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Keep A Pain Diary
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PAIN RELIEF FACTS AND INFORMATION - PAIN RELIEF TREATMENTS
Everything You Need To Know About Pain, Pain Relief And Pain Management
Facts And Information About Pain, Pain Relief And Pain Relief Treatments
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Everything You Need To Know About Pain, Pain Relief And Pain Management
Facts And Information About Pain, Pain Relief And Pain Relief Treatments
Order Prescription Medications Online To Treat And Prevent Chronic Pain
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Back Pain Frequently Asked Questions - Back Pain FAQ’s
What are common causes of back pain?
The most common cause of back pain is muscle tension or spasm. This is generally caused by fatigue or overload of the back muscles associated with poor posture. Other causes are post traumatic in nature, where there are a range of injuries to soft tissue structures supporting the spine, including ligaments and intervertebral discs. A third cause are degenerative changes. These are injuries of the spine due to the wear and tear and degeneration of tissues. Other more serious causes include tumors and infections, which could have as their only initial symptom back pain.
How do disc injuries cause back pain?
The intervertebral disc is a gelatinous-like filled structure, which acts as a cushion to separate the vertebrae of the spine. The intervertebral disc has a tough outer cover called the annulus. Sometimes the integrity of the annulus is disrupted allowing for the change in the shape or contour of the disc. The disc material can protrude away from the normal contour of the disc and cause pain. Injury to the disc can cause pain in three different ways. First, the injured disc can itself be painful. The damage results in development of pain coming directly from the disc. Second, the injured disc may be weakened to the point that it no longer functions as it should. Normally, the discs allow for normal movement of the spine by acting as "shock absorbers" between the blocks of bone of the spine (vertebra). When the disc fails to do its job, the other parts of the spine, such as the joints known as facet joints, may suffer. This can generate secondary pain arising from the other structures. Finally, an injured disc may be displaced from its normal position and pinch (compress) a nerve, causing pain. If the displaced disc compresses or inflames a nerve, there may be back pain, leg pain or a combination of both.
What is the difference between a herniated disc and a bulging disc?
As the disc undergoes the natural process of degeneration, it loses the ability to retain the hydration necessary to support the spine. The result is a diffuse bulging similar to a tire that loses air pressure. In the case of the disc it is loss of hydraulic pressure. Another consequence of the degenerative process is the development of fissures or cracks that result from the desiccation of the disc. Fragments of the inner portion or "nucleus" of the disc can herniate or rupture by way of these fissures through the outer layer (the annular ligament). While a bulging disc is a diffuse process, a herniation is a focal protrusion that often results in painful symptoms called radiculopathy. A bulging disc is an early step in the degenerative process of all lumbar discs. As the disc begins to lose its normal water content, it will begin to gradually narrow. This causes the disc to lose much of its "shock-absorbing" effect. This loss of height also allows the outer lining of the disc, called the annulus, to gradually bulge outward as the disc narrows. This process is often compared to an air mattress or a pillow, which would gradually broaden out as it flattens down while losing air. It is rare for a bulging disc to cause significant pressure on the adjacent nerves. A herniated disc, by comparison, occurs when the outer lining of the disc becomes torn, allowing the inner softer disc material to be expressed out of the normal confines of the disc itself and, thus, out pressure on the adjacent nerves. Herniated discs tend to cause "sciatica" or leg pain, due to this pressure on the nerves. A bulging disc usually tends to cause only mechanical back pain, due to irritation of the disc lining itself.
Is it true that a bulging disc can be normal?
Yes. Some discs bulge normally, as part of the normal variation that is part of being human (tall vs short). As we age, the surrounding supporting fibers tend to stretch. This will allow some bulging of the disc, without an injury, and without pain. Under normal conditions, our discs are designed to slightly bulge during normal activities. This allows our spine to absorb the tremendous forces we expose it to everyday. However, any significant, persistent bulge present in the absence of applied forces (such as when we lay down), is not "normal." However, this bulge may possibly be entirely painless. It is well known that not all disc bulges are painful. Many people live with disc bulges and are entirely unaware of it because they have no pain.
