READ FIRST: How to Use the Information In the Neck Pain / Cervical Spine Category

5 Painful Facts You Need to Know

By Robert Roy Britt, LiveScience Managing Editor
http://www.livescience.com/health/080725-pain-facts.html

5 Painful Facts You Need to Know

First off, let’s set the record straight: Pain is normal. About 75 million U.S. residents endure chronic or recurrent pain. Migraines plague 25 million of us. One in six suffer arthritis.

The global pain industry peddles more than $50 billion in drugs a year. Yet for chronic pain sufferers, over-the-counter pills are typically little help, while morphine and other narcotics can be addictive sedatives.

An overview study published last month in the Journal of General Internal Medicine looked at multiple studies of pain and found “researchers don’t yet know how to determine which [treatment] is best for individual patients.” From studies of drugs to surgeries and alternative medicines, “We have found that there are huge gaps in our knowledge base,” said Dr. Matthew J. Bair, assistant professor of medicine at the Indiana University School of Medicine.

So what is pain and why do so many suffer so long?

Pain is felt when electrical signals are sent from nerve endings to your brain, which in turn can release painkillers called endorphins and generate reactions that range from instant and physical to long-term and emotional. Beyond that, scientific understanding gets painfully fuzzy.

Here’s what’s known:

Fact 1 - Scientist Don’t Understand Pain

When you’re in pain, you know it. But if scientists could fully grasp how pain works and why, they might be able to help you more. The American Academy of Pain Medicine defines pain as “an unpleasant sensation and emotional response to that sensation.” Some pain is the result of an obvious injury. Other times, it is caused by damaged nerves that are not so easy to pinpoint. “Pain is complex and defies our ability to establish a clear definition,” says Kathryn Weiner, director of the American Academy of Pain Management. “Pain is far more than neural transmission and sensory transduction. Pain is a complex mixture of emotions, culture, experience, spirit and sensation.”

Fact 2 - Chronic Pain Shrinks Brains

If you have chronic pain, you know how demoralizing and debilitating it can be, physically and mentally. It can prevent you from doing things and make you irritable for reasons nobody else understands. But that’s only half the story. People with chronic backaches have brains as much as 11 percent smaller than those of non-sufferers, scientists reported in 2004. They don’t know why. “It is possible it’s just the stress of having to live with the condition,” said study leader A. Vania Apkarian of Northwestern University. “The neurons become overactive or tired of the activity.”

Fact 3 - Migraines and Sex Go Together

It may not eliminate the phrase “Not tonight, honey …” but a 2006 study found that migraine sufferers had levels of sexual desire 20 percent higher than those suffering from tension headaches. The finding suggests sexual desire and migraines might be influenced by the same brain chemical, and getting a better handle on the link could lead to better treatments, at least for the pain portion of the equation.

Fact 4 - Women Feel More Pain

Any man who has watched a woman having a baby without using drugs would swear that women can tolerate anything. But the truth is, guys, it hurts more than you can imagine. Women have more nerve receptors than men. As an example, women have 34 nerve fibers per square centimeter of facial skin, while men average just 17. And in a 2005 study, women were found to report more pain throughout their lifetimes and, compared to men, they feel pain in more areas of their body and for longer durations.

Fact 5 - Some Animals Don’t Feel Our Pain

Animal research could offer clues to eventually relieve human suffering. Take the naked mole rat, a hairless and nearly blind subterranean creature. A study this year found it feels neither the pain of acid nor the sting of chili peppers. If researchers can figure out why, they might be on the road to new sorts of painkilling therapies for humans. In 2006, scientists found a pathway for the transmission of chronic pain in rats that they hope will translate into better understanding of human chronic pain. Lobsters feel no pain, even when boiled, scientists said in a 2005 report that is just one more salvo in a long-running debate.

What You Can Do

Meanwhile, exercise is a useful remedy for many types of chronic pain.

In an Italian study detailed in the May issue of the journal Cephalalgia, office workers did relaxation and posture exercises every two to three hours. Over an eight-month period, they kept diaries, which were then compared to those of a control group that did not change habits. In the end, the group that exercised reported that headaches and neck and shoulder pain decreased by more than 40 per cent, and their use of painkillers was cut in half.

“Physical activity is actually a natural pain reliever for most people suffering from arthritis,” concludes another study published in the Arthritis Care and Research journal in April. “Even minor lifestyle changes like taking a 10-minute walk three times a day can reduce the impact of arthritis on a person’s daily activities and help to prevent developing more painful arthritis,” said Dr. Patience White, chief public health officer of the Arthritis Foundation. “Physical activity can actually reduce pain naturally and decrease dependence on pain medications.”

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A Doctor that Specializes in Pain Management is a Physiatrist!

A Physiatrist (Pain Management Doctor) is the specialist to help you with non-surgical “conservative” treatments to reduce pain. These Doctors use many injection therapies and do no “cure” pain, they only treat it. Do not confuse Physiatrist with a Psychiatrist or Psychologist who treat mental disorders - not pain.

5 Pain Treatment Methods for Spinal Related Pain

About these Spinal Pain Treatment Modalities

Treatments I list on this page are those I have not investigated throughly. I have not tried these treatments, some mainstream, some alternative. I list them only so that those of you who are visiting the site may have additional access to possible therapies. it’s hard to say I’ve tried everything when there are so many therapies “Out there”. The real problem is not every therapy works for every person. So with that being said I give you this list.

Intrathecal Drug Delivery (Pain Pumps) - This is heavy duty, you do not want this… only the very worst cases may need this treatment.

Spinal Chord Stimulator -Surgically implanted pain treatment devices similar to Intrathecal except they deliver low voltage electrical stimulation instead of drugs.

