FAQ Category: Lumbar Spine

More and more surgeons are using patient-controlled analgesia (PCA). This refers to a special pump that allows the patient to decide when to receive the next dose of pain medication.

Morphine is the most commonly used drug. But a recent study compared using just morphine after spine surgery to using a combination of morphine and an antiinflammatory medication. The antiinflammatory drug used was a special type called cyclooxygenase-2 (COX-2) inhibitors.

COX-2 inhibitors can decrease pain from inflammation without causing increased blood loss during and after surgery. They are frequently used after many other kinds of surgery. This is the first study to combine them with opioids after spine surgery.

The results showed significantly improved pain control in the patients using PCA plus morphine. Overall, they used less pain medication during the first 48-hours after surgery. Pain relief was obtained both at rest and during movement. This helped patients get up, move around, and complete daily self-care tasks in the early post-operative period.

Tell your surgeon about your concerns. Ask if PCA combined with a COX-2 inhibitor is possible. Find out what all your options are for post-operative pain-control before having the surgery.

Lower back pain has many causes, ranging from poor body mechanics when moving heavy objects to trauma (injury or illness) to a body being out of shape and not able to bear the weight that the back takes on.

Because the Western world has changed from an active lifestyle to a more sedentary one, when people do get active, they often injure their backs. Another important issue is job safety. Many jobs require moving in awkward motions or at awkward angles, even if there is no lifting. These can also cause lower back pain.

It can be frustrating to live with chronic pain, especially of the back. However, even though it sounds simplistic, in a way, your doctor has a point.

Studies have been done that evaluate how people with chronic lower back pain see and accept their pain. Those who accept their pain and move on do tend to have a better quality of life than those who accept it but then are resigned to it.

It may be helpful to speak with your doctor about ways that you can try to live with the pain and still go about and do things you really want to do. Activities may require some adjustment or accommodation for the pain, but if you are active, you may build up enough enjoyment in what you are doing to be able to pass the frustration that can develop with chronic pain.

Chronic pain of any type is defined as pain (or discomfort) that has been present for 3 months or longer. The pain does not have to be constant – it can come and go – but if it is there by the same cause for 3 months or more, it will generally fall under the chronic category.

Lower back pain is one of the most common complaints in the Western world. Painful backs can affect how we live our life and cause other physical problems due to loss of mobility, lack of sleep, and other issues.

While only your doctor knows for sure why he or she offered the antidepressants, it is important to realize that many medications are given for reasons other than their original use. Some types of antidepressants, like some types of anti-seizure medications, work well on chronic pain.

Regarding meditation and therapy, this type of recommendation does not at all imply that the pain is in your head. Researchers have learned over the years that sometimes treatments like meditation can have a powerful effect on pain and how your body perceives pain. It is often worth a try because it is non-invasive (meaning it’s a treatment that doesn’t go into your body somehow) and can make a difference in managing pain.

The high cost of back pain begins with the vast number of people (employees) affected by it. Loss of work productivity while on the job and from days absent from work increase the costs for employers. And disability only adds to the total cost.

Many experts agree that a multidisciplinary approach is the best way to successfully treat patients with chronic low back pain (LBP). This method involves many types of treatment at the same time. The cost adds up when you are paying for a physician’s services along with the physical therapist, psychologist, massage therapist, and so on.

However, studies show there’s a higher rate of success when such a team of specialists treats patients. Pain is reduced and function improved. There are better long-term results than when patients are treated using a traditional biomedical model.

There’s no doubt that a multidisciplinary approach does cost more than traditional medicine. But the cost is offset by fewer sick days. A cost-benefit analysis would be helpful in determining how many and what kind of sessions are needed for acceptable (cost saving) results.

The problem of chronic low back pain (LBP) is faced by many people each day. Finding a way to manage it is the goal of many research studies. Taking a look at studies done all over the world has shown us that many different therapies combined together may make the difference.

That’s what is referred to as a multidisciplinary approach. It starts with intensive physical exercises along with behavioral therapy. Cognitive and behavioral therapy helps patients change the way they think about and respond to pain.

