FAQ Category: Lumbar Spine

It sounds like you’re going to a clinic with a multidisciplinary approach to chronic pain. Many studies of human illness and pain show this works the best. This type of treatment views chronic pain as more than just a physical problem.

When a person has pain as long as you have, then other factors are involved.
Multidisciplinary treatment looks at physical, behavioral, emotional, psychological, and even environmental factors. Studies show both a positive short-term effect with this approach and a long-term change in most patients.

Pain that lasts longer than expected for the healing time needed is called chronic pain. Usually pain that lasts more than three months is chronic. Some doctors use six months as the defining point.

Many studies show that pain can affect mood and motivation. Sometimes we fall into thinking, “I can’t do that because my pain won’t let me.” At other times, chronic pain patients change the way they move, or they stop trying certain actions because it might
cause more pain. This is called avoidance behavior. Most of the time, patients don’t know they are doing this.

A psychologist can help patients in these areas. They can help assess how much pain interferes with daily activities in your life. The goal is to get as much function back as possible, even if the pain doesn’t go away.

There are actually three different terms used to describe patients. The first is impairment. Impairment is any loss of function or abnormal function that affects the mind or body.

The second idea is functional limitation. This refers to problems doing a physical action, task, or activity. Disability is the inability to carry out an action or
activity. Such an action is needed or expected for the person to function in society.

As an example, think about someone who has injured his or her back. Impairment refers to the actual damage to the spine, discs, muscles, joints and other structures of the back.

Pain and muscle spasm keep the patient from walking more than 10 minutes or lifting any heavy objects. These are the patient’s functional limitations.

When functional limitations are severe enough to keep the patient from going to work or attending meetings, there’s a disability. What if the patient can’t bend over to pick up
a bar of soap from the floor of the shower but can still shower? This is a functional limitation, not a disability. The person who can’t shower at all or unless someone helps is disabled.

Deciding who’s disabled and who isn’t is based on medical judgment. A patient may consider himself “disabled” because he walks with a cane when he used to be able to run a marathon. A medical doctor may call that a functional limitation and not a disability. The person can get around and isn’t in a wheelchair.

Yes and no. Yes because you must be able to function normally in order to prevent re-injury. No because there aren’t individual tests for each person with different job requirements. You may end up taking a test that measures motion and speed when you don’t normally move around that much in your current job.

Researchers are working hard to find simple tests that can predict how well a worker will do when going back to the job. But it takes time because each task must be measured in normal subjects and compared to the results from patients with various injuries.

Age, gender, and other health issues can make a difference from person to person. As much as possible, scientists try to “match” people in groups that are compared. This way we know the different results are not due to such factors.

Engineers are able to use math to calculate the stresses on aircraft parts like wings and tires. Aircraft tires are made of elastic materials that also slide much like discs in the spine. Both tires and discs are subject to large strains. They must hold up without damage.

Aircraft companies like Boeing must make sure the tires can handle the loading and unloading during take off and landing. Mathematical models developed by aircraft engineers work quite well for measuring strain on the tire-shaped disc in the spine.

They take into account the shape, strain inside and out, forces of energy, and loading and unloading related to the spinal discs. The same methods that look at the properties of tires can be used to determine the dynamic deformations of discs.

Research shows spinal discs have a lot of variation from person to person. In fact it’s impossible to come up with one model that represents everyone for scientific study. Your discs and your brother’s may be very different.

There could be other damage to the discs from previous injuries that your brother may or may not remember. Age is another factor as well as how much use and stress the discs have taken over the years.

Social scientists claim emotional and psychologic factors are a big part, too. There’s really no known single reason for differences after injury between people. It’s likely that many things combine together to give us our final outcome in these types of situations.

This is the biggest problem with spine fusions for disc damage or degeneration. Researchers around the world are studying the links between cause and effect. Does the
fusion cause more damage than it repairs? Fusion increases stability at the painful level but often increases the load above and below it. Over time the disc at those levels starts to degenerate.

A recent study from Japan advises doctors to think twice before fusing the lumbar spine when disc changes are already present nearby. From all the studies done so far, it looks
like you have about a 50-50 chance of getting good results.

IDET is a means of heating the disc up to high temperatures. The result for many patients is less pain and a more stable spine. Failure to provide pain relief is viewed as a treatment failure. These patients often have the disc removed later and may have the
spine fused at that level.

How often does this happen? Using math models, scientists predict surgery will be needed 15 percent of the time one-year after IDET. It’s predicted that as many as 30 percent of patients having IDET will need an operation two years later.

