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When should I get treatment for low back pain? |
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Low back pain (LBP) typically is due to injuries of the soft tissue structures, spinal joints, or discs. Your should seek medical attention if your LBP does not improve or if it increases over a period of 2 to 3 weeks. In addition, you should seek immediate medical care if you have sudden LBP and are over the age of 50, LBP that is related to a fall or trauma, sciatica (leg pain), loss of bowel or bladder control, loss of groin or rectal sensation, leg weakness, falling when walking, fever or weight loss, and LBP worse at night. |
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December 12, 2006
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What can I do to prevent injuring my back? |
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Low back pain (LBP) is the 2nd most common reason, other than the common cold, to seek medical care. Approximately 90% of us suffer a significant episode of LBP in our lifetime. The good news is that 9 out of 10 patients recover from their LBP within 4 weeks with or without treatment. Some of the precautions that you should take to prevent LBP include lifting with your legs not your back, don’t lift heavy objects alone, wear low heeled shoes, get consistent sleep, shift heavy purses or briefcases, stop activity that hurts your back, don’t stoop and exersicise regularly. |
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December 5, 2006
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What is discogenic low back pain? |
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Discogenic low back pain (DLBP) is a common cause for chronic back pain resulting from tears in the outer disc. Lack of physical examination findings and limitations with imaging studies make diagnosing DLBP difficult. Discography is the only reliable means of diagnosing DLBP which involves injecting dye into the disc to detect the tears and to reprodue the back pain. A CT scan follows for a more detailed evaluation. Treatment for DLBP includes physical therapy and pain medications. Discography is considered in those who fail conservative treatment. Depending on the results, treatment options include interventional pain procedures or spine surgery. |
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November 7, 2006
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I have a very physical job, what can I do to avoid getting back pain? |
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Approximately 90% of us will suffer a significant episode of low back pain in our lifetime. The good news is that 9 out of 10 patients will recover from their back pain within 4 weeks with or without treatment. Risk factors for developing low back pain include poor posture, repetitive motion, prolonged sitting/standing, smoking, poor nutrition, and incorrect bending, lifting, or twisting. In order to prevent back pain, lift with your legs not with your back, don't lift heavy objects, wear low-heeled shoes, get consistent sleep, shift heavy purses and briefcases, stop activity that hurts, don't stoop, and exercise regularly. |
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October 10, 2006
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What is the IDET procedure and can it help my back and leg pain? |
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IDET (IntraDiscal Electrothermal Therapy) is a procedure designed to treat patients with discogenic low back pain confirmed by discography. Discogenic pain originates from disruption of fibers within the disc leading to irritation of nerve endings in the outer portion of the disc. This is different than the pain from a herniated disc pressing on a nerve root. This procedure is performed on an out patient basis without incisions. A catheter is placed into the disc through the skin under x-ray guidance. IDET presumably works by destroying pain nerve endings in the disc and strengthens the outside of the disc. |
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September 26, 2006
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Spinal cord stimulation has been recommended for my chronic pain. What is spinal cord stimulation and will it help my pain? |
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Spinal cord stimulation is a device that uses technology designed to reduce pain in the arm or leg. It can also help with neck and back pain but is more effective in treating arm or leg pain. The device consists of an electrical wire that is surgically placed into the spinal canal that electrically stimulates particular nerves in the spinal cord. The electrical stimulation blocks pain impulses from reaching the brain. This technology stops pain without pain medications. This procedure is used in patients who don't improve after neck or back pain surgery and in those who suffer from RSD. |
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September 12, 2006
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I have been diagnosed as having Fibromyalgia. What is it and what can I do for it? |
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Fibromyalgia is a rheumatological disorder that affects the muscles, ligaments and tendons. It can be very painful and disabling often significantly limiting one's quality of life. This condition is typically associated with some sort of trauma; although, no one really understands the cause of fibromyalgia. Those suffering from fibromyalgia often complain about a diffuse muscular aching pain, fatigue, depression and insomnia. Other associated disorders include irritable bowel syndrome, chronic headaches and TMJ syndrome. Treatment focuses on improving sleep, reducing stress and controlling the pain through exercise, medications, physical therapy, trigger point injections and relaxation technique. |
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August 29, 2006
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I suffer from interstitial cystitis. What treatment options are available for me? |
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Interstitial cystitis is a chronic, non-infectious, inflammatory condition of the bladder wall usually affecting women with symptoms including urinary urgency, hesitancy, frequency, and pelvic pain. Pentosan (Elmironâ) [only drug approved by the FDA for this condition], anti-inflammatory drugs, tricyclic antidepressants, and antihistamines are the medications often used for treating interstitial cystitis. Electrical stimulation (TENS unit or peripheral nerve stimulator), bladder distention (water or gas), and bladder instillation (DMSO or BCG) can provide symptom relief. Surgical options include burning or resecting bladder ulcers with a laser or electrical current, and rarely bladder removal (cystectomy) is considered in those with severe symptoms. |
