makes me tired just reading about it.

Recent excerpts from our message board explain the real challenges of sleep problems due to chronic pain:

Can't fall asleep

CindyS: "I have a difficult time falling asleep because I just can't get comfortable. [url:2205,type=|node|,content=|Neuropathy|] in my leg drives me crazy when I am lying down."

Dilauro: "Biggest problem I have going to sleep is getting comfortable with my legs. From my hips down I get various degrees of numbness and stabbing pain. The symptoms have been identified as being RLS (Restless Leg Syndrome). In the past year, I've spent about half of the time sleeping on a couch with my legs hanging of the edge (this made sleeping a lot better)… I can sleep for about 4 hours, but then my legs start to bother me."

Can't stay asleep

CindyS: "…my [url:912,type=|node|,content=|neck pain|] makes it impossible to stay in one position, so once I finally do doze off to lala land, I wake up and then can't go back to sleep… I generally move from bed to couch to recliner to bed, and I am usually able to sleep for a little while in each location, but then when I change positions, I'm awake again... During the day I am busy enough to keep my mind off of it, but night time is the worst."

Virg: "When my back is at its worst, nothing and I mean NOTHING really helps me to get a good night's sleep. Lortabs, flexeril, nada. I would go to sleep but it was not a deep and restful sleep. .. I always wake craving a few more hours of shuteye even though there are tons of things I want to accomplish during my day."

ErinM: "I was fine until after I got off the narcotics. Then I could actually feel everything. I went for a good six months fighting [url:1318,type=|node|,content=|insomnia|], due to pain I could not sleep more than an hour or two and then wake up."

Dilauro: "Then there are other nights where I just have to get up of bed and walk around, watch TV, get on the computer for couple of hours. Warm milk doesn't help, De-Caf tea does not help , a glass of port or wine helps get me back to sleep but doesn't keep me sleeping… I am happy with 4 hours of sleep, that's a gem."

Mwebb40: "I have two things working against me...I am starting menopause, so I deal with the night sweats and hot flashes. Once those wake me up, then I cannot get back to sleep. I will sleep a total of 6 hours in about 3 days, which with two small kids is not a good thing. Then, if I don't get a good nights sleep, my pain is worse and my numbness in my right leg is less tolerable…I am due to go back to work (after being off for six months) on July 1. I am an RN and need to sleep!! I have an 8 year old and a 4 year old. Life is challenging to say the least right now....sleep would definitely help!"

Krazigirl: "I typically ‘sleep' about 5-6 hours / night. Not a bad number, BUT it is never a rested sleep. I wake up every morning feeling like I never went to sleep, or like I caught a short nap. Then, when I wake up, the pain is worse than it was before I went to bed. When I'm not on painkillers before bed, typically I toss and turn all night, waking every couple of hours from sharp pains or throbbing aches."

Some things do help

Krazigirl: "Typically sleep is more restful if I exercise the night before. Swimming, [url:1196,type=|node|,content=|elliptical|], or things of that nature that won't irritate my back too much, but wear me out enough to make me sleep soundly. BUT the hard part is getting to the gym because I'm already hurting and don't want to hurt more- so I avoid working out- so it is a vicious cycle."

Bion: "Lying awake counting sheep is definitely for the birds and does not work; rather than do this I get up, make myself a hot cup of Milo and come to our study where I spend a couple of hours on the computer before trying out the sleep routine again. I find the no TV rule to be a bit of an old wives tale, for if I lie on our recliner in our lounge in the middle of the night, watching TV, this can happily set me off to sleep at times, but it's not always the answer."

Ddenn65: "I take Lunesta for sleep. I can sleep 4 hours, up to 5 1/2 on a good night. It isn't a bad medicine. It works fast."

ErinM: "Airborne PM if I feel really jittery helps me, it is a hot drink. So during the colder months I loved it before bed. No caffeine after 2pm has helped me as well. Also the fact that I can actually exercise really helps once you get past the holy-crap-my-muscles-hurt-stage. Now I don't get sore muscles, and it just plain expends some energy and is helping my over all recovery. [url:1349,type=|node|,content=|Yoga|] has helped me to center myself, learn to relax some, and gain flexibility, which also combats muscle soreness"

And in one sentence ...

CindyS: "Ahhh, sleep. I can't remember the last time I had a good night's sleep."

