Do You Suffer From Back Pain?

Pain is a universal condition among humans. Whether from illness or accident, every person has felt pain at some point in their lives—in fact, many times for most of us. Fortunately, the vast majority of painful episodes, referred to as acute, are resolved rather quickly with medication that eases the discomfort until healing dissipates it altogether. Acute pain can result from broken bones, burns or cuts, dental work, labor and childbirth, soft tissue injury (such as whiplash), or surgery.

There are those individuals who are not so lucky, and pain becomes a constant in their lives. Pain that lasts more than three months is classified as “chronic.” Chronic back and neck pain are the most common complaints, and the leading reason people seek medical care. There are several root causes for chronic back and neck pain such as arthritis, cancer, degenerative disc disease, or trauma from a fall or vehicle accident resulting in soft tissue injury. The results can be severe emotional as well as physical pain. Depression is often a serious side-effect of chronic pain.

Pain management is a relatively recent specialty that addresses chronic pain through a wide variety of treatments that include:

  • Restriction of the activity that has been identified as the cause.
  • Prescription medication, including anti-inflammatory drugs, muscle relaxants, or narcotics, plus anti-depressants, and anti-seizure medications that have proven to be effective.
  • Injection therapy that may help isolate the cause in addition to providing relief. These would include epidural steroid, facet joint, and sacroiliac joint injections and nerve blocks to the nerve root, medial branch, peripheral and sympathetic nerves.
  • Physical therapy which would include therapeutic exercise, transcutaneous electrical nerve stimulation, spinal traction, massage, and heat/ice application.
  • Pulsed radiofrequency neurotomy, which prevents nerves from sending pain signals to the brain.
  • Spinal cord stimulation, which is an implanted device that produces electrical impulses to block pain perception.
  • Intrathecal pump, which is a device surgically implanted and dispenses measured doses of medication within the spinal cord.

So, an in-depth conversation between doctor and patient will uncover the plan of pain management that best suits the individual and his or her lifestyle. Whether the final outcome is pain cessation or a reduction to a tolerable level, life can once again be a meaningful journey worth pursuing.

Back Pain Defined

As much as 20% of Americans report that they experience back pain every year. Males and females experience back pain equally, and it can occur at any age, with the majority of initial episodes taking place between ages 20-40.

Causes / Predisposing Factors

Generally back pain has mechanical causes and most of which are relatively benign, although a small number of cases are due to more serious illness. Common causes of back pain include degeneration (osteoarthritis), muscle strain, mechanical problems (such as herniated disc), and vertebral fractures associated with osteoporosis. Rare, more serious causes include cancer, infection, vascular problems and damage to nervous tissues. Tobacco, alcohol and drugs, poor diet, and lack of regular physical activity have been implicated as risk factors for back pain.

Modifying these risk factors, avoiding certain repetitive motions such as bending and twisting or heavy lifting, and treating obesity and depression can help prevent back pain before it becomes debilitating.

Symptoms

Back pain is usually reported in the lower back but can occur in the upper back as well. The pain may be aggravated with movement, or may radiate into the upper or lower extremities. Patients may also experience limited range of motion and/or tenderness upon touch.

back-pain

Diagnosis

Diagnosis leading to effective back pain treatment is done by a doctor through a comprehensive history and physical examination.

Additionally, a full neurological review is often performed to accurately diagnose the back pain. Any extra imaging is usually reserved for symptoms that persist beyond several weeks despite conservative treatment, or if a physician suspects serious pathology.

Depending on your particular back pain, the doctor may order an imaging procedure. An x-ray will be conducted if a bone infection or tumor is suspected. A magnetic resonance imaging (MRI) or computed tomography (CT) scan is conducted if disc herniation is suspected.

Treatments

The goals of back pain treatments are to relieve symptoms and improve function. Back pain treatments range from conservative management to surgery, depending on the cause and severity of the pain. Back pain typically resolves on its own within weeks with conservative treatment. More conservative back pain treatments include:

  • Physical therapy and exercise helps strengthen the back to avoid future injury and speed the recovery process
  • Lifestyle adjustments to avoid aggravating movements and reduce body weight
    Alternative therapies such as massage, yoga, and acupuncture may provide benefit to some patients
  • Interventional pain medicine, such as epidural steroid injections and spinal cord stimulation therapy
  • Pain-relieving medications may also be prescribed for back pain. These can include over-the-counter pain medicines such as acetaminophen (Tylenol™), ibuprofen (Advil™), muscle relaxants, or prescription pain medicine

Certain red flags indicate a more serious condition that may require emergency evaluation or surgery, including weakness, numbness or tingling, fever, weight loss or problems with bowel and/or bladder control.

When conservative measures suggested by your doctor for back pain are ineffective, local anesthetics, steroids or pain medicine can often be injected at the site of pain to block the pain signals from reaching the brain. Back pain due to disc herniation may require surgical intervention via spinal fusion or discectomy.

Dr. Skaribas prescribes pain medicine only when medically necessary and after certain conditions are met as part of a comprehensive treatment plan that reduces risks and maximizes benefits. We follow strict DEA recommendations and we prescribe these substances only if the patient has failed other therapeutic options, after they meet specific inclusion criteria and only if it is absolutely medically necessary.

If you suffer from back pain, it’s important to get help early. The pain can become more debilitating the longer it goes untreated, and can affect every aspect of your life, from daily productivity to emotional well being. Dr. Skaribas of the Greater Houston Pain Consultants wants to help you get well with expertise and nonjudgemental care. Call and book an appointment with Dr. Skaribas as your first step toward a better quality of life without pain.

