Medical Care & Diagnosis

Pain Management Cheat Sheet

Pain management is one of the oldest areas of medicine. And just as there are many different causes of pain, there are many different treatment options. One of the most controversial options is pain-relieving drugs, especially the long-term use of opioids for chronic pain. One thing is for sure – all patients should have access to a variety of pain management options. Pain-relieving drugs may be the right choice in some cases, but they should never be the only option on the table. A recent bill sponsored by Wisconsin congressman Ron Kind serves to highlight this issue. Many veterans receive only drug therapy for their chronic pain. The bill, called the Chiropractic Care Available to All Veterans Act, would make chiropractic care a standard benefit of Veterans Affairs health care, and require chiropractic care and services at every VA medical center by the end of 2016. The bill is also supported by the Veterans of Foreign Wars, Paralyzed Veterans of America, the American Legion, Vietnam Veterans of America, National Chiropractic Leadership Conference, and the American Chiropractic Association. Pain management is a major health care issue in America. According to the National Institutes of Health (NIH), pain affects more Americans than

April 14, 2015

A Look at Spinal Manipulation Therapy and Back Pain

If you’ve ever been to a chiropractor or had a professional “crack your back,” you may have been a recipient of spinal manipulation therapy (SMT). Spinal manipulation, also called spinal manipulative therapy or manual therapy, is used in both Western and traditional East Asian medicine; in North America, it’s typically performed by chiropractors, osteopathic physicians, and physical and occupational therapists. Over 100 types of adjustment techniques are known throughout the world, but typically chiropractors will focus on eight to 10 varying approaches within their practice. Spinal manipulation therapy uses force, while spinal mobilization therapy is gentler. Some conditions such as osteoporosis, the patient’s size, or simply patient comfort may require spinal mobilization therapy. Chiropractic treatment can be extremely effective for acute neck or back pain due to muscle spasm, strain or sprain, and inflammation. If you’ve never experienced it before, it can be surprising just how much force can go into the manipulation of different joints of the spine. The most frequently used technique in SMT is the high-velocity low-amplitude thrust, which often results in an audible “pop.” A more sophisticated technique relies on using a flexion distraction technique that is somewhat gentler and safer. The goal of these techniques

April 8, 2015

Acupuncture and Back Pain

Does acupuncture work for pain relief? It’s a question that’s been debated by the medical community for some time, but of late, more and more physicians have come down on the side of supporting it, or at least maintaining that it does no harm. In 1998, the National Institutes of Health (NIH) stated that there was enough evidence to show that acupuncture has beneficial, pain-relieving qualities for adults suffering from postoperative dental pain, the nausea of chemotherapy, lower back pain, headache, myofascial pain, osteoarthritis, and carpal tunnel syndrome. There have been several important studies that report acupuncture is effective in reducing chronic pain. Most recently, a study in the Journal of Clinical Pain suggests that people being treated for lower back pain with acupuncture are less likely to gain benefit from treatment if they have low expectations for its effectiveness – an interesting twist to the earlier findings on pain relief. Emotion and attitude seem to have quite an impact on acupuncture’s efficacy. Dr. Felicity Bishop, author of the study, wrote: People who started out with very low expectations of acupuncture – who thought it probably would not help them – were more likely to report less benefit as treatment

April 1, 2015

AARP’s Surgeries to Avoid

An AARP article that discusses common surgeries to avoid – including spinal fusion – has recently made its way back into the headlines. Specifically, it cites studies that show the frequency of this procedure has increased 1,400 percent between 2002 and 2007, and does not appear to be slowing down. The article suggests that the surgery is dangerous and is no more effective than physical therapy, which is inaccurate and misleading. Spinal fusion involves the joining of two or more vertebrae together, using screws and rods along with bone graft material, and sometimes cages (devices that support the vertebra). These techniques provide strong support for the spine, as well as correction of alignment and protection of the spinal canal and nerves. While spinal fusion has increased in frequency, in my experience it is a safe and highly effective treatment for patients when performed properly and for the right diagnosis. The key to success is careful selection of the patients who need a fusion (i.e., performing the procedure for the correct diagnosis), and also performing the surgery carefully to achieve maximal success (i.e., achieving a solid fusion). Where patients and doctors get into problems is when the procedure is performed for a

March 10, 2015

Back on the Dance Floor: Kathryn’s Patient Experience

Kathryn is a former patient of mine who has left a lasting impression. Her back pain began when she hurt her L3/L4 disc after a spinning class, and she believes she aggravated the injury during a subsequent game of golf. Initially, Kathryn told me she didn’t think too much of it because she’s athletic and used to pushing herself outside her comfort zone. Kathryn thought this was something she could deal with – so she sought a massage treatment, iced her lower back area, and rested. Afterwards, she continued to play golf and attend spinning class. Unfortunately, what Kathryn didn’t do was listen to her body and get help when she needed it. I see this in a lot of patients; a good rule of thumb is if the pain persists, starts to travel down your arm or leg, and/or keeps you up at night, it’s time to see a physician. Unfortunately, the pain took a turn for the worse when Kathryn further exacerbated her injury lifting a mattress while vacuuming. Kathryn contacted my office and met with me to discuss different options that would work for her injury. Because she had severe nerve compression in her lower back due

