LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

back pain

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.

Is Your Job Giving You Low Back Pain?

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occupational back pain
Is your job giving you back pain?

There are many factors that contribute to low back pain.  Some obvious, some not so.  But in many cases, these factors are under your control.

However, without some serious reworking of your life, you occupation is not easily changed.  But does your job contribute to your back pain?  Sometimes.

I hear it almost daily.  “If I just had a job that I didn’t have to sit all the time.”  “If I just had a job where I could sit down.”  The truth is that we are designed to be out hunting boars and gathering berries.  Not a whole lot of job openings for these positions, however.

I consider myself very lucky because my job has me up and down, sitting and standing, bending and straightening, pretty much all day long (unless I happen to be doing a blog post at my computer, of course).

There has been no real clarity in studies over the years looking for factors that predispose to the development of back pain.  Nothing can be clearly identified in a pre-employment physical that would indicate that a worker is more likely to suffer injuries.

However, there has been a consistent pattern over the studies on workman’s compensation injuries; those who are not happy with their jobs or feel unempowered are more likely to suffer an injury.  Not that anyone is faking an injury because he or she does not like his or her job; rather, this reflects the complex interplay between the mind and the body when it comes to pain.

This particular study, however, seems able to add some insight.  In it, researchers looked at 2,161 men working in various occupations across France who were followed across 5 years.  Twenty-one biomechanical, organizational, psychosocial, and individual factors were assessed in the first survey.  Five years later, in the second survey of these workers, they were asked about low back pain during the previous week.

Here’s what they found:

  • 394 (30.0%) men had low back pain in the second survey.
  • Frequent forward-only bending increased the risk of low back pain by 45%.
  • Frequent forward-and-sideways bending increased the risk 213%.
  • Driving industrial vehicles increased the risk 35%.
  • Working more hours than officially planned increased risk 38%.
  • Reported low support from supervisors increased risk 35%.

Notice that psychological factors showed up on this list again (low management support and working longer hours than planned).

There are other, general factors that play a role in low back pain.  Things like smoking and a sedentary lifestyle play a role in back pain, but these are easily modifiable.  If your occupation requires any of the behaviors or movements noted above, there is going to be a challenge.

The best you can do is manage your workstation, using back posture support devices when possible or lumbar support cushions if your job requires prolonged sitting or driving.  If you happen to own a company that uses team members who have to perform these repetitive movements, it might be well worth your while to invest in an ergonomic evaluation to see if any changes can be made to the workstation to minimize your team’s risk of low back pain.

 

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.

 

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.

The Answer to Obamacare Contained in 4 Simple Facts

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Just in case you thought I was going to get political, get your disappointment over with now.  Or at least, not Republican versus Democrat political.

This blog is not long enough, nor do I have the time to point out all that is wrong with the current concept of the Affordable Care Act.  But I can help illuminate one glaring problem.  “Health care” in this country just costs too damn much.  The waste, fraud and abuse is at epic proportions and nothing short of the downfall of medicine as we know it will change this.  There’s just too much money invested in the machine for anyone with any shred of reality left to believe otherwise.

However, amidst the financial carnage lies an answer to at least some of the woes we can identify.  This particular set of “woes” is wrapped up in what those in the insurance industry like to call “non-surgical spinal care.”  At one of the largest (if not THE largest) health insurance companies in the US, orthopedics is the number one cost driver.  Of the orthopedic expenses, the single largest line-item cost is non-surgical spinal care, sitting at about 45% of overall orthopedic costs.  This number is so large, not because of the massive costs of treating a case of back pain, but rather because of the sheer volume of cases of non-surgical spinal complaints.

So what if you could shave a small percentage, maybe 30%, off the top of this large chunk of orthopedic costs?  The direct cost savings are in the billions of dollars.  DIRECT only.

