FAQ Category: Lumbar Spine

These are all very good questions and certainly ones that many family and friends have asked about others who suffer from chronic pain. Social scientists work just as hard as biologic scientists trying to understand the mind and behavior of chronic pain sufferers.

Some people seem to give in to their back pain while others push through and do whatever they want regardless of the pain. What makes the difference in these two groups of patients? What makes the persistent group keep on keepin’ on? Why does the avoidance group give up?

One way to better understand the difference in behavior among chronic low back pain sufferers is to look at self-discrepancies. These are the differences between how the patient sees him or herself versus how he or she would like to be. Other measurable self-discrepancies include who you would like to be versus who you think other people want you to be. There is also the difference between who you are and who you are afraid to be.

Differences between these conflicting viewpoints can create anxiety, fear, depression, distress, and more pain. Your sister may be experiencing some of this self-discrepancy. Understanding that these conflicts exist, measuring them, and reducing them may help improve function and eliminate disability among chronic back pain sufferers.

In fact, researchers in The Netherlands have been working on creating a model to identify and measure self-discrepancies based on behavior. Now they are using this tool to evaluate level of perceived disability and quality of life.

They hope to be able to uncover the thought process behind avoidance versus persistence actions. Finding better ways to treat chronic low back pain may depend upon recognizing these behavioral variables.

You just described two different groups who have been identified and studied. The first group is the persistent group. These folks keep on keepin’ on despite high levels of pain. The second group is (the avoidance group) is more likely to avoid activities, movement, or anything that might make the pain worse. Why does the avoidance group give up?

One way to better understand the difference in behavior among chronic low back pain sufferers is to look at self-discrepancies. These are the differences between how the patient sees him or herself versus how he or she would like to be. Other measurable self-discrepancies include who you would like to be versus who you think other people want you to be. There is also the difference between who you are and who you are afraid to be.

Differences between these conflicting viewpoints can create anxiety, fear, depression, distress, and more pain. Understanding that these conflicts exist, measuring them, and reducing them may help improve function and eliminate disability among chronic back pain sufferers.

Studies show that men are more likely to demonstrate persistent behavior (push through the pain). And patients who were most like who they wanted to be were also more likely to be persistent in their behavior.

But patients who were far away from being their ideal-self were also more likely to engage in persistence behaviors. In both groups (avoiders and persisters), the stronger these behaviors, the more disabled the patients perceived themselves. Overall, higher pain levels translated into poorer perceived quality of life and mental health.

You might think that people who are up and going despite the pain would be close in who they want to be and who they are (called the ideal self). But in fact, one study from The Netherlands showed it was more likely that there is a subgroup of persistence patients.

This subgroup (called endurance copers) overdo in order to “get everything done.” They end up pushing too hard and suffering more pain, which then puts them farther from where they want to be.

Researchers are just in the first phase of making hypotheses (theories) about the relationship between chronic pain and behavior and testing them out. The goal is to find better ways to help and treat patients with chronic low back pain. If it turns out that self-discrepancy behaviors are part of the problem, then treatment strategies directed toward regulating these thoughts and actions may be helpful.

You will have to ask your surgeon about this. It’s possible they used a bone substitute instead of harvesting your own bone for the procedure. It’s also possible to remove bone from the iliac crest for use in the fusion without making a separate incision from the fusion incision. The iliac crest is the area of the pelvic bones where bone graft is taken most often. You can feel this bone when you put your hands just below your waist.

You may be wondering how bone can be harvested using the same incision that is used to perform the fusion? Especially because the iliac crest is out to the side from where the bone being fused in located.

An incision is made in the middle of the spine — that’s called a midline incision. With today’s modern surgical tools, the surgeon can harvest bone from the iliac crest right from there.

The fascia (connective tissue) over the bone has to be cut first. Then the surgeon chisels off the top (periosteal layer of bone. A window is cut into the bone and bone is harvested from inside that window. Once the donor bone is removed, the hole is filled with a special Gel-foam. The window is closed and the fascia sewn back together.

The donor bone is transferred to the fusion site and laid down on either side of the spine. Metal plates and screws (called instrumentation) are used as well to hold everything together until the body has enough time to fill in with bone material.

So depending on how your surgeon did the procedure, you may very well only have one incision showing!

