Backpain [Archive]

07-13-2004, 09:41 AM

-Non-Surgical: Acupuncture

Acupuncture has become very popular in the United States as a treatment for many illnesses and symptoms, including low back pain. This treatment method was originally developed in China, over 2000 years ago, and has become a common method for relieving pain and other symptoms in this country.

In addition to studying the role of acupuncture in the treatment of low back pain, the National Institutes of Health has also funded a large amount of research on the effectiveness of acupuncture in the treatment of nausea and vomiting associated with pregnancy, chemotherapy, and after an operation. It has also been studied as a useful treatment for addiction to cigarettes, alcohol, and drugs, as well as a method for alleviating headaches, menstrual cramps, tennis elbow, carpal tunnel syndrome, and asthma.

Acupuncture treatments consist of placing very thin stainless steel needles into the skin of the patient in certain locations that are thought to correspond to certain organs and anatomic areas deep within the body. There are several thousand "acupoints" that have been described by traditional Chinese acupuncturists, each of which has a particular significance in the treatment of different diseases and symptoms. According to the traditional Chinese understanding of the human body, a natural form of energy that is vital for the proper functioning of the human body flows through twelve "meridians" in the human body. This energy force is called "chee," and is understood to have both good and bad qualities. The balance between these two aspects of the life force, the yin (a dark, female force), and the yang (a light, male force), controls every aspect of the human body. Acupuncture seeks to correct imbalances in relative amounts of yin and yang within the human body by inserting needles into acupoints that are aligned with certain meridians.

Acupuncture, when practiced by a skilled individual, is usually painless, and modern disposable needles carry almost no risk of infection. While the theory behind how acupuncture works has not been validated by modern scientific investigations, many people have obtained substantial relief as a result of these treatments. Acupuncture is relatively inexpensive, is readily available in most communities in the United States, and is even starting to become covered by some health care plans. There are several large-scale studies that are currently underway that are trying to determine how acupuncture compares to other forms of treatment for patients with low back pain, but unfortunately, the results of these studies won't be available for several years.

The issue of whether or not to seek the services of an acupuncturist for the treatment of low back pain is largely personal. Many people believe that an ancient form of medicine that is based upon thousands of years of experience must be able to offer some benefit in the treatment of a disease, like low back pain, that has not been "cured" by modern Western medicine. Today, it is becoming a well-accepted form of treatment, especially as a means of alleviating pain and reducing the amount of medications that someone with low back pain takes.

-Non-Surgical: Chiropractors

Chiropractors that specialize in the treatment of low back pain attempt to improve the function of the joints and the nervous system by adjusting vertebral subluxations. Manual spinal adjustments are the key to chiropractic treatment, and in fact, the word "chiropractor" is derived from the two Greek words "cheiros" and "praktikos", which together mean, "done by hand".

Chiropractic adjustments are very popular in the United States, with as many as 40 million Americans receiving regular treatment. Because there are major philosophical and theoretical differences between the ways in which chiropractors and medical doctors treat back pain, there has always been a rift between these two groups. Recently, the chasm between chiropractors and medical doctors has started to narrow as they have begun to share information and provide each other with more insight into their respective methodologies, practices, and treatments.

Chiropractors today are more likely to refer a patient to a medical doctor when they suspect that an underlying condition may be responsible for back pain, and some chiropractors insist that their patients have a primary care physician that they can communicate with in order to ensure that the patient is receiving the best quality care. In this sense, Chiropractors are becoming part of the broader spectrum of providers that treat back pain.

Chiropractors frequently have different methods of adjustment, but the theory behind the success of chiropractic treatment is that realigning the spine relieves pressure on the spinal nerves, which can help to restore natural nerve function throughout the body. As such, they believe that a "well-aligned" body is more likely to be in a state of natural balance and the patient will experience less pain and disability. Many chiropractors today have incorporated electrical stimulation, diathermy, ultrasound and a variety of other therapies, but the mainstay remains manual spinal manipulation or adjustment.

What should you expect when visiting a chiropractor?
When you visit a chiropractor for the first time, you will probably be asked for a general medical history and also asked to complete a questionnaire about the type of back pain that you are having. A hands-on examination will typically be performed, which involves moving your neck and limbs around to determine your limitations. Sometimes the chiropractor will take x-rays of your back to determine which vertebrae are misaligned. The diagnosis and treatment of vertebral subluxations is one of the sticking points between medical doctors and chiropractors, since there is often some disagreement between these two groups about what constitutes a spine that is out of alignment. The final treatment phase of a visit to a chiropractor is based on manipulation of the spine in an attempt to correct subluxations and misalignments. Some chiropractors also use vitamins, massage, and electrical therapies as part of their treatment.