Radiofrequency and Pulse Radiofrequency - Electromagnetic energy is delivered via a needle to treat nerves for pain.

Phoresis - High frequency sound waves are used to push a steroid medication through the skin. Lontophoresis uses a small machine to produce a mild electrical charge to carry the medicine through the skin.

Spinal Chord Stimulator -Surgically implanted paint

Therapeutic Ultrasound - I’m still learning about how this works. I’ve had both hot and cold Therapeutic Ultrasound and the hot felt great, but I don’t know the side effects if applied improperly. Most of the mainstream medical community would agree there is not real evidence to support this treatment.

Exercise - Exercise Therapies - Yoga - Tai Chi

General Exercise

The body is designed for movement and movement aids healing, just don’t over do it! You have to remember there is no blood flow to the discs so if you do not move, the spinal fluid does not move!

Your road to recovery will be much slower or non-existent without some form of gentle to moderate exercise. I’ve had Doctors tell me for Cervical Problems not to swim, but others have said it’s good. I like to swim and while I don’t do anything specific for very long, I believe just the buoyancy provided such incredible relief there are immense benefits in aqua therapy even if all you do is walk through the water. This allows me to relax and stretch and move around and it feels great.

Yoga

The benefits of movement and stretching can not be understated unless directly contradicted by your condition. Give yoga a try I’m still working on my personal yoga experience and I think the benefits are making my pursuit worthwhile.

Beautiful Yoga Movements

Yoga is for everyone. I show you this video to show how incredible movement of the Human Form can be. You do not have to be flexible to start Yoga. The whole point is you are working towards your own goals at your own pace. If you never are able to touch your toes, that’s fine. That’s not the point. The point is to get your body moving and stretching with gentle, relaxing, and peaceful movements.

Tai Chi

Gentle movements and motions many have touted to have brought about relief from spinal pain throughout the back and neck. I have not been to an instructed class on Tai Chi, but from what I’ve read I would like to start.

Tai Chi Fundamentals for Taiji Beginners

Sympathetic Nerve Blocks

Sympathetic Nerve Blocks - Peripheral Nerves consist of two systems: sensory-somatic nervous system and the autonomic nervous system. All of the spinal nerves are “mixed”; that is, they contain both sensory and motor neurons. All our conscious awareness of the external environment and all our motor activity to cope with it operate through the sensory-somatic division of the PNS.

Only your Physician will be able to determine if this will benefit you should read about it and bring it to their attention. Many doctors want to believe their patients are uneducated morons, others will listen intently if you give them the opportunity. Physicians are busy people and often overlook the possible causes of pain in that they get so narrowly focused in their own little specialties. You may need a referral to a specialist to diagnose a cause or condition that would be best treated with a Nerve Block.

Please see additional posts on Nerve Blocks such as the Occipital Nerve Blocks for Cervogenic Headache.

Nucleoplasty

A minimally invasive procedure for disc Herniations involving radio wave therapy delivered via a needle to dissolve the disc herniation reducing pressure on the disc and the irritated nerves.

Learn more about the use of Nucleoplasty for Spinal Surgery.

TCM Traditional Chinese Medicine and Ayurvedic Medicine

Ayurvedic Medicine

A whole different world of treatment opportunities to vast to cover in a single post. Start with this link for information on Ayurvedic Medicine

TCM Traditional Chinese

Another system of Medicine that has been around for thousands of years, but today typically falls into the realm of “Alternative Medicine” in the eyes of westerners. I would encourage you to at least investigate the basics of Traditional Chinese Medicine.

I have been to a Chinese Medicine Doctor for acupuncture, and I have taken some Chinese Herbs, but beyond that I know little about the practice.

You may find treatmentd in either or both practices that work effectively for your pain problems.

IV Drips - Intravenous Therapy

This is not the same as Intrathecal drug delivery. IV drips can be anything from drugs to vitamins or minerals. The reason this is valid and helpful treatment modality is the medication or vitamins/minerals go directly into the veins bypassing the stomach.

Most people do not realize that oral vitamin consumption may only deliver as little as 5 to 15% of the vitamin to your system. People who are ill generally absorb even less! You’re intestinal tract is your “Second Brain” full of nerves and needs the care an attention the rest of your spine receive. Opportunistic pathogens in one area of the body may prevent another area of the body from receiving the healing attention it needs. The body is a whole!

This is a complex topic whose use extends from Mainstream to Alternative Therapies. The whole point is to bypass the digestive tract and deliver Nutrition/Drugs directly to the bloodstream.

Visit this link to learn more about Intravenous Therapy

Kinesiology vs Applied Kinesiology

Kinesiology

Kinesiology, also known as Human Kinetics, is the science of human movement. It focuses on how the body functions and moves. A kinesiological approach applies scientific and evidence based medical principles towards the analysis, preservation and enhancement of human movement in all settings and populations. Kinesiologists work in research, the fitness industry, clinically, and in industrial environments. It is not to be confused with Applied Kinesiology, an alternative medicine technique.

Applied Kinesiology

Applied Kinesiology (AK) is a practice of using manual muscle-strength testing for medical diagnosis and a subsequent determination of prescribed therapy. It purportedly gives feedback on the functional status of the body.

AK is a practice within the realm of alternative medicine and is therefore different from “kinesiology,” which is the scientific study of human movement. AK has been criticized on theoretical and empirical grounds, and characterized as pseudoscience. With only anecdotal accounts providing positive evidence for the efficacy of the practice, a review of peer-reviewed studies concluded that the “evidence to date does not support the use of [AK] for the diagnosis of organic disease or pre/subclinical conditions.”