The results of a recent study may help answer your question. In that study, orthopedic surgeons tried to see if patients having low back spine fusion using their own bone graft have more pain than those who don’t have a bone graft. Those who did not have bone graft to help with the fusion were given a bone substitute instead.

The bone graft does not require harvesting bone from the patient. After surgery, each patient was tested for tenderness over the incision site as well as over the back of each iliac crest (posterior right and left).

Fifty-seven per cent (57%) of the bone graft group had tenderness or the posterior iliac crest on one or both sides. This compared with 51 per cent in the bone graft substitute group.

And oddly enough, patients in both groups had pain over both iliac crests (not just the donor side and not just in patients who had their own bone harvested for the fusion site). The severity of pain (as rated by each patient) was no different between the two groups.

Of course they wondered what could be causing this type of pain response in patients who have not had any bone harvested from the iliac crest. The presence of pain in both groups may suggest something else besides bone harvesting from this site is causing the tenderness.

One possibility is referred pain from new lumbar spine pathology. Other sources of iliac crest pain following lumbar spine fusion include inflammation, nerve root irritation, or muscle scarring from the fusion procedure. And it’s possible that the iliac crest tenderness was really caused by residual pain from the low back area.

The authors did not test patients in either group for the presence of iliac crest tenderness before surgery. It may be they all had iliac crest pain/tenderness that didn’t go away after surgery. And even though you don’t remember having iliac crest pain, it’s possible you did and it was masked by the more painful low back pain symptoms.

In any case, since this could be caused by a new problem, it’s probably best to have your orthopedic surgeon do a follow-up examination to see what’s going on. It may be part of the recovery process and just require additional time to heal. But if it’s something new developing, early diagnosis and treatment could prevent worsening of the symptoms and/or prevent future problems.

A careful examination and evaluation are required in order to make the diagnosis. An orthopedic surgeon, osteopathic physician, physical therapist, or chiropractor can perform this type of examination for you. Usually, the patient’s history is a key factor in the diagnosis. Studies show that more than half of all cases of sacroiliac joint pain are linked with some form of trauma (fall, motor vehicle accident, direct blow to the low back/sacroiliac joint area).

Other factors that can increase the risk of sacroiliac joint problems include pregnancy (stretching of the pelvic ligaments leads to instability), scoliosis (curvature of the spine), polio, and hip arthritis. A previous spinal fusion and unequal leg lengths are two additional risk factors.

There isn’t one single test that is 100 per cent reliable in diagnosing the sacroiliac joint as the cause of the pain. But by combining the results of the history along with several other tests, the examiner is able to make what’s called a presumptive diagnosis. Here are a few of the diagnostic features:

Multiple pregnancies can be a factor in the development (or worsening) of a sacroiliac joint (SIJ) problem. A previous spinal fusion and unequal leg lengths are two additional risk factors.

Other factors that can increase the risk of sacroiliac joint problems include , scoliosis (curvature of the spine), polio, and hip arthritis. Having more than one of these factors can compound the problem and must be dealt with as best as possible.

SIJ as a cause of pain is a challenge to treat but not impossible. In fact, we’ve come a long way in our understanding that the sacroiliac joint can cause painful symptoms and in finding ways to solve the problem. There was a time when the SIJ wasn’t believed to move or develop movement impairments.

Fusion of the joint is really a last resort effort and only used when all other approaches have failed. Surgery to fuse the joint is not guaranteed to end the painful symptoms. So, nonoperative (conservative) care is really the order of the day.

Conservative (nonoperative) care is the first step. The patient will be seeing a physical therapist who will assess pain, posture, alignment, core stability, and biomechanics before setting up a patient-specific treatment program. Joint mobilization to correct joint alignment, stabilization exercises, and supportive sacral belts are newer additions to our treatment arsenal that can make a difference.

Failure of the patient to improve after at least six months of nonoperative care is required before fusion surgery is even considered. There are several different ways to fuse the sacroiliac joint — none of them are easy or guaranteed to be successful.

The surgeon may use pins, screws, or plasma-coated implants along with bone graft to hold the sacrum and pelvic bones together and prevent motion at the sacroiliac joint. After surgery, the patient may be in a cast from the waist down to the toes.