My take: Those with such chronic pain often find that sleep is impossible. For me, this signals the reality of the pain – if you're up half the night, you can't be "faking" or exaggerating the pain – it must be bad.

Posted by: Stephanie

More Reading: [url:1318,type=|node|,content=|Breaking the cycle of chronic pain and insomnia|]

What is Your Pain Rating Today?

spine-health — Mon, 25 Jun 2007 19:03:58 -0700

June 25, 2007
by: Stephanie

Exhausted and frustrated by this question at each checkup, our chronic pain community has gotten together and is requesting a better pain rating system. For many different reasons, the overwhelming consensus seems to be that the current one -- gauging your pain at one point in time on a scale of one to ten -- is just too simplistic.

Here are snippets from the discussion - very insightful:

The pain isn’t better but your body has adjusted to it

Virg: “…your body "adjusts" to the pain and something that a month ago you might have rated a 7 becomes a 4 (which) that stupid pain scale doesn't take into account. That doesn't mean that the pain is getting easier to deal with - generally it means that overall it is escalating and now you have even more intense pain that your body is learning to deal with so that you can still try to function.”

Erin: “Yup, yup, yup.....exactly. I really hate when I say I am still in as much pain but tolerating it better. Then I get the great ‘so you are doing better!’ Ummmm noooooo I did not say that. So I stopped saying that. Now I go in and say it is the same. Cause it is! I just am doing more since I figure I will hurt no matter what!”

The frownie faces are just silly

Don: “That freaking pain scale, why and who came up with this dumb thing, …I worked out a thing with my pain dr’s office. I’ve been with him 8 mths now so we both know what I hurt like most of the time so when they or he asks me what my pain is, I will either say baseline, or lower than or higher than.”

Squirrelypox: “I like your baseline scale idea. Sounds a lot more informative than the arbitrarily chosen "5" (aka the blushing constipated frownie on the visual image scale, if you're ever so lucky as to be asked to use that measure).”

One number doesn't give the full picture

Squirrelypox: “What is your pain rating today?” This question makes me want to slam my head into a brick wall…After months of pain shooting down my leg, I've managed to find a few innocuous positions for idle time. Chances are I am standing in one of those positions as they ask me the question. When I answer with a "0," I get asked if I really need to see the doctor today, since I have no real pain. But it doesn't take into account that the moment I move it's going to start up again. It's so arbitrary. I get stabby every time someone asks me this b/c I don't know how I am supposed to answer while giving a full picture of the pain.”

Me: Hopefully, voicing the above frustrations will help with the clinician-patient communications. To all chronic pain patients and clinicians out there, what do you use that works better than the 1 – 10 pain scale?

Posted by: Stephanie

More reading:

How is your pain rating today – full discussion

Sometimes Surgery is Quickest Path to Sciatica Pain Relief

spine-health — Fri, 22 Jun 2007 17:09:10 -0700

June 22, 2007
by: Stephanie

The study, published in the May 31 New England Journal of Medicine, compared surgical treatment of back and leg pain (sciatica) caused by disc herniation.

Dante Implicito, MD, an orthopedic surgeon in Paramus, NJ, pointed out that non-surgical treatment or a wait-and-see approach isn't always right for the patient in term of quality of life. Some people are in so much pain, they can't function or may risk losing their jobs, so they opt for surgery ([url:1584,type=|node|,content=|microdiscectomy|]) sooner. "(This study) shows that there can be tremendous improvement if patients are selected well for surgery," he said.

HealthDay reports: "The study...included 283 people who had severe sciatica -- leg pain caused by a compressed nerve in the spine (a [url:885,type=|node|,content=|herniated disc|]) -- for at least six to 12 weeks prior to the start of the study. Half of the group was selected to undergo early surgery -- an average of 2.2 weeks into the study; while the other half was chosen to receive conservative treatment with the option of surgery at a later date. Thirty-nine percent of the conservative treatment group eventually decided to have surgery, and the average time from the start of the study to the surgery was 18.7 weeks."

The findings:

Those who had a microdiscectomy sooner reported faster pain relief than the non-surgical treatment group.
Recovery for both the groups was same (95%) at the end of one year; however, the patients undergoing an early surgery experienced faster relief from sciatica.

