Posts Tagged ‘ pain ’

Oct.27.11-Chiro & Neck Pain

A literature review of existing studies shows that chiropractic care is effective for patients suffering from chronic neck pain.  The study, published in the scientific periodical, the March 2007 issue of the Journal of Manipulative and Physiological Therapeutics, looked at 16 prior studies and put the data from these studies together to get a larger picture of results.

The results of this literature review were also picked up by several news outlets including Medical-News.net and the United Press International. This review was very specific and did not look at cases involving whiplash, headaches, or arm pain.  The reviewers only looked at scientifically sound crashes that involved chronic neck pain.

Howard Vernon, DC, PhD, the review’s chief author and his colleagues found what they called “high-quality evidence” that patients with chronic neck pain showed significant pain-level improvements following chiropractic.  They also found that in reviewing all these previous studies none of the groups studied remain unchanged, and all of the groups showed showed results in the first 12 weeks.  Additionally, they noted that no trial reported any serious adverse effects.

The fact that all these different studies found the same results shows the consistency of chiropractic for these problems.  Dr. Vernon commented, “The results of the literature review confirm the common clinical experience of doctors of chiropractic: neck manipulation is beneficial for patients with certain forms of chronic neck pain.”

The authors of the review noted that neck pain is a very common problem, second only to low back pain in its frequency in the general population.

 

To Download this Article: Literature Review Shows Chiropractic Beneficial for Patients with Neck pain

 

 

Sept 1.11-Changing the Pain-relief Mindset

Changing the Pain-Relief Mindset: Dietary Alternatives to NSAIDs

 

By David Seaman, DC, MS, DABCN

More than 50 million Americans suffer with chronic pain, accounting for more than 25 million physician visits per year for low back pain alone.1 The outcome is a nation of people who rely on nonsteroidal anti-inflammatory drugs (NSAIDs) for relief. Unfortunately, this is associated with various side effects that can be life-threatening for some. The second leading cause of peptic ulcers is the use of NSAIDs. Concerning ulcer-induced mortality, one third of NSAID / aspirin deaths are associated with low-dose aspirin use, presumably to prevent cardiovascular disease.2

NSAID use is also associated with cardiovascular mortality, particularly in the elderly. Associations exist for both selective COX-2 inhibitors, such as Celebrex, and non-selective NSAIDs, such as ibuprofen and naproxen.1

Diet Is Connected to NSAID Use

It is well-known that dietary omega-6 fatty acids (linoleic and arachidonic acid) become a painful prostaglandin (PGE2) and a cardiovascular-promoting thromboxane (TXA2).3-4 Also well-known is that we in America consume excessive levels of omega-6-rich foods.5 Over time, excess omega-6 fatty acids become incorporated in human tissues, an example being joints. Studies have identified an excess concentration of arachidonic acid in arthritic joints.6-9 In 1991, it was determined that the histological severity of osteoarthritis was associated with increasing levels of arachidonic acid.7 In short, this means we need to stop eating plates full of “pain” – the best examples of which include fast food, bags of potato chips, and omega-6-oiled packaged foods. It is difficult to modulate pain unless the excessive consumption of “painful” foods is slowed.

Chronic NSAID Use Is No Surprise

Based on the fact that we consume arachidonic acid / PGE2 excessively, it is no surprise that we have become reliant on drugs that inhibit the COX enzyme that converts arachidonic acid into painful PGE2. Consider comments from a recent Cochrane review:10 “Non-steroidal anti-inflammatory drugs (NSAIDs) are the most frequently prescribed medications worldwide and are commonly used for treating low-back pain.”

Dietary Changes to Reduce Pain

Making behavioral changes to reduce dietary inflammation is not easy for most people, so the likelihood that a substantial reduction in NSAID intake will occur in the near future is not high. Motivating patients to consider that food choices can influence painful body chemistry is very important – urging people to eat more vegetables, fruit, nuts, omega-3 seeds, and lean animal protein is known to substantially reduce the inflammation chemistry associated with pain.3-4,11-14 An added benefit to making such dietary changes is that fruits and vegetables contain salicylates. Vegetable and fruit intake at a level consumed by vegetarians provides a level of dietary salicylates that appears to be equivalent to 75 mg of aspirin.15-16 Basic supplementation should also be considered. No matter what level of dietary change is made, supplementation with magnesium, vitamin D and omega-3 fatty acids seems reasonable, as low levels of each have been linked to the expression of inflammation.3,17-18 Magnesium deficiency in animal models is known to increase nociceptive activity,19 and vitamin D deficiency has been linked to musculoskeletal pain expression in general20-21 and with low back pain in particular.22 These supplements may be beneficial no matter what level of dietary change is initiated.