In some cases a removable splint is used instead of a full cast. Weight-bearing (standing and walking) are limited for up to eight weeks after surgery. The specific guidelines depend on the surgeon’s recommendation.

Patients with chronic sacroiliac joint dysfunction are also counseled to lose weight, quit using tobacco products, and consider behavior therapy for pain that does not go away even with conservative care. Until better ways are found to surgically correct the problem, fusion is the end-choice for this diagnosis.

If you haven’t heard about Pilates, you’re not alone. But for the millions of people who have discovered and now use of this specialized exercise for core stabilization, you will find the results of this study of interest. And if you are looking for some help with exercise, fitness, or rehabilitation from an injury, Pilates may be something to consider.

Pilates is actually the name of the German born man (Joseph Pilates) who first developed this technique back in the mid-1900s. It was almost a lost art until about 10 years ago. And then the momentum behind the Pilates movement seemed to snowball. The word spread and now it is a technique that is offered in classes at the local YMCA, health club, fitness center and even physical therapy clinics.

The combined use of focus, breathing, rhythmical movement, and precision results in total body strengthening (not just the core or central muscles of the abdomen and trunk). Weaker muscles start to contract and participate in the movement when stronger muscles are engaged. With improved muscle control comes better alignment and protection of the spine. The end result is the ability to perform even more advanced skilled movements with perfect balance and coordination.

You can see why this approach appeals to dancers, martial artists, and athletes of all kinds who need strength, balance, coordination, and endurance all at the same time. And physical therapists quickly saw the advantage of these techniques for patients suffering from chronic back pain and recovering from injuries.

Research to better understand the effects of Pilates has fostered the growth of Pilates technique in rehab. It has been shown to help reduce stress and chronic back pain, improve flexibility, and promote better posture and relaxation. Future studies are needed to investigate the effects of using the traditional classical approach as taught by Joseph Pilates versus the modified forms of Pilates currently in use by physical therapists.

For example, his program has been varied and changed for the more physically challenged individual who cannot perform the advanced or technical Pilates techniques. Are these altered movements just as effective? More effective? Less effective? Is there any benefit at all in doing Pilates when there are any physical limitations?

These are all questions that must be addressed before physical therapists incorporate Pilates as a mainstream rehabilitation technique. In the meantime, some therapists are making good use of the Pilates technique as an effective tool for some patients.

Low back pain seems to be something most people experience at least once in a while. Many studies have confirmed this fact. Up to 90 per cent of all adults report an episode of back pain once in their lifetime. Despite a high level of fitness and even flexibility, athletes from young to old are not exempt from this problem.

In fact, studies show that up to 30 per cent of competitive athletes have back pain from time-to-time. If all athletes with back pain reported it, this figure might actually be much higher — many play through the pain and don’t report it. When playing time is lost in professional sports, it’s most often as a result of low back pain.

An important question is how to tell if back pain is serious enough to require a medical evaluation. Back pain can be a symptom of infection, inflammation, fracture, tumors or other malignancies.

Anyone who cannot put weight on both legs and stand up because of severe back pain must have an immediate medical examination. Likewise, the athlete with back pain accompanied by fever, chills, nausea, vomiting, or blood in the urine or stools must see a doctor.

As the coach (or for any staff member working with team members), it is important to keep in the back of your mind that low back pain in anyone (including athletes) can be caused by mechanical, emotional, medical, or traumatic causes.

Knowing what to listen for can help speed up the diagnostic process. An early and accurate diagnosis is important when dealing with potentially serious health conditions. Early diagnosis and intervention is the key to a successful outcome for athletes young and old.

Osteoarthritis in this age group is not a likely cause of low back pain. But there are many other potential problems that could be linked with this symptom. For example, infection, tumors, trauma, fractures, and inflammatory conditions can cause back pain in adolescents.

Teens who are involved in sports can develop back pain from overextending the spine and/or from repetitive motions. If your son is involved in throwing activities (baseball, football, track and field) or gymnastics, martial arts, diving or dance, then repeated microtrauma of the soft tissues could be the root cause.

Although less common in younger people, teens can develop disc problems early on contributing to their back pain. There are also some inflammatory conditions that show up for the first time in teenagers. Back pain accompanied by early morning stiffness, night pain, or pain that is relieved by rest could be a sign of an inflammatory (rheumatologic) problem.

