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Back Pain Chiropractor Mesa AZ

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Chiropractic Hospital –

CHIROPRACTIC CARE OF LOW BACK PAIN IN HOSPITALS IMPROVES CARE?  There have been many stories of the better outcomes and happier patients when chiropractic care is added to the ER care for patients with low back pain, but this is the first study that I’m aware of that actually proves it.  It makes sense.  I can’t tell you how many times patients went to the ER with their neck pain, headache, shoulder pain, mid back pain, low back pain before they came in to see me.  Rarely do they ever feel the visit produces any real benefit.  What if that patient had a chiropractor to see after everything else had failed (actually…it should be BEFORE everything else failed, but that’s an even larger hurdle to jump..)?  Reports from hospitals that have added chiropractic care to their ER consistently shows happier and better satisfied patients who presented with low back pain. Read More…

Natural Treatments for Arthritis Go Head to Head with Dangerous Drugs

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Natural Treatments for arthritis
Natural Treatments for arthritis

There are lots of claims about natural treatments for arthritis, but which ones work?

Without any good answers, all too many of us drop back on drugs for arthritis pain.  The list can include drugs like steroids and NSAIDs.  These drugs come with a list of side effects that you would not want to experience (if you’re really up to learning all about why NSAIDs are so bad for your health, feel free to check out my eBook on the topic by clicking here).

A few years back, the drug companies were able to come up with a new version of the most common class of anti-inflammatories, the cyclo-oxygenase inhibitors.  This NSAID class includes drugs like ibuprofen, and indomethacin.  The problem with this class of drugs is that one of the enzymes they block just so happens to protect the lining of the stomach.  This is why the big risk with these drugs is bleeding ulcers and why some 20,000 people per year die as a result of taking these drugs.

Because of this tiny little side effect, researchers developed a class of drugs that do not block the one version of the enzyme that protects the stomach lining.  Thus was born the selective cyclo-oxygenase inhibitors that rose to the top of the drug food chain to become one of the most financially successful blockbuster drugs of its time.

At least, until it was determined that, while this drug was a wee bit safer on the stomach,  unfortunately this drug DID block one enzyme that protected the heart, leading to some 100,000+ heart attacks and who knows how many deaths from Vioxx alone.  To make matters worse, Merck hid this data for years until it blew up in their face, resulting in hundreds of lawsuits from families that lost their loved ones.

Luckily (for the drug companies) the public has a short memory and Celebrex is still available on the market and prescriptions are still being written today for patients with arthritis pain who probably forgot about the entire Vioxx debacle.

So, if you happen to be one of those patients whose primary care doctor also has a short memory and wrote you a prescription for Celebrex, there may be an answer.

This particular article pits the natural combination of glucosamine and chondroitin up against Celebrex in 606 patients with knee arthritis and severe pain (Kellgren and Lawrence grades 2–3 knee osteoarthritis and moderate-to-severe pain based on the Western Ontario and McMaster osteoarthritis index-WOMAC-score ≥301 an a 0–500 scale).

Patients received either 400 mg chondroitin sulfate, 500 mg glucosamine combination three times a day or 200 mg celecoxib (Celebrex) every day for 6 months.  Here’s what they found:

  • The natural arthritis treatment group dropped 50.1% (WOMAC score).
  • The drug-known-to-kill group had a matched 50.2% decrease.
  • At 6 months, 79.7% of patients in the natural arthritis treatment group and 79.2% in the toxic arthritis drug (Celebrex, in case you’re not following along) group fulfilled OMERACT-OARSI criteria.
  • Both groups had more than a 50% reduction in joint swelling and effusion.

Sounds like a pretty even match, right?  Yeah–except that neither glucosamine nor chondroitin, in the history of its use, has been associated with even a single death (that I’m aware of–I’m sure there’s a patient or two who choked to death taking the supplements…), while Celebrex is in a class of drugs that is so bad for the heart that cardiology recommendations now state that NO heart disease patients should be on NSAIDs.

Oh..and it’s WAY cheaper.  So which one are YOU taking?

Having Orthopedic Surgery? You NEED to Know this Scary Risk

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orthopredic surgery and troponin
lenetsnikolai / Dollar Photo Club

Everyone knows that there are risks associated with any surgery. But the risks that you know about are the obvious ones.

Problems with the anesthesia such as aspiration pneumonitis or respiratory failure.  Problems with the surgery itself such as excessive blood loss, damaging the spinal cord or spinal nerves, infection or blood clots.

But what if there was something more insidious that can occur?  Something that won’t kill you today or tomorrow, but waits in the shadows until years later?

Before I tell you what this scary thing is, I do need to point out that there is a time and a place for orthopedic surgery.  But this should only be considered as an absolute last option.  All too often we THINK something is a last option.

But time and time again research proves that this is just not true.  Some examples:

This list is much longer, but you get the idea.  There are an uncountable number of orthopedic surgeries done every year that were unnecessary.  Which would be fine if there weren’t dangerous risks associated with orthopedic surgery and the chance that you will be no better after the surgery, or worse, in more pain after the surgery.