How did I herniate my disc?
At least 70% of patients have no idea how they herniated their disk. The other 30% can trace the herniation to an injury, most often a bending and twisting maneuver. There are two steps to a herniated disc. Number one you have to have an opening in the outer lining of the disc. This can occur with any type of trauma. Number two, over time; the inside of the disc has to become loose and actually come out of the disc wall. That is a herniated disc. The cause for this escape of the disc matter can be minor things like sneezes, or it can be major like a motor vehicle accident.
What are the symptoms of a herniated disc?
Typically, a herniated disc causes radiating leg symptoms. Generally, this is what people refer to as sciatica or radiculopathy. The herniated disc is defined by a disc where the outer lining has been torn, and the inner soft disc material has expressed out of the tear and compressed the adjacent nerve roots. This pressure on the nerve roots tends to cause not only low back pain but leg pain, as well. This can be accompanied by numbness and weakness, which can be progressive in nature in its more severe form. When disk herniations are very severe, they can even affect the function of the control of the bowel and bladder. This is called cauda equina syndrome and tends to be a very unusual complication of disc herniations.
What is the treatment for herniated discs?
The most common treatment is a couple of days of bed rest followed by the use of anti-inflammatory medications, possibly pain medications and then a progressive increase in physical activities such as walking. Often physical therapy or chiropractic management are valuable treatment modalities that get people feeling better more quickly. When that regimen does not work, then epidural steroid injection may be tried and may also be beneficial. If all these treatments fail, then surgery is indicated and depending on the size of the disc herniation and the location of the herniation and the experience of the surgeon, the techniques may vary. The most common technique for a single herniated lumbar disc is an operation called a microdiscectomy but now becoming more and more prevalent as well is a minimally invasive microdiscectomy or endoscopic assisted microdiscectomy.
What is lumbar instability?
Lumbar instability involves excessive motion between vertebral segments. This motion may be caused by spinal fractures, tumors, infection, scoliosis or other bony abnormalities that weaken the architecture of the spine. When severe, the instability can cause incapacitating deformity or pain as a result of the structural changes. Instability can also lead to damage or inflammation of the nerve roots. Disc degeneration may cause more subtle instability and produce pain from repetitive motion. True Lumbar Instability occurs when the ligaments, discs and joints that support the bones of the spine are damaged to the point they can no longer hold the bones together. This causes back pain. As the bones move out of place, they can pinch the nerves and cause leg pain and weakness. The term "Lumbar Instability" is sometimes used instead of Internal Disc Disruption, or Derangement. This is a similar condition in that there is damage to a disc which leads to back pain, although there is no abnormal movement of the bones.
What is spinal stenosis?
Stenosis refers to a narrowing of the opening in the spine through which the spinal cord and nerves pass. It can be congenital (something you are born with) or, more often, due to degenerative disease. Most patients present with leg pain when walking. Spinal stenosis is a narrowing of the space that the nerves occupy inside the spinal canal. Bone spurs, disc herniations, tumors, or the buckling of ligaments inside the spinal canal can produce this. Fractures are also associated with this condition when a piece of bone displaces into the spinal canal.
What is the treatment for spinal stenosis?
