Neck 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|]
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[url:1080,type=|node|]

10 Lesser-Known Tips for Easing Neck Pain

cmaynard — Thu, 10 Sep 2009 08:42:03 -0700

September 10, 2009
by: Sylvia Marten

When common non-surgical treatments (e.g. NSAIDs, chiropractic care, neck exercises) or even surgery haven’t provided effective relief of [url:149,type=|term|,content=|neck pain|], patients often get creative and identify simple yet unique techniques they do on their own.

With the help of our dedicated forum community of neck pain sufferers, Spine-health has compiled some suggestions that have worked for these people, who certainly know what it’s like to deal with neck pain on a daily basis.

Take a Swim

Getting the water level up to the neck and simply moving around
Squatting until the water reaches the chin, and then moving back and forth and to the right and to the left.

If patients do not own a pool or can’t get to a community pool in the summers or an indoor pool in the winters, taking a bath every night is a popular alternative for other neck pain sufferers.

Utilize a Water Pillow

Keeping on this “water” theme, some patients note the rejuvenating effects of water pillows that allow patients to dictate the firmness of their pillow. Specifically, more water equals a firmer pillow; less water provides a softer pillow.

Various water pillow products are available on the market and may be worth considering for patients who have tried more traditional neck pillows and braces to no avail.

Consider Melatonin Sleeping Aids

Even the greatest pillow may have no chance against neck pain that interferes with sleeping. Various supplements that stimulate the hormone Melatonin (which is highest prior to bedtime) have been used by forum members and allowed them to at least get some much-needed quality restorative sleep.

Of course, when considering supplements, it’s important to do your own research and speak with a trusted medical professional about the benefits/risks involved.

Focus on Magnesium Intake

As many cases of neck pain are the result of muscle strains or sprains, speaking with a nutritionist about magnesium (an essential mineral that helps contract and relax muscles) may be worth learning more about.

Magnesium is found in certain fruits, vegetables, nuts, peas, beans, soy products and whole grains, and is also available in supplemental formats. Some forum members note how taking magnesium helps with muscle tightness in the neck.

Learn More about Acupuncture

Involving the insertion of thin needles into the skin, [url:1358,type=|node|,content=|acupuncture|] has been described as providing varying degrees of neck pain relief for forum members, with some people swearing by its effectiveness, others noting success about half of the time, and some other patients noting no relief.

One forum member raised the interesting point that the efficacy of acupuncture and deep tissue massage often depends on the skills of the practitioner, making it important for patients to research these treatment methods and really understand how to identify a skilled professional.

Get a Remedial Massage

Some forum members champion this type of massage for neck pain relief. But what’s the difference between a regular [url:1287,type=|node|,content=|massage|] and a remedial massage?

During a remedial massage, oil is applied to and massaged into the skin, with the purpose of penetrating the muscles and joints, removing toxins in the muscles, and ultimately relaxing the muscles and improving joint mobility.

Relax via Holistic Treatments

Stress can exacerbate neck pain; thus, holistic treatments like aromatherapy (during which essential oils are used for relaxation and mood improvement), meditative music, candlelight, etc. may be incorporated to soothe the patient and clear the mind of neck pain.

One chronic neck pain sufferer has experienced so much pain relief from holistic treatments that he now has made such therapy a nightly ritual.

Avoid Situations that Trigger Neck Pain

Other forum members note how limiting instances that often spur and exacerbate neck pain (like sitting at a computer for long periods of time, [url:1094,type=|node|,content=|driving|], heavy lifting, other activities that require heavy use of the arms) have helped achieve relief.

Others have noted modifying such activities, like bringing the steering wheel as low as possible and putting a towel behind their neck when driving, as preventative measures for neck pain.

Strategically Place Ice on Certain Areas

Neck pain may also be joined by nagging headaches and numbness and tingling in the back of the head, neck, shoulders and hands. Some forum members suggest putting [url:1664,type=|node|,content=|ice|] on different areas of the body (between the thumb and index finger, on the bone 1.5-2 inches behind the ear, on the indent between the middle of the eyebrow) to help achieve relief from such symptoms.