There aren’t enough studies yet to confirm these predictions. A study on general back patients having surgery showed the reoperation rate to be eight to 10 percent. This was true no matter what kind of back surgery was done. A recent report from a clinic in Los
Angeles showed 14 percent of their patients had back fusion or disc removal one year after IDET.

Sometimes doctors conduct research about their results by sending patients surveys or asking questions over the phone. The person calling is often an independent worker who doesn’t work for the clinic. This helps keep the research pure and unbiased.

Researchers may send patients a letter ahead of time letting them know what’s coming and what to expect. It’s easy to read such a letter and toss it out without realizing what it really means. When the call comes, the patient is surprised or doesn’t remember anything about it.

It’s always a good idea to take the name and number of anyone asking personal question. Then you can call that person back. You can also ask for the contact information of the person in charge of the study.

Doctors rely on patients to help advance medical research. Your cooperation is important, but the decision is yours entirely. You can always decide not to participate.

It’s possible that the additional therapy has made a difference. Seeking various treatments to keep good function is often advised. Studies haven’t been done to show what each kind of therapy does to maintain our health.

It isn’t possible to find out what worked for you without a control group (patients with the same injury who weren’t treated). Was it the combined therapy at the time of your
injury? The chiropractic and massage therapy later? Or just good luck?

Future studies are needed to find out what works best and why. Maybe patients who aren’t treated at all have the same long-term results as those who are in treatment. This kindof information is hard to come by. Researchers aren’t usually allowed to put patients in
a “no treatment” group.

Cardiovascular fitness testing can bring on back pain in patients with a previous history of chronic pain. Back pain can alter the test results. You may be okay to take the stress test if you aren’t having any episodes of back pain at the time of the test. Be sure to
ask your doctor about this problem.

Sometimes a special test is given for patients with heart and musculoskeletal problems. The doctor injects a chemical into your vein that goes to the heart. The chemicals irritate the heart and can simulate a heart attack. The heart is closely monitored. This test must be done by a doctor and is only used for cases like yours.

Talk to your doctor about your concerns before scheduling any further testing. It may be possible to stress your heart without stressing your back while still using a traditional stress test. If not, there are other options.

Steroid injections have been used for many years in spinal disorders. Scientists think they have an anti-inflammatory action. The steroid isn’t always injected into the disc. It can be used around the nerve root where the inflammation occurs.

Steroid injection directly into the disc causes the disc to dissolve. Researchers suggest the polymerizing effect of the steroid helps the disc heal itself. Polymerization is a chemical reaction that occurs causing molecules to link together. The result is decreased back pain and sciatica.

The long-term effect of concern is the ability of the steroid to dissolve healthy tissues around the damaged disc. The short-term benefit is avoiding major back surgery.

You’ll want to check with your doctor about his or her recommendations. Having the specific test results of what the problem is and how involved the disc is helps guide treatment decisions.

On the conservative side, some disc problems respond to nonsteroidal anti-inflammatory drugs and physical therapy. The therapist can show you certain positions to use to help
the disc move away from the nerve root. Symptoms can be relieved by taking pressure off the nerve root. Posture, proper lifting, and good positioning in bed will also help.

Steroid or chymopapain injections into the disc space have been used for many years. Both require an outpatient operation with some sedation. Both dissolve the disc material. The results vary from patient to patient. Long-term effects of steroids scare some people
away from steroid treatment. It can dissolve other tissue in the area besides the disc causing a weak and unstable spine.

Very rarely, use of chymopapain can cause serious side effects. These include leg paralysis or even death. Some patients can have a severe allergic reaction to this chemical.

Surgery is a final option. The doctor can take some of the disc or bone out to take pressure off the nerve root. The spine can be fused if it’s unstable.

Some studies show the end result 10 years after disc pain began is the same in all patients no matter what treatment was used. In light of that information, treatment is geared toward managing the symptoms.

There are some tests that can be done. Your doctor can examine your movements, check your reflexes, and assess your pain pattern. Questions about what you can and can’t do in the way of movement and activities also give helpful information.

It’s generally accepted that if a patient feels better and can do more, it’s a good sign that healing is taking place. You can trust your sense that you are getting better. Many people make the mistake of sliding back to their old ways once they feel better. It’s likely they will have a relapse.

Weight loss and exercise help prevent and cure many conditions. Keep up the good work.

