Cure My Low Back Pain

posted by editor on Aug 24

During WWII when one of the U.S. Army hospital anesthesiologists ran critically short or morphine, his nurse initiated injections of saline (salt water); it worked.  If saline injection was effective, so would sucrose (sugar) pills work as a panacea for pain.

Dr. Beecher, the anesthesiologist, returned to his position at Harvard after his military tour of duty and in 1955 published “The Powerful Placebo” in the AMA Journal. Multiple prospective trials noted the curative effectiveness of placebos. Moreover, Beecher found that the effects of many current drugs were no better than placebo. However, the pharmaceutical products wee all associated with risk of side effects whereas the placebos were not.

By 1962 even the FDA was willing to acknowledge “placebo effect”. As such, new pharmaceutical products have to outperform placebos in at least two authenticated trials. We are not yet out of the woods. Pharmaceutical companies market physicians and now directly to patients via television and other media, grossly downplaying costs, adverse effects, and effectiveness compared to alternatives.

If your doctor offered you pill #1 that is effective in 5/10 cases and perfectly safe always versus pill #2 that is effective in 9/10 cases but may cause ulcers, dizziness, blindness, and in rare cases death, which would you choose? Just listen to the disclaimer statements in direct to consumer pharmaceutical related television advertising, then tell your doctor that it would probably safer (and maybe just as effective) to prescribe so sugar pills for my pain.

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posted by editor on Aug 8

The term restless legs syndrome (RLS) was used initially in the mid-1940s by Swedish neurologist Karl A. Ekbom to describe a disorder characterized by sensory symptoms and motor disturbances of the limbs, mainly during rest.

However, early descriptions date back to the 17th century. It is recognized now as a neurologic movement disorder of the limbs, often associated with a sleep complaint.

RLS is often simply a component of another condition or a toxicological response of medications and consumables.

Pathophysiology

The pathogenesis of RLS is unclear, although there are numerous non-unifying hypotheses yielding limited effective treatments for specific subsets of cases. RLS also tends to run in families. However, so does a preference to cornbread over white bread run in some families. Although, some would suggest existence of genetic relationship, humans share 99.9 percent common genetic code. As such, the genetic profile (family history) is most important in relation to cultural/family behavior, environmental exposures, discrepancies in resources and their affects upon genetics triggers.

Frequency

Although frequency of incidence may be suggested in some literature, defining a set of signs and associated diurnal symptom tendencies does not make for an adequate disease definition. As such, true frequency is unclear. Severity of symptoms in patients with RLS ranges can be remarkably variable, worse in older patients probably related to other concurrent neurovascular disease. Health status matched men and women appear to me equally affected.

Diagnosis

Pins and needles, numbness and tingling, and insect crawling sensations accompanied by uncontrollable urge to  move the lower extremities with occasional short-lived periods of forceful dorsiflexion of the feet. Physical examination is generally normal.

Treatment

Idiopathic familial association is offered as an explanation in more than fifty percent of cases. Just as “success” has been described by many as the juncture between preparedness and opportunity, disease precipitation due to family history generally implies engagement in common family behaviors, lifestyle choices, choices in living environments, work and other comparable factors that concordantly adversely interacts with pre-existing sensitive biology.

As such, to suggest familial association is to ask the patient to hunt for familial commonalities. Other recognized associations are:

• Lumbar disc herniation
• Anxiety,
• Situational stress,
• Excessive fatigue,
• Iron deficiency,
• Peripheral neuropathy (numerous causes),
• Dietary deficiencies: iron, folic acid, magnesium, B-12,
• Lyme disease,
• Sjogren syndrome,
• uremia,
• unclear hormonal imbalances of pregnancy,
• End-stage renal disease,
• hyperphosphatemia,
• Antidopaminergic drugs,
• diphenhydramine,
• tricyclic antidepressants,
• selective serotonin reuptake inhibitors (SSRIs),
• alcohol,
• caffeine,
• lithium,
• beta-blockers,
• caffeine overuse,
• and nicotine overuse.

The pathogenesis of RLS seems to involve so many possible mechanisms that one may wonder if it deserves to have an ICD code.  Particularly, it is important that both patients and clinicians recognize that the significant variety of mechanisms implies that no “one treatment fits all.” Moreover, the least toxic and invasive interventions (massage, warm baths, acupuncture, walking, stretching) are probably the best initial choices of in the absence of a definitive cause. Do no harm.