One creative forum member noted using a headband to secure the ice in these different spots and on the temple. And when his neck pain got really intense, he suggested slowly moving to and lying on the floor with a towel behind the neck.

Liquefy Medications

In some instances after [url:1563,type=|node|,content=|neck surgery|], swallowing difficulties may ensue. To compensate, some patients may ask their doctors for liquid versions of their medications or take matters in their own hands, crush their medications and stir in apple sauce, which one forum member did to seek relief.

Of course, sharing experiences with other neck pain sufferers may help spark other ideas for achieving desired pain relief and at least provide comfort that there are people out there who really do care. Consider joining the Spine-health Neck Pain Forum Community to share and gain additional tips.

These unconventional tips for relieving neck pain have worked for others. The hope is that some of them may work for you too, or help spur new ideas that will. Please leave a comment to let us know.

Other Resources

[url:6018,type=|node|,content=|Neck Pain Videos|]
[url:913,type=|node|,content=|Types of Neck Pain|]
[url:914,type=|node|,content=|Neck Pain Symptoms, Causes and Diagnosis|]
[url:163,type=|term|,content=|Alternative Care|]
[url:857,type=|node|,content=|Cervical Herniated Disc Symptoms and Treatment|]
[url:685,type=|node|,content=|Cervical Degenerative Disc Disease|]

"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

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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|]

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|]

FDA Approves Third Cervical Artificial Disc: the Bryan Cervical Disc from Medtronic

mlepore — Wed, 03 Jun 2009 08:00:17 -0700

June 4, 2009
by: Spine-health Staff Writer

After long trials of deliberation, Medtronic’s Bryan Cervical Disc became FDA-approved on May 12, 2009. The Bryan Cervical Disc, designed to alleviate [url:149,type=|term|,content=|neck pain|] and related disability caused by degenerative disc disease, had received a favorable FDA recommendation back in July of 2007.

Although approved, conditions have been put in place for the approval of the Bryan for the next ten years. Medtronic will be conducting a post-market study, which will include tracking of patients' neck disability index scores, radiographic information, neurological status and a number of other outcomes in addition to data on adverse events and explanted devices.

What is unique about the Bryan is it is designed to better mimic natural disc shock absorption. It is made of titanium and polyurethane, which is softer than the nuclei of competitive discs, such as the Prestige’s metal on metal design. The polyurethane in the Bryan raised questions on wear debris during the FDA panel, but was determined to not be an issue for short-term use. Long-term use is an area of concern though, and will be under surveillance.

The Bryan (Medtronic), Prestige (Medtronic) and ProDisc-C (Synthes) are the only cervical [url:164,type=|term|,content=|artificial disc replacement|] options for the U.S., although there are expected to be more approvals and launches soon. At this point, Medtronic has not commented on the Bryan’s approval, or on projected launch dates when it will be commercially available.

Posted by: Spine-health Staff Writer

Additional Artificial Disc Replacement sources:

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[url:1380,type=|node|]
[url:1388,type=|node|]
FDA approves Medtronic’s Bryan Cervical Disc

First Cervical Disc Replacement Surgery with ProDisc-C

spine-health — Fri, 25 Jan 2008 07:01:34 -0800

January 25, 2008
by: Sylvia Marten

The very first ProDisc-C surgery was performed last week since the FDA approved the device in December 2007.

Michael E. Janssen, DO, a Denver surgeon and a Spine-health.com Member, became the first physician in the United States to perform two cervical disc arthroplasties using the ProDisc-C Total Disc Replacement System. The ProDisc is designed to treat patients suffering from cervical disc degeneration and disc herniation, which occurs when natural shock absorbers in the [url:1113,type=|term|,content=|cervical spine|] become worn and start to degenerate, often resulting in pain, discomfort, and impaired cervical mobility creating neck and upper arm pain.

One of the patients was an active 35 year old male with cervical disc degeneration that developed as a result of a traumatic hockey injury, causing pain, stiffness, and numbness in his left-hand. The second patient was a 53 year old female accountant who had been suffering with neck and upper extremity pain from a disc herniation compressing her spinal cord.