AK draws together many similar therapies. It attempts an integrated, interdisciplinary approach to health care. George J. Goodheart, a chiropractor, originated AK in 1964.  Subsequently, its use spread to other chiropractors, and a few physical therapists, dentists, and medical doctors. In 1976, the International College of Applied Kinesiology was founded.

Applied kinesiology is a system that evaluates structural, chemical, and mental aspects of health using manual muscle testing alongside conventional diagnostic methods. The essential premise of applied kinesiology that is not shared by mainstream medical theory is that every organ dysfunction is accompanied by a weakness in a specific corresponding muscle, the viscerosomatic relationship. Treatment modalities relied upon by practitioners include joint manipulation and mobilization, myofascial, cranial and meridian therapies, clinical nutrition, and dietary counseling.

A manual muscle test in AK is conducted by having the patient resist using the target muscle or muscle group while the practitioner applies a force. A smooth response is sometimes referred to as ‘a strong muscle’ and a response that was not appropriate is sometimes called ‘a weak response’. This is not a raw test of strength, but rather a subjective evaluation of tension in the muscle and smoothness of response, taken to be indicative of stresses and imbalances in the body. A weak muscle test is equated to dysfunction and chemical or structural imbalance or mental stress, indicative of a body dissatisfied with suboptimal functioning. The most common test is the arm-pull-down test, or “Delta test,” where the patient resists as the practitioner exerts a downward force on an extended arm. Proper positioning is paramount to ensure that the muscle in question is the prime mover, minimizing interference from adjacent muscle groups

Heat and Cold Packs

Ice or Heating Pads bring temporary relief to some, but are not very effective in the treatment of chronic pain (at least not for me). Be sure to get advice on the correct use of these modalities from your Physician or Physical Therapist. Too much or too little may not be effective and may make you feel worse.

Suprascapular Nerve Block Effectively Treats Shoulder Pain

Suprascapular nerve block with bupivacaine and methylprednisolone acetate is a safe and effective treatment for shoulder pain experienced by patients with degenerative disease and arthritis, say Australian and Irish researchers.

These painful conditions can be difficult to manage, and are also common causes of morbidity, the researchers note, but there have so far been limited trials on the nerve block’s efficacy.

Consequently, the investigators, from the Repatriation Hospital in Daw Park, southern Australia, and Dublin’s St Vincent’s University Hospital, performed a randomised, double- blind, placebo-controlled trial to investigate the potential efficacy of suprascapular nerve block.

A total of 83 patients with chronic shoulder pain or rheumatoid arthritis participated in the study. Each shoulder was randomized separately, say researchers, resulting in 108 shoulders being studied.

A single suprascapular nerve block was administered to those patients in the group who were undergoing active therapy, while the placebo group were given a subcutaneous injection of normal saline. They were then followed up by an independent observer for 12 weeks, and reviewed at weeks 1, 4 and 12 following the injection. During this time data relative to pain, disability and movement were gathered.

The researchers established that those in the active group displayed clinically significant improvement in all pain, disability and some range of movement scores in their shoulders, in comparison to those in the placebo group. In addition, no significant adverse effects were encountered in either group, they concluded.
Annals of Rheumatic Diseases 2003;62:5:400-406. “Suprascapular nerve block (using bupivacaine and methylprednisolone acetate) in chronic shoulder pain”

Occipital Nerve Blocks for Cervicogenic Headaches

Cervicogenic Headaches

The cervical spine and associated muscular support of the head interwoven with vessels and nerve supply in the head and upper extremities, compose a complex structure with many sites for the generation of pain. A reduction in the space in which nerves pa ss through or lie can result in pain and loss of function. If the pressure is acute, pain is more likely to occur. Loss of function is generally the result of more prolonged and continuous pressure.

The sites of nerve compression in the neck are the intervertebral foramina, the spinal canal, the interscalene space and the course of the occipital nerves through the trapezius muscle at the base of the skull. Impairment or free movement at the joints, discs or ligaments may lead to irritation of sensitive structures of the joints and soft tissue of the neck. Reflex muscle spasms resulting from this irritation can produce continuous tension on the periosteal insertion of muscles. It is common for head and neck pain to originate with stress on the cervical musculature. Tension headaches are the result of sustained muscle contraction which produces both irritation at muscle insertion points and ischemic pain of the muscle itself.

Irritation of the cervical nerve roots at any point from their origin of the spinal cord to their paths to the occipital muscles can result in pain referred to the head and neck or upper extremity. Common sources of such irritation are the degenerative changes associated with osteophytes. As the degenerative process progresses, the spinal canal decreases in all diameters causing pressure on the long ascending and descending tracts as well as the cervical nerve roots. The most frequent complaint of the patient with cervical spondylosis is cervical, occipital or atypical facial pain due to irritation of the C2, C3 and C4 nerve roots. The continued irritation of these roots as they exit from the intervertebral foramina produce an inflammatory response i n the root with secondary edema.

As the greater and lesser occipital nerves pierce the trapezius at the base of the skull they are subject to pressure by cervical muscles and spasm. The result, an occipital neuralgia, produces further cervical spasms leading to a reflex perpetuation of occipital pain. Carcinoma and tumor invasion of the cervical spine and soft tissues of the neck may cause destruction as well as encroachment in cervical nerve roots or invasion of branches of the cervical plexus. These malignant forms of cervicogenic headache will not be discussed.

Treatment

The purpose of this discussion is to describe those injection techniques that have been found useful in the treatment of muscle tension and cervicogenic headaches. These procedures include: trigger point injections, occipital nerve blocks, anesthetic blocks of the cervical nerve C2-C5, facet joint blocks at C2, C3 and cervical epidural steroid injections.