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August 15, 2006
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I have been diagnosed as having RSD. What is RSD? |
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RSD stands for Reflex Sympathetic Dsytrophy. Complex regional pain syndrome type I is the term now used for RSD — a disorder of the sympathetic nerves that results in pain. The pain is typically located in an arm or leg and usually is preceeded by trauma. The syndrome is characterized by intense pain, hypersensitivity, and a cool limb. RSD can lead to osteoporosis, muscle atrophy, joint contracture and paralysis of the involved limb in severe cases. Treatment includes: physical therapy, pain medications, and sympathetic nerve blocks. Spinal cord stimulation or morphine pumps have been used in severe cases for pain control. |
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August 1, 2006
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What is nucleoplasty and can it help my low back pain? |
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Nucleoplasty is a procedure designed to treat patients with leg pain (sciatica) caused by small disc protrusions. It is performed on an out patient basis and does not involve an incision. The procedure is performed by placing a probe into the disc herniation through the skin under x-ray guidance. The probe essentially evaporates disc material that reduces the pressure on the involved nerve root providing relief of leg pain. The procedure has also been reported to help reduce low back pain from disc herniations. Contraindications include significant disc degeneration, fragmented disc herniations, and severe narrowing of the spinal canal. |
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July 18, 2006
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What is you opinion about a cement injection for my father who has osteoporosis and a lot of pain from a spine fracture? |
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Osteoporosis is a disease that leads to low bone mass predisposing individuals to fractures often involving the spine, hip, and wrist. There are approximately 700,000 compression fractures of the spine every year from osteoporosis. Vertebroplasty and kyphoplasty provide quick and effective pain relief for those with compression fractures stemming from osteoporosis. These procedures involve the injection of cement into the vertebra that reduces pain, improves stability and, in the case of kyphoplasty, restores height in recent spine fractures. These procedures should be considered after conservative means of pain control have failed and the individual is significantly impaired by the pain. |
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July 4, 2006
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I have had chronic back pain for several years and have been getting epidural shots for my pain. How often can I get these shots and how many is too many? |
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Epidural steroid injections are used to primarily treat sciatica and in some cases back pain. They should be use in conjunction with an exercise program to reduce your pain. There is controversy as to how many epidural steroid injections are too many. Some believe that no one should receive more than three epidurals in a life time where as others think that there is no limit. My opinion is that three to four epidurals a year is reasonable as long as you are getting good pain relief from the epidurals and are not having any side effects from the injections. |
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June 20, 2006
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I have osteoporosis and was wondering if that new drug Forteo would be better than my Fosamax? |
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Forteo® (teriparatide) is a new class of drug for the treatment of osteoperosis that stimulates new bone formation. This drug might lead to the development of osteosarcoma (a deadly bone cancer). Therefore, it is not recommeded for patients with an increase risk for osteosarcoma. It is also not recommended for treatment of metabolic bone diseases other than osteoporosis, and those with bone cancer or metastases. Discuss with your physician if Fosomax® has been successful in treating your osteoporosis and whether you should consider another drug. Just realize that Forteo has risks and might not be the right choice for you. |
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June 6, 2006
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What is radiofrequency surgery and can it help my back pain? |
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Radiofrequency surgery destroys tissue with the use of high frequency radiowaves via alternating current. This leads to vibration of electrons in tissue within the vicinity of the radiofrequency probe that results in an increase in temperature and subsequent tissue destruction. Radio-frequency surgery for pain management is performed at temperatures between 60 and 90°C depending on the structure that is causing the pain. This procedure is used to treat a variety of painful conditions including back pain depending on the structure responsible for the pain. Other conditions amenable to radiofrequency surgery include headaches, trigeminal neuralgia, RSD, sciatica, TMJ and cancer pain. |
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May 26, 2006
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I have had two fusions of my back, and although I do feel better, what else can I do besides taking pain medication for my remaining pain? |
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If you continue to have back pain after fusion surgery, it is important to first make sure that the fusion is solid and that there is no incomplete healing of the fusion. If the fusion is solid, the next step is to identify other potential structures that could be causing your pain. Stuctures, such as the sacroiliac or facet joints, can lead to ongoing pain, as well as, the disc above the fusion that undergoes increased biomechanical stress since the disc(s) involved in the fusion or immobile. Identifying the source of pain can lead to treatment that reduces the pain. |