Dr. Implicito emphasized that the most important thing someone with back pain can do is see a specialist with as much specific training in back problems as possible. "Back pain comes in a lot of different 'flavors', you need to be evaluated and diagnosed by a very well-trained person so you know what's relevant to your condition."

Posted by: Stephanie

Primary sources:

SOURCES: Weinstein, J.N. The New England Journal of Medicine, May 31, 2007; vol 356: pp 2257-2270. Peul, W.C. The New England Journal of Medicine, May 31, 2007; vol 356: pp 2245-2256. Deyo, R.A. The New England Journal of Medicine, May 31, 2007; vol 356: pp 2239-2243.

Additional reading:

[url:151,type=|term|]
[url:884,type=|node|]

Chronic Pain May Interfere with Memory

spine-health — Fri, 22 Jun 2007 13:23:46 -0700

June 22, 2007
by: Stephanie

One more problem with chronic pain: it may impede the brain’s ability to form and store memories, according to recent research.

In the study, 24 adults with [url:137,type=|term|,content=|chronic pain|] took simple memory tests at two different times: one test after having a procedure to relieve their pain (e.g. an epidural injection for chronic low back pain), and another on a day when they hadn't received any pain relieving procedure.

The findings: Two-thirds of the patients had more difficulty with memory on the days when they hadn't had a recent pain-relieving procedure.

According to the researchers, the study indicates that chronic pain may disrupt the brain’s ability to hold and store memories.

Frequent comments on our message board about difficulty with remembering things anecdotally – and often humorously - support these findings.

Posted by: Stephanie

Source: Dick, B. Anesthesia & Analgesia, May 2007; vol 4: pp 1223-1229. News release, University of Alberta

For Health Information, Enter Wikipedia at Your Own Risk

spine-health — Wed, 20 Jun 2007 17:12:38 -0700

June 20, 2007
by: Stephanie

Thanks to KevinMD for highlighting a hilarious post by anesthesiology resident Michelle Au about residents using (aka misusing) Wikipedia to look up health information.

The idea behind Wikipedia is admirable, and I think it works well in many categories - looking up places, historical facts, etc. But in the areas of health - at least in the 100 or so pages I've worked on editing - it is such fodder for commercial interests it's scary.

For example, on the Back Pain page some phrases are clearly commercial - eg. "Dr. John Keating talks about some of the ways to treat the pain in this VIDEO LINK" (links to Youtube video of a dr. talking about his approach to fixing si joint dysfunction). Other interests are presented less obviously. Dr. Sarno's approach to treating back pain used to dominate the page and still keeps popping up from time to time.

But even if one were to zealously hunt out and delete the obvious commercial plugs, there are some intrinsic problems with Wiki that will always make it unreliable for health information.

Conflicting information. Example: the Back Pain and Low Back Pain pages give conflicting information - each presented by "authority" sources - about whether various treatments (spinal manipulation, epidural injections, acupuncture) work or not.
Lack of detail. I don't really care about the above conflicting treatment information, because it's so high level its moot. Who cares if epidural steroids "may be" beneficial for low back pain? Patients need to know what specific back conditions the injections work for - do they work for patients with low back pain from [url:815,type=|node|,content=|degenerative disc disease|]? Do they work for low back pain from muscle strain? Otherwise, who cares.
Poor writing. Typos, grammar problems, redundancy .... don't even get me started.
Lack of balance. Since anyone can insert (or delete) anything at anytime, the pages often come across as ramblings rather than anything cohesive. For example, on the degenerative disc disease page, following two very high level paragraphs about the full range of surgical and non-surgical treatments, there was a third paragraph that dives deep into osteopathic treatments and why it is preferable. I fully support osteopathic treatments for low back pain, but it is given way too much weight here.

I used to be very active with helping build Wikipedia. I thought the idea of so many people who were experts in a given field contributing to make a common, free educational resource was very exciting. Now I'm just frustrated.

All IMHO.

(P.S. Just went back and fixed the Degenerative Disc Disease page - couldn't resist!)