Occipital Nerve Blocks

To understand how a blockade of the occipital nerve is efficacious in the treatment of headache, a review of the anatomy will be presented. The greater and lesser occipital nerves are sensory nerve which enter into the second, and to some extent the thir d cervical segments. The nerves enter the spinal cord via the Tract of Lissauer to terminate in the substantia gelatenosa of the upper cervical cord where they synapse. The infratentorial intracranial structures are innervated by the upper three cervical nerves. Sensory cutaneous distribution in the occipital nerve is over the back of the head anteriorly to the borders of the innervation of the first division of the trigeminal nerve. The C2 component is a more medial band extending form the superior nuch al line to this boundary. C1, when present, innervates an overlapping area more posteriorly. The greater occipital nerve passes over the superior nuchal line midway between the mastoid process on the occipital protuberance just lateral to the insertion of the nuchal ligaments. The lesser occipital protuberance is just lateal to the insertion of the nuchal ligaments. The lesser occipital nerve passes laterally to the greater occipital nerve over the nuchal ridge.

The greater occipital nerve runs transversely and then turns at right angles to run posteriorly. It then emerges through the aperture above the aponeurotic sling between the trapezius and the sternomastoid. This fact renders untenable any speculation t hat it may be compressed by spasm in the trapezius. Similarly, the nerve is not vulnerable to bony compression between the posterior arch of the atlas and the lamina of the axis. How the occipital nerve becomes sensitive to the diverse headache condition described is still a matter of speculation.

Occipital nerve blockade has been used for the treatment of diverse headaches for decades. The most effective position for greater occipital blockade is sitting or lateral decubitus with the chin flexed upon the chest. A short 25 gauge needle is inserted through the skin at the level of the superior nuchal line so as to develop a wall of local anesthetic surrounding the posterior occipital artery. The procedure should be done under strict aseptic conditions. The artery is commonly found approximately one-third of the distance between the external occipital protuberance and the mastoid process on the superior nuchal line. Injection of 3-5 ml of local anesthetic in this area with or without depo-corticosteroids will produce satisfactory anesthesia. Due to the superficial nature of this block complications are infrequent but may include hematoma, infection and paresthesia. Occipital nerve blockade will local anesthetic may also be used as a prognostic tool to determine if rhizotomy is warranted in refr actory cases. Occipital rhizotomy may be performed surgically or using a cryoprobe.

To learn more and read the complete article please visit Dr. Lichten’s Website.

Cryoanalgesia - Cryoneuroablation - Cryoneurolysis,

Basic Description of Cryoanalgesia

Cryoanalgesia is a pain-relieving technique which uses cold to treat nerve pain. It’s been around for centuries, and in its crudest form, uses ice to numb nerves. The more sophisticated, current type of cryoanalgesia uses a needle-like probe to deliver very, very cold sensation and thereby incapacitate nerves.

Detailed Description of Cryoanalgesia

Cryoneuroablation, also known as cryoanalgesia or cryoneurolysis, is a specialized technique for providing long-term pain relief in interventional pain management settings. Modern cryoanalgesia traces its roots to Cooper et al who developed in 1961, a device that used liquid nitrogen in a hollow tube that was insulated at the tip and achieved a temperature of - 190 degrees C. Lloyd et al proposed that cryoanalgesia was superior to other methods of peripheral nerve destruction, including alcohol neurolysis, phenol neurolysis, or surgical lesions.

The application of cold to tissues creates a conduction block, similar to the effect of local anesthetics. Long-term pain relief from nerve freezing occurs because ice crystals create vascular damage to the vasonervorum, which produces severe endoneural edema. Cryoanalgesia disrupts the nerve structure and creates wallerian degeneration, but leaves the myelin sheath and endoneurium intact.

Clinical applications of cryoanalgesia extend from its use in craniofacial pain secondary to trigeminal neuralgia, posterior auricular neuralgia, and glossopharyngeal neuralgia; chest wall pain with multiple conditions including post-thoracotomy neuromas, persistent pain after rib fractures, and post herpetic neuralgia in thoracic distribution; abdominal and pelvic pain secondary to ilioinguinal, iliohypogastric, genitofemoral, subgastric neuralgia; pudendal neuralgia; low back pain and lower extremity pain secondary to lumbar facet joint pathology, pseudosciatica, pain involving intraspinous ligament or supragluteal nerve, sacroiliac joint pain, cluneal neuralgia, obturator neuritis, and various types of peripheral neuropathy; and upper extremity pain secondary to suprascapular neuritis and other conditions of peripheral neuritis.

Stress

Practical Advice for Dealing with Stress

This is for real! Avoid the drugs. Deal with your issues head on. LET GO! The Dali Lama (I am not a follower, but appreciate his wisdom) has said Follow the three R’s: Respect for self, Respect for others, Responsibility for all. Love what you do and do what you love is another quote that will set you free from the burdens of stress.

When you get down go outside on a clear night away from city lights and just look at all the stars. You are part of the universe! You’re place is here and now and one day you will advance to someplace special based on your actions. When everything you do in life becomes more about you than those around you it’s time for self reflection.

Life is about giving! Once you have experienced the joy of a selfless act (And you can define a selfless act by doing something for someone and telling no one) you’ll be hooked. Don’t ask why me, ask why not me? You have the capacity to suffer; you’ll get through this! You may have no other options at this point in time. Nothing is static; everything changes.

Make everyday as good as you can. Don’t be afraid to cry - each tear is a drop of stress leaving your body! Focus on the positive, the beautiful, the enriching while you continue to educate yourself to various treatments. This is not a pep talk. These principals work.

People will forget what you do, people will forget what you say, but people will never forget the way you make them feel!