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May 9, 2006
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What can be done for disc degeneration of the back? |
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It is important that you keep your back as healthy as possible and avoid activities that might cause further further disc degeneration. Avoid or limit heavy lifting or get help when lifting heavy objects. Use good mechanics when lifting such as using your legs not your back. Maintain general fitness by exercising regularly. Also strengthen your abdominal, hamstring, quadricep, buttock and low back muscles to help reduce weight bearing forces on the disc. Wear low heeled shoes, eat properly, get consistent sleep and avoid smoking. Stop activity that causes back pain and seek medical attention for back pain that persists. |
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April 25, 2006
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I have disc degeneration in my back. What is disc degeneration? |
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There is confusion as to what constitutes degenerative disc changes from what normally occurs with aging. Fibrous tissue replaces healthy disc material over time with aging without leading to loss of disc height. This is considered to be a normal part of aging. Degenerative disc changes begin in response to repetitive micro trauma producing mechanical failure of the spine. Tears involving the outer disc occur over time as the disc begins to “wear out” and the center of the disc loses its ability to withstand normal weight loading which eventually leads to abnormal disc degeneration and ultimately disc space narrowing. |
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April 11, 2006
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What can be done to treat sciatica? |
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Conservative treatment includes the use of oral steroids, anti-inflammatory agents (ibuprofen [MOTRIN®]), muscle relaxers, and pain killers. Physical therapy or chiropractic care maintains activity, reduces pain, increases motion and normalizes function. Epidural steroid injections or nerve root blocks are used in conjunction with and to enhance physical therapy or chiropractic care by reducing sciatic pain through the elimination of nerve root inflammation. Surgical procedures are considered in those who fail conservative treatment depending the cause of sciatica including removing disc material through a needle like device (percutaneous diskectomy), or open surgical removal of disc and/or bone material. |
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March 28, 2006
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What tests are used to diagnose sciatica? |
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X-rays are used to evaluate for fracture and/or instability of the spine. Computer Tomography (CT) is a computerized x-ray test that provides a two and three dimensional evaluation of the spine including the bones, discs and nerve roots. CT is often combined with myelography to enhance visualization of the spine and nerve roots. Magnetic Resonance Imaging (MRI) is a high tech imaging modality that provides the best assessment of soft tissue structures such as the spinal cord. EMG/NCV is a test that evaluates nerve and muscle function of the arms and legs in those with sciatica. |
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March 14, 2006
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What is sciatica? |
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Sciatica, pinched nerve or radiculopathy, describes the symptoms associated with the irritation or compression of the nerves from the lower spine that supply sensation and motor function for the legs. Sciatica occurs in approximately five percent of those who have back pain. The typical presentation of sciatica is pain in the back, buttock, posterior thigh and calf with numbness in the lower leg, foot and toes. Weakness can occur in more severe cases of sciatica. Conditions that can lead to sciatica include a herniated (slipped) disc, stretching of the spine nerve (stinger or burner), narrowing of the spine (stenosis) or tumor. |
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February 28, 2006
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What can be done to treat osteoporosis? |
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Take calcium and vitamin D, which is important for calcium absorption, daily. Avoid smoking and excessive alchohol. Exercise regularly. Bisphosphonates (Fosamax) and Calcitonin, a natural hormone, slow the rate of bone resorption. Selective estrogen receptor modulators (Evista) are used in women to slow bone resorption and increase bone density. Parathyroid hormone injections are given to those with severe osteoporosis who are at high risk for fracture. Estrogen with or without progesterone reduces bone loss but both have been recommended for short term use because of their increased risk for breast cancer, heart attack, stroke, blood clots, and dementia. |
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February 14 , 2006
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What is a DEXA scan? |
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A DEXA (dual-energy x-ray absorptiometry) or bone density scan is a special and painless x-ray test that evaluates the bone density of the hip, lumbar spine (back) and wrist. The test can determine if you have normal bone density, low bone density (osteopenia) or severely low bone density with a significant risk for bone fracture. DEXA scans are generally recommended for postmenopausal women, men or women over 65 years, estrogen deficient women, those on long term gluococorticoid therapy, primary hyperparathryoidism, and monitoring of those taking drug therapy for osteoporosis. |
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January 31 , 2006
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How much calcium is recommended for the prevention of osteoporosis? |
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It is important to take calcium regularly from the time of birth to maximize calcium stores. We lose calcium as we age, so the more calcium that we have the better our chances to prevent the development of osteoporosis. The National Academy of Sciences recommends the following daily calcium intake in milligrams (mg) by age.
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