FAQ Category: Lumbar Spine

It’s best to discuss the question directly with your physician. Most patients using analgesics for back pain do so for 30 days or less. Drug addiction isn’t likely in this short time period. If you have a previous history of drug addiction or substance abuse, then an opioid such as codeine or morphine isn’t advised.

Other treatment such as chiropractic care, physical therapy, or spinal injection may be some options. Over-the-counter analgesics such as ibuprofen can be prescribed in higher doses if needed. Again, ask your doctor for some guidance in this area.

Over-the-counter drugs for pain relief such as Tylenol or ibuprofen are used most often for acute low back pain that doesn’t require a doctor’s visit. Patients who seek medical care for acute back pain are most likely to be given a muscle relaxer and/or an anti-inflammatory.

Rest is advised (only if needed) for the first 24 to 48 hours of acute back pain. Whenever possible, activity is still the best way to treat back pain.

When strong pain relief is needed, opioid drugs such as codeine or morphine are used. The potential for addiction makes the use of opioids less favorable than other, less addictive agents.

Narcotics for pain control can be used successfully for chronic, severe low back pain in a small number of patients. Such drugs can help improve function and help patients get back to work. With monthly check-ups the long-term use of opioids can be managed.

A recent study from the University of Pittsburgh showed patients with a wide variety of back pain problems made use of narcotic and other, less potent pain killers (analgesics). Adults over 40 are more likely to use these types of drugs. Women are slightly more likely than men to take prescription pain relievers.

Analgesic drug therapy is used to provide pain relief during the recovery process. Most musculoskeletal problems are healed within four to six weeks. The use of medications should decrease over that time as well.

You’ve just described a problem called fear avoidance beliefs. The more a person fears pain, the less he or she does and the more disabled they become. Some of this response is natural. It can be based on past experience or “pain memory.”

Studies show that most people fear a level of pain far greater than anything they actually experience. Many other studies show that physical activity and exercise is the best medicine for back pain.

Just being aware of the problem is the first step. You may want to seek help if you are unable to talk yourself through increasing your activity. Sometimes patients need behavioral help from a counselor or psychologist. Others seek the services of a physical therapist to help them with a rehab program.

Researchers have been working on an artificial disc replacement (ADR) for many years. Finally, the technology is available to give us several ADRs to choose from. ProDisc II, Link SB Charité III, and the Maverick disc systems are three examples of ADRs on the market.

The implants do come in several sizes. Each one angles the low back slightly differently. The disc height also changes with different dimensions of the disc plate. The goal is to restore normal motion and stability at the segment or level of repair. Properly working facet joints in the back of the spine are also needed for normal spinal motion.

You make a good point. Many people who suffer from chronic low back pain do become “disturbed” by the pain and loss of function. This is a natural response to pain when the pain doesn’t go away.

Tests of psychologic function can be helpful. Sometimes low back pain is linked with clinical depression. The real medical diagnosis is depression. In these cases back pain may be just a symptom. Treating the psychologic problem will help the physical problem.

It isn’t always easy to tell which came first: the depression and then the back pain or vice versa. It is helpful to find out if there is a psychologic link in order to treat more specifically and accurately.

There are many, many tests for use in assessing the psychologic status of chronic pain patients. These are called psychometric instruments. One of the most popular is the Minnesota Multiphasic Personality Inventory (MMPI).

The MMPI-2 is used by clinicians in a wide range of settings to assist with the diagnosis of mental disorders. It can help show major symptoms of social and personal maladjustment. It’s frequently used to assess chronic pain patients. It also helps doctors and therapists choose the best way to treat each person.

Most patients with an emotional or psychologic side to pain can be helped with counseling or behavioral therapy. Ask your doctor to refer you to someone who can give you this or other more appropriate tests for your situation.

Pain drawings are a common tool used with back pain patients. Different drawings have various meaning and uses. Some are just used to show where the pain is located. Filling out the form each time gives the doctor an idea if the pain is changing. The drawings can map out other symptoms, too such as numbness or tingling.

