LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Low Back Pain

Survey Shows Patients With Low Back Pain Delay Seeking Help – (11-02-00)

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Survey Shows Patients With Low Back Pain Delay Seeking Help

Consider me biased in this issue, but I would have to agree. Too many times I have patients coming in months later, thinking that “it would go away.” The longer a problem is there, the more difficult it becomes to manage.

(article) A majority of physicians (87%) reported that patients with acute lower back pain waited 3 or more days before seeking medical help, according to a recent Internet survey of 378 primary care physicians. Furthermore, physicians indicated that the primary reasons for patients seeking help were that the condition interfered with their ability to work, to conduct daily activities, and because over-the-counter (OTC) treatments were ineffective. The survey was sponsored by www.pain.com, which is developed and maintained by the Dannemiller Memorial Educational Foundation.”Acute lower back pain might be more of a national problem than we originally thought. It was especially surprising to learn that so many people waited for days before getting the help that they needed,” commented Larry P. Vervack, Executive Director of Dannemiller Memorial Educational Foundation. “People need to know that they don’t have to delay seeking help for their pain.”

Chronic Back Pain Patients on an Airbed vs Innerspring Mattresses – (10-16-00)

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Chronic Back Pain Patients on an Airbed vs Innerspring Mattresses

Sleeping surface can have a large impact on back pain. Many patients ask me if they should be sleeping on a softer or harder mattress. Unfortunately, in my experience, every patients is different in their needs. That’s why the new generation airbeds are becoming popular; patients can adjust them to levels that are comfortable for their bodies.
MedGenMed, September 11, 2000 Objective: To compare SF-36, pain Visual Analog Scale (VAS), and sleep VAS outcomes of an adjustable airbed with innerspring mattresses in a population of chronic back pain sufferers. Discussion and Conclusion: SF-36 and VAS outcomes measures showed a highly significant benefit for the airbed design in this short-term comparison. The airbed appears to be a useful sleep aid and an adjunct to medical and physical therapies for chronic back pain sufferers.

Radio Frequency Ablation Dangers – 4 Things to Know

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“They’re going to burn out the nerves in my neck.”  Sounds pretty permanent, but fortunately, not accurate.

Radiofrequency ablation or neurotomy, aka RFA, is a procedure done in a pain management or anesthesiologist’s office.  RFA is the next step after a series of epidural steroid spinal injections have failed to provide lasting relief.  Usually, a nerve block procedure is done first as a test to see if burning out the nerve is going to be done on the correct level or area.

As I mentioned, this does not “burn out” the nerve.  Rather, it is a procedure that uses a high frequency electrical current at a very specific temperature to destroy the myelin sheath that surrounds the nerve, while not damaging the nerve itself.  For low back pain (not sacroiliac pain) caused by the facet joints, the nerve that is cauterised is the medial branch nerve that provides feedback between the joint and the brain.  If there is a problem with this facet that is creating inflammation, it is likely that there is a constant message up to the brain that you perceive as pain.  Burning off the myelin sheath cuts off communication between that facet and the pain centers in the brain.

Sounds like a great idea and sometimes, it is one of the few options left to patients.  While I don’t have any numbers to back me up, I would not be surprised if a large chunk of patients referred for RFA have never seen a chiropractor.

So what’s the problem if it works?  Even if it is just temporary (the myelin sheath ultimately grows back and the communication between the facet and brain is restored, usually taking anywhere from 3-12 months)?  The problem, like all medical procedures, is that there are dangerous side effects.  But before we get into the gist of this blog post, I need to highlight some problems that occur when the nervous system is cut off from a joint.

Charcot joint (aka neuropathic arthropathy) occurs when damage is done to the nerves feeding a joint.  This can be from diabetes, leprosy, syphilis or any other disease process that destroys the nerves.  Ultimately, the joint breaks down and severe joint damage occurs.  While the exact mechanism is still not understood, part of this process is believed to occur by dysregulation of the autonomic nervous system that leads to an increased blood flow to the denervated joint.  This increased blood flow results in weakening of the bones surrounding the joint and breakdown of the joint.