Contact us with questions.

posted by editor on Jul 21

Eighty percent of our population will experience lumbar pain at some time in their lives. The majority will experience mechanical pain that temporarily affects pains receptors due to injury of muscles, ligaments and intervertebral cartilage. The nervous system associated with these structures informs the individuals about the incident and/or cumulative traumatic insults to the structures. Contributors to etiology may be multifactorial.

Diagnosis of mechanical back pain in most allopathic or osteopathic medicine patients generally entails x-rays, and may eventually include CT/MRI evaluation. However, these studies only demonstrate structural “abnormalities” which are very often not responsible for the symptoms. Consider the numbers of people that believe that they need regular adjustment because they have been informed by non-radiologists that their spines are “out of alignment”. Diagnosis and treatment that is predominantly based upon radiographic “abnormalities” will result is a plethora of ineffective plans. Even worse, poor and exaggerated interpretation of radiographic data will cause some many to believe that they have some type of pathology that will persist. To the contrary, we must avoid premature use of unnecessary technologies and avoid expedient application of diagnostic labels that infer trauma and potential causes of neuralgia with the intent and/or effect of yielding convenient case labeling for billing, supporting insurance algorithm directed treatment plans and/or appeasing patients.

A precursor circumstance that immediately preceded the onset of back pain is frequently offered as the cause of the pain. More often than not, this “cause” is a label of convenience for the insurance or legal systems that may eventually be responsible for adjudicating issues of liability and impairment, particularly if the onset of pain occurred in a setting in which they have some fiduciary alliance.

The etiology of back pain is often multifactorial. At times, patients may not be able or willing to address all contributing factors. Moreover, others with limited liability in the case may wish intervention to be focused upon elements of the case for which they deem themselves to be responsible as if they could be precisely microtomed away from the remainder of the pathology and associated symptoms. The clinician and patient should be prepared to acknowledge and address all factors if possible.

Factors may include:
1. age,
2. gender,
3. ethnicity regarding behaviors associated with social customs,
4. diet including vitamins and mineral supplements,
5. weight and fitness,
6. activities of daily living and recreation,
7. personal habits (e.g., smoking, alcohol consumption),
8. rigorous work,
9. pre-existing disease and pathology, and
10. prior injuries.

You are highly likely to experience lumbar pain at some time in your life. The majority of you will experience reversible mechanical pain. However, as contributors to symptoms are often multifactorial, be prepared to address them all.

Contact us with specific questions.

posted by editor on Jun 20

If you have a spiritual foundation your greatest confidence should be in the philosophies or words defining your beliefs. Secondarily, your next greatest faith should be in the power of your own words; presuming that if you are willing to say it, you believe it to be true. Thereby, your daily faith should be greatest in beliefs spoken by you, aloud. As such, if you wish to start feeling better you need to begin stating aloud “The pain is gone,” believing that it is gone, never contradicting yourself.

While some might question this approach, how many times have you accepted a job offer from a complete stranger, believing that you would be paid in two weeks? You not only had faith in the stranger’s offer, but you went home and declared your success to family and/or friends. Moreover, by announcement, and hearing your own words spoken, you affirm the statements as true, reinforcing your confidence that you actually have check coming soon.

A limited example of how Christians might employ this strategy to medicine is demonstrated by a combination of Isaiah 53:5 and Romans 10:17, engaging scripture to address their healing. The rest of you should simply verbally affirm that pain has no place in your life, never referring to it as “my pain.” Rather, suggest that you are presently experiencing pain, as it resolves via means including your word power.

posted by editor on May 16

Neuropathic pain is characterized by numbness, burning, tingling, shooting sensation, itching, and crawling sensations. It may occur locally or distally along either side of the body. Neuropathic pain results from infection, trauma or disease effects upon peripheral nerves (in extremities) or the central nervous system. Statistically, approximately 200 million people suffer from neuropathic pain worldwide.

Traditional western treatments are variable in effectiveness, usually delivered via a combination of NSAIDs, opiates, and anticonvulsants or antidepressants. These pharmaceutical products are all associated with their own side effects and in combination may yield significant gastrointestinal distress, altered mental acuity and diminished motor skills, tolerance (requirement of ever increasing product volume/strength for effectiveness) and dependence.