Some drawings are combined with choosing words to describe the pain. The McGill Pain Questionnaire is such a tool. It can help identify the source of pain. For example, pain described as “throbbing” could be a sign of vascular disease. The doctor may be able to diagnose the problem by looking at the location of the pain and the description at the same time.

These types of tools can also point out when there’s an emotional or psychologic response to back pain. Pain drawings by themselves aren’t able to predict anxiety or depression. They are much more useful when combined with other measures.

When the disc is replaced with an artificial device the disc space suddenly increases to a more normal size. This can put traction or increased tension on the nearby spinal nerve. The result is back pain or even back pain that goes down the leg called sciatica.

Once the body gets used to the new spacing and position, the symptoms may go away. Damage to the nerve or ongoing swelling from inflammation in the area may cause persistent pain.

Most often the patient history and symptoms guide the doctor in making the diagnosis of lumbar disc herniation. Adults in their middle years (40 to 60) are affected most often. There may be a history of heavy lifting, twisting, or other trauma. Sometimes disc degeneration with aging is the main cause.

Low back pain that’s worse when bending forward signals a possible disc problem. Forward flexion puts increased pressure on the front portion of the vertebra. The effect is to put pressure on the disc and move it in a posterior direction. If the disc is protruding and it’s pressed back toward the spinal nerve, then back pain is the result. The pain may travel down the leg.

At the same time, when done properly, back extension can ease painful symptoms from a protruding or herniated disc. Pain that’s made worse by backward or side bending may be coming from the facet joints.

A course of conservative treatment can help confirm or deny the diagnosis. If your symptoms aren’t improved, then an MRI might be in order.

Complementary and alternative medicine, also known as CAM is becoming more and more popular–and not just for back pain but for many problems and conditions.

Right now conventional licensed providers include doctors, physical therapists, nurse practitioners, and physician assistants. CAM providers include chiropractors, naturopathic physicians, acupuncturists, and in some states, massage therapists.

There aren’t a lot of studies yet to compare how much CAM is used. Many people have to pay out of pocket for these services because they aren’t covered by insurance. This is slowly changing as states pass laws requiring health insurance companies to cover all licensed providers.

Sometimes treatment decisions are made strictly on the basis of finances. If you have insurance that only covers a medical doctor for the treatment of back pain, then that’s who you go see.

For some people it depends on who’s available. If it takes three months to get in to see the doctor but the chiropractor can see the person today, the patient gets chiropractic care.

A study was done recently of over 100,000 patients. All had coverage for both medical and alternative care. About half the group went to a conventional care provider (doctor, physical therapist, nurse). The other half saw an alternative specialist. Alternative care included chiropractors, massage therapists, and acupuncturists.

Differences were seen in gender and geographic location. For example, men in rural towns were more likely to see a chiropractor. Patients who were cared for by alternative specialists were usually healthier. They had fewer other problems.

Low back pain (LBP) is a common problem the world ’round but it doesn’t have a common cause or a single solution. About 80 percent of LBP in adults is called nonspecific. That means the exact cause is unknown but it’s not a tumor, infection, or a fracture.

Many studies show exercise is the most likely treatment to reduce disability and pain. Researchers haven’t been able to find one specific type of exercise that works better than others.

There is increasing data to show that psychosocial factors are the key to nonspecific LBP. Personal beliefs, fear of pain, and social factors like work and family seem to be the biggest contributors to LBP. Exercise is especially helpful in getting people past avoiding movements that might cause pain.

Athletes are most often tuned into the saying, “No pain, no gain” for any and all injuries. But when it comes to acute injuries of the soft tissues anywhere in the body, the old adage “let pain be your guide” is more helpful. Further stressing or straining an already damaged area will only delay healing.

Chronic back pain is a different problem compared to an acute injury. With chronic back pain there is a tendency to avoid movements that hurt. This sets up a cycle of disuse,
then pain, then more disability.