Posted by: Stephanie

Back Surgery Best for Patients with Degenerative Spondylolisthesis

Wed, 06 Jun 2007 17:53:41 -0700

June 6, 2007
by: Sylvia Marten

Surgery Videos

The recently released results of the second SPORT study showed that patients who selected surgery to treat their [url:709,type=|node|,content=|lumbar degenerative spondylolisthesis|] had better outcomes when compared with those who selected nonsurgical treatment. The study included two groups of patients:

Randomized group – 304 patients
In the randomized group, 304 patients were randomly selected to receive either standard posterior decompressive [url:6023,type=|node|,content=|laminectomy|] (with or without a [url:1582,type=|node|,content=|spinal fusion|]) or nonsurgical care. Nonsurgical treatments included [url:171,type=|term|,content=|physical therapy|], epidural steroid injections, NSAIDS, and opioids. There was significant crossover from patients in the surgical and nonsurgical groups, with 64% of the surgical group having surgery and 49% of patients assigned to nonsurgical care also having surgery.

Because of the large percentage of patients who crossed over to from non-surgical treatment to surgical and vice-versa, the results of the study are really only meaningful by evaluating how the patients were actually treated, (vs. by their randomized groups).

Observational group – 303 patients
This group was allowed to choose whether to have surgery or receive nonsurgical treatment. 97% of patients who selected surgery went through with the operation, and 25% of the nonsurgical group ultimately chose surgical treatment.

The surgery for [url:6000,type=|node|,content=|spondylolisthesis|] included a decompressive laminectomy with or without an accompanying spinal fusion.

The large cross-over of patients and the favorable outcomes show what doctors and patients already know: those with pain fare best when their care was left to the individual discretion of patient and surgeon.

Primary source:

Surgery vs. Non-surgical Treatment for Lumbar Degenerative Spondylolisthesis

With Low Back Pain, Simple Remedies Are Often Best

Sat, 12 May 2007 20:20:41 -0700

May 12, 2007
by: Stephanie

Many of the e-mails I get from people visiting Spine-health.com ask “what’s new for back pain” or “what do you know about this new technology?” And I understand - it’s tempting to get caught up in seeking the newest, most sophisticated [url:137,type=|term|,content=|chronic pain treatments|]. But new technology isn’t always better. Sometimes it’s just the simple, tried and true therapies that help the most.

A recent review of 9 studies involving 1,200 participants shows that [url:1665,type=|node|,content=|heat does in fact reliably help relieve low back pain|].

I know it works for me. Personally, I prefer gel heating packs and low level heat wraps. They’re soothing, easy to do, and don’t have any negative side effects. I like the long lasting, extended wear heat wraps because they last for several hours and never get too hot. During long plane trips they’re a life saver for my low back. I also like the gel packs you can warm up in the microwave – they’re fast, easy, and reusable, so very economical.

Posted by: Stephanie

Additional reading:

[url:1662,type=|node|,content=|Benefits of heat therapy for low back pain|]
[url:896,type=|node|]
[url:137,type=|term|]

Back Pain Sufferers: Avoid These 6 Common Mistakes

spine-health — Thu, 10 May 2007 16:16:08 -0700

May 10, 2007
by: Stephanie

If you have [url:145,type=|term|,content=|back pain|], make sure you’re not inadvertently making your situation worse with the following common mistakes:

Mistake #1: Ignoring your pain for too long
While it's true that [url:896,type=|node|,content=|low back pain|] usually gets better within a few weeks, this doesn’t mean that you should ignore it. Pay attention to the pain and go to spine specialist to get a diagnosis and treatment plan. With a correct diagnosis, you can start an appropriate [url:1723,type=|node|,content=|exercise regimen|] that will minimize future pain.

Mistake #2: Relying on your GP for too long
Primary care physicians and general practitioners don’t have in-depth training in spine medicine, so it may be harder to get an accurate diagnosis and/or treatment plan. If your back pain is severe and lasts for more than a couple of weeks, I recommend going to a doctor of [url:166,type=|term|,content=|chiropractic|] or a spine specialist – such as a [url:1720,type=|node|,content=|physiatrist|] who specializes in treating back pain. Doing this sooner rather than later could help save you a lot of time, money and frustration in finding some pain relief.

Mistake #3: Jumping to surgery too quickly
For many, it’s tempting to view spine surgery as a "quick fix". However, with a few exceptions, it is typically recommended to try non-surgical treatment for at least several weeks or months before seeing a [url:1616,type=|node|,content=|spine surgeon|]. While surgery can fix a specific anatomical problem, such as a disc pressing on a nerve, the only way to completely heal is through a sustained exercise and rehabilitation program. Even with surgery, you’ll need to exercise.