For back pain that has persisted past three months, a medical evaluation is advised. When the history and physical exam point to a possible problem that could be seen more closely with imaging studies, then X-rays, CT scans, MRIs, and sometimes ultrasound studies may be ordered.

X-rays help rule out (or rule in) bone fractures. For infections, inflammation, and some types of tumors, additional lab work (blood tests or urinalysis) may offer helpful results leading to an accurate diagnosis. An early diagnosis with follow-up treatment can help nip the problem in the bud, so-to-speak with fewer long-term consequences and better results.

Based on studies performed, the use of mechanical traction as you described just hasn’t been proven effective for the majority of back pain sufferers. Some therapists still do use traction but they are more selective in who they use it on.

For example, patients with numbness or pain down the leg may be helped by traction. There are a couple of special tests that can be done to see who might benefit from mechanical traction. One is the prone extension test. If the leg symptoms go away or move up to the low back area while lying on your stomach and pushing the upper part of the body up (propped on your forearms), then traction might be indicated.

Another predictive test is a crossed straight leg raise. If the therapist raises the uninvolved leg straight up (while you are lying on your back) and the pain, numbness, or other symptoms increase on the involved side, then again, you might be a good candidate for traction.

There’s still much we don’t know about low back pain but research is helping us inch forward in identifying the type of treatment that will yield the best results quickly. Traction has its place in that scheme but it’s no longer the main treatment offered to everyone with back pain.

It might be helpful to review a bit of anatomy in order to explain how something like this can be difficult to diagnose. Let’s start with the sacrum — a wedge- or pie-shaped bone that sits between the two pelvic bones. Above the sacrum is the lumbar spine. The last lumbar vertebra (L5) has two extensions of bone sticking out (one from each side) called the transverse process.

These bony wings actually form part of the sacrum and attach L5 and the sacrum to the ilium (upper portion of the pelvic bones). The narrow point of the sacrum ends where it attaches to the tailbone or coccyx.

The force of an impact causing a U-shaped fracture can break the transverse process where it comes out from the fifth lumbar vertebrae. The fracture forms a vertical (up and down) line partway down the sacrum. What makes this a U-shaped fracture is the horizontal (side-to-side) fracture connecting the bottom of the two vertical fracture lines.

Based on the history (how the injury occurred), an X-ray would be the first step. But this type of U-shaped sacral fracture can be missed very easily. The angle of the fracture and the shadow of the bowel can hide the fracture lines. It takes a special CT scan to find a fracture of this type.

The injury is rare enough and information on the accurate diagnosis scarce enough that additional imaging might not even be ordered. As in the case with your daughter, once new symptoms like numbness in the feet develop, the patient returns for further diagnostic workup.

Early diagnosis and treatment gives the best results. Treatment within the first two weeks following the injury is ideal. There are fewer negative long-term effects with early surgery when surgery is required.

It sounds like you not only broke your sacrum, you did it in a way that may have caused injury to the spinal nerves. The nerves that come down the spinal canal end at the sacrum in a group called the cauda equina (literally “horse’s tail” because that’s what they look like). These are the nerves that help control bowel and bladder function as well as sensation and motor function of the groin and legs.

In a fracture of this type, the force of the impact shifts the fractured bone into the spinal nerves that exit through tiny holes in the sacral bone. In cases like this, there is often tearing of the nerve roots and rupture of the dural sac (thin protective membrane around the nerves).

Further damage to the sacral nerves can occur as the bone fracture fragments push into the dural sac cutting into the nerves. The damage sets up an inflammatory response with bleeding, swelling, and eventual scar tissue formation from S2 to S4. Early surgery is advised in order to get the pressure off the nerves and help them recover.

Now that you have finished the first step in treatment, you are understandably eager to get back to normal. Nerve healing is a very, very slow process. You can expect this to take months up to a year or more. You will notice gradual improvement over time. A physical therapist can help you recover strength in the muscles that control urination and defecation.

Keep in mind there is a chance that full recovery won’t happen if the damage to the nerves is just too much. Keeping a journal of your symptoms can be helpful in recognizing subtle changes because recovery is going to be slow. Seeing small but steady changes can help prevent discouragement. Your surgeon will be able to offer you a more accurate timeline for recovery based on your symptoms the first few months.