The past is over, each new day brings new opportunity and new challenges. Only you can determine your future by the decisions you make today. Once you are well do not forget the plight of those still suffering!

Faith and Spirituality

We Are All Spiritual Beings

Regardless of your religion at a molecular level we are all atoms, beings that are electro chemical. Faith, energy, our brains, mood, stress, all play a role in healing. When we are emotionally stable and emotionally healthy we feel better, and we can heal faster.

Practice your religion, follow your faith; if you pray - then pray, if you meditate - then meditate. You will find some interesting information by searching online for “Violet Flame”, “Archangel St. Michael”, “Archangel St. Germaine”, “Buddhism”, “Higher Self”, etc. Find a doctrine that makes sense to you and explore. At the very least you will educate yourself to the fact that we as human beings are not alone.

What matters is you find your core belief system, you then practice it. Keep an open mind as there is much to be learned from all religions. And the “right” religions is merely the one you believe.

Minimally Invasive Endoscopic Surgery

Minimally Invasive Endoscopic Surgery is any surgical procedure done with an Endoscope and a minimal incision. Unfortunately the definition varies, and an Endoscopic procedure can end up in a full incision depending on the procedure and needs of the patient.

As far as this applies to Spinal Procedures it’s main meaning is to remove only the offending portion of a disc through a small (Until it’s stuck in you!) needle like tube (Endoscope). The remaining portion of the disc is left intact. Search the NET for “Jho Proceedure” or Dr. Jho’s No Fusion Microforaminotomy for detailed information. Dr. Jho is one of many surgeons using Endoscopic Techniques, but I refer you to him as he explains a lot of the procedures.

Endoscopic Laser Spine Surgery (aka PLDD Percutaneous Laser Disc Decompression) A laser is threaded within a needle to the center of your disc then activated, the result is the water is evaporated out of the disc (the disc also contains fat) resulting in immediate shrinkage or resorption of the disc material and in practice for the right candidates this should reduce pressure on the nerves the disc was aggravating. Note this only works for the “right” candidates. You should note that this stops the pain for many, but it does not “fix” the disc. Once the pain is gone you must take dietary, postural, and lifestyle changes to ensure you do not cause further injury to your spine. Once the water is gone your disc is basically degenerated. You can read more about it at Dr. Daniel S.J. Choy Laser Spine Center. This link is not an endorsement, it’s a reference. I do not know Dr. Choy.

Note: While Minimally Invasive Endoscopic Surgery may seem the best “Answer” at first, it really doesn’t mean anything. What matters is patient selection, your condition, and whether an Endoscopic approach is your best treatment option. A Surgeon should always choose the best procedure for you, and to approach the procedure from the least invasive method which accomplishes the objectives.

Facet Joint Blocks

Graphic Image of a Facet Joint

A Facet Joint is a joint between two adjacent vertebrae. Each vertebra is connected at the intervertebral disk in the front and the two facet joints in the back. Facet Joints are the bony masses connected to the vertebrae in the image above. Facet Joints are prone to wear and tear as our spines degenerate, so as the Intervertebral Discs degenerate so do the Facet Joints (once the cartilage is gone).

A “Block” can be done to determine if this is the source of your pain. If this is the case then the nerves can be “burned” giving up to a year of temporary relief. Osteoarthritis (meaning bone inflammation) as a diagnosis if often really Facet Joint Pain. You will still need to fix your diet and posture, but this could help if the Facet Joint is truly the source of your pain. This is a minimally invasive procedure involving needles and outpatient surgery and in the Cervical Spine is usually done under Fluoroscopic Guidance.

Spinal Traction

Traction is a gentle consistent pressure that is applied to “Pull” the spine segments apart gently reducing pressure on the discs and adjacent materials. Traction can be performed manually by a trained medical professional or through the use of a traction device or machine.

I have used both an over the door ratcheting system (Neck Pro) and a Pronex inflatable system (Much Preferred). Unfortunately little relief in my case. I’ve read how this has helped many; however those with fused vertebrae should not attempt this modality as it can weaken or pull apart the fusion site.

My recommendation for anyone considering traction is to purchase an “Inversion Table” which I write about in a separate post Titled “Inversion Therapy”. Inversion is a very gentle method of traction that involves the entire spine. You simply lie on a table and invert (Tip upside down) a few degrees at a time. You do NOT have to hang completely upside down to enjoy benefits. In fact many people feel tremendous benefits from inverting only a few degrees.

Hydro Therapy - Aqautic Therapy for Pain Relief and Exercise

Benefits of Hydro Therapy

Hydro Therapy is simply the use of warm water to help us relax or exercise or both. Hot Tubs, Swimming Pools, Therapy Pools, and even your Home Bathtub can serve as appropriate vehicles for this purpose. Today’s “Hot Tub” contains dozens of jets that can feel wonderful and allow us to release muscle tension and relax. You may have a high end “Whirlpool Tub” or built in Home Spa. Larger bodies of warm water allow us to move from relaxation into exercise, stretching and strengthening. So while passive relaxation has it’s benefit, if you can, try and find a warm water pool large enough to exercise in. Ideally the pool will be no deeper than mid chest level to the bottom of your neck (48″ to 52″) is just about right.

If a pool is too deep it can be dangerous should you become ill. If a pool is too shallow you won’t receive the full benefits of flotation and buoyancy. Water allows us to exercise without stressing the joints. As muscles relax and the forces of gravity are lessened we can enjoy stretching that would not otherwise be possible. An ideal temperature for exercise is 84 to 90 degrees. Much warmer and you’ll become uncomfortable with your movements and begin to sweat a lot. For just relaxation 100 to 102 degrees is wonderful. When the water temperature drops below body temperature and we are not moving it becomes uncomfortable, and water over 104 degrees is very dangerous to our bodies. In fact if your water temperature is above body temperature you should limit your sessions to 20 minutes. Water 104 degrees and higher for periods longer than 20 minutes can damage your internal organs.