Given my bias, by now you should know that I’m talking about chiropractic care for the management of non-surgical spinal complaints.  The data encompassing millions of episodes of musculoskeletal complaints (yes–millions) leaves chiropractors at the top of the hill as far as the most cost-effective provider to manage this type of case.  This occurs mainly because the average DC can truly manage the care.  Only a small percentage of cases presenting to a chiropractors office FIRST will need to leave that office for his or her episode.  Contrast this with PCPs, PTs, ERs and orthopedic doctors.  Very few of these providers can manage these cases within his or her office alone (BTW–writing a prescription would be considered to have another provider, in this case the pharmacy, involved, driving up costs).

Sadly, only 28% of these cases start with a chiropractor.  Worse, if a chiropractor is not part of the initial treatment, less than 7% of the time will that patient end up in a chiropractic office.

The bottom line is that chiropractic care is the only treatment path that follows the best evidence of spinal care, meaning:

  1. Imaging should NOT be used at the initial stages of treatment (orthopedic doctors order imaging at a very high rate).
  2. Opioids are not recommended as the first line medication (PCPs will frequently lead with Percocet or Vicodin).
  3. Injections should never be used in the initial stages of a back pain episode.
  4. Manipulation is added in almost every case seen in a chiropractor’s office.

Here’s a bonus.  Remember when I said that chiropractic care led to a DIRECT 30% savings?  This does not include the indirect cost savings which can include:

  • Additional cost savings when comparing chiropractic care treatment in surgical spinal care episodes
  • Practically unfathomable savings due to less drugs and less side effects from these drugs (I’ve written an entire eBook on the side effects of NSAIDs)

So here’s the real problem.  Despite the evidence, chiropractic care remains the truly hidden gem of healthcare.  Even looking at this particular study that suggests that mainstream medicine is getting WORSE at managing back pain, me and my colleagues are still limited to being heroes in our own little offices, rather than across the healthcare spectrum.  But there is an answer over the horizon…

The employers.  Yes, it may very well be that the members of your HR department could help change the face of health care.  Imagine that.  Going forward, the group that truly wants to save money on health care is the employers.  They truly have the most to lose with treatments that run completely opposite of what the medical literature suggests is the best care pathway.

I guess only time will tell how it is going to play out.

 

Lumbar Belts Fail to Prevent Back Pain or Back Pain Disability – (03-08-01)

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Lumbar Belts Fail to Prevent Back Pain or Back Pain Disability

Despite their widespread use and general acceptance, several large studies have not demonstrated any benefits from the use of back belts. One of the reasons for this is that many may use the belt and consider themselves safe from poor lifting habits. This is NOT true. A back belt is supposed to be used as a reminder when you exceed or perform certain undesirable movements. I believe many may cause their own injuries thinking that back belts make them “super” lifters, immune from injury.

Back Letter 16(1):1, 6, 7, 8, 2001 According to a large new prospective cohort study conducted by researchers at the National Institute of Occupational Safety and Health (NIOSH) back belts do not prevent back pain or back pain disability, according to James T. Wassell, PhD, and colleagues. (See Wassell et al., 2000.)”In the largest prospective cohort study of back belt use, adjusted for multiple individual risk factors, neither frequent belt use nor a store policy that required belt use was associated with reduced incidence of back injury claims or low back pain,” Wassell et al. conclude. (See description of Wassell study on page 6.)The study found no beneficial effect of belt use in any group: among employees with and without a history of back injury, employees with consistent belt-wearing habits, or employees with the most strenuous jobs. The study had some obvious strengths. In addition to its large size, it included subjects from a wide geographic area. The investigation had concurrent comparison groups and detailed exposure information, and was able to control for a wide variety of potentially confounding factors.”Results based on these multiple analyses of data all converge to a common conclusion: back belt use is not associated with reduced incidence of back injury claims or low back pain in material handlers,” according to Wassell et al.