White Willow Bark

An additional supplement to consider is white willow bark, which may be an effective alternative to NSAID use. Bogduk23 provides the following commentary on its efficacy:

“Studies of natural therapies have provided a challenging alternative to conventional drugs for the management of acute low back pain, at least in the context of exacerbation. Controlled trials have shown that willow (Salix) bark extracts are more effective than placebo, and no less effective than a COX-2 inhibitor or NSAID; yet they are considerably less expensive.”

In 2007, the American Pain Society and the American College of Physicians developed a joint clinical practice guideline for the treatment of acute low back pain that was published in the Annals of Internal Medicine.24 The level of evidence supporting the use of white willow was fair and the net benefit was moderate, which is the same benefit as acetaminophen, NSAIDs and muscle relaxants. The dose of salicin that was used to offer analgesic benefits, 240 mg, is found in 1,000 mg of white willow bark extract. Side effects with white willow are less than with NSAIDs and the same as placebo.25-26 Salicin is converted to salicylic acid after absorption, which is thought to be a reason why there are minimal side effects compared to aspirin and traditional NSAIDs.27 Additionally, 240 mg of salicin produces salicylate concentrations equivalent to those after consumption of 100 mg acetylsalicylate, which is a more cardioprotective rather than an analgesic dose. Other co-active compounds such flavonoids provide the additional the anti-inflammatory and analgesic effects and are not harmful to the gastrointestinal mucosa, in contrast to acetylsalicyclic acid (aspirin).28 Dietary change appears to be a key to creating body chemistry that is anti-inflammatory / analgesic. Supplemental magnesium, vitamin D, and omega-3 fatty acids are important additions. White willow bark extract can be used as a natural analgesic as needed.

 

References

  1. Hochman JS, Shah NR. What price pain relief? Circulation, 2006;113:2868-70.
  2. Lanas A, Perez-Aisa MA, Feu F, et al. A nationwide study of mortality associated with hospital admission due to severe gastrointestinal events and those associated with nonsteroidal anti-inflammatory drug use. Am J Gastroenterol, 2005;100:1685-93.
  3. Simopoulos AP. The importance of the omega-6/omega-3 fatty acid ration in cardiovascular disease and other chronic diseases. Exp Biol Med, 2008;233:674-88.
  4. Seaman DR. The diet-induced proinflammatory state: a cause of chronic pain and other degenerative diseases? J Manipulative Physiol Ther, 2002;25:168-79.
  5. Cordain L, et al. Origins and evolution of the Western diet: health implications for the 21st century.Am J Clin Nutr, 2005;81(2):341-54.
  6. Bonner WM, Jonsson H, Malanos C, Bryant M. Changes in the lipids of human articular cartilage with age. Arthritis Rheum, 1975;18(5):461-73.
  7. Lippiello L, Walsh T, Fienhold M. The association of lipid abnormalities with tissue pathology in human osteoarthritic articular cartilage. Metabolism, 1991;40(6):571-76.
  8. Adkisson HD, et al. Unique fatty acid composition of normal cartilage: discovery of high levels of n-9 eicosatrienoic acid and low levels of n-6 polyunsaturated fatty acids. FASEB J, 1991;5(3):344-53.
  9. Plumb MS, Aspden RM. High levels of fat and (n-6) fatty acids in cancellous bone in osteoarthritis. Lipids Health Dis, 2004;3:12.
  10. Roelofs PDDM, Deyo RA, Koes BW, Scholten RJPM, van Tulder MW. Non-steroidal anti-inflammatory drugs for low back pain. Cochrane Database of Systematic Reviews, 2008;1.
  11. Giugliano D, Ceriello A, Esposito K. The effects of diet on inflammation: emphasis on the betabolic syndrome. J Am Coll Cardiol, 2006;48;677-85.
  12. Basu A, Sridevi Devaraj S, Jialal I. Dietary factors that promote or retard inflammation. Arterioscler Thromb Vasc Biol, 2006;26;995-1001.
  13. O’Keefe JH, Gheewala NM, O’Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol, 2008;51;249-255
  14. Galland L. Diet and inflammation. Nutr Clin Pract, 2010;25:634-40.
  15. Hare LG, Woodside JV, Young IS. Dietary salicylates. Another benefit of fruit and vegetable consumption? J Clin Pathol, 2003;56:649–50.
  16. Lawrence JR, Peter R, Baxter GJ, Robson J, Graham AB, Paterson JR. Urinary excretion of salicyluric and salicylic acids by non-vegetarians, vegetarians, and patients taking low dose aspirin. J Clin Pathol, 2003;56:651–53.