Instruction to help educate patients is essential. Improving skills for coping psychologically and emotionally is also included. The goal is to increase function and activity even if pain levels don’t change. Many patients want to get back to work. This may be possible with work-related and vocational training.

Studies show that people seem to do better when they get instruction and education to help explain their back pain. A wide range of health care specialists are often involved in providing this information. There may be psychologists, physical therapists, orthopedic surgeons, and behavioral therapists on the team.

Ask your doctor for a referral to a pain clinic or other facility that offers a multidisciplinary approach. A wide range of therapies may help improve your pain and increase your functional abilities. The final result may be to reduce your level of disability.

Long-term management of low back pain (LBP) is often a combination of proper nutrition, posture, and activity or exercise. Many people find that doing a regular routine of exercises maintains a pain free status. Exercise also seems to help prevent back pain from recurring.

Research shows that about half of the people with LBP who get better with exercises must keep them up on a regular basis. That means that an equal number could stop doing their exercises and return to work and daily activities without further intervention.

What’s the difference between those who must follow a regular program and those who get better and stay better? Further studies show that there are some factors linked with chronic LBP. People who smoke are more likely to have recurrent symptoms.

Patients with low expectations for overcoming disability and getting back to normal also seem to be at risk for poor outcome. Other risk factors under investigation include age, gender, pain intensity and duration, and prior surgery.

Studies report mixed results between these (and other) variables linked to chronic LBP. More study is needed to identify risk or prognostic factors and results (outcomes). Right now we just don’t have a sure fire way to predict who must continue exercising or how to remain pain free without exercise.

Exercise therapy has been proven effective as a first-line treatment for low back pain (LBP) and disability from disc disease. Injections and/or surgery are important options for patients who have not improved with exercise. Patients at risk for permanent neurologic damage are also advised to consider more invasive treatment.

Exercise guidelines for the management of LBP are not specific yet. Research so far comparing one type of exercise to another shows no long-term difference in results. Aerobic exercises, strength-training, and flexion or extension exercises all seem to benefit the patients who try them.

It’s not clear if that’s because any type of exercise works or the fact that people who exercise feel more in control and benefit psychologically from doing exercises. There may be other factors to explain the reasons exercise works. It may turn out that these vary from person to person.

Whatever type of exercise is chosen should be done consistently five to seven days a week. The program should last at least six to eight weeks. Some people find they must continue exercising indefinitely in order to maintain the benefits. Exercise sessions three to five times a week seem to do the trick.

Incorporating different types of exercise and alternating them may help prevent recurrence of back pain. Studies are underway to identify types of patients who get the most help from each kind of exercise. Some day we may know what type, frequency, intensity, and duration of exercise are needed to prevent or manage LBP.

The concept of stiffness is one that has puzzled scientists for many years. Increasing age does seem to be a key factor. Likewise, as you suspected, activity does help.

Stiffness can be a sign of an underlying disease process such as osteoarthritis (OA). If you wake up in the morning and your joints feel good (or better than the night before) but start to hurt as you move about, you may have OA.

But there are many possible causes for joint pain and stiffness. A medical exam is needed to sort this all out. Your doctor will be able to examine you for mechanical stiffness.

For example, a test called the PA maneuver may be used. The patient lies down on an examining table in the prone position (face down). The examiner places the base of his or her fist against each individual spinal segment. A force is applied in the posterior-anterior (front to back) direction.

Perceived movement of the spine at the test level is classified as normal, hypomobile (loss of motion), or hypermobile (increased motion). Such a test is easy to perform and doesn’t cost more than the office visit. If a problem is observed, then a dynamic MRI may be useful in measuring actual motion or mobility of the spine.

If it’s a simple matter of stiffness (loss of motion between the vertebrae), then a prescribed program of specific exercises might be needed.

Treatment is based on the underlying cause of the problem. Stiffness that comes with the aging process may respond best to motion that occurs during yoga or Tai chi. Keep up your other activities but consider adding one of these other types of movement. The slow, fluid repeated actions seem to really help many adults who notice stiffness developing.