Warm water can really help to reduce your stress levels. Often Hydro Therapy is combined with aroma therapy and music to complete the relaxation. It’s hard not to just relax when the pressure is taken off your injury. It’s like an anti-gravity experience where we become weightless.

Some Spas contain special “Neck jets” or “Lumbar jets” that just melt (at least temporarily) away your pain. The warm water dilates the blood vessels promoting healing, and a 20 minute session will help you fall asleep faster

Caveats: You’re skin is an organ and will absorb chemicals in water so ask your dealer about the least chemical solution to keeping the water pure and clean. Tubs will make you sweat and release toxins in the water so be sure to keep your Spa’s water clean. Do not exceed 20 minutes in water over 104 degrees (The limit at which you can set the Spa’s) as your internal proteins will start to cook! If the water feels too hot turn it down, anything over body temperature will make you sweat. Ask your Physician about Hydro Therapy for your condition. Hydro Therapy will not “cure” your condition, but it can go a long ways to making your pain more tolerable and will aid in your recovery most of the time. If prescribed by your Physician you may be able to deduct the expense of a Hydro Therapy Solution from your personal taxes.

Note: Not everyone is comfortable in water. Some people never learn to swim as youngsters, this is okay. That’s why we recommend to find a pool that is not too deep. Find a partner to go with you. Swimming and splashing is fun! Enjoy yourself.

Tips on Purchasing a Hot Tub

There are so many brands available and Hot Tub dealers come and go. Find a local dealer that has been in business a long time with an established track record. The tub is important, but even more important is the warranty and service for that warranty. Tubs require maintenance, you’ll need a source for chemicals. Pumps break, control panels break. Just like purchasing an automobile - think about the “Total Cost of Ownership” not just the up front cost. Be sure to “Wet Test” the tub before you buy! Wet testing is essential, because the tubs feel completely different with and without water. Wet testing means taking your swimsuit to the dealer and sitting in the tub for 10 or 15 minutes. Make sure you can control the jets, make sure the jets are not so powerful that they blow you out of your seat. Try all the seat positions to be sure they are comfortable to your body.

Massage Thereapy Treatments for Back and Neck Pain

Note: See Also My Post on Myofascial Release

Different Types of Massage Treatments

• Deep Tissue - Targets deep layers of muscles and connective tissue
• Rolfing - A specific form of deep tissue work
• Trigger Point Therapy - Addresses Adhesions in the muscles
• Swedish - most common, long smooth strokes and kneading, circular motions
• Shiatsu - Finger pressure on acupuncture meridians
• Thai
• Many many more

My point in this post is not to cover every single variation of massage, but to point out there are treatments that may address your specific problem areas.

Therapies like Deep Tissue Massage are designed for relieving muscle contraction and reducing pain. Not all massage therapists are alike, some do not understand how to do this properly - this is a form of medical massage, as opposed to just a relaxing massage to reduce stress. All massage work has benefits. Try several different modalities and see what works best for you. Be careful of the oils the therapist uses - I like grapeseed oil.- as some oils contain fragrances and are toxic to the chemically sensitive. You’re skin will absorb these chemicals.

The only downside to massage treatments is cost. I would go everyday if I could afford the expense, or better yet I’d have the therapist stop by my home. Give massage a try, it’s great!

Video About Massage Treatments

UltraSound for Pain

High frequency sound waves are directed to the sore area causing the body tissues (molecules) to vibrate. This changes to heat in the deeper tissues helping to flush the area and bring in a new supply of nutrient and oxygen rich blood. I’ve had this treatment and it feels wonderful, but the effects did not last for very long.

I have uncovered very little evidence to suggest Ultrasound is an effective treatment for spinal pain. All I can tell you is when I had Heated Ultrasound and it really loosened up my muscles which felt great. I had Ultrasound at another facility with a cold gel and it did nothing. So I believe it was the heat that made me feel better.

Ergonomics - Maintain Your Posture Maintain Your Health

Are You Ready for a Rude Awakening

If you have Spinal Problems (Neck or Back) you have bad posture! Have someone video tape you sitting on the sofa, working on your computer, eating dinner, just the everyday activities you do all day long! Then watch that video and you’ll be amazed at how you slump, move, sit, etc.

Correcting bad postural habits will stop and may even reverse spinal problems. But the battle is difficult if your furniture is not designed with Ergonomics in mind. Most sofas, beds, chairs, etc. are NOT designed for proper posture. So the more you use the non-ergonomic disaster the more your spine has to compensate, and the more difficult it will be to ever recover proper posture and live pain free.

Videos to Introduce You to Ergonomics

This video is primarly about lifting properly

Selecting Ergonomic Office Furniture

Ergonomics Matter!

You can do every kind of therapy and/or treatment but if you continue on with old poor postural habits and non-ergonomic furniture, you’ll just fall into the same old trap that ruined your spine in the first place.

Ergonomics is simply a term to describe making your environment “spine friendly”. You simply can not underestimate the importance of keeping your spine in correct posture through the use of ergonomic furniture and office equipment. How many hours a day do you spend sitting or sleeping? During these times it is essential that you provide your spine the optimal correct support so it can heal, and to prevent further injury.

Use a lumbar pillow on your chairs or better yet purchase truly ergonomic chairs. A cervical injury will be made worse if you do not correct your lumbar posture (the spine and body work as a whole!). Steelcase™ Humanscale™, Bodybilt™ all build truly ergonomic office chairs; while the $200 OfficeMax chairs that claim to be ergonomic are NOT ergonomic at all! Sit in a well designed chair and you will immediately “feel” the difference.

