When to Get Medical Help for Back Pain?
September 3, 2008
Many of us have had some kind of back pain. According to the Journal of the American Medical Association, back injuries have been the most expensive health-care problem for people ages 30 to 50.
«Back pain is probably the commonest reason people seek help for pain management other than acute post-surgical pain,» says Dr. Michael Ramsay, chief of the department of anesthesiology and pain management at Baylor University Medical Center at Dallas.
Yes, sometimes over-the-counter meds work. But not always. So how do you know when it’s time to move past ibuprofen?
We asked Dr. Ramsey. But first, he told us this:
«Pain is a wonderful thing. That sounds crazy, but it’s your body’s way of telling you something is going on and we need to protect this area of the body.»
Here are his suggestions and comments about when to seek professional help for pain:
1. When it’s not eased by current medications or coping techniques.
2. When it disables you to the point you can’t function. «You can’t get up, you can’t get dressed.»
3. When it has lasted more time than seems reasonable. How much time depends on the severity of the pain, he says. Allow more time for less-severe pain.
4. When it’s accompanied by numbness. «If a nerve injury is associated with the pain, time is of the essence. If the nerve is getting compromised, the chance of getting it back is smaller if you don’t seek treatment.»
5. When it’s causing stress or emotional fatigue. «We look at the effect of this pain. What is the patient’s general health? What’s their mobility? Are they depressed? Depression is a factor on the longevity of pain, on the pain continuing.»
He also has tips for avoiding back pain: Exercise, and learn how to do so correctly. Try aquatic sports. And, if the pain remains, seek help in a facility that deals with the physical, mental and emotional aspects of pain.
«The more specialties you have working together, the best outcome you’ll have,» he says. «It’s all about treating the whole you.»
BY LESLIE GARCIA / The Dallas Morning News
Posture Is Key to Keeping Neck Pain In Check
September 3, 2008
Waking up with a stiff neck can be the first sign of a really bad day.
And chances are, it’s your own fault.
There are dozens of possible causes for a stiff neck – everything from a virus or the flu to arthritis or degenerative disease in the neck or spine.
But, most likely, what you really need to do is listen to your mother. Stiff necks are usually caused by bad posture.
«Most instances of what people call a ‘crick in the neck’ are caused by a person’s positioning while asleep,» says Dr. Brian Bruel, an assistant professor at UT Southwestern Medical Center with dual appointments in physical medicine and rehabilitation, and anesthesiology and pain management. «You’re sleeping with your neck at a weird angle, and that causes muscle strain.»
Treating a crick
Assuming the pain is not caused by an injury, here are Dr. Bruel’s suggestions for treating the crick:
First, eliminate worst-case scenarios. If your stiff neck is accompanied by headache and a fever, there’s a chance you have meningitis. The pain tends to be quite severe with meningitis. Although this is a very unlikely possibility, call your doctor immediately if all three symptoms are present.
For a garden-variety stiff neck, try gentle, range-of- motion stretching exercises as your first line of defense.
«Try turning your head slowly toward the side with the ‘crick’ for about 10 to 15 seconds,» Dr. Bruel says. Turn the head up and down, side to side and ear to ear. Repeat as tolerated throughout the day.
If the problem persists, or you have spasms, apply ice. Do this for the first 48 to 72 hours, and if cold doesn’t work, try heat – hot packs, a heating pad, hot showers or compresses.
Pain relievers can help. Dr. Bruel recommends ibuprofen. But if that upsets your stomach, acetaminophen works well, too.
Getting to the root
Those measures will help the symptoms, but you must address the causes. Bending over a desk for hours, slumping in front of the television or curling up the wrong way with a book can contribute to a stiff neck. Consider these:
- Stand up straight: Dr. Bruel tells patients to stand straight by picturing a plumb line that aligns the ears, shoulders, hips, knees and ankles.
- Keep your head on: Your head weighs five to 10 pounds. It should sit atop your neck, forming a straight line. Holding it too far forward or back strains neck muscles.
- Sleep tight, sleep right: Your head should be positioned in a straight line with your neck. «Use pillow rolls to get the neck in that plumb-line position,» Dr. Bruel says. «Even if you sleep on your side, your neck should not be too far forward.»
- Ergonomically correct: Do you sit at a computer all day? Keep your head straight and your back supported.
«Leaning forward shortens the neck muscles, so when you lie down at night, they’re still tight,” Dr. Bruel says. “We’re not made to be all scrunched up all day or all night.»
By MARY JACOBS / Special Contributor to The Dallas Morning News
The 5 Myths of Pain Relief
September 2, 2008
Local pain specialist Dr. Bradley Carpentier has narrowed down what he calls the five myths of pain. The most common, unfortunately, is the myth that all pain can be cured.
«I think our expectation is all pain problems can be solved,» said Carpentier, sitting in his Salinas office. «Unfortunately, not all pain can be relieved.»
With private practices in Salinas and Monterey, Dr. Carpentier is board certified in anesthesiology and pain medicine by the American Board of Anesthesiology. His special interests include the treatment of painful neuropathic conditions — chronic pain caused by injury or damage to the nerve system — using neuromodulation techniques, including spinal and peripheral nerve stimulation.