Both surgeries were performed on January 16, 2008, and both patients pre-operative symptoms were gone the following day. The patients were discharged from the surgery center on January 17, 2008 with minimal pain.

The full story is available here.

Additional resources:

[url:685,type=|node|]
[url:857,type=|node|]
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[url:6001,type=|node|]

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.

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:

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[url:808,type=|node|]

Cervical Artificial Discs: Valuable New Technology or Fashion?

Wed, 12 Sep 2007 16:55:19 -0700

September 12, 2007
by: Sylvia Marten

Spine surgery, like many other areas of medicine that are experiencing rapid technological growth, is often subject to fashion trends. At this period in time, the fashion is tilted towards motion preservation technology – both in the lumbar spine (low back) and [url:1113,type=|term|,content=|cervical spine|] (neck). The first artificial disc was approved for the lumbar spine in November of 2004 (Charite, Depuy Spine Inc.) to much fanfare, but for a variety of reasons it has largely not lived up to its expected dominance in the spine industry.

In this author’s opinion, cervical artificial disc replacement should enjoy better overall acceptance and success than lumbar artificial disc replacement by insurance companies, physicians and patients for several reasons:

Preserving motion in the neck will work, because motion is not causing the pain

By its very nature, treating a cervical disc herniation with a motion preservation device (cervical artificial disc) is very different than treating chronic low back pain with a motion device. This is because motion is not the cause of pain for neck surgery, so using artificial disc replacement to preserve the motion (instead of fusion, which limits motion) is practical.

Neck surgery is done to relieve pressure on the nerve root. After removing the cervical disc something needs to replace the disc space or it will collapse (kyphosis). Traditionally, what has been left in the disc space is a bone graft to create a fusion and prevent disc space collapse. However, the motion in the disc space is usually not in and of itself a pain generator, and therefore preserving the motion in this space with a cervical artificial disc is reasonable.

Chronic low back pain because of a painful disc is entirely different from neck surgery. With low back pain, the disc itself may be the pain generator, or something else with the motion at the disc space may be generating the pain. Spine fusions for chronic low back pain work by limiting the motion at the painful level; but preserving the motion in this area by using a lumbar artificial disc may preserve the source of the pain.

Neck surgery to relieve arm pain is a more reliable procedure

When neck surgery is done to relieve arm pain (or [url:165,type=|term|,content=|back surgery|] is done to relieve leg pain, or [url:998,type=|node|,content=|sciatica|]) due to a pinched nerve the surgery is very reliable. However, neck surgery for either chronic neck pain (vs. arm pain), or low back surgery for chronic back pain (vs. [url:887,type=|node|,content=|leg pain|]) is not nearly as reliable. Artificial disc replacement surgery in the [url:149,type=|term|,content=|neck|] is indicated for arm pain, whereas the artificial disc replacement in the lumbar spine is not for leg pain (herniated discs). Lumbar artificial disc replacement is designed to treat chronic low back pain due to a painful disc (degenerative disc disease). Lumbar disc herniations resulting in leg pain, if they are treated surgically, are treated with a microdiscectomy, not a fusion or artificial disc.

Indications for cervical artificial disc surgery are more clear-cut

Besides being a more reliable surgery than lumbar artificial disc replacement, cervical artificial disc replacement will also have the advantage in that a new disease entity will not need to be considered. In lumbar artificial disc replacement the disease entity it was intended to treat - lumbar artificial disc disease - is not clearly defined and there is still quite a bit of controversy concerning proper surgical indications for degenerative disc disease, whereas cervical disc herniation resulting in arm pain ([url:1038,type=|term|,content=|radiculopathy|]) is very well defined and the indications are not at all controversial. For this reason, insurance companies will not be as reluctant to cover any added expense for a new procedure.

When the Food and Drug Administration approved the first lumbar artificial disc many felt that insurance companies would automatically cover the procedure. This did not happen and many have still not approved it as an alternative to fusion surgery. This was unprecedented in medicine as approval usually meant coverage. With the new realities of cost containment in medicine, new technologies with not only have to be proven safe and efficacious, they will also have to be cost conscious.

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

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|]

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