Lumbago is defined as mild to severe pain or discomfort in the area of the lower back. The pain can come on suddenly and go away quickly. For some people it lasts for months. Lumbago occurs in people of all ages. Younger people whose work involves physical
effort are most likely to have lumbago. It’s not uncommon in people of retirement age.

Most of the time, there’s no known cause of this backache. Slipped disc, osteoporosis (brittle bones), and scoliosis are three of the most likely causes. Tumors and infection can also cause lumbago.

You’ll probably notice your grandmother has some trouble moving. Bending forward and leaning back are difficult. Muscle tension and stiffness are common problems with lumbago. Patients may even have numbness and tingling in the back, buttocks, or leg.

Keep an eye on your grandma. If she suddenly loses control of her bladder or bowel movements call her doctor right away. There could be some pressure on the spinal cord or spinal nerves. Early treatment is essential if permanent damage is to be avoided.

Remind her to stay active. Encourage her to do as much as she can given her pain and stiffness. A swimming or aquatic program in warm water is often helpful. Remind her to avoid stooping, bending, lifting and sitting on low chairs.

There are many, many tests and measures out there for assessing treatment results. Each one looks at something different. Some measure change in pain levels. Others compare
activity level before and after treatment. Finding the right one for each patient may be a challenge.

Researchers at the University of Sydney School of Physiotherapy compared four different tests to one another. They wanted to see which one was most likely to show changes in patients with treatment. Such a study could help us find the best tool to measure change while also seeing which treatment works best.

They found that measuring changes in the pain level and disability scores gave the best idea of patient responsiveness to treatment. Pain was measured simply by rating the pain on a scale from zero (no pain) to 10 (worst pain). Disability was tracked by asking what the patient could or couldn’t do.

You can do this yourself or you can ask your physical therapist to test you before and after treatment. The authors suggest using the visual analogue scale (VAS) for pain and the Patient Specific Functional Scale (PSFC).

It’s clear that exercise does have an impact on pain levels. This is true for many conditions. The exact way it works isn’t clear. Exercise does release natural pain killers in the body. It’s possible exercise alters pain you’re expecting before you even begin.

Scientists aren’t sure how that works either but they are studying various aspects of exercise and diseases, illnesses, and other conditions. It’s clear that general exercise
benefits the body overall. In time we expect to be able to find out which exercise works best for each problem and apply that to each individual patient. This idea is called
prescription exercise.

Some exercise programs are already known. Back problems caused by disc disease can be managed with McKenzie exercises. Osteoporosis is treated with specific weight bearing and weight lifting exercises. Heart disease can be prevented with aerobic exercise. Someday it’s expected that we will know what exercise to prescribe for liver disease, thyroid conditions, autoimmune diseases, and so on.

It’s true that many patients with low back pain report their pain levels vary throughout the day. For some patients time of day makes a difference. Others say their pain is worse if they stay in one position too long. Many patients say certain actions increase their pain. This could be bending, lifting, or turning.

In cases like yours, it may be best to report the most common pain level as you think over a 24-hour period. Some forms allow space for comments. You may want to leave it blank and give offer the information directly to the doctor. When in doubt, just ask the office staff or the doctor.

Not usually. One hopes to have decreased pain and relief of symptoms after the injection. Numbness in the area described may be what’s called saddle anesthesia. This is
named for the area that comes in contact with a saddle when sitting on a horse.

It may be a sign that the disc is putting too much pressure on the spinal nerves inside the spinal canal. The area of nerves controlling bowel and bladder function is called the cauda equina or “horse’s tail.” It’s the lower end of the spinal cord where all the final nerves come together and go down as a bundle.

Call your doctor and report these new symptoms. You may need immediate treatment to prevent long-term problems.

Timing does seem to be a key in the success of disc injections. Injection in the first few weeks of disc herniation may have little effect since many patients get better on their own anyway. Most doctors advise an early plan of treatment using antiinflammatory
drugs and physical therapy for the first six weeks.

Injection is considered if conservative care doesn’t work to relieve pain. Many patients
get relief from pain and other symptoms with one steroid injection for disc herniation. If no improvement occurs, you can get a second injection one week after the first. Some doctors will try a third injection a week after the second. After that, surgery to remove the disc is considered.

Your chances for long-term problems go up the longer you wait to treat a disc herniation. Muscle weakness, changes in sensation, and possible bowel or bladder problems can occur. Trying conservative treatment for up to three months doesn’t seem to change the final outcome. This applies to most patients who crossover from conservative care to injection or disc removal.