Part of the problem, Carpentier said, is people’s insistance on ignoring pain until it’s too late. By the time they address the issue, there is little that can be done to address it.
«I have patients that come in and they can’t put their foot on the ground. They can’t put on a shoe or a sock,» he said. «If we had gotten to them earlier, we could have done something.»
Another issue is patient’s ignorance of pain specialists and what they do. Often they are lumped in with other specialists, and some family physicians will not refer their patients to see a pain specialist.
About 70 percent of the patients Carpentier works with have spinal pain or are recovering from surgeries. But he said he treats all sorts of pain, from chronic aches to repetitive motion pain.
Carpentier breaks down the five myths of pain:
- Doctors can almost always take the pain away: You hear advertisements that promise to rid you of your pain, when in reality it is rare that pain is completely cured.
«As a pain specialist, I give my patients specifics when looking at the best treatments, but I don’t over promise and I never overtreat, as this can make things worse,» he said.
- The best remedy is pain medication: It is important to treat drugs as a possible short-term solution. Long term it is much better for patients to learn how to effectively manage their pain.
«This may not be what my patients want to hear, but it is better for the body to use both short- and long-term strategies in order to heal properly,» he said. «Drugs can actually make you feel worse and can leave you feeling dopey — it is better to live life fully aware of your surroundings.»
- Alternative treatments don’t work as well as drugs: Carpentier said the right state of mind is the key to healing. Some alternative treatments work very well for patients, without the risk of dependency.
«While drugs are sometimes necessary, I encourage my patients to try things like hypnosis, meditation, biofeedback, physical therapy or specific exercises to help manage and even alleviate their pain,» said Carpentier.
- Talking about pain can make it worse: Some think that if you discuss your pain with others that it makes it harder to live with. This is only true if you continue to complain, without constructive conversations.
«I have my patients on an online journal program to help them manage their pain and explore for themselves better ways to manage it,» he said. «That way we are a team working toward the best solution. Diaries sometimes help you ‘get it out’ and keep your conversations with others more positive.»
- Exercise makes pain worse: Often there is nothing better than working out, as long as it is in proper form.
«I enjoy treating athletes because they tend to really pay attention to how their bodies work and they have a potential to heal faster and better,» he said. «Make sure you discuss your method of exercise with your physician and don’t overdo it. When you reach your goals you can be even more proud of yourself for completing your regimen with added challenges.»
For more information on pain care, visit the Web site of the American Chronic Pain Association at www.acpa.org.
Guardian: At last, the cure for back pain?
September 1, 2008
A new study has shown that the Alexander Technique may be more effective than other common methods of treating back pain. But what is it, and how does it compare with other techniques? Sam Murphy looks at the evidence.
Back pain. If you haven’t got it now, the chances are you’ve either had it in the past or will get it in the future. Statistics show that seven in 10 of us suffer from it at some time in our lives. And it is one of the most common causes of sickness absence and disability in the western world. In fact, research from the British Chiropractic Association earlier this year found that in the UK, back pain is on the increase, rising from 47% of people “currently suffering” in 2007, to 52% in 2008.
Although the days when bed rest was the standard treatment for chronic back pain are long gone, the medical profession has yet to find a single effective solution that it can uniformly prescribe, thanks to a dearth of scientific evidence and, where studies have taken place, conflicting findings. But one back-pain treatment option for which there has been little funded research in the past (and therefore, scant evidence to support its use) is now making news in the medical community – the Alexander Technique (AT).
A study published this week in the British Medical Journal reports the results of a large-scale trial on the effects of AT on back pain. The study, which took place at GP practices in Southampton and Bristol, hypothesised that AT could alleviate back pain by limiting muscle spasm, strengthening postural muscles, improving coordination and flexibility, and decompressing the spine. One year on, the results bear this out: subjects who received 24 AT lessons reported an average of three days of back pain per month, compared with 21 days per month in the control group. The AT group also reported better function and quality of life.
So what is AT? I’ve asked many an Alexander teacher this over the years, and it’s a question that even they find difficult to answer. «What AT isn’t is a series of gentle exercises,» says Elizabeth Dodgson, an AT teacher in west London, and a trustee of the charity BackCare. «It’s not about being taught fixed positions (postures) in which to hold the body and it isn’t manipulation, like, say, physiotherapy or massage.»
Dodgson is happier talking about what AT does, than what it is. «The goal of AT is to set up the right circumstances under which the body can function as it was meant to,» she explains. «You’re learning the tools you need to use your body more effectively and efficiently and getting to know your patterns and habits, so you can let go of the bad ones. The hands-on element is important because it helps you feel how a movement can be different. That’s difficult to do from a book.»
It’s no coincidence that AT talks of pupils and teachers, rather than therapists and patients: there is a strong educational element involved. AT sessions are usually one on one, and the onus is on exploration and awareness rather than on forcing and fixing things.