February 3, 2015

How to Find the Right Mattress

Your bed may be the most important piece of furniture in your home. After all, we spend roughly a third of our lives sleeping, recharging our bodies and minds for a new day. But when that sleep is interrupted by back pain, it’s time to start learning how to find the right mattress. Decide if it’s time to get rid of your mattress. How do you know when it’s time to get rid of your mattress? Good mattresses typically have a lifespan of 10 years, but if you’re experiencing back pain, you may want to consider replacing it sooner. Choose the proper firmness. Mattress experts say many customers mistakenly think a firmer bed is a better one for dealing with existing back pain or preventing it. Those suffering from degenerative disc disease often find that the firmer mattress alleviates pain, but if that’s not your particular challenge, you won’t need the firmest mattress in the store. Too-firm mattresses can lead to pain at pressure points like the hips. A mattress that’s too soft, on the other hand, may make it difficult for you to move, and also will not give enough support. It’s important to know the difference between a

November 18, 2014

Feeling Back Pain at Night?

It’s hard enough experiencing back pain as you go through your day, but back pain at night when you want to sleep is especially grueling. Many patients experiencing nighttime back pain aren’t even especially uncomfortable during the day, but find that once they climb into bed, the pain may be too much to bear. These people find themselves in a nasty cycle: insufficient or interrupted sleep can exacerbate the very same pain that keeps them up each night. Nighttime back pain can be caused by a number of issues. Disc degeneration and arthritic changes as the result of aging may be to blame for some patients. A bulging or herniated disk putting pressure on a nerve can cause back and leg pain when lying flat. Sprains or fractures and conditions such as scoliosis, spinal stenosis, or even endometriosis may also cause pain at night. It’s possible that nighttime back pain may be an indicator of spinal tumors, though this is quite rare. Typically, mechanical causes of lower back pain will get better once you are in a comfortable position, but when you roll over in bed, may wake you up. Also they are often accompanied by morning pain or stiffness. Before turning in,

October 21, 2014

Ebola: What You Need to Know

If you’ve been paying attention to the news—and even if you haven’t—you know that an outbreak of the Ebola virus has been ravaging West Africa since August and, in recent weeks, has made its way to Spain and the United States. After approximately 10,000 cases and nearly 4,000 deaths in Liberia, Guinea, Sierra Leone, Senegal, Nigeria, the Democratic Republic of the Congo, plus two in Spain, one in Germany and one in the United States, there’s a lot of concern about what comes next. Of course, it all sounds scary, but this isn’t quite the dire situation of disaster movies. First discovered near the Ebola River in what is now the Democratic Republic of the Congo in 1976, the virus causing the current outbreak is one of five known strains. It is unclear where the virus originated or how exactly it spreads, but we believe the virus was probably transferred to humans by bats. The virus can only be spread by direct contact from person to person once symptoms have started. The virus is not thought to be spread by airborne mechanisms, but only by direct contact with bodily fluids. Outbreaks of Ebola have affected areas of West Africa sporadically

October 14, 2014

Your Hips and Back Pain

From day to day, as we walk, run, sit, and lie down, it can be easy to forget about our hips – that is, until they suddenly start to hurt. They need care, especially in relation to the rest of the back; the spine rests on the hips, so the hips have a very important job when it comes to alignment and posture. In fact, pain you feel in your hip may signal a problem in your back – and tight or weak hips can disrupt your back’s proper alignment. Some hip and back pain may be the result of lumbar spinal stenosis, a condition that becomes more common as we age past 50. In this condition, the spinal canal narrows, squeezing the nerves inside. In milder cases, symptoms can be treated with a combination of medications, physical therapy, and injections. In cases with severe narrowing of the spinal canal, surgery is necessary to get symptom relief. With arthritis of the hip, decreased range of motion can occur, which can put increased stress on the lower back. Also if one leg is shorter than the other, that can cause pelvic tilt which can induce scoliosis and abnormal stress on the vertebra and disks of the lower back. For muscular forms of hip pain, exercise can likely address the problems. Consider them part

October 7, 2014

Bras, Breasts and Back Health

With these exercises, you should be able to avoid discomfort or lessen existing back pain. If the pain is unbearable or is accompanied by tingling in the arms, I recommend consulting your doctor. Whether big, small, sports, or lace – industry figures show that women around the world spend $16 billion on bras. Aesthetics aside, many women find themselves dealing with the frustrating problem of upper and mid-back back pain caused by large breast size. Excessively large breasts, known as breast hypertrophy, put extra stress on the back extensor muscles and spinal disks, leading to muscle tension, spasm and pain. It can also exacerbate the symptoms of thoracic kyphosis, commonly known as hunch back or round back. Other symptoms include tingling in the arms from compressed nerves and pain from bra straps digging into the shoulders. Patients often come to me with the question, “Will breast reduction surgery help my back pain?” The answer is often yes if other treatments – such as physical therapy and postural exercises – fail. Bethannie Snodgrass, MD, plastic surgeon and author of When Less is More: The Complete Guide for Women Considering Breast Reduction Surgery explains, “As women get older and heavier, their shoulders

September 23, 2014

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