Mistake #4: Postponing back surgery for too long
On the other hand, for certain conditions patients tend to do better if they have surgery sooner. For example, when there is arm or [url:887,type=|node|,content=|leg pain and weakness|] because a nerve root is pinched, it is often best to take pressure off the nerve root through surgery sooner to avoid developing nerve problems.

Mistake #5: Focusing on the MRI results
Time and time again people e-mail me about their MRI scan results. But this does not mean there is a problem. However – and I can’t stress this enough – the scan is just a picture, it doesn’t show pain. In fact, you may have terrible pain and an MRI scan that shows a normal-looking spine, or you may have an MRI that shows a large [url:885,type=|node|,content=|herniated disc|] yet have no pain. You need the full [url:885,type=|node|,content=|clinical diagosis|], and don't focus too much on just the MRI results.

Mistake #6: Staying still
This is probably the mistake I hear about most often: people with back pain staying as still as possible to avoid aggravating the back and triggering painful episodes. One or two days of doctor-recommended rest is fine, but over time lack of activity will in fact lead to more pain. Keeping your back and supporting structures flexible and strong means that they can better support your spine, hasten the healing process and minimize the chance of future pain or injury. The [url:1130,type=|node|,content=|ab and back muscles|] don’t get much exercise from everyday activities and need specific exercises.

Most importantly, back pain is different for everyone, so trust yourself – and get educated about your situation – so you have the best chance of getting better quickly.

By: Stephanie

Additional reading:

[url:896,type=|node|]
[url:1183,type=|node|]

Top Ten Reasons You Should Run from Your Surgeon

Tue, 08 May 2007 18:36:12 -0700

May 8, 2007
by: Peter

Read this before selecting a surgeon to operate on your back.

If the surgeon says "Everyone does well with this surgery". There is no surgery that does not have risk and always has a good outcome.
If hip surgery is their main focus and spine surgery comprises only a small part of their surgeries - it takes a lot of practice to get good at operating on the spine.
If they cannot clearly articulate what they think is the anatomic problem that is causing your pain and how they propose to correct it.
If they state "I always do the neck first and then do the back". This sounds ridiculous but it happens. It is highly unlikely that a patient would have anatomic lesions in both the neck and back.
If they propose doing a multilevel fusion in the lumbar spine for [url:815,type=|node|,content=|degenerative disc disease|]. The spine is meant to move and although fusing one or possibly two levels for a badly degenerated disc is reasonable, fusing multiple levels rarely is necessary or advisable.
If the surgeon does not offer a patient any [url:806,type=|node|,content=|non-surgical treatment options|] they may be operating under the old [url:6587,type=|node|,content=|"I have a hammer so everything I treat is a nail"|] adage.
If they get perturbed by the [url:1505,type=|node|,content=|patient asking questions|]. A well qualified informed physician does not mind a patient asking questions. A marginal physician is more likely to be put out by an inquisitive patient.
If the surgeon states that he has never done this particular type of surgery but would like to try it.
If the first surgery does not work and the surgeon proposes doing it all over again. The most common reason [url:1470,type=|node|,content=|a surgery does not work|] is that the patient did not need the surgery in the first place.
If the given reason for proceeding with surgery is that the surgeon needs a new boat.

Posted by: Peter Ullrich, Jr., MD

Additional resources:

[url:1462,type=|node|]
[url:1792,type=|node|]
[url:1547,type=|node|]
American board of spine surgery

How to Help your Surgeon Help You

Tue, 01 May 2007 19:12:52 -0700

May 1, 2007
by: Sylvia Marten

Anyone who has experienced [url:137,type=|term|,content=|chronic low back pain|] knows how frustrating it can be to find a doctor to help. From a surgeon's perspective, I often see patients who have seen multiple other doctors and physical therapists and have not had relief of their pain. (After all, if non-surgical treatment was working they wouldn't be coming to me to get a surgical opinion in the first place.)

If you've had your back pain for a long time, you already know that finding the cause of the pain and an effective treatment is quite complicated. Treating chronic low back pain is almost like detective work, and the better the communication is between the patient and the physician, the better the expected outcome. Apart from basic courtesies such as arriving to your appointment on time with all your paperwork ready, there are several important things that you can do to assist in your own care.