Problems associated with spinal surgery vary depending on the approach taken (anterior versus posterior), age of the patient, and the presence of comorbidities (other health problems).

With an anterior approach, the incision to get to the spine is along the front of the body. Although this goes through the abdomen and must avoid the organs and large blood vessels, it is less risky than the posterior approach. Entering the spine from the back increases the risk of damage to the spinal cord and subsequent permanent loss of all function (e.g., paralysis, not just sexual dysfunction).

The problem you are describing is called retrograde ejaculation. Instead of propelling the semen forward and out the penis, it goes backwards and into the bladder. Not everyone recovers from this problem. In fact, only about one-third regain complete sexual function.

Various studies report complication rates of retrograde ejaculation anywhere from 1.7 up to 11.6 per cent. Young men should be fully informed about the possibility of this complication with anterior spinal surgery. It sounds like your surgeon has done exactly that!

Complications, problems, or adverse events refers to anything that occurs during or after a surgical procedure that has a negative effect on the patient’s outcomes (results). Any problems from the surgery that require additional treatment (e.g., blood clots, failure of the wound to heal, nerve damage) are also considered complications.

There are many different ways to classify or group complications. If we just look at it from a timeline point-of-view, then there’s intraoperative (during surgery) and postoperative (anytime after surgery up to six weeks) complications.

But other categories of complications include problems that occurred as a result of the patient position, device-related (implants), or approach (anterior versus posterior incision).

The anterior approach is necessary when the risk of spinal cord or nerve root damage is too great using a posterior approach. In the case of tumors or infection, the location of the problem may dictate the use of an anterior incision. But there are a lot of organs, arteries, veins, and deep muscles that can get nicked (cut) by accident during the procedure.

Adverse events linked with the anterior approach tend to be vascular (damage to blood vessels), visceral (injury to abdominal organs including the bowel), and neural structures (traction or cutting of nerve roots or nerve groups).

Of course, every surgeon does everything possible to avoid procedure, patient, or device-related complications. The use of fluoroscopy, a real-time, three-dimensional) type of X-ray helps guide the surgeon. Even with fluoroscopy, ileus (paralyzed bowel) can develop.

When any type of problem does arise, the next best thing is to manage it well and prevent the need for additional surgery. Management depends on what the problem is. For example, bleeding complications such as uncontrolled bleeding can result in serious complications (e.g., paralysis).

Blood clots can cut off blood supply in the legs or travel to the lungs and cause death. Watching for and recognizing early signs and symptoms is a key to prevention fatal blood clots. Pulses in the feet, skin color, and oxygen levels are measured frequently to assure proper blood circulation.

Spinal surgeons do everything they can to prevent and avoid such problems right from the start. Patients must be warned what to expect should something go wrong as a result of the surgery itself. Fortunately such adverse events are rare and usually temporary. With quick intervention, the problem can be managed quite well.

Family concerns about potential suicide are very real and very important. Although your mother’s physician will not be able to discuss her situation with you without her written approval, you are free to express your concerns.

Physicians don’t always have all the information they need to properly assess and treat patients. Knowing about a history of mental illness or other problems like alcohol or other drug abuse would be very helpful.

If your mother is open to conversation or communication about her health, it might be best to discuss your concerns with her first. However, we understand this isn’t always possible.

Research shows that back pain is common among women who commit suicide. Older adults are especially vulnerable and the use of presription drugs (narcotics for pain control) as a means of suicide (intentional overdose) has been documented.

If nothing else, your mother’s physician will be able to use the information you provide to carefully prescribe and monitor her medications. Perhaps you could help your mother find ways to manage her pain. It may be worth it to explore alternate treatment for pain control such as hypnosis, biofeedback, relaxation techniques, acupuncture, massage, and so on.

These are two very good questions. Based on studies of results from balloon kyphoplasty, it looks like the procedure can be repeated. Results are not compromised by having had a previous kyphoplasty.

Many vertebral compression fractures (VCFs) that occur later (after the first kyphoplasty procedure) affect the adjacent (next) vertebra — but just as many are at a distance from the original fractures. It does not appear that the increased bone height or stiffness from the kyphoplasty procedure is linked with further fractures.