Side note–these comments do not apply to trauma-induced orthopedic surgeries–in these cases there are usually no options for avoiding an emergency surgery after trauma.

All of this brings me to this particular study.  In it, researchers looked at a scary side effect of orthopedic surgery called myocardial necrosis.  As you may be able to tell from the name, this is a condition were the heart muscle dies as a result of the stress on the heart from the surgery.  This bad effect from surgery is well known and characterized for short term mortality after orthopedic surgery.

What is not as well-known is what happens in the long term.  To get a better idea of how often this happens, researchers looked at levels of troponin (a protein found in the heart; elevated troponin levels are a sign that damage to the heart has occurred) immediately after orthopedic surgery and whether this related to long term death in hip, knee, and spine surgery 3 years later.  Here’s the details:

  • There were 3,050 surgeries with an average age of 60.8 years.
  • Myocardial necrosis occurred in 179 cases (5.9%) and heart attacks in 20 (0.7%).
  • In those patient who experienced myocardial necrosis, 16.8% of them did not survive in the long term (3 years).
  • In those who had normal troponin levels around the time of surgery only 5.8% did not survive.
  • To put it clearer, those orthopedic surgery patients who had higher levels of troponin were 233% more likely to die in the long term evaluation, while those who had a heart attack after the surgerys were 351% more likely to die.

Now certainly, if you had a heart attack just after your orthopedic surgery you’d know about it.  But myocardial necrosis may not have been fully explained to you if it had been identified.  Either way, if you DO end up having orthopedic surgery, it may makes sense to push your surgeon to run troponin levels along with everything else to get an idea about whether or not you’re going to be around in the next 3 years.

Seems simple enough.

 

Tylenol for Your Pain; Surprising Finding on How Well it Works

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Tylenol for back pain
Radosław Brzozo / Dollar Photo Club

Society would never consider going without over the counter pain meds. Doesn’t matter what’s it’s for; headaches, knee pain, shoulder pain, back pain.   We don’t seem to care where the pain is; that magical little pill hones in with radar precision to zap the pain and give you relief.

Or at least this is what the advertising messages would have you believe.

For starters, there is no magical honing; all drugs reach all areas of the body.  This is one of the reasons why so many side effects occur in organ systems that have nothing to do with the reason for taking a drug in the first place.

Personally, I haven’t taken any over the counter or prescriptive medications for at least 20 years (it may have been longer—I just can’t actually remember…) despite my share of martial arts injuries over the years.  But I certainly have my share of patients who take them on a regular basis.  We’ve become somewhat immune to the idea that every drug has a risk / benefit ratio.  There is not a drug out there that does not have side effects; since every single drug interferes with the way your body functions to some degree or another this is inevitable.

Paracetamol, the active ingredient found in Tylenol and generic acetaminophen, has a long list of side effects.  Just some of these include:

But, as mentioned, sometimes the side effects are worth the risk (although anyone on the liver or kidney transplant waiting lists may disagree…) so long as there are benefits.

But what if what you’ve been taking your Tylenol for really doesn’t work?  I can tell you that it certainly seems like many of my patients who are in pain and take many of the OTC pain medications aren’t jumping up and down for joy over how well they work (because, after all, they are in a chiropractor’s office looking for additional pain relief.

At the most, they seem to help “take the edge off” or help for a few hours at the most.  This particular study seems to agree with what I’ve experienced in my office.  In it, researchers looked across 13 different clinical trials looking at the use of paracetamol for back pain, knee or hip arthritis pain.  In the review, the researchers looked for the quality of the studies to see what the outcomes were.  Here’s what they found:

  • High quality results from the studies found that paracetamol is ineffective for reducing pain intensity and disability or improving quality of life in the short term in people with low back pain.
  • High quality results from the studies found that paracetamol used for hip or knee osteoarthritis for that any short-term improvement on pain and disability was not clinically important.
  • High quality results showed that those taking paracetamol were nearly four times more likely to have abnormal liver function tests.

When it comes to research, there are no absolutes and no single study can determine whether something works or not. To make it a little more complicated, there are good quality and bad quality studies.  But when you have multiple high quality studies pointing to the same outcome, you can be far more confident that the results from that study may apply to you.

That’s what we have here.  Could you be one of the few for whom Tylenol is going to work for back, knee or hip pain?  Possibly.  But it should not be your first choice given that there is a long list of side effects associated with the use of Tylenol and this review strongly suggests that it is not going to work.

Of course, being somewhat biased towards chiropractic care for these conditions, I would strongly suggest that chiropractic care should be your first choice for treatment of these conditions.

Degenerative Disc Disease in the Back; Mesa Chiropractic Shines YET Again

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The preconceptions surrounding chiropractic care are legendary. For those who have seen a Mesa chiropractor, the advantages are usually clear.

For those who have never been to a chiropractor in Mesa, however, there are a long list of fears and incorrect ideas.  Unfortunately, many physicians outside of chiropractic share the same fears and misconceptions.  If these erroneous thoughts were non-existent, I personally think the musculoskeletal health of this country (and globally) would be in a much better state.