Activity and pain killers best for back pain – (02-19-01)

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Activity and pain killers best for back pain

Apparently, this author has been living in a cave and has never heard of manipulative therapy. The activity I can unquestionably agree with, but the pain killers? Does anyone out there actually still believe that pain killers and anti-inflammatories address the cause of the pain in the first place? There has never been, and probably will never be, a study on chiropractic care for low back pain. Sure, there’s been studies on manipulation on low back pain. But, (to me anyway…) chiropractic care involves soft tissue techniques, stretching, lifestyle modifications, addressing sleeping and working positions, postures and environment and yes, manipulation. It’s the global package. That is why natural medicine fits so well into the chiropractic philosophy; therapy for almost any condition involves attacking the problem from multiple angles at once, safely and effectively.

bmj.com Somani 322 (7282): 318b

Read entire article here

Slipped Disc in Back: Common Sciatic Nerve Treatment Falls Short

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MRI finds a slipped disc in back. Options are short, but you decide on a common sciatic nerve treatment from your doctor’s suggestion. But what’s the best option?

The task of deciding what options are the best seems daunting. Medications, injections, chiropractic (my personal favorite), acupuncture, massage, physical therapy and probably 10 others I’m forgetting.

But before you decide on a treatment, we need to back up a little. The conversation needs to start with where you got your diagnosis. The diagnosis of a disc problem (slipped disc, disc bulge, disc herniation – the actual description is quite technical, but you get the idea) can be make quite accurately in a competent physician’s office. Rarely is an MRI needed to diagnose a disc problem, and the guidelines clearly state, that in the absence of red flags, any imaging needs to wait until 4 weeks of conservative treatment. Despite this mainstream medicine seems to want to order MRIs and CT scans at the first sign of back problems.

This is were the problems begin. Numerous studies have confirmed that early MRIs are a bad thing, driving expensive, dangerous and unneeded treatments. But let’s say you made the mistake of not going to a chiropractor first for your back pain and you did get an MRI or CT scan. And this MRI or CT shows that you have some type of problem with the intervertebral discs of your lumbar spine.

Here comes the big question. Do you have leg pain or not? And is this leg pain scleratogenous, radicular or radiating? I don’t really expect you to answer that question, but hopefully you can begin to see that just because your back pain is accompanied by leg pain this does NOT mean that you have sciatica. I can’t tell you how many times I’ve seen patients with leg pain that, after some targeted soft tissue work on his or her low back and glut region (gluteus maximus, posterior hip, rump, derriere–you get the idea), the leg pain gets better or is gone.  There is no way a slipped disc in back would respond that fast.

Sciatica refers to radicular pain that comes from chemical or pressure (from a disc) directly on the sciatic nerve. For those of you unsure of where the sciatic nerve goes, I’ll clarify. It goes into the leg. Despite this, I have seen patients spend tens of thousands of dollars for epidural injections for low back pain that doesn’t involve pain in the leg. I’m not sure there’s ever been an indication to use epidural injections in the lumbar spine for treatment of local back pain (without leg pain). It may be done all the time, but that doesn’t make it right.

Overall, this means that you need to see someone who understands all the nuances of back pain and leg pain. (hint, hint….a chiropractor). Anything short of that and you may get sent in the wrong direction.

Back to this particular article that looked at the effectiveness of epidural steroid injection as a common sciatic nerve treatment.

I have personally referred a small handful of patients out for epidural steroid injections over the years, but they are few and far between. I have never considered spinal injections as a stand alone therapy. At the most, they allow a small window of pain relief, where other options have failed, where other therapies can be used more aggressively.

So what happens if an epidural is the only therapy used? Basically, confirming other studies, these researchers found that they suck. Here are the specifics:

  • Researchers looked at 25 different studies.
  • Epidural corticosteroid injections improved leg pain 6.2 points (out of 100).
  • This was only noted in the short term (2 wks to 3 months).
  • Beyond 3 months, the benefits were even smaller–pretty much non-existent.

So basically, an epidural injection for sciatic pain is very expensive (I’ve seen bills as high as $5,000 per shot) and really does nothing but provide a small amount of pain relief for a short period of time. Worse, it may accelerate destruction of the disc and lead you to surgery. Of course, none of this takes into account the close to 400 cases of fungal meningitis on the East Coast from contaminated vials of the steroid used in this procedure, with almost 30 deaths so far.

Where do I sign up?