Many patients want to please their doctor or therapist by making light of their own symptoms. Sometimes they exaggerate their improvements. There are often natural fluctuations in how patients respond to treatment. The alert doctor or therapist will be watching for overall change in the patient’s response.

They can do this in one of several ways. The first is by interviewing the patient while observing for signs of pain, dysfunction, and disability. The second is by conducting specific tests. There are formal and informal tests that can be carried out.

There are many standardized tests available to measure physical function, pain, health status, and patient satisfaction. Test scores are compared before and after treatment. But a statistically significant change in the score on these tests doesn’t always mean the patient feels or functions better.

An experienced and alert health care practitioner is often able to see what’s really going on with their patients. But talk with your mother if you feel that sharing your observations is important.

She should be encouraged to write down her concerns and questions and give them to the physician. This can help them both assess her situation and plan future treatment more carefully.

Low back pain (LBP) can be very difficult to sort out. There are many possible causes and the symptoms are often vague or too subtle to identify. For many people, there is a significant psychologic or emotional overlay masking the true cause.

Experts who study the best way to handle patients with LBP have published clinical decision rules (CDRs). These rules or guidelines help physicians diagnose and treat LBP patients. The idea is to make as specific a diagnosis as possible and then direct treatment at that problem.

Some CDRs focus strongly on psychologic and social factors. It’s possible to overlook more serious neurologic pathology. It isn’t until the condition has progressed (gotten worse) that the correct diagnosis is made.

Researchers are trying to come up with a CDR that can be used with all LBP patients. Such a CDR would help identify the underlying problem no matter what the cause. Recently, a group from New Zealand published a report that neurologic syndromes aren’t always included in CDRs.

CDRs will continue to be modified and improved as more information is found out about LBP. Having a more accurate CDR will help doctors in the future to identify which patients are at risk for a more serious form of LBP.

There are many possible causes of low back pain (LBP). But LBP along with pain down the leg is frequently a signal of neurologic involvement. This is usually from pressure on the spinal nerve root.

Narrowing of the spinal canal and/or the opening for the nerve root can cause these kinds of symptoms. This condition is called spinal stenosis. This narrowing can be the result of bone spurs, tumors, or thickening of the spinal ligaments.

Degenerative disc disease (DDD) can also cause the type of symptoms you have described. A degenerated or herniated disc can press against the nerve root. A damaged disc can also release chemicals that irritate the nerve endings. The result is back and/or leg pain.

When neurologic symptoms do not improve with conservative care, then surgery is considered. Numbness in the groin area called saddle anesthesia is a red flag. Without surgery to remove pressure from the nerves, permanent paralysis is possible.

Studies show that early intervention improves your chances for a good recovery. The longer you wait, the more risk there is for a slow recovery rate and recurrence of the problem.

If you are having doubts, ask your surgeon to review your case with you. Answering any questions you have may help point you in the right direction. Surgery is a big step and should be considered carefully. But the right operation at the right time can make a difference in your symptoms and function.

Infection is the most common cause of implant loosening. But osteolysis (bone loss) caused by the implant can also result in a failed fusion.

Corrosion of the metal seems to be a possible cause of periprosthetic osteolysis. Periprosthetic means the bone loss occurs around the implant or prosthesis.

A recent study of failed and removed implants has shed some light on what may be causing the corrosion. It seems that when two pieces of metal are close to each other (such as plates and screws used in spinal fusion), an electric current can develop.

The loss of electrons due to the corrosion process starts this process. It seems to generate an increased effect over time. The longer the electromagnetic force (EMF) is present, the greater the bone loss.

Whether or not there is an actual allergic response has not been determined. It seems that the environment within the human body is not suitable for metal devices. The immune system tries to get rid of it. At the same time, the corrosion prevents bone from building up around the implant.

More studies are needed to understand the nature of the EMF. Exactly how is it generated? Can it be stopped? Are some people more susceptible to this problem than others? An allergic response may be one possible explanation. There may be multiple factors that when combined together cause corrosion and implant failure.

There have been some good, quality studies done with evidence to support chiropractic care. But whether this is because of the spinal manipulation or better patient education remains a topic of debate.