It is more likely that the underlying cause (osteoporosis or “brittle bone”) is the problem. Spine bones weakened from osteoporosis (brittle bones) may become unable to support normal stress and pressure.

As a result, something as simple as coughing, twisting, or lifting can cause a vertebra to fracture. In fact, a simple action like reaching down to pull on a pair of socks can cause a weakened vertebra to crack or fracture.

The front of the vertebra (the part closest to the front of the body) crumbles, causing the round vertebral body to become wedge-shaped. This angles the spine forward, producing a hunch-backed appearance, called kyphosis. That’s where a balloon kyphoplasty comes in.

The procedure restores the height of the vertebral body and corrects the kyphosis deformity. Balloon kyphoplasty is considered both safe and effective — and not the cause of further problems.

We found a recent study on the use of this drug following lumbar spinal fusion surgery that might be of some interest to you.

In this study, anesthesiologists compared different dosages (amounts) of this drug called pregabalin for postoperative pain control after lumbar spinal fusion. Pregabalin has been selected as a possible adjunct (helper) treatment because it is quickly absorbed and acts in a predictable and safe manner.

Pregabalin works because it blocks the release of neurotransmitters (chemical messengers) that tend to overexcite the nervous system, ramping up pain messages. Pregabalin is already in use but the optimal dosage for this purpose is unknown. That’s where this study comes in.

Patients were assigned to one of the three groups randomly. One group received 75 mg of pregabalin one hour before surgery and again 12 hours after surgery. The second group was given twice that amount of drug (150 mg) at the same time periods. The third group was the placebo (control) group. They were given fake pills. No one taking the pills knew which group they were in.

The results of this experiment were measured in terms of pain intensity, amount of opioid medication used after surgery, and frequency of rescue analgesics required in the first 48 hours after surgery. Rescue analgesics refer to additional pain relievers needed to get control of pain because pain intensity has increased too much and the patient is very uncomfortable.

After collecting and analyzing all the data, they found that the higher dose of pregabalin (150 mg) was much more effective in controlling postoperative pain. The group receiving the higher dose used much less narcotic for pain control in the 48 hours after surgery. Symptoms after surgery were similar in all three groups, so clearly the pregabalin at any dose did not compromise the patients in any way.

The need for additional rescue medications was also reduced in the 150 mg group. With less pain after surgery, there is an added benefit: reduced risk of becoming a chronic pain patient.

The authors concluded that although 150 mg of pregabalin before and after lumbar spinal fusion surgery reduced postoperative pain, they still don’t know if this is the optimal dose. Likewise, there’s room for further study of the timing of the drug administration. This study only reviewed lumbar spinal fusion, so other studies looking at other surgeries may yield different results.

For now we know that 150 mg of pregabalin is more effective in pain control than 75 mg (or placebo). The 75 mg dosage was about as helpful as the placebo, so it may be possible to reduce the amount of pregabalin given but not down to 75 mg.

The optimal dose may be somewhere between 75 and 150 mg — or it could be at a level greater than the 150 mg tested in this study. Future studies with different doses while monitoring side effects are still needed.

It’s possible your surgeon is already aware of the use of pregabalin for pain control after spinal surgery. He or she may even be using it routinely. Let him or her know of your brother-in-law’s suggestion and see if you might be a good candidate for use of this particular medication.

Pain control after spinal fusion is a major concern for your surgeon and his or her team. Everyone works together to make sure each patient is cared for. Part of that care is adequate management of postoperative pain.

Getting you up and moving requires good pain control. Early mobility also reduces your risk of complications and problems. And getting you out of the hospital as soon as possible benefits your pocketbook. The bottom line is patient satisfaction.

Many surgeons are making use of a pain management program called patient-controlled analgesia or PCA. In the early postoperative hours, the patient is allowed to push a button and receive a dose of a pain reliever (usually a narcotic).

The amount of drug is pre-determined and controlled so you won’t have an unlimited amount of opioid (narcotic) but enough to stay on top of the pain. Likewise, you won’t be able to push the button every five minutes. The length of time in between doses is also controlled. But the program has been well-developed and works beautifully for most patients.