Cannabis has been recognized as an effective analgesic for both focal and neuropathic pain since the late 1800’s. Chemical receptors have been identified in our body with which the cannabanoid compounds interact. These receptors are distinct from opiate receptors, thereby accounting for the additive effectiveness of cannabis in persons already using other prescription analgesics. In fact, our body also produces its own endocannabanoids (some similar to endorphins) that act on these cannabanoid receptor sites. The existence of the endocannabanoids and associated receptors provides an explanation for the effectiveness of various marijuana strains with differing chemical constituent concentrations.

Sativex®, a cannabis based product has been approved in Great Britain for the neuropathic pain occurring in Multiple Sclerosis. In the U.S., Cesamet® (nabilone) and Marinol® (dronabinol) are already available as synthetic THC for appetite enhancement in end-stage AIDS and post-chemotherapy patients. However, they have very limited chemical effectiveness compared to the full spectrum effect of cannabanoids in natural plant sources. Moreover, Cesamet® and Marinol® use in pain management is considered “off-label”, thereby not supported by most health insurance

Given the variable and sometimes markedly limited effectiveness of combinations of NSAIDs, opiates, anticonvulsants and antidepressants in pain management, traditional western physicians should be excited about an alternative, very effective natural plant product, cannabis. However, most clinicians sublimate their awareness of ongoing problems of opiate abuse and diversion as well as minimize the importance of adverse effects of all of these products because of their traditional biases.

Contact us for more regarding pain management and cannabis.

posted by editor on May 3

Many people attempt alternative intervention solely or as a primary means to address musculoskeletal pain. The following is a brief introduction to one of these, transcutaneous electrical nerve stimulation (TENS).

TENS involves placement of sticky stimulus pads (electrodes) over or near the sites of pain, the pads attached to wires from a source of electrical stimulation. The TENS units function via a combination of means including overexciting the pain receptor nerves, inhibiting their ability to send off pain signals, blocking pain signals in route to the brain and causing release of natural pain relieving chemicals from our bodies (endorphins, enkephalins, and dynorphins).

High frequency and low frequency TENS has slightly different effects. As such, working with multi- frequency units is preferable. Satisfactory response to specific frequencies and pulse patterns differs from person to person. Optimal settings vary and are determined by trial and error. Electrode positioning is often based upon a combination of recommendations from professionals and source materials that accompany the TENS units and subsequent to personal experience.

Medical complications arising from use of TENS are rare. However, there are a few contraindications for TENS use including concurrent use of fixed electrical stimulators (e.g., pacemaker), pregnancy and others. Although TENS are very simple devices, please contact your primary health provider regarding the safety of TENS use for you as part of a plan to address your low back (or other) pain.

Contact us and start TENS use for pain reduction.

posted by editor on Mar 6

Chinese Medicine, classical and traditional involves a range practices originating in eastern Asia. Although well accepted throughout China and many other parts of the world, it is considered an alternative medicine in the West. Practices include use of herbs, dietary adjustments, movement therapies, massage therapies, moxibustion and acupuncture.

While western medicine is based upon theories related to anatomical function and physiology, Chinese medicine is based upon at least five major theories relating the human body and its life energy to nature, the universe, and a higher being. Its practices have roots that are thousands of years old.

One aspect of Chinese medicine, acupuncture, is the procedure of inserting and manipulating very fine needles into points on the body to treat and cure medical disorders, including pain. Acupuncture points, stimulus placement sites, are situated along body meridians through which our theorized life energy flows. Modern acupuncture texts present meridians as conceptual targets. While there is no physical evidence to support their existence, consider that the only evidence of gravity is the fact that bodies attract each other in predictable manners (e.g., objects stay on the ground). Similarly, people respond to acupuncture stimulation along meridians in predictable manners. Moreover, acupuncture does not cause undesired side effects like most regularly prescribed medications.