If you are a computer user a LCD flat panel and invest in a moveable monitor arm. If you are a laptop user you should do this and hook your laptop up to the larger monitor and monitor arm. Make sure you take breaks from your chair every 20 minutes to stretch and change position. You need to move your spine and shift those discs!

Make sure you have a good bed. Avoid the Tempurpedic™ or Memory Foam Mattresses (The toxins emitted from these materials are very unhealthy). It’s all marketing hype. Buy real cotton or invest in a Talay Latex (Natural Rubber) mattress. Royal Pedic in Los Angeles makes outstanding beds (but they are expensive) and offers excellent information on their website about natural bedding materials. Yes some of you will have Latex allergies and will need all cotton mattresses, but otherwise Talay Latex is wonderful!

Purchase the proper back supports for you Car, Truck, or RV seats (It’s cheaper than purchasing new seats) It’s your health. Fix your posture or continue to pay the price. Yes it can be expensive to buy all these things, but can you afford not too? What is the true price of pain? How much is your health worth?

Acupuncture

Acupuncture Videos to Help You Understand How it Works

My Experience with Acupuncture

Works for some to help with pain. I tried Acupuncture with electrical therapy (At a Chiropractors Office” and it did nothing for me, but he person doing the work may not have been fully schooled as to the proper treatment.

I then found a true Oriental Acupuncture Specialist, and it made me realize the Chiropractor was clueless. The Doctor I saw for Acupuncture was born in China, Trained in China, and was actually a retired Orthopedic Surgeon in China. The number of needles he placed, the location of placement and the effects on my muscles were completely different from the “treatment” (Money bilking) I received from the Chiropractor. In my defense the Chiropractor came highly recommended by the Naturopathic Physician I was seeing at the time. But I should have been smart enough to know that they Guy had no clue what he was doing. Now I do. The benefits of hindsight.

In short, make sure your Acupuncturist is fully trained and licensed (Yes they have schools for Acupuncture).

I received some pain reduction and additional range of motion from my treatments (A series of 10 every couple of days). Unfortunately for me the treatments did not solve my chronic problems and due to the expense ($60 per treatment) vs. benefit I was forced to abandon further treatment.

Similar Modalities Like Gua Sha

Gua Sha is a healing technique used in Asia by practitioners of Traditional Medicine, in both the clinical setting and in homes, but little known in the West. It involves palpation and cutaneous stimulation where the skin is pressured, in strokes, by a round-edged instrument; that results in the appearance of small red petechiae called ’sha’, that will fade in 2 to 3 days.

Raising Sha removes blood stagnation considered pathogenic, promoting normal circulation and metabolic processes.The patient experiences immediate relief from pain, stiffness, fever, chill, cough, nausea, and so on. Gua Sha is valuable in the prevention and treatment of acute infectious illness, upper respiratory and digestive problems, and many other acute or chronic disorders.

Gua Sha Video

Neural Therapy

Popular in Germany this treatment modality involves injections of procaine (an anesthetic) and vitamins. The intention is to reset the nerves. Learn more… Neural Therapy

Soft & Hard Collars

No doubt everyone has seen someone in a Cervical Collar at some point in their lifetime. Soft Collars are worn as “reminders” to keep your neck in the correct postural position and to provide limited support and stabilization for your neck. The consensus I read among the medical community is to limit your use of collars and to keep moving.

Spinal fluids require movement to allow for healing as there is no vascular supply to the discs after the 2nd to 3rd decade of life (essentially by age 25). Hard collars such as the Philadelphia and Miami collars are generally used after surgical procedures. I believe collar use in chronic conditions should be supervised by a Physician. Having said that - listen to your body, I use a soft collar infrequently, but it serves as a great reminder while driving.

Forminotomy

A foraminotomy is a surgical procedure that is performed to enlarge the passageway where a spinal nerve root exits the spinal canal. The term foraminotomy is derived from the medical term for a hollow passageway - foramen. The latter half of the term foraminotomy - otomy - means to remove. During a foraminotomy, the spine surgeon removes bone or tissue that obstructs the passageway and compresses (’pinches’) the spinal nerve root, which can cause inflammation and pain. Often the nerve (neuro) passageways are called neuroforamen.

Steroid Injections for Back and Neck Pain

Lumbar Epidural Injection Procedure Video

Where the Steroids are Injected

The epidural space (or extradural space or peridural space) is a part of the human spine. It is the space inside the bony spinal canal, but outside the membrane called the dura mater (sometimes called the “dura”). In contact with the inner surface of the dura is another membrane called the arachnoid mater (”arachnoid”). The arachnoid encompasses the cerebrospinal fluid that surrounds the spinal cord.

Epidural Steroid Injections

An epidural injection, or epidural steroid injection, may be used to help reduce the pain caused by a herniated disc, degenerative disc disease, or spinal stenosis. These spinal disorders often affect the cervical (neck) and lumbar (lower back) areas of the spine.

The medicine used in the injection is usually a combination of a local anesthetic (e.g. bupivacaine) and a steroid (e.g. triamcinolone). The technique and risks of the procedure are similar to those for standard epidural analgesia. The effects of an epidural steroid injection vary, but permanent benefit is unlikely. The technique is believed to work by reducing the inflammation or swelling, or both, of the nerves in the epidural space.

Some patients who have some residual pain after the first injection may receive a second or third epidural steroid injection. Patients who do not receive any relief from the first injection are unlikely to benefit from a second injection.

Side Effects of Epidural Injections

Note: Yes I know that some of these side effects refer more to pregnant women than back pain, but the process is the same, it’s the injected drugs that differ.