Many common therapies involve lying down while someone «does» something to you but AT is a practice that you «do» yourself. Does Dodgson think that this «taking part» in your own treatment is an important factor? «Definitely. By the time people walk through the door, they are usually willing to change something,» she says. «They’ve been through the ‘my back’s not working – can you fix it?’ mindset and tried a lot of other things so by the time they come to me they are more open to change.»
The difficulty in pinning down what AT is, or doing it yourself at home, is probably one of the reasons why it hasn’t been embraced by the medical profession, thus far. «With physiotherapy, you can receive some treatment and be shown all the exercises you need to do in, say, six sessions,» says Dodgson. «With AT there’s no clear timescale or end point. It’s a bit like learning a musical instrment. At what point have you ‘learned it?’» Lessons cost around ?30 each, and Dodgson says that after 20-30 lessons you should have learned enough about your body to continue working on your own.
To find an AT teacher visit stat.org.uk. Tel: 0845 2307828.
How does the Alexander Technique compare with other treatments?
Pilates
Pilates is often the first port of call for people with back pain, as far as exercise is concerned. Indeed, a study from Queen’s University in Ontario, Canada, found that it was valuable in alleviating non-specific lower back pain. But Lynne Robinson, director of the Body Control Pilates association advises, proceeding with caution. «Pilates is not a treatment for back pain,» she says. «We don’t diagnose and we don’t treat – our role comes after treatment, and any good teacher will ideally work one-to-one, in conjunction with the client’s medical practitioner.»
A key element of Pilates is core stability training – exercises to work on the deep-set muscles situated in the trunk and pelvic area that have a role in protecting the spine and keeping the «core» of the body stable. A recent study from the University of Queensland found that isolation of the deep abdominal muscles could successfully improve recruitment patterns in lower back pain sufferers, reducing pain. But, contrary to popular belief about Pilates, it’s not all about the core. «Pilates is brilliant for backs because it works the spine through all its planes of movement,» says Robinson. «Extension, flexion, rotation and side flexion – as well as teaching good body awareness and use, improving breathing and posture.»
· To find a qualified Pilates teacher, visit pilatesfoundation.com.
Chiropractic
There’s a lot more to chiropractic than crunching and clicking bones and joints, according to Tim Hutchful from the British Chiropractic Assocation. «Chiropractic is wrongly pereceived to be simply a manipulative technique – that’s just like saying dentists only do fillings,» he says. «It’s actually a complete package of care, which could involve everything from hands-on treatment to postural assessment and stretching.»
«Most back pain is accumulative.» – says Hutchful. «Symptoms are the last thing to come and the first thing to go – so we tend to blame the problem on the last action we did, rather than looking at the bigger picture.» There has been some controversy about manipulative techniques, however, Hutchful argues that the chiropractic treatment package offers the opportunity to prevent the likelihood of problems happening in the first place, by addressing everything from the pen you write with to the way you pick up your baby. «When a patient walks in, yes, I want to alleviate their pain, but I also want to look at its cause and the aggravating factors, because without addressing these, the problem will return.»
· To find a chiropractor, contact the British Chiropractic Association chiropractic-uk.co.uk.
Osteopathy
While a Pilates or AT teacher isn’t qualified to diagnose your back pain or prescribe treatment, an osteopath is. In fact, osteopaths specialise in dealing with back pain – non-specific chronic cases as well as acute injuries and post-surgery rehabilitation. «The role of the osteopath is to help the individual manage themselves in ways that will optimise their recovery,» says Professor Eyal Lederman, who is registered with the General Osteopathic Council. «Treatment will likely involve a combination of hands-on treatment, movement re-education and exercises to practise at home, as well as the development of coping strategies.» Even while looking specifically at back pain, an osteopath will take into account the health of the entire musculoskeletal system and treat the whole body, rather than just focusing on a specific symptom or region of pain.
While many people find relief from back pain from osteopathy (expect to feel the benefits within two to six sessions) one study, published in the New England Journal of Medicine, found that it was no more effective than «standard care». That’s not to say that it is ineffective – just that both approaches work equally well (and osteopathy subjects need fewer painkillers).
· To find a registered osteopath contact the General Osteopathic Council, osteopathy.org.uk. Tel: 020-7357 6655.
Acupuncture
Sceptics argue that the benefits of acupuncture are in the mind, or at best temporary, as the treatment addresses only the symptoms (pain) and not the underlying cause (for example, by addressing posture). It is based on the theory of energy or «chi» pathways throughout the body. Problems occur when there is an energy blockage, and acupuncture needles are said to help get energy flowing freely again. A study from the University of Maryland lends weight to this argument – researchers analysing the findings of 33 different studies concluded that it did have a positive effect on lower back pain – in the short term. But what about in the long term? One small British study found a modest reduction in back pain in patients who received 10 sessions over a three-month period – and pain levels were still lower than a control group two years later.
Acupuncture is also said to increase levels of the natural pain-killing chemicals in the brain, endorphins, as well as relaxing the muscles.
· For more information, contact the British Acupuncture Council: acupuncture.org.uk.
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