The earliest recognized written record of acupuncture is from the second century BC. Different variations of acupuncture are practiced throughout the world. Acupuncture has been difficult to study by western medical researchers due to the invasive nature of the practice (having to place needles). Scholarly reviews are often biased by origin of the researchers. However, there is general agreement that acupuncture is safe when administered by well-trained practitioners using sterile needles, and further research is ongoing. Alternative treatment approaches are available to the untrained and general public via electroacupuncture and acupressure. These are applied at the same points, along the same meridians, without the risks related to needle use by the novice, in case I wish to cure my own low back pain.

One extraordinary source of information on acupuncture is A Manual of Acupuncture, published by the Journal of Chinese Medicine Publications. Following research of many years, Peter Deadman, editor-in-chief of The Journal of Chinese Medicine, and colleagues created the primary reference for the study and practical application of acupuncture points and meridians. With subtle use of color to illustrate the acupuncture points and anatomical features in approximately five-hundred illustrations, it is a very comprehensive, attractive and user-friendly tool for the novice and professional. The index identifies every part of the body reached by each meridian, and there are separate indexes to direct readers to address health issues via Chinese medicine categorization and western medicine symptom approaches.

posted by editor on Feb 28

Whether you want to reduce back stress or fatigue or stimulate your blood circulation, an inversion table makes a great household accessory. An inversion table contributes to your body’s overall health via lumbar traction, relieving pressure on your vertebral discs and nearby structures, stretching muscles in your torso and promoting circulation. Additionally, when your back starts to relax, the rest of your body follows. For frequent and relentless symptoms, even reduced pain is a relative cure for your or my low back pain.  A table can also help with flexibility for improved athletic performance, reducing the apparent aging effects of gravity, relieving pain related to prolonged sitting or standing. Spine inversion is better than manual adjustments and it pays for itself within a few sessions.

Quality products boast durable tubular steel frames that are light, yet strong. More importantly, inversion systems are a breeze to use. You rest your body against comfortable foam backboards, slipping your feet into the ergonomically molded ankle cushions, simply reaching your arms overhead to initiate your treatment. As your arms go up, your body gradually inverts, as far as 90 degrees as desired. All that is needed is you, your inversion table and gravity.

Quality tables have non-skid floor stabilizers, keeping the table stable, and extra-long safety handles to provide an easy return to upright. Tables weighing less than ninety pounds that can support frames up to 6 feet 6 inches, weights up to 350 pounds, with easily adjusted ratchet ankle locking systems are ideal for the consumer market. With chronic pain, even intermittent markedly reduced pain is a relative cure for your or my low back pain.  Spine inversion has been around for more than two thousand years.  Spine inversion is better than manual adjustments because it is effective and pays for itself within a few sessions.

posted by editor on Feb 16

A patient presented asking “Do you have an alternative approach by which I might cure my low back pain?” A few minutes into discussion I determined his low (lumbar) back pain symptoms to be relatively minor and not radiating into his legs or feet. However, he had substantial anxiety about a concurrent illness with which he had been suffering for years. Not curable by present western medicine and somewhat stigmatizing, he lived with recurrent anxiety, depression and insomnia. We completed the evaluation and determined that his primary concern was not the physical pain, rather the psychological issues that complemented his pain. He tried and disliked prescription medications, and formal medical counseling. He did not like disease associated support groups, feeling them to magnify the stigmata. He said his spiritual peers, atheists, had nothing to offer him.

After discussing numerous options, he was willing to try acupuncture and herbs. He had not grown up with traditional Chinese medicine or other herbal intervention. He did not have any prior scientific understanding or reference by which to accept the underlying mechanisms by which these alternative treatments might work. However, he stated “With hope and faith, I am willing to explore these approaches.” “Hope and faith”, maybe he should consider an alternative spiritual perspective as well.

posted by editor on Feb 9

Do you think hanging upside down to relieve back pain is unusual, or a new-age approach? Reconsider your perceptions. Spinal inversion probably goes back to the dawn of documented human medical care.

We know that inversion has been used at least since 400 B.C., when Hippocrates, the father of western medicine, first observed a patient have his knees and ankles tied to a ladder to be hoisted upside down for a dose of what has come to be known as inversion therapy.

The Greek theories on inversion are still valid, but today there is a much easier way to relieve the back pain than having your family and friends hoist you with ropes. The process is called spinal inversion therapy, and it can be the natural way to a better back and a better body.