Spinal stenosis can be treated initially by decreasing the inflammation and the swelling on the nerves so that they fit a little bit better in the space that is still available. When there is no response to conservative treatment, then surgical treatment may be required. Surgical treatment for spinal stenosis consists of removing the material that is producing the stenosis, such as bone spurs or pieces of bone from fractures. Spinal stenosis is a slowly progressive condition. Symptoms develop over many years and are often overlooked. Walking in particular becomes more difficult. The loss of this activity in elderly people may have a profound effect on their overall health. The goal of treatment is to maintain function, particularly walking. The initial treatment may include physical therapy and anti-inflammatory medication. The inability to walk may interfere with the success of therapy and epidural steroid injections can be extremely helpful in controlling leg symptoms. When these treatments fail, surgical decompression can lessen and in some cases permanently eradicate the symptoms of neurogenic claudication. In a recent article in Spine, Kleeman, et. Al. showed that by preserving the posterior elements of the spine, a successful decompression could be performed with a low risk. At four years after surgery 98% of the patients continued to do well.My doctor told me that I have arthritis of my spine and that I should learn to live with the pain. Today there are many treatment options for patients with spinal arthritis. Some options are nonsurgical and some options are surgical. One does not have to "learn to live with the pain." Learning to live with the arthritis is certainly most commonly recommended, but that need not always mean learning to live with the pain. For example, often a consistent exercise program will significantly reduce or even eliminate the pain. If excess weight is a problem, that may contribute to the pain caused by the spinal arthritis. Sometimes, reducing excess weight will make the problem significantly more tolerable. In some instances, a medication such as an anti-inflammatory drug may provide dramatic relief. (Of course, don't take any medication without discussing with your physician). If the pain does not respond to the above measures, and is of great enough intensity, you may need to be evaluated by a specialist (if you haven't already done so).
When is surgery necessary for patients with spine problems?
Surgery is recommended when a patient's pain doesn't respond to conservative treatment or if they have neurological deficits. Surgery is considered when nonsurgical therapy fails to adequately control the symptoms of pain, weakness or nerve dysfunction. The need for emergent spinal surgery exists but is infrequent. Emergency surgery may be indicated if there are progressive or severe neurologic deficits or bowel or bladder difficulties. Generally the need for surgery is a quality of life decision and not a life and death decision. Spinal surgeons do not treat MRIs and X-Rays but rather treat patients. The same MRI findings may be found in both patients with severe pain or patients with little to no pain. There is no such thing as a "magic bullet" for patients with spinal problems. Your surgeon will work with you to customize a treatment plan. There are also some situations where spinal surgery is still not appropriate even after poor response nonoperative treatments.
What is a laminectomy?
Laminectomy is removal of the back side of the spinal canal under which lie the nerve tissues. This provides access to the nerves and the discs for specific treatment. When commonly performed in the "low back" or lumbar spine this may actually be below the level of the spinal cord itself. A laminectomy is, in the strictest sense, the removal of the lamina or roof of the spine. The two lamina come together on either side to form the spinous process, which is that bone that sticks up into the back that one can feel when one runs a hand along the spine. It is also more generically used as any term meaning a procedure that involves removing even part of that bone in order to enter the spine
My spinal specialist said I need a fusion. Is that true?
A fusion is needed if you think the patient's spine is unstable or if after performing surgery on the spine, you think it will become unstable. The other potential reason to fuse the spine is degenerative disease because the disc itself can cause pain, and sometimes the only way you can treat that is by fusing the spine. In my opinion the best procedure to treat patients with disc disease associated with chronic back pain is to have a fusion. The fusion component of this procedure is vital to the short and long term success of the surgery. Fusion is important because it stabilizes the vertebrae in their original and proper spatial relationships and prevents the possibility of patients developing recurrent pain at that level.
If I have a fusion does that mean I will never be able to bend?
A 1-level or 2-level fusion of the lumbar spine does not appreciably decrease the overall range of motion of the spine. With greater lengths of fusion, however, patients do have a sense of stiffness and may have difficulty with twisting maneuvers. The ability to bend over is usually preserved as this is primarily a function of hip bending. For patients who have 1 or 2 levels fused, they may not notice a difference in bending ability. Some actually bend better after fusion because they hurt less. For longer fusions, patients with normal hips will still be able to bend forward enough to put on their socks.
Will fusing my spine cause damage to adjacent areas?
Fusing the spine causes increased work loads on the adjacent segments of the spine. This can lead to increased wear and tear and early degeneration. This may or may not become symptomatic in the future. The answer is still unknown. The problem is that most people will develop degenerative disc disease over time. When a patient who had a fusion presents years later with a disc problem, how do we decide if that problem is caused by the fusion, or caused by the normal aging process. If fusions do cause adjacent disc problems, it is not common, and usually occurs later. Moreover, continuing with a proper exercise problem may help diminish this risk. It would be foolish to decide against a fusion and live with severe pain for many years just to avoid a possibility of needing more treatment later on.