Studies don’t show an advantage of chiropractic care when it comes to time it takes to recover or return to work. A large study of over 1500 patients with back pain showed no difference when treated by primary care physicians, chiropractors, or orthopedic surgeons.

And chiropractors don’t spend more time with their patients compared to other types of doctors. It may be the fact that chiropractors help their patients understand their back pain. They give patients information on the mechanics of the pain. They also counsel patients on how long to expect recovery and the benefits of exercise during the process.

It seems that offering patients support and healing comfort may be the key difference in care. There still isn’t a lot of evidence that one treatment type works better than another. Staying active is the one bit of advice everyone can give that is supported by the results.

Most low back pain (LBP) isn’t serious and will go away on its own. The cause of the pain often remains a mystery. Even with all of today’s technology and advanced imaging available, there seems to be no clear cause of LBP for many patients.

But doctors do look for what they refer to as red flags. These are signs that something more serious is going on and needs closer attention. Some of these red flags are signs and symptoms the patient reports. Others are part of the patient’s medical history.

A few of the more common findings that require medical attention include:

Artificial disc replacements (ADRs) are fairly new in the United States. They were first approved for use in the U.S. in 2004. Long-term results from their use are not available here yet.

But studies are ongoing to evaluate their function and outcomes. There has always been some concern about increased wear and tear at adjacent levels with spinal fusion. That’s one of the reasons ADRs are used instead of fusion. Fusion stops motion at one level. The result is that there is an increased load to the next (adjacent) level.

At least in theory, restoring normal motion at the degenerated spinal level(s) should help take the load off the levels above and below. To help prove this, a special measuring device has been used to measure spinal motion before and after spinal surgery.

The device is called a six-degree-of-freedom simulator. It can be used for patients who have ADRs, fusion, or spinal implants such as the titanium cages. Measurements of spinal flexion, extension, sidebending, and rotation have been shown to be accurate and reliable. Sidebending and rotation can be measured to both the right and the left.

Preliminary studies show that a one-level ADR restores near normal spinal motion at that level and at the level above and below the ADR. It remains to be seen what the effects will be at the adjacent levels over time. The hope is that with normal motion, the load on the next level above and below will be less, too.

More and more, patients are finding that an artificial disc replacement (ADR) is a good alternative to spinal fusion. Degenerative disc disease is the most common underlying problem for which ADR is used.

This procedure is quickly replacing spinal fusion for patients with degenerative disc disease who qualify. Motion is restored. Pain relief is a major benefit of ADR for many people.

In fact, with less pain, they can move more. There is an improvement in quantity and quality of motion. These benefits are not expected with spinal fusion. Once one level of the spine is fused, then motion is stopped at that level.

However, the load and force are then transferred to the next level. There is some concern about increased disc degeneration at the adjacent spinal levels after spinal fusion. This type of response is not expected with an ADR. Restoring motion at the damaged segment should relieve any extra load on adjacent levels.

Spinal stenosis is no respecter of persons as the old expression goes. It is a degenerative condition of the spine brought on by aging, not activity.

Stenosis refers to a narrowing of the spinal canal and openings for the spinal nerves. Changes in the bones, soft tissues, and joints contribute to stenosis.

For example, the broad band of ligament that runs down the spine called the ligamentum flavum (LF) starts to thicken. It can even get pinched between the vertebral bones causing additional pain.

The vertebral bodies start to weaken and compress. The discs thin out and lose their soft flexibility. The vertebrae and joints start to move closer together. Bone spurs form around the joints. The joints may become misshapen and lose their normal ability to slide and glide. The joints may no longer fit together and move smoothly. This adds to the problem.

Some people are born with a narrow spinal canal. This is not a problem during the younger years. But with the changes described here, the spinal opening is gradually closed off. Pressure on the spinal cord or spinal nerves causes back and/or leg pain.

A recent study looked at two specific discs in the lower back: the L4-L5 discs. The researchers wanted to know if tears, which appear in the discs, change in quality and type as people age.

The researchers did find that there was a significant difference. There were some types of tears that were very frequently seen among younger people and rarely among people who were over 30 years old. Other types of tears only occurred in older people. So, the researchers did find that there was as definite difference according to age.