To Download this Article: Changing the Pain Relief Mindset

May 12.11-The Confusing World of Low Back Pain Research

Correcting faulty posture
Posture is essentially the position of the body in space, the relationship of the body parts—head, trunk, and limbs—to each other. Changes in posture occur when any part of the body is moved.
Posture also communicates nonverbal body language, reflecting self-esteem and mental attitude.
Optimal or ideal posture is the state of muscular and skeletal balance that protects the supporting structures of the body against injury or progressive deformity, whether at work or rest. It involves the positioning of the joints to provide minimum stress on the body.

Conversely, faulty posture increases stress on the joints. Increased stress can be compensated for by strong muscles, but if they are weak or the joints lack mobility or are too mobile, joint wear and modification can occur. Damage and changes to the surrounding tissues can also occur.

Posture involves the chain-link concept of body mechanics in which problems anywhere along the body chain can lead to problems above or below that point.

Examples:
· Low back or knee pain can arise from pelvic joint disorders.
· Headaches, eyestrain, and neck and upper back pain can be caused by the head being too far forward or rearward.
The effects of posture can be far reaching, involving respiratory, digestive, and circulatory systems as well as the musculoskeletal system. But how is poor or faulty posture developed?

Causes of poor posture

The causes of faulty posture can be divided into two categories: positional and structural.
Structural causes are basically permanent anatomical deformities that may not amenable to correction by conservative treatments. However, some leg length inequalities and some ankle and foot issues can be corrected conservatively.
Positional causes of poor posture include :

· poor postural habit—for whatever reason, the individual does not maintain a correct posture
· psychological factors, especially self-esteem
· normal developmental and degenerative processes
· pain leading to muscle guarding and avoidance postures
· muscle imbalance, spasm, or contracture
· joint hypermobility or hypomobility
· respiratory conditions
· general weakness
· excess weight
· loss of proprioception—the ability to perceive the position of your body
· over reliance on passive support from a non-ergonomic chair
 
Correcting postural faults

Postural faults must be accurately analyzed before they can be effectively corrected.
Examination should include the following:

· observation of the patient as they sit and move about
· spinal alignment-
· if appropriate: measurement or estimation of the deviation from ideally erect postures using 4 views of X-ray, inclinometry, and posture guides —done in three or all four views
· leg length measurements
· flexibility tests and joint mobility tests
· muscle length and strength tests
· “Mirror-image” Adjustments, Specific traction to remold the spinal alignment and exercises to strengthen the spine are key elements in overall correction.

· ***  WHO DO YOU KNOW THAT CAN BENEFIT FROM  CORRECTIVE CHIROPRACTIC CARE??

TO Download this Article: The Confusing World of Low Back Pain Research

Oct.27.10-Back Surgery May Backfire…

Back surgery may backfire on patients in pain
Patients who had spinal fusion were less likely to return to work and needed more opiates, study says