What are the risks associated with spinal surgery?
The risks of spinal surgery are the same for all surgical procedures-infection and anesthesia problems. Depending upon where the surgery is done-cord or nerve root level, neural risks are possible. Depending upon what the surgery is-specific risks from instrumentation or the approach are possible. Like any other surgery, spinal surgery carries the risk of infection, bleeding, need for transfusions, nerve damage, bowel, bladder, and sexual dysfunction as well as medical complications, such as heart attack, stroke, blood clots, or death. There is always the possibility of worsening the pain and requiring additional surgeries. In the hands of a properly trained spinal surgeon, however, these risks can be minimized
How quickly can I expect to recover from surgery?
Most patients recover quite quickly from surgery. The initial phase requires healing the incision and the soft tissues which typically occurs over the first few weeks. Patients are walking the day following surgery, and from that day, they can expect to ambulate on a daily basis. The rate of recovery is dependent on each individual patient and their health status before surgery. If patients are healthy before the surgical procedure, we expect them to recover quite quickly. This is very specific to the individual, the disease being treated and the surgical procedure. Regardless, most patients are walking within 24 hours of surgery and go home with the ability to care for themselves. Within 3 mos., one should be back to normal everyday activities. Within 6 mos., one should be able to perform any activity except unique highly labor intensive activities.
Will I have to have physical therapy? If so, for how long?
The length of physical therapy depends on your particular needs. A good conditioning and spinal strengthening program is a very important part of any recovery. The use of physical therapy following surgery is certainly individualized to the patient and surgeon. In general, patients should avoid extensive lifting, twisting, bending and stooping for four to six weeks following any spine surgery.
Will I have to take medication for pain? Are there any medications I should be concerned about?
It is common for patients to require narcotic pain medications following surgery. In fact, most patients prior to surgery are on these medications because of their intensive pain. Other non-narcotic medications that are sometimes helpful include Tylenol, Aspirin, and Advil-type products called nonsteroidal anti-inflammatory medication. It is important patients understand that nonsteroidal anti-inflammatory medications and Aspirin do cause an increase in bleeding and should be avoided prior to any surgical procedure. Tylenol does not have this side effect. The use of narcotics in the peri-operative period is not associated with problems of addiction. The major side effect is constipation, which typically occurs with all narcotic medications. Generally, the use of these medications is reserved for a period of weeks and can be individualized to minimize side effects such as nausea or stomach upset. Pain medications are helpful to try to get you through your injury or surgery initially. Like any other treatment, pain medications have side effects. You need to discuss these side effects with your medical doctor before you use any type of medication. Almost all patients are required to take narcotic pain medicine in the very acute period following spinal surgery. We generally try to discourage the use of narcotic pain medicine for longer than a period of four-six weeks because of the chance of habituation or addiction. There are, however, a small portion of patients with serious chronic problems who have to remain on chronic pain medicine. This is frequently best prescribed not by a surgeon, but by a doctor who specializes in pain management, such as a pain management specialist or a physiatrist.
People talk about the pain associated with harvesting bone from the hip. Does this happen to everyone and how long does it last?
Most people have more pain at bone graft site than the actual spine surgery. Everyone has some pain from a bone graft harvest. In many patients this pain is gone in 4-6 weeks but in up to 30% of patients it may persist for 2 years or more.When the pack of the pelvis is thinned to harvest bone graft, pain is the natural result. That pain usually goes away in several weeks. About 20% of patients have some lasting discomfort at the site, whether sporadic or constant. Narcotic pain medication occasionally required. It is common for patients to experience discomfort from their bone-graft site that is more intense than that of their spinal operation after surgery. In general, it rapidly improves, but many patients still complain of at least some bone-graft donor-site discomfort up to 2 years after surgery. This is a commonly cited reason for using alternatives to your own bone when performing a fusion surgery. You and your surgeon will need to discuss which bone-graft option is right for your specific situation.