Treating chronic low back pain is almost like detective work, and the better the communication is between the patient and the physician, the better the expected outcome.

Document the treatments you've already tried
Knowing ahead of time what you have tried and whether it worked (even if it worked for only a short time) is helpful. The more information you can give pertaining to your prior care, the less time will need to be spent [url:1872,type=|node|,content=|re-exploring these treatments|]. Being specific about the treatments is also very important.

Just saying you have tried physical therapy is meaningless. What the physician will want to know is what was tried in [url:1183,type=|node|,content=|physical therapy|] and for how long. Are you still continuing with an excercise program? Did the therapy just consist of ultrasound and hotpacks with no active excercise? Were you instructed in core stabilization exercises?

Similarly, if you have tried [url:1915,type=|node|,content=|pain medications|], the physician will want to know the specifics on which medications have been tried, at what dosage and for how long. Did they help with the pain or help increase daily functioning? The same is true for any injection. What kind of injection was it? Did it help and if so how much and for how long.

Having all of this written out prior to the appointment will help the physician be able to quickly understand and assess your situation, and it'll make sure you don't forget anything.

Bring any prior imaging studies
Besides the history and physical exam, the next most important piece of information to a surgeon is the [url:729,type=|node|,content=|imaging studies|]. The actual imaging studies are what will be needed. Reports on imaging studies (vs. the image itself) are pretty much meaningless as there is no standardized terminology for reporting on imaging study findings. Old studies can also be useful to see if there are any progressive changes.

Ask the physician in person for any paperwork
At the end of an interview, you should not be afraid to request any needs you have such as medication refills or return-to-work paperwork. It is far easier to close out all these practical problems of chronic low back pain while you have face to face time with a physician rather than ask their staff for these items on their way out of the office or calling back later.

Keep the peace
Lastly, while dealing with chronic low back pain is frustrating, and we all know that dealing with the healthcare system can also be frustrating, it never helps to get angry with your surgeon on the first visit. This may sound obvious, but it happens. Some patients lose perspective and take their anger and frustration out on the surgeon, which will not help the patient and may cause the surgeon to ask them to leave.

Remember, especially if this is the first time you are meeting with a surgeon, he or she is not to blame for your pain and may actually be able to provide your best chance for some pain relief.

Have clear expectations of what a spine surgeon can do for you
When you consult with a spine surgeon, what he or she will be mainly looking for is an anatomic lesion (problem) that is both the probable cause of your pain and is amenable to surgery. Basically, [url:1563,type=|node|,content=|spine surgery|] can only decompress a nerve or stabilize a painful motion segment, and these two conditions comprise a surprisingly small percentage of all the causes of chronic low back pain.

In about 80-90% of cases no anatomic lesion can be found as a cause of the patient's pain. This does not mean the patient has no reason for the pain he or she is experiencing; it just means that an anatomic cause of pain is not identifiable and this is not uncommon with back pain. Understandably, this disappoints many patients, as they may feel their pain has not been validated and surgery cannot provide a clear course of action for pain relief.

After the initial consultation, a spine surgeon should be able to tell a patient whether he or she may be a surgical candidate. Most patients conditions will fall into one of three categories.

They may definitely have a surgical lesion
They may have a lesion that is potentially surgical but requires further work up
They may have no identifiable anatomic lesion as a cause of their pain.

The patient is the only one who has the pain, and the only one who knows how it is impacting his or her life. The surgeon should be able to articulate what can technically be done and what kind of postoperative course and outcome a patient can reasonably expect. Armed with the knowledge from the surgeon a patient should be able to make an informed decision. The patient information on this site can help a patient with their decision making process.For those patients who have an anatomic lesion that potentially may be treatable by a surgical procedure, they will want to know the same above information before further workup. If they do not have enough pain to undergo surgery, further workup is not warranted. For instance, if the proposed surgery is a fusion for degenerative disc disease, and a discogram is necessary as a preoperative study to confirm if surgery would help, a patient may choose not to undergo the discogram if they do not wish to consider fusion surgery.