Brad Armstrong  /  for msnbc.com
Nancy Scatena, 52, of Scottsdale, Ariz., lives with chronic pain following two back surgeries.
By Linda Carroll
msnbc.com contributor msnbc.com contributor
updated 10/14/2010 2010-10-14T12:55:44
Just a month after back surgery, Nancy Scatena was once again in excruciating pain. The medications her doctor prescribed barely took the edge off the unrelenting back aches and searing jolts down her left leg. “The pain just kept intensifying,” says the 52-year-old Scottsdale, Ariz., woman who suffers from spinal stenosis, a narrowing of the chanel through which spinal nerves pass. “I was suicidal.”
Finally, Scatena made an appointment with another surgeon, one whom friends had called a “miracle worker.” The new doctor assured her that this second operation would fix everything, and in the pain-free weeks following an operation to fuse two of her vertebrae it seemed that he was right. But then the pain came roaring back.
Experts estimate that nearly 600,000 Americans opt for back operations each year. But for many like Scatena, surgery is just an empty promise, say pain management experts and some surgeons.
A new study in the journal Spine shows that in many cases surgery can even backfire, leaving patients in more pain.
Researchers reviewed records from 1,450 patients in the Ohio Bureau of Workers’ Compensation database who had diagnoses of disc degeneration, disc herniation or radiculopathy, a nerve condition that causes tingling and weakness of the limbs. Half of the patients had surgery to fuse two or more vertebrae in hopes of curing low back pain. The other half had no surgery, even though they had comparable diagnoses.
After two years, just 26 percent of those who had surgery returned to work. That’s compared to 67 percent of patients who didn’t have surgery. In what might be the most troubling study finding, researchers determined that there was a 41 percent increase in the use of painkillers, specifically opiates, in those who had surgery.
The study provides clear evidence that for many patients, fusion surgeries designed to alleviate pain from degenerating discs don’t work, says the study’s lead author Dr. Trang Nguyen, a researcher at the University of Cincinnati College of Medicine Unfortunately, for most patients with bad backs, there is no easy solution, no magic bullet. Pain management experts — and some surgeons — say that patients need to scale back their expectations. With the right treatments, pain can be eased, but a complete cure is unlikely.
In the wake of her operations, Scatena has turned to less invasive therapies. She’s learned to baby her back and to find ways to avoid irritating the nerves in her spine. She’s working to strengthen muscles in her lower back and abdomen so her spine will get better support. “I’ve been getting some relief from physical therapy,” she says. “And I hope that’s going to be permanent.”
27 million adults with back problems A recent report by the Agency for Healthcare Research and Quality, a federal organization, found that in 2007, 27 million adults reported back problems with $30.3 billion spent on treatments to ease the pain. While some of that money is spent on physical therapy, pain management, chiropractor visits, and other non invasive therapies, a big chunk pays for spine surgeries.
Complicated spine surgeries that involve fusing two or more vertebrae are on the rise. In just 15 years, there was an eight-fold jump in this type of operation, according to a study published in Spine in July. That has some surgeons and public health experts concerned.
For some patients, there is a legitimate need for spine surgery and fusion, says Dr. Charles Burton, medical director for The Center for Restorative Spine Surgery in St. Paul, Minn. “But the concern is that it’s gotten way beyond what is reasonable or necessary. There are some areas of the country where the rate of spine surgery is three or four times the national average.”
Burton and others recommend that patients get a second opinion when back surgery is recommended for the treatment of back pain without neurological symptoms, such as sciatica, especially if other treatments haven’t been suggested first.
“We are very successful at improving leg symptoms,” says Dr. William Welch, vice chairman of the department of neurosurgery at the University of Pennsylvania Medical Center and chief of neurosurgery at Pennsylvania Hospital. “We are less successful at treating back pain.”
Source of pain is often hard to pinpoint
The reason, Welch says, is that it’s often hard to pinpoint the exact cause of someone’s back pain. Even MRIs can be misleading because abnormalities, such as degenerating discs, can be seen on scans for virtually everyone over the age of 30 regardless of whether they have pain. Even when the surgery is a success, it rarely dispels 100 percent of back pain, Welch says.
And while many surgeons are careful about which patients they recommend for spine operations, some are not so discriminating, says Dr. Doris K. Cope, professor and vice chair for pain medicine at the University of Pittsburgh School of Medicine. “It’s a case of, if you have a hammer, everything looks like a nail,” she explains.
In general, the best results come about through a combination of approaches, Cope says. Each strategy may reduce pain by just 10 or 20 percent, but those percentages can add up so ultimately the patient’s pain is cut back by as much as 70 or 80 percent. Strategies can include exercise and weight loss, Cope says.
That advice resonates with Marilyn Seiger, a friend of Nancy Scatena in Scottsdale. Seiger opted to skip surgery, not wanting to follow her friend’s painful path, even though her doctor recommended an operation to fuse two of her vertebrae.
She has gotten some relief from physical therapy, a back brace that reminds her to keep her back straight, and the occasional pain pill.
“I don’t know anyone who’s had surgery for back pain who had success,” says Seiger, 61. “I just figure this is part of growing older. We’re living longer than our bodies were meant to last and we’re just constantly shoring things up.”
© 2010 msnbc.com.  Reprints

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