One of these misconceptions deals with chiropractic care being useful only for acute, non-specific low back pain.  Neck pain, disc injuries, arthritis of the spine, knee pain, shoulder pain, carpal tunnel—none of these are on the list of generally acceptable conditions that chiropractic can treat.  However, these conditions and more are seen quite commonly in our office.

There is research on the effectiveness of Mesa chiropractic care for some of these conditions but it is usually limited to manipulation only, yet many musculoskeletal conditions have a pretty significant soft tissue component to can’t be addressed with joint manipulation.

So anytime I see a study that shows a positive effect with manipulation alone, I can feel confident that, which the addition of competent soft tissue work, the outcomes in real life (outside of a research study) are going to be pretty darn good.

All of this leads me to this particular study.  In it, researchers looked at 40 men who had been diagnosed with degenerative lumbar disease at L5-S1.  These men were divided into an adjustment group, who only received a single adjustment (L5-S1 “pull move”) or into a control group with no treatment.  They were then evaluated for various outcomes, including:

  • Participants’ height using a stadiometer (that height bar thingee on your doctor’s scale)
  • Perceived low back pain (measured using a a10 point VAS scale)
  • Neural mechanosensitivity (how much tension was in the nerves using a passive straight-leg raise
  • The amount of spinal mobility in flexion (measured using the finger-to-floor distance test)

If you understand chiropractic care, you will not be surprised to find that all of these measurements were improved in the chiropractic treatment group over the placebo group.

It would be easy for detractors to say that this was a single treatment that really doesn’t mean anything long-term.  The easy response to this would be to ask what medical treatment for degenerative disc disease is anything other them temporary?  And how many of these have a very small list of only minor side effects?

The answer is, of course, none of them.  Even if chiropractic care provided no long-term benefit in this situation, if you suffer from chronic low back pain, even a single days’ relief is valuable.  And none of this looks into whether or not a course of chiropractic care can have more long-lasting effects, but I can tell you from personal experience that the results can be very strong.

So if this fits you and you have not been to a chiropractor in Mesa, what are you waiting for?

 

Serum levels of YKL-40 and CRP in patients with hip osteoarthritis – (10-26-00)

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Serum levels of YKL-40 and CRP in patients with hip osteoarthritis

This article is a little technical. For most of medical history, despite the use of the ending “itis,” osteoarthritis has not been considered an inflammatory disease. However, recent research has shown that inflammation is indeed a factor. This can change the entire was we view the treatment of OA. And opens up new therapies for dealing with and preventing OA. Many researchers are begining to show that the underlying cause of OA is a nutritional problem of the bone underneath the joint.

Ann Rheum Dis — Abstracts: Conrozier et al. 59 (10): 828

Read entire article here

Muscloskeletal Pain? Primary Care Docs Not Giving Good Advice

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Sciatica.  Knee osteoarthritis symptoms.  While these two conditions seem a world apart, there is something they have in common:  Bad advice.

Both of these conditions have solid research on things that you should and should not be doing to help you recover.  The “should” category involves exercise and moving around.  Almost always with musculoskeletal pain, moving around is better and staying sedentary is a very bad idea.  While my opinion is clearly biased on this one, the acceptable medication approach to most musculoskeletal complaints involves the use of NSAIDs like ibuprofen.  Strong pain medication like opioids (Vicodin, Percocet) should not be used, especially initially, and fall into the “should not” category.

In the “should not” category is also imaging.  While plain X-rays may be appropriate to evaluate for osteoarthritis symptoms, advanced imaging like MRI and CT scan should not be ordered unless certain red flags are present.

All of this is well supported by the medical research over the past 10 years or so.  But one of my continued frustrations with all branches of medicine is just how rare it is for doctors to actually crack open medical journals.  The research itself suggests that doctors are, in general, about 19 years behind the medical literature.  That means that this particular article, looking at just how well primary care doctors understand the current recommendations for sciatica and osteoarthritis symptoms, won’t grace the typical doctor’s eyes for two more decades.

Basically, they won’t know that they don’t know until around 2033.

Just in case you think I’m being a little too facetious, let’s look at what researchers found in the study:

  1. Despite the clear benefit, less than 1/3 of physicians would give exercise advice (30.2% for osteoarthritis, 32.8% for sciatica).
  2. Overall, though, at least newer docs were more likely to give advice on exercise (39.6% of newer physicians versus 26.0% of older docs for sciatica / 20.8% for osteoarthritis).
  3. Newer physicians were less likely to order tests like CBC or CMP (9.4% vs 21.9%) or a urinalysis (4.2% vs 16.7%).
  4. For osteoarthritis, X-rays were more often ordered by newer physicians (85.4% vs 69.8%).

Overall, these numbers reflect poorly on the typical primary care doctors’ ability to handle common musculoskeletal complaints.  For my entire chiropractic practice life I have been confronted with patients and people in the community that ask whether they should see his or her primary care doctor or a chiropractor first.  The evidence is very clear–seeing a chiropractic physician first is the best option that will be more likely to lead you down a path with the best and most efficient outcomes.

But clearly I’m biased.

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.