If a surgeon cannot articulate what a patient has and what type of treatment will be potentially advantageous, the patient may want seek yet another opinion. After all, deciding on surgery can be very difficult and if the surgeon cannot help in this process, it is doubtful he or she will be effective in helping one deal with postoperative rehabilitation or treating potential postoperative complications.

Additional resources:

[url:1547,type=|node|,content=|How to select a spine surgeon|]
How to find a good spine surgeon

Lumbar Herniated Disc: Is Surgery Better?

Sat, 31 Mar 2007 12:04:33 -0700

March 31, 2007
by: Sylvia Marten

Surgery Videos

A very large study, the Spine Patient Outcomes Research Trial (SPORT) has recently concluded and found that both surgical and non-surgical treatments tend to help patients with pain from a [url:715,type=|node|,content=|lumbar herniated disc.|] Due to problems with the study design, however, it is difficult to say much more than that. Unfortunately, because the trial did not demonstrate that surgery is superior to non-surgical treatments for a lumbar herniated disc, there is new concern among spine physicians that insurance companies may now cite this study as "evidence" that surgery is not necessary.

[url:1581,type=|node|,content=|Lumbar laminectomy|] or [url:1584,type=|node|,content=|microsurgical discectomy|] for lumbar disc herniations is the most common spine operation performed in the United States. Although this operation has a long history of safety and reliability, there are large variations in the frequency of the procedure in the U.S. There have been several studies in the past that have compared non-surgical treatment of [url:5990,type=|node|,content=|lumbar herniated discs|] with surgical treatment, but none have been on the scale of the recently released Spine Patient Outcomes Research Trial (SPORT). Published in the Journal of the American Medical Association in November, 2006, this study was coordinated by Dr. James Weinstein of the University of Vermont. It began in 2000, and included 13 different sites. 500 patients who agreed to participate in the study were randomized into either surgical vs. none surgical treatment arms.

The purpose of the study was to determine if there was either equivalence or superiority between the two types of treatment (surgery vs no surgery). The data were collected at multiple time intervals for 2 years and the two treatment arms were compared. Overall, both patient treatment groups had substantially improved by two years, and while there was a general tendency for the surgical group to do better, the differences between the two groups were not statistically significant.

Although the two groups fared roughly the same, the authors could not conclude that surgical and non-surgical outcomes were equivalent, because:

45% of the patients randomized to the no-surgery group switched to having surgery, and
40% who were randomize to the surgery group declined the surgery.

With this amount of crossover, it was difficult to draw any solid conclusion as to whether or not the two treatment options were equivalent or if one is superior.

The main problem with non-adherence to randomization and the crossover between groups is that there was a general tendency for patients with severe symptoms to choose surgery even though they had been randomized to the no-surgery group.

Patients who had been randomized to surgery and subsequently declined to proceed with surgery tended to have less severe symptoms. The authors also very wisely followed the patients who declined to be randomized during the two year follow up. These patients chose to have surgery at a better than 5:2 ratio. Basically, if a patient has severe symptoms and cannot manage their pain through non-surgical treatment options they will choose to proceed with surgery.

Both treatment options did eventually lead to satisfactory results in the majority of patients, so it can be concluded that a patient with [url:887,type=|node|,content=|leg pain|] due to a [url:885,type=|node|,content=|disc herniation|] can expect a favorable outcome. This study also was consistent with past studies in that surgery leads to a quicker resolution of symptoms. Lastly, both treatment options are relatively safe. The surgery group had no complications in 95% of the cases, and not having surgery did not lead to any episodes of serious neurological damage (e.g. cauda equina syndrome).

What patients can conclude from this study is that if they have pain from a disc herniation, trying [url:154,type=|term|,content=|non-surgical treatment|] is a reasonable option. If they can control their pain with non-surgical treatment options (medicines, injections, therapy, manipulation, etc...) continuing with this type of treatment is reasonable. If not, [url:165,type=|term|,content=|surgery|] is a reasonable option and can be expected to lead to quick and reliable resolution of the patient's symptoms.

For physicians, this study is useful in that it confirms that not all patients with leg pain ([url:1038,type=|term|,content=|radiculopathy|]) from a lumbar disc herniation need surgery. It also confirms that surgery is safe and reliable for those patients who fail conservative treatment.