In addition to blocking the nerves which carry pain, local anaesthetic drugs in the epidural space will block other types of nerves as well, in a dose-dependent manner. Depending on the drug and dose used, the effects may last only a few minutes or up to several hours. This results in three main effects:

• Loss of other modalities of sensation (including touch, and proprioception)
• Loss of muscle power
• Loss of function of the sympathetic nervous system, which controls blood pressure

Pain nerves are most sensitive to the effects of the epidural. This means that a good epidural can provide analgesia without affecting muscle power or other types of sensation. The larger the dose used, the more likely it is that the side-effects will be problematic.

For example, a laboring woman may have an epidural running during labor which is providing good analgesia without impairing her ability to move around in bed. She requires a Caesarean section, and is given a large dose of epidural bupivacaine. After a few minutes, she can no longer move her legs, or feel her abdomen. Her blood pressure is noted to be lower and she is given an intravenous infusion of ephedrine or phenylephrine to compensate. During the operation, she feels no pain.

Very large doses of epidural anaesthetic can cause paralysis of the intercostal muscles and diaphragm (which are responsible for breathing), and loss of sympathetic function to the heart itself, causing a profound drop in heart rate and blood pressure. This requires emergency treatment, and in severe cases may require airway support. This happens because the epidural is blocking the heart’s sympathetic nerves, as well as the phrenic nerves, which supply the diaphragm.

It is considered safe practice for all patients with epidurals to be confined to bed to prevent the risk of falls. The loss of the sensation of needing to urinate may require the placement of a urinary catheter for the duration of the epidural.

Opioid drugs in the epidural space are very safe (as well as effective). However, very large doses may cause troublesome itch, and rarely, delayed respiratory depression.

For patients with nerve root pain involving one or two roots, I believe that fluoroscopically guided foraminal injections will prove to be superior to the approaches that do not use x-ray guidance. Epidurals in general, but especially foraminal injections, do not appear to be as effective if the pain is caused by widespread degenerative or arthritic problems in the spine. - Steven Richeimer, MD

Prescription Medications - Drugs

The Scary Truth About Prescription Drugs

This should go without saying, but some people don’t really understand the purpose of Prescription Medications and their role in healing. Drugs treat symptoms, drugs do NOT CURE, only the body can cure. It’s really just that simple.

Drugs are foreign to the body, synthetic substances created to alleviate a symptom. When you fall ill you don’t fall ill because of a drug deficiency. I have too often read posts of patients suffering and their treatment includes a handful of pills. These people continue to take these pills over and over, and guess what? They do not get better? Why? Because the medications are not designed to “fix” the cause, they are designed to treat the “symptom”.

Now I am not about to suggest that “Drugs are Bad”, I am only going to suggest that you consider what your medications are doing for you and your recovery. So many people start a medication, then another, then another to the point where they really have no idea what is helping and what is not. And their Doctors are not sure either. Read the fine print on prescriptions and dig a little into the research behind a particular medication and you’ll uncover statements like “The exact mechanism of … are unknown”.

Drugs are required to pass an evaluation period under FDA Supervision. This means the drug has been tested for a specific purpose. This does not mean the drug is “safe”. All drugs have side effects. It’s your responsibility to dig in and figure out what those side effects are and how they effect you as a patient. It’s your responsibility to keep your Physician in the loop.

Here is an example of Side Effects for the Drug Neurontin (Generic: Gabapentin)

Approximately 7% of the 2074 patients > 12 years of age and approximately 7% of the 449 pediatric patients 3 to 12 years of age who received Neurontin in premarketing clinical trials discontinued treatment because of an adverse event.

The list of “Adverse Events” for this Drug during clinical trials is staggering and include specific conditions far to vast to list here. How ever I will list the parts of the body that events were reported:

• Body As A Whole - Frequent
• Cardiovascular System - Frequent
• Digestive System - Frequent
• Endocrine System - Rare
• Hematologic and Lymphatic System - Frequent
• Musculoskeletal System - Frequent
• Nervous System - Frequent
• Respiratory System - Frequent
• Dermatological - inFrequent
• Urogenital System - inFrequent
• Special Senses - Frequent

Here is an example of the conditions for the “Special Senses” category:

Special Senses: Frequent: abnormal vision; Infrequent: cataract, conjunctivitis, eyes dry, eye pain, visual field defect, photophobia, bilateral or unilateral ptosis, eye hemorrhage, hordeolum, hearing loss, earache, tinnitus, inner ear infection, otitis, taste loss, unusual taste, eye twitching, ear fullness; Rare: eye itching, abnormal accommodation, perforated ear drum, sensitivity to noise, eye focusing problem, watery eyes, retinopathy, glaucoma, iritis, corneal disorders, lacrimal dysfunction, degenerative eye changes, blindness, retinal degeneration, miosis, chorioretinitis, strabismus, eustachian tube dysfunction, labyrinthitis, otitis externa, odd smell.

Gabapentin was originally approved in the U.S. by the Food and Drug Administration (FDA) in 1994 for use as an adjunctive medication to control partial seizures (effective when added to other antiseizure drugs). In 2002, an indication was added for treating postherpetic neuralgia (neuropathic pain following shingles, other painful neuropathies, and nerve related pain).

So the FDA has approved Neurontin/Gabapentin for 2 conditions! However it is prescribed by Physicians to treat a huge list of ailments. Those Aliments were not part of the clinical trials! And Neurontin/Gabapentin is one of those “exact mechanism of action is unknown” drugs. This simply means it seemed to work in clinical trials for most people (The 7% who were not forced to drop out due to adverse effects), but is widely prescribed for conditions for which it has not even been tested!