In addition, it is possible that the lack of feedback from the joint due to the nerve damage leads to further damage and destruction of the joint.

Back to this particular study.  In it, researchers looked at the long-term effects of radiofrequency ablation on the disc, joints and muscles surrounding the joint (specifically the multifidus).  Here’s the details:

  1. 27 patients were identified that had before and after MRIs done.
  2. Spinal levels not treated with RFA were used for comparison.
  3. The disc in the area of the radiofrequency ablation had 342% more degeneration (14.9% versus 4.6%).
  4. Luckily, there was no difference in the multifidus cross-sectional area or rates of deterioration in the facet joints.

The greatly increased disc breakdown is not a good thing.  There is a chance that all of the damage was not caused by the RFA since we already know that epidural steroid spinal injections also increase the degeneration that occurs within the disc  and it is highly likely that patients had epidurals before they got to the point of needing a RFA.

Either way, this information once again supports the idea that chiropractic care should, unequivocally be at the front end of care for musculoskeletal complaints and especially spinal complaints.  This does not ensure that epidurals and radiofrequency ablations will not happen, but it darn well makes sure it’s only used as a last resort.  And a last resort is where it should sit.

 

To Cut or Not to Cut: Very Long Term Outcomes of Spinal Fusion Surgery

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Over time, surgeons have moved to more and more complex procedures.  But whether these lumbar spine surgeries are better is still in question.

Initially, spinal surgeries were less complicated with procedures like laminotomies and laminectomy, but surgeons (at least under Medicare) have been moving towards more complex procedures that are more expensive with a higher rate of complications.  The problem with the vast majority of studies on the outcomes of surgery look at very short-term, usually no longer than 1 or 3 years.  The re-surgery rate is known to be as high as 23% after 10 years.

So, if you didn’t have a repeat surgery, what can you expect after 10 years, and will you outcomes be any better than under the care of a competent physician who truly understands low back pain (like maybe a chiropractor….)?  This is the question that was asked in this particular study.  Researchers followed 473 patients with chronic low back pain of at least 1 year’s duration who were all considered candidates for spinal fusion.  The average follow-up was 11 years.  The patients were put into one of two groups:

  1. Lumbar spine fusion with either instrumented or noninstrumented fusion.
  2. Nonoperative treatment that included multidisciplinary cognitive-behavioral and exercise rehabilitation.

Keep in mind that true management in the #2 scenario above is not done by the average practitioner.  Rather, this is a comprehensive approach encompassing both your mental state, the way you related (or don’t relate) to your pain as well as the physical treatments that can go a long way towards reducing the level of pain.

So what did the researchers find out after 11 years about the differences between spinal fusion and the comprehensive approach?

Nothing.

Yup.  No difference in the long run.  And this does not take into account the fact that a lumbar fusion will lead to further degeneration of the levels above and below as well as the chance that the surgery will not relieve the original symptoms it was attempting to address.

The bottom line is that surgery really should absolutely, positively be your last resort.  And THEN you still try something else before surgery.  You need to make sure that you can look yourself in the eye 6 months after surgery and tell yourself that you tried everything else before surgery.  And yes, this DOES include chiropractic.

 

Willow Bark Extract Relieves Low Back Pain – (09-14-00)

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Willow Bark Extract Relieves Low Back Pain

This is really not a big shocker, considering that aspirin was actually derived from a substance found in willow bark.

Am J Med 2000;109:9-14 Willow bark extract is more effective than placebo for the reduction of low back pain, according to the results of a double-blind study. The extract was well tolerated, with only one patient experiencing allergy symptoms that were possibly related to willow bark. The symptoms disappeared 2 days after treatment was stopped. “The low incidence of adverse events observed in this and other studies suggests willow bark extract may be an effective alternative, especially in patients who cannot tolerate nonsteroidal anti-inflammatory drugs,” the authors write.

Paucity of Evidence Supporting Lumbar Belts and Braces – (08-03-00)

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Paucity of Evidence Supporting Lumbar Belts and Braces

Too many people rely on these lumbar belts to protect them. They should be used as a reminder to always use good lifting techniques and posture.