If you get into trouble and find the pain is more than you can handle even with a PCA program, rescue analgesics are prescribed as well. Rescue analgesics refer to additional pain relievers needed to get control of pain because pain intensity has increased too much and the patient is very uncomfortable.

Another option in use by some surgeons is a medication called pregabalin. Pregabalin has been selected as a possible adjunct (helper) treatment because the drug is quickly absorbed and acts in a predictable and safe manner. It works because it blocks the release of neurotransmitters (chemical messengers) that tend to overexcite the nervous system, ramping up pain messages.

Talk to your surgeon and the anesthesiologist about your concerns. Ask if any of these approaches (patient controlled analgesia, rescue analgesics, pregabalin) will be available. Their interest is in making your surgery as smooth, worry-free, and pain-free as possible.

That’s a very good question. Patients with low back pain who are overweight or obese are often advised to lose weight. That sounds like good advise, but some experts question whether there is any evidence that weight loss is linked with reduction of back pain. In other words, is it worth all the calorie restriction, exercise, meal replacement, and group therapy needed to accomplish the goal?

A recent pilot study from Canada was designed to see what they could find out along these lines. They used a medically supervised nonsurgical weight loss program and studied change in back pain. A group of 46 obese adults with mild-to-severe back pain and moderate-to-severe loss of function participated in the study.

Everyone followed a diet and exercise plan for a full year. The first 12 weeks involved a liquid meal program followed by another 13 weeks of reduced food intake. Throughout the first six months, everyone attended group therapy and educational meetings. Physical activity and exercise were a daily requirement (60 to 90 minutes).

Various aspects of the program were supervised by a variety of different health care professionals. This multidisciplinary team was made up of nurses, dieticians, physicians, and exercise specialists.

Before and after results were measured in three main ways: weight loss, pain intensity, and function. After 14 weeks, 98 per cent of the group had lost a significant amount of body weight. Half the group reported major pain relief. Function improved for almost three-fourths of the group (73 per cent).

Those who did lose weight and kept it off had the greatest amount of back pain relief.

The program used involved more than just weight loss. There was also exercise, group support, individual attention, and behavioral changes as part of the whole package. Using a comprehensive program like this did yield some promising results.

More study is needed to find out if all parts combined are really required for change in back pain or if some individual components have a greater impact than others. It’s clear that weight loss is beneficial for many things, not just low back pain.

Congratulations on your new found resolve to lose weight and keep it off. You will be rewarded for your efforts in more ways than one. Weight loss benefits the joints, the spine, the heart, and reduces your risk of insulin resistance syndrome, diabetes, and other chronic diseases.

There’s no doubt that weight loss is difficult for many people. Right now, one-quarter of the U.S. and Canadian populations are considered obese by medical standards. Children are quickly outpacing adults in this area. Type two diabetes associated with obesity is on the rise in all age groups — children, teens, and adults.

Studies show that obesity is linked with low back pain. The exact mechanism by which this develops remains unclear. Likewise, studies that show reduced low back pain with weight loss doesn’t explain the relationsip between diet, exercise, weight loss, and reduction in low back pain.

It’s possible that the effects of weight loss on physical activity (increased daily activity at home and at work) someone turns off inflammatory cycles that contribute to joint and low back pain. Fat is a highly active substance in the body. It can produce chemicals that promote inflammation. Less fat could mean fewer inflammatory cells and thus less pain.

Exercise is a key element in weight loss and reducing low back pain and disability. The condition of obesity causing musculoskeletal pain and pain preventing exercise leads to a viscious cycle of no exercise. Yet many people find their pain is no worse when they exercise than when they don’t. So, with their physician’s approval, they exercise anyway.

Pool exercise has become a very popular way to burn calories without stressing the spine or joints. Most health clubs offer water classes for those who are not already fit or who have joint problems requiring a modified approach.

A stationary bicycle is also fairly easy to ride at your own pace. Hand weights can be used in the sitting position and offer another way to build muscle, use up calories, and strengthen body parts all at the same time.

Talk with your doctor about what might work best for you. If it will help you get started, use pain relievers with your physician’s guidance. If one approach doesn’t suit, don’t give up.

Keep trying to find the one type of exercise or combination of activities that works for you. Do what you can even if it is in one-minute increments. Start slowly and build up your tolerance. Good luck!