Inversion-traction and Tissue Movement Studies

The journal – Spine: 1 May 1998 – Volume 23 – Issue 9 – pp 1061-1063

Study Design. Experimental study of 30 patients diagnosed with low back pain resulting from lumbar disc herniation, disc degeneration, and segmental instability. Patients underwent gravitational traction, and widening of the intervertebral space and posterior facets was measured on x-rays. This same procedure was performed with a group of 30 healthy individuals.

Objectives. To determine the effect of gravitational traction on the widening of the intervertebral space and the other vertebral structures in patients with low back pain and in healthy individuals.

Summary of Background Data. Gravitational traction is performed by suspending the patient in a hanging, upright position for an extended period of time. (inversion)

Methods. A specially designed apparatus was used to apply gravitational traction. Before and after inversion x-rays were obtained to study the changes in the L2-L3, L3-L4, L4-L5, and L5-S1 intervertebral spaces. Other data was also collected.

Results. Inversion-Distraction/traction created more than 3 mm of increased intervertebral disc space in subjects.

Conclusion. Spinal gravitational traction (inversion) had a very measurable effect on intervertebral space and was found to be an effective method to distract lumbar vertebrae.

Other studies

1) Kane, M, et al: Effects of Gravity-facilitated Traction on Intravertebral Dimensions of the Lumbar Spine. Journal of Orthopedic and Sports Physical Therapy. 281-288, Mar 85. Study found gravity-facilitated traction (inversion), produces significant intravertebral separation in lumbar spine.

2) Gianakopoulos, G, et al: Inversion Devices: Their Role in Producing Lumbar Distraction. Arch Physical Med Rehabil 66: 100-102, Feb 85. Study found all subjects experienced intervertebral separation in the lower lumbar vertebrae.

3) Nosse, L.: Inverted Spinal Traction. Arch Physical Med Rehabil 59: 367-370, Aug 78. Study found EMG activity (an indicator of muscle activity, which tends to be greater with pain) declined 35 percent within the first 10 seconds of inversion

4) Nachemson, Alf, et al: Intravertebral Dynamic Pressure Measurements in Lumbar Discs. 1970. The study measured internal disc pressure (in the 3rd lumbar disc) during a range of activities, including standing, sitting, bending and vertical and traction. The study results identified that a traction load equal to sixty percent of body weight was sufficient to reduce the internal disc pressure to zero. This suggests that pain related to intradiscal pressure can be relieved by inversion.

5) Sheffield, F.: Adaptation of Tilt Table for Lumbar Traction. Arch Physical Med Rehabil 45: 469-472, 1964. One-hundred, seventy-five patients who were unable to work due to back pain were treated. After eight inversion treatments, 155 patients were able to return to their jobs full time. Study concluded that the main basis for improvement was the stretching of paraspinal vertebral muscles and ligaments and possibly the widening of intravertebral discs. The study found significant improvements in patients with a variety of diagnoses including spondylolisthesis, herniated discs, lumbar osteoarthritis with sciatica, and coccydynia.

6) Dimberg, L, et al: Effects of gravity-facilitated [spinal inverson] traction of the lumbar spine in persons with chronic low back pain at the workplace. One-hundred sixteen people were enrolled in a randomized controlled trial that lasted for 12 months. The study compared inversion trained subjects to a control group who did not perform inversion to asses the effect of gravity inversion on pain level and absenteeism due to low back pain. After 12 months of training program, the employees performing inversion 1 or 2 times per day decreased sick days due to back pain by 33 percent. Moreover, the average number of sick days used due to back pain fell by eight days per individual in the inversion group.

If you have some disc bulging or herniation, and you are not a surgical candidate or do not wish to proceed with surgery, many of you will markedly decrease your pain with inversion-traction.

Over half of people who perform spinal inversion regularly do so to relieve back pain. But, to discount inversion as simply a back pain remedy would be to ignore a wide range of benefits that can be easily achieved by a passive, or more active, inversion session.

Inversion represents the quiet side of fitness, helping your body to recover from the compressive effects of gravity and daily activities. Doctors, physical therapists and sports trainers recognize spinal inversion as a safe and effective form of therapy for the spine and weight-bearing joints. In fact, the US Army is evaluating including spinal inversion into its worldwide physical training.

Whatever your reason for inverting, inversion equipment provides a comfortable and easy method to turn your painful world upside down.