Joint Letter 6(5):50, 2000 Enthusiasts recommend lumbar belts and back braces for both the prevention and treatment of back pain. However, two recent reviews suggest there is little high-quality evidence to support either intervention. There is no definitive evidence from scientific studies that lumbar supports can effectively prevent back pain. Mireille van Poppel, PhD, et al. performed a systematic review employing Cochrane Collaboration methodology and a qualitative meta-analysis to determine if the evidence of effectiveness (or lack thereof) is strong, moderate, limited, or conflicting.

Surgery for Lumbar Degenerative Disc? How About Doing it a 2nd Time?

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The decision to undergo any type of spinal surgery is a difficult one for everyone.  But what if you had to consider not one, but a SECOND surgery as well?

Turns out, there is a large chance this may be the case.  (Spoiler alert: I’m a chiropractor whose main goal is to keep patients out of surgery)

First of all, the realities.  If I had a dollar for every time someone told me he or she had lumbar degenerative disc problems and was going to avoid surgery at all costs, I’d be doing this post from my own island in the Caribbean.

Most of those who informed me of this goal have that tone of inevitability to the voice.  Like there is no other option except to delay the surgery.  This could not be further from the truth.  I just had a conversation yesterday with a young doctor who informed me that he had L5-S1 disc degeneration and would love to be more active in the martial arts to try to stabilize his spine and avoid surgery, but every time he tried to train, it flared up his low back.

This doctor had not tried seeing a chiropractor competent in advanced soft tissue techniques that has a high likelihood of giving him almost complete relief.  So of course I gave him some resources to find a doctor who might be able to help.  There is no guarantee that this would help, but it would be foolhardy to even consider surgery without trying.

But what about all those other patients who incorrectly think there are no other options?  The ones who stress about whether or not to have surgery on his or her low back?  This decision alone is challenging.

But what if the risks of having to have a second surgery were high enough so that this same contemplative patient really needs to be deciding if he or she can undergo TWO surgeries, not just one?

You know I wouldn’t be asking this question if it didn’t have anything to do with this particular study.

In it, researchers looked at the risk of having a second surgery when the first one was done for stable (without a spondylolistethesis) lumbar disc degeneration over the next five years.  Here’s what they found:

  1. The resurgery rate was 4.7% at 3 months,
  2. 7.2% at 1 year,
  3. 9.4% at 2 years,
  4. 11.2% at 3 years,
  5. 12.5% at 4 years,
  6. 14.2% at 5 years.
  7. Based on this trajectory, they calculated a reoperation rate of 22.9% at 10 years.
  8. Reoperation rate was not different between decompression and fusion surgeries.

Wow.  Over a 1 in 5 chance you’re going to have to go under the knife a second time, with all the additional costs, downtime and rehab.  Worse—outcomes after a second surgery are worse than after the first surgery.

Not a rosy picture.  But heck—don’t see a chiropractor—we’re all quacks and dangerous to boot.

 

Osteopathic Manipulation vs. Standard Care for Subacute Pain – (07-17-00)

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Osteopathic Manipulation vs. Standard Care for Subacute Pain

Of course, this article mentions osteopathic manipulation, but since chiropractics deliver 90% of the manipulations in the US with only 10% of the adverse side effects, who would you rather go to?? The basis of this article is that manipulation is just as effective as medications. The article does not go into the long list of potentially very harmful side effects of the meds…

Twelve weeks of osteopathic manipulation and twelve weeks of standard medical care resulted in the same degree of clinical improvement among patients with subacute back pain, according to a randomized trial by Gunnar B.J. Andersson, MD, PhD, et al. Although patients in both treatment groups made similar recoveries in the new study, Andersson et al. found an advantage for osteopathic treatment. The osteopathic treatment group used significantly less medication (e.g. NSAIDs and muscle relaxants) and physical therapy. “Given the known and potentially serious adverse effects and costs of nonsteroidal anti-inflammatory drug therapy, the achievement of equal outcomes in regard to pain relief, function, and satisfaction, with less use of medication and physical therapy, suggests an important benefit of osteopathic manipulative treatment,” according to Andersson et al. “This type of treatment deserves careful examination through a formal cost-benefit analysis.”