Increasing activity and movement might cause more pain as the body adjusts to the new movement or activity level. In such cases pain is not an alarm to signal more damage. The patient with chronic low back pain is advised to try to increase function even if pain
increases.

Workload is defined as the amount of work assigned to or expected from a worker in a specified time period. The United States Department of Labor has defined workload as 1-2 or 3-5 based on activity and lifting.

Level one is sitting, no lifting required. Two is a maximum lift of 15 to 30 pounds. Three is a maximum load of 30 to 70 pounds. Four is a maximum load of 70 to 125 pounds and five is a load greater then 125 pounds.

Whether or not you can handle a workload level 2 is based on several factors. Age, general health, and strength are important. Lifting using proper body mechanics will help anyone who has lifting requirements.

Family support is always an important key in patient recovery from any operation. Helping her at home during the early post-operative period is a good idea. The goal is to help the patient regain as much function and independence as possible. Don’t do everything for her–just help her when she asks for help.

A post-operative exercise program has been shown effective. Patient motivation is the key here. Many people start out enthusiastic but after several weeks or months their interest fades and they stop doing the exercises.

There are several ways to support your mother in this area. Purchase a membership in a health club or other exercise group for her. Go with her and exercise together. A goal of 30 minutes of exercise at least three to four times a week is best. A program of strength
training, aerobics, spinal stabilization exercises, and flexibility may be best.

Many studies of patients who had lumbar disc surgery show only a 60 percent success rate. This means that up to 40 percent have continued pain, weakness, and loss of function a year or more after the operation.

An active rehab program is advised for patients with continued symptoms after surgery. The sooner the program is started, the better your chances for improvement. Studies show patients return to work faster and improve function more when an active program is started early.

The best training program still remains unknown. Right now it looks like any kind of exercise seems to help. It may be best to combine a program of strength training with flexibility and stability. A physical therapist can help you match a program to your specific needs.

Many studies have been done to find the best rehab program after lumbar disc surgery. The results are good for several different approaches. Short-term intensive programs give the best results. Patients get more function and return to work sooner than patients in a mild exercise program.

Early intervention seems to work best. Patients who begin exercising right after surgery (up to six weeks after surgery) have better results than those who wait three months or more to begin.

Target frequency, duration, and intensity are still unknown. Studies show patients get better even with minimal exercise (twice a week). It may be that more is better, but the exact measure of exercise needed for best results remains a mystery.

A general guideline that seems to work well for many kinds of conditions, illnesses, and diseases is: moderate intensity exercise at least three times a week. Five times a week is even better. Daily exercise isn’t advised. The body needs at least one day a week for rest and recovery.

That’s a good question. There are two kinds of motion to consider. The first is the exact amount of increased motion that occurs in the vertebra because of the new disc. Then how much does this motion translate into actual bending forward or backwards?

Studies are just coming out with some long-term results of motion and function. A recent study from France linked increased motion with improved function. Patients were followed for 8.6 years, which is about the halfway mark for the life of the implant. Increased motion ranged from two degrees to 18 degrees.

It remains to be seen how patients fare after that. It could be that the increased spinal motion at the disc-vertebral interface helps protect and preserve the spine. It may be that given enough time, there will be degeneration caused by the increased motion. At this point, we just don’t know what’s the ideal amount of motion after LDR.

It’s true that some patients have more motion than others after a total disc replacement (TDR). Doctors and researchers aren’t sure why this happens. It’s widely known that different people have different motion. In fact, different spinal levels within the same person have different amounts of motion, too. Maybe these two factors make a difference.

Based on studies of other joints and previous spine studies, it appears that patients with more motion before surgery have more motion and a better result after spinal surgery. Some research seems to suggest different TDR implants have different results, too. A slightly different design may make a difference in outcomes.

It’s also been shown that early movement without bracing results in greater spinal motion. Doctors want to get to whatever is causing the difference so they can give patients the best results possible. More research is needed to sort this all out.