The real danger of a randomized controlled study of this magnitude that did not show superior results with the more expensive surgical treatment option, is the federal and private health care systems of this country may use this information to deny patients surgical treatment. Payors of all kinds are trying to ration care they will pay for based on "evidenced based" guidelines from the literature. What is not provided, however, by the literature is that not all diseases have the same severity. There was little stratification in this study as to severity of symptoms, and what little stratification there was showed a general tendency for patients with more severe symptoms to choose surgery, even when randomized to the no-surgery group.

In an effort to save money, payors would like to deny patients' requests for invasive interventions. They will claim the treatment is medically "unnecessary". Of course, they have not seen or examined the patient, and are simply following an algorithm. In our practice, we are already seeing insurance companies denying surgery for patients with severe leg pain due to a disc herniation unless they first have three epidural injections. We have observed that patients with a lot of tethering of their nerve root (a positive straight leg raise) actually have increased pain after trying to inject around the nerve root. I have also noted over the years that patients with a very shallow canal are less likely to benefit from non-surgical treatment. Patients who have already had their pain for several months can expect little benefit from an epidural injection. At any rate, there are always extenuating circumstances, and this should not be a decision made by the insurance company, but a decision made by the patient after consulting a spine expert. It would be a travesty if this very Herculean effort at a large research study such as the SPORT study was used to deny patients care that is beneficial in certain circumstances.

What Every Back Pain Patient Needs to Know

Tue, 20 Mar 2007 13:25:21 -0700

March 20, 2007
by: Peter

The old adage "if all you have is a hammer, everything looks like a nail" applies in spades to treatment of back pain. Doctors tend to have a way of looking at a patient's problem in terms of what their skills can do - a surgeon evaluates patients in terms of whether or not they should have surgery, a pain medicine anesthesiologist will consider an injection, and a [url:1636,type=|node|,content=|chiropractor|] will evaluate patients for manual manipulation therapy. So when a back pain patient goes to three different doctors, he or she will typically get three very different treatment recommendations.

So what's a patient to do?

Well, on Spine-health.com we first and foremost advocate getting educated - simply go to some patient information sites, make sure the information is reliable, and research your symptoms, diagnosis, treatment options - so that when you talk to your doctor you're informed and able to ask to the right questions and have some context in which to evaluate the responses. That is definitely the first thing you should know. But there's one other thing you should know too: with all the complexity involved with back pain diagnosis and treatment, it's sometimes not feasible for one doctor to know enough to be able to make the right recommendations. You could consult with three or four doctors for their opinions, but this is quite a hassle, and if you're in a great deal of pain then you might not want to wait that long. Here's where [url:1944,type=|node|,content=|integrated back care|] comes in: you can go to a spine clinic that has all of the specialists working together under one roof.

What does [url:1944,type=|node|,content=|integrated spine care|] mean for you?

No more losing your MRI scans while they're being transferred from one clinic to another - your MRI's, other tests and medical file all stays in one place
No more having to listen to a surgeon tell you why a chiropractor can't be trusted, or vice-versa - they've already agreed to work together, so you know they trust each other and value each others skills
No more having to find physicians who specialize in back pain on all your own and go for several opinions - you know that the different specialists (physiatrists, physical therapists, chiropractors, surgeons, etc.) all specialize in spine care, and with integrated care they should all be working on your case.

Traditionally, the practice of medicine has been an individual effort, with one or two person clinics, but as the field of medicine has progressed there are lot more treatment choices available for many disease entities and collaboration among physicians as become more important. This is particularly true with back pain, where each specialty brings a certain skill set to the treatment of patients with complicated problems such as chronic low back pain. Integrating the different specialities gives patients options for treatment that are not be as readily available in single specialty practices.

If these same specialists are collaborating with one another in an integrated clinic (and not competing against each other), they will be much more inclined to offer a patient [url:1943,type=|node|,content=|more treatment options|] in a more fair and balanced fashion. Also, they are more likely to learn from the other specialists what does and does not work for any particular diagnosis.

In my practice, we believe the patient also benefits from focusing on non-surgical care first. Patients are usually first diagnosed and treated by a chiropractor, physiatrist or physical therapist, or by a combination of these specialists. If they do not find enough pain relief with these treatments, or if their pain is so bad that they are unable to function, then they are referred to a spine surgeon in our practice for evaluation and possibly surgery.

I'm interested to read your thoughts.