-Non-Surgical: Exercise

Regular exercise is an essential part of having a healthy back. In the treatment of back pain, almost every healthcare provider agrees that exercise plays an important role in recovery. Every day we make demands on our bodies that can stress our backs. It's a well known fact that the more fit you are, and the stronger your back is, the more easily your body can deal with the stress and strain of every day activity.

Unfortunately, when most people start to experience back pain, they become less active. As a result, the muscles that support the spinal column become weaker and have less endurance. If your back loses enough muscle tone, the muscles can shrink, contract and tighten. Your back may feel tight much of the time, tire easily, and start to feel uncomfortable even when you are sitting in a chair. The feelings associated with chronic back pain and spinal fatigue make most people feel drained, tired and depressed. It becomes harder and harder to break the cycle of pain causing inactivity, which causes more pain, which then causes more inactivity. Eventually, this scenario can lead to other health problems that are the direct result of inactivity, such as heart attacks, strokes and obesity.
Therefore, exercise is an important part of the "use it or lose it" theory of overall spine health. Patients with chronic low back pain are particularly susceptible to suffering from the ill effects of too little exercise. If it hurts when you move your back, and is less uncomfortable when you don't, then you have the perfect incentive to become less active with time. Although this may seem like a logical reaction to pain, it is almost certain that avoiding physical activity will make the pain become even worse over time. This knowledge comes from the unhappy experience that doctors have had in the past with prescribing prolonged bed rest and inactivity for back pain, which over time, only aggravated the situation and made it more difficult to treat in the long run. We now know that if you want to relieve the physical pain of many types of back pain while also making yourself stronger both mentally and physically, you need to get moving.

A commitment to a physical conditioning program that is approved by your physician is important to everyone, but it is especially important to those with chronic back pain. Exercise has many benefits, and has even been called a healthy "non-chemical tranquilizer," because the process of stretching and strengthening the muscles of the back produces a feeling of relaxation and well being similar to that produced by many muscle relaxants and pain relievers. Low back pain is often described as a "psychobiological" problem, meaning that it includes both physical and psychological components. Exercise can help treat both parts of this problem, by providing you with a healthy means of relieving some of the frustration and sense of helplessness associated with low back pain, in addition to treating the problem at its very heart.

-Non-Surgical: Family Practitioners

Most people who have back pain will make at least one visit to their family practitioner or internal medicine physician. Many of these visits are used as an opportunity for the patient to learn more about what causes back pain, whether or not a particular patient needs to see a surgeon soon, and what can be done to alleviate the pain.

In the past, many doctors used to advise patients to spend a significant amount of time in bed, waiting for their back to feel better. Today, we recognize that the best treatment for a back sprain or strain is early mobilization and a relatively rapid return to normal activities. Most doctors will now recommend a brief period of rest, generally one or two days, during which most patients are also advised to take a course of anti-inflammatory medications in order to help reduce the pain and inflammation. They are then advised to return to their normal activities and begin an exercise program that will make them feel better with time.

Many medical plans will require that a patient be seen by a family practitioner before they are referred to a specialist, and these family doctors are often very skilled at selecting those patients that should be seen by a surgeon sooner rather than later. They often also have a physical therapist that is instrumental in getting patients up on their feet again, and they can be a terrific resource for suggestions on how to cope with mild to moderate cases of back pain or strains.

-Non-Surgical: Medications

In the use of medicine to treat chronic low back pain physicians are advised to consider the specific needs of the patient when prescribing and scheduling these medications. The goal when prescribing medication to chronic pain patients should be to derive maximum benefits or reduction of pain and discomfort, encourage compliance and minimize the risk of overuse or abuse of the medications.

Non-Steroidal Anti-Inflammatory Medications (NSAID's)
This group of drugs includes common over-the-counter drugs such as aspirin, ibuprofen, and ketoprofen among others.

These drugs have potent analgesic effects that can be sustained for long periods of time without concerns of toxicity or dependence. These drugs have almost specific effects in reducing pain and inflammation of inflammatory spondyloarthropathies. By the anti-inflammatory and analgesic activity of these medications, they can promote the initiation and maintenance of rehabilitation efforts that might otherwise be impossible.

