Chronic Back Pain

Chronic back pain is not pneumonia. If you get pneumonia and you get the right antibiotic, the pneumonia is cured, never to be seen again-unless the patient has other problems. But we don't have a magic bullet with chronic back pain. That means we need to educate the people that this medical model-a specific condition with a specific treatment for a cure-doesn't work for chronic back pain.

If a patient with mechanical chronic back pain has severe osteoporosis, a high-velocity, low-amplitude manipulation cannot be used. Continuous passive motion, such as spending time in a pool every day in a buoyant environment or using an Ortho-Track pneumatic vest, which unloads the spine in an upright posture, can prove helpful in reducing the symptoms. In other severe situations, multiple treatments for chronic back pain - for example, continuous passive motion, Ortho-Track pneumatic vest, and co-treatment with joint injections to shut down the local inflammation-- deliver much better results than any one of these procedures for chronic back pain alone.

This raises wide-ranging questions for the profession to consider treatment of chronic back pain. Can chiropractic always stand alone against chronic back pain, or is an interdisciplinary approach more efficacious for some cases? What role do diet and exercise play on chronic back pain? How does the mind both ease and exacerbate chronic back pain? And how do research practices contribute to both understanding and misunderstanding of chronic back pain?

Diet is a major component of the chronic back pain healing process. In addition to recommending a healthful diet with ample hydration, doctors are looking into supplements. There are some nutritional products that we think will help with joint pain, supplements such as glucosamine sulfate and chondroitin seem to work well.

As for alcohol consumption, one recent study concludes that there is no evidence of a connection between alcohol and chronic back pain problems. Smoking, however, is a different story, evidence suggests that smoking interferes with the ability of connective tissue to recover. Whether it weakens the tissues enough to promote injury is still speculative, but it's clear that smoking does interfere with recovery of connective tissue. It changes the vascularity of the tissues and the ability to carry oxygenated blood to the tissues.

Chronic back pain can be realed to lifestyle issues such as smoking and obesity. It is very difficult to make these changes in our lives.

It is well documented that exercise can have a positive impact on chronic back pain. Walking and swimming are two of the least stressful activities that can make a difference. Get more active, get out in the fresh air it will pop up the mood, so you wont need a mood enhancer.

This kinds of physical activities against chronic back pain and the length of time spent doing them depend on the individual patients' abilities. More difficult cases need to work within small increments of improvement. Rehabilitation equipment, such as the Swiss ball or Pilates Ball and stretching bands, encourage range of motion through an incrementally graded resistance. In addition, set attainable goals that can be reached-and then extended.

As the profession begins to look at different ways of diagnosing and treating chronic back pain, it is also exploring new theories about pain source. Neurophysiological theories have evolved from the classic theory: something becomes irritated, the irritation is constant, this signal goes up to the brain and causes pain. Now, theory holds that the irritation causes a change in the way the central nervous system interprets pain impulses. For example, an irritation in the muscles of the spine can disappear, the patient can have a normal exam-and yet still complain of a great deal of pain.

This somehow explains a lot of the problems with chronic pain

and why many treatments such as surgery, injections, and adjustments, have not been as successful in relieving chronic back pain as they have been in acute pain.

Temporary relief of chronic back pain could be achived with ice packs or hot packs or give an adjustment or an aspirin, but what really is required is to improve the normal lifestyle, it needs to focus attention away from the chronic back pain. If peoples think about their chronic back pain, they reinforce it. There are even some who think that people with chronic back pain should not see a doctor because the doctor keeps asking them if they have pain, which reinforces their thought process about chronic back pain. Some doctors of chiropractic are turning back to our original philosophical approach, which is to restore these people to a normal life.

It needs to help to improve the diet, resume exercise, and reduce psychological stress. We've got to get working properly and stop from thinking about chronic back pain. Just as the mind can contribute to the presence of chronic back pain, it can play a beneficial role in easing chronic back pain.

A other approach to get relief of chronic back pain could be hypnotherapy and biofeedback. Both methods involve deep muscle relaxation, breathing, and imagery techniques that help to process pain signals. With hypnosis, people try to alter the sensations they have in their bodies. They may imagine a metaphor for the pain-a bright red burning light bulb, for example, gradually changing the color and intensity from red to blue, from bright to dim. Others work with sound metaphors-a loud, grating sound they gradually change to a duller sound.

Post-hypnotic suggestions help people re-create these feelings outside the clinical setting. People may say a phrase to themselves, or make a physical gesture and imagine that this take the pain, move it into their hand, make their hand into a fist, and release the pain as they release the fist.

Biofeedback, which also uses breathing and relaxation techniques, focuses on the physical component of the people chronic back pain, usually the muscle tension, which biofeedback equipment monitors.

Surface EMG electrodes are placed on a painful area, and in a baseline session, determines the difference in intensity from what a pain-free person experiences. If somebody is experiencing a lot of surface EMG tension, relaxation exercises are created and audible and visual signals from this equipment that help them learn how to bring the tension down.

Other techniques to relief chronic back pain include meditation, a deep-breathing approach with limited imagery, and guided imagery, which involves more visualization.

In addition to what somebody can do for himselve, family support is vital for recovery. Confusion and misunderstanding about what people are experiencing can hinder improvements. In some cases, spouses are overly protective. This often limits patients' ability to improve function because when they start something that might cause pain, spouses urge them to stop. At the other extreme, spouses may be angry and not believe the partners are in pain. That, in turn, leads people to prove to their spouses just how disabled they are."

It is useful to get behavioral medicine specialists involved in pain cases because so much pain stems from the peoples psychological state. Chronic back pain is often accompanied by depression, anxiety, and a tendency toward dependence on drugs and dependence on the doctor,

A shortage of research on the chiropractic role in treating chronic pain is also a serious problem, and not one that can be remedied quickly. But good scientific method begins with observation-and not observation of what doctors are doing in the field, because they are affected by who's going to pay what they re paying for, and so on. The question is, of all of those people a doctor see, which patients seem to be getting better? What are the characteristics of a patient who is responsive to care? If we become selective in identifying the patients who are most appropriate for the chronic back pain treatment that we work with, and then study those people, I believe we'll have improved outcomes in the randomized trials.

Surgeons had to face this problem when they found that the surgery performed on chronic back pain patients had poor outcomes. When they became more selective- for example, when they began studying surgery on people with herniated disks who were not experiencing much back pain and whose primary complaint was radiating leg pain-- results improved considerably.

Tame chronic back pain -  Moving to relief

Women are more prone to muscle aches (myalgias) and joint pain arthralgias) than men, and the incidence increases with age. Conditions that cause joint pain and loss of mobility are the most common cause for limiting activity and for disability among women who are middle aged and older. While diseases such as osteoarthritis are a common cause of chronic pain, back, neck, and shoulder pain are a major reason for doctor visits. In many cases, says Dr. Lachmann, physical therapy and proper exercise helps resolve the pain.

Many women with chronic musculoskeletal pain, especially chronic back pain, suffer from muscle spasms. Muscle spasms are the body's attempt at preventing movement that hurts, spasms can be treated acutely by a physical therapist with heat, ice, electrical stimulation, or ultrasound to bring more blood flow to the affected area. Once the spasm is calmed down strengthening the muscle is the target.

A physical therapist can also teach you the right exercises to limber and strengthen a muscle to ease pain and prevent future problems. "Without working on support muscles, the spasms will recur. For example, in women with back pain, we work on strengthening the abdominal muscles and improve the flexibility of hip flexors, which tighten in people with chronic back pain."