The D.E.A. is Implementing Sweeping Changes in the Way Painkillers are Prescribed

The Federal government is finally cracking down on the prescribing of certain strong painkillers, mostly opioids like Vicodin. This is a move some state governments have already made after seeing an alarming rate of overdose deaths on these drugs. Over-prescription and addiction to opioids have escalated since the late 1990’s, and overdose on these painkillers is the #1 cause of accidental death in our country – it’s so bad that the CDC has officially called it an epidemic.

 

The DEA is placing very strict rules on prescribing and handling these drugs. Pain doctors can no longer call in prescriptions by telephone, and refills will require an entirely new prescription from their physician. The drug will also be kept in special vaults in pharmacies, which in the end will help discourage theft and decrease the illegal sale of these drugs. We can no longer turn a blind eye to the tragedies happening everyday in our nation because of these medicines. These changes will take effect in about 30 days.

Read about this important new policy here.

Pain Researchers Take A VERY Close Look Into Microbiology

Because of researchers’ efforts to understand pain, ideas that formed two decades ago are now materializing. The study of microbiology of pain is now known to have an effect on the way you experience pain – that the nervous system changes after you experience acute pain. Under normal circumstances, the brain uses pain as a teaching signal. The brain says that something is wrong, and that you should do something about it. If you hurt yourself, the acute pain tells you to take it easy so that you can heal; hopefully the pain will resolve. It’s a lack of resolution of those changes that can cause pain to become chronic and outlive an injury.

Why wouldn’t these changes be resolved? The spinal cord modulates these pain signals, but the brain’s cortex perceives the pain. If nerves are damaged, the body may not know it, but the brain does because of the changes in neural transmission that correspond with the pain. The brain continues to communicate with the peripheral nervous system that something is wrong, and you experience pain.

Researchers are moving deep into the microbiology of pain, and innovations in therapy are developing that can stop or reverse these signals from reaching our brain. The“Gate Theory of Pain” is the idea that molecular processes are occurring in response to pain, and the nervous system acts like a gate that controls these molecular processes. If we could switch that molecular process with pharmacology, we might be able to stop pain. But treatments will vary; this is not a one-size-fits-all approach to therapy. Some things to take into account about how we handle pain:

  • Different injuries molecularly respond in different ways throughout the body. Understanding these responses and the mechanisms behind them may offer insight into treatment
  • Each of us metabolizes chemicals differently, so pharmacogenetic testing may able to tell which medication treatment may be better than another for an individual
  • Hereditary factors may also be an indication of types of pain and their treatment

Listen to the full discussion here.
This research was heard on Dallas Ft. Worth KERA public radio’s program Think, “Managing Chronic Pain” June 23, 2014. This presentation featured Dr. Greg Dussor and Dr Theodore Price of the University of Texas Dallas.

High Heels: Foot Pain for Fashion

We are well aware that wearing high-heeled shoes is painful. Why do we do it? “They make me taller.” “Heels help define my curves.” “It’s all a part of femininity.” “It’s expected of me in certain situations.” So many people have already caught on to the idea that no one needs to wear heels, no matter what Joan Rivers says.

How exactly does it hurt us?

  • Posture – the complete skeleton is thrown out of whack, which in the long-term can cause some serious pain
  • Knee – the body is adjusted forward, increasing pressure on the inside of the knee and putting you at risk for osteoarthritis
  • Calf – the calf muscles remain tightened when wearing heels, and over time this can cause the calf to permanently shorten; if this happens, standing flat-footed can become painful
  • Achilles Tendon – likewise, the achilles tendon shortens and tightens when wearing high heels, so when the foot is flat, pain and inflammation develop (known as achilles tendonitis)
  • Ankle – wearing heels puts the wearer’s balance at risk, and falling can lead to a twisted or broken ankle (or worse!)
  • Ball of the foot – wearing heels puts pressure on the ball of your foot because all the body’s weight is shifted forward
  • Toes – squeezing the foot into tight shoes will cause the toes to curl up; sometimes the damage is irreversible and your toes remain forever-curled

In a better world, the injuries, deformations, and long-term damage of wearing high heels would outweigh the need to look a certain way. Next time you see someone teetering around in their high heels like a newborn calf, remember that you can (and should) move above cultural expectations and toward more healthful living.

With an Increase in Opioid Use, Combat Lies in Alternative Pain Management Treatments

This article published by the Pain Physician Journal provides the results from a ten-year perspective study on the use and abuse of opioids. Pain management physicians have used opioids for decades in the abatement of chronic pain, but the rapidly growing sale of opioids is leading physicians to question the ethics behind opioid prescription. This spike in opioid sale, use, and abuse is contributed to higher doses prescribed to patients and in higher quantities. Higher opioid use, higher overdose rates, and higher reporting of pain conditions among those already on opioid treatment points to a dangerous cycle that physicians cannot ignore. Interventional pain treatments like spinal cord stimulation are providing an alternative therapy that is reducing the need to prescribe narcotic pain killers.

Read the article here.

Ultrasound imaging and occipital nerve stimulation

Until recently, occipital nerve stimulation procedures were based on identifying bony or arterial landmarks with direct palpation or fluoroscopy. In this case study, the use of ultrasound imaging provided accurate, real-time placement of introducer needles and stimulating electrodes by allowing visualization of tissues as well as vessels and nervous structures. This reproducible positioning allows accurate depth of placement and limits the risk of injury to the occipital artery or nerves.