Opioid Therapy
Opioid therapy or narcotic administration for the purpose of controlling chronic back pain is widely rejected because of potential toxicity to the body, physical dependence, and the loss of efficacy due to developmental tolerance and psychological dependence or addiction.
There is a select group of patients with chronic nonmalignant pain, including low back pain that can experience sustained improvement in comfort from opioid drugs without developing toxicity to the body or having any evidence of psychological dependence or addiction. Treatment by this class of drugs should in essence be the last resort, when patients do not at all respond to all reasonable non-opioid drugs. In addition, patients must be warned about the side effects of this class of drugs and it is strongly encouraged that patients being treated with opioid drugs be forced to have an ongoing conversation with their doctor. There should be an agreed upon period of consistent increase in dosage of the drug (titration) until the patient sees a minimum partial relief of pain. Monthly visits should be required from that point.

Psychiatric Medications
Pain has been characterized as a multidimensional phenomenon involving many different systems in the body. As of yet, there is little known about the basic mechanisms that produce or perpetuate the sensory component of pain after tissue damage. There is also little known about the individual person's behavioral response to pain. This is particularly true for chronic pain.

Four basic issues should be addressed to ensure the appropriate use of psychiatric mediations for low back pain. First, the healthcare provider should have a clear understanding of the etiology of the patient's pain in order to decide whether the pain will be responsive to the drugs. In addition, psychiatric disorders causing the pain or disability should be diagnosed accurately so that the appropriate target symptoms can be identified for treatment. Secondly, patients must be detoxified from analgesics or sedative-hypnotic medications in order to evaluate perceived pain and functional capacity and to predict treatment outcome.

Patients must keep in mind that psychiatric medications are an additional element and not a substitute for a comprehensive treatment plan for chronic pain. The comprehensive treatment plan should involve the healthcare provider and the patient and should include education, physical reconditioning, behavioral assessment and evaluation of family and occupational roles. Lastly, constant and attentive follow-up is necessary to chart progress, to detect recurring symptoms or to discontinue ineffective treatment.

-Non-Surgical: Physical Therapy

Physical therapy is an important treatment option for most back pain sufferers. A physical therapist is trained to carry out your doctor's orders to stretch, strengthen, and exercise your back in a safe and effective way. It is important that physical therapy is coupled with education, so that patients can be empowered to take charge of their own recovery.

Physical therapists are trained to give instruction on posture, educate patients about basic anatomy and physiology, and instruct patients in body mechanics, stretching, strengthening and conditioning exercises. The physical therapist also works with the physician to determine if other types of treatments including ultrasound, heat, diathermy, transcutaneous electrical nerve stimulation (TENS), electrical stimulation, hydrotherapy, massage or spinal manipulation may be indicated.

What should you expect from a visit to the physical therapist?
The physical therapist will do an evaluation and will determine if there are any joint limitations or muscle weakness as well as pinpointing the pain distribution in your back. Heat therapy and massage, as well as ultrasound may be used to ease back pain. In the past these types of treatments, which demanded little from the patient, and soothed the pain were used as the mainstay of treatment. Unfortunately, while these "modalities," as they are called by physical therapists, feel good at the time, the pain relief produced by massage and ultrasound treatments are often only temporary.

More recently physical therapists have demanded physical activity from their patients, which may cause minor pain at the beginning of the course of treatment, but has longer lasting therapeutic effects: strengthening the back and relieving pain in the long run. Physical therapists that treat patients with movement, exercise, strengthening and conditioning, encouraging gradual increase in activity, are usually the most successful.

-Non-Surgical: Spine Surgeons

Spine surgeons receive their primary medical training as either neurosurgeons or orthopedic surgeons. Recently, these two groups have become more and more similar in the ways in which they diagnose and treat back pain. When most patients see a surgeon for the first time they often have a thousand questions: Will my pain last forever? What can I do to make it better? Am I going to be crippled? Will I need to have surgery?

In contrast, most surgeons are primarily concerned with the question of whether or not the cause of the back pain can and should be corrected with surgery. In this way, spine surgeons play an important role in determining who should receive non-operative treatment, and who is unlikely to get better without surgery. While there is no doubt that spine surgeons are the best resource in your medical community for determining whether or not you need surgery, they are often not as practiced in the art of conservative management of low back pain as other health care providers. Since almost 95% of patients with low back pain do not need to have surgery, a spine surgeon may not be the first doctor to start with if you are having low back pain. However, there are a few warning signs that you should be aware of that are your body's way of telling you that you need to see a surgeon first.
Some of the warning signs that you should see a surgeon when you are having back pain include:

Changes in the way your bowel and bladder work, causing incontinence or difficulty controlling your bowel movements.

Weakness in the muscles of your legs, a feeling of instability when you walk, or progressive decrease in the distance that you can walk.

Pain and numbness that travels down your legs, especially when it is worse with sneezing, coughing, or sitting down

There are also 2 sections Surgical & Pain Manangement @ http://www.back.com

Sources back.com!