Back pain treatment often not in line with guidelines
Talk to your doctor about non-opiate pain-relief meds that wont dull your lust for life. 3. Ease pain with smart sleeping positions. Put a small pillow under your knees when sleeping on your back. Put a pillow between your legs at your knees when you sleep on your side (no tight fetal positions). Keep pillows pretty flat. Now youll get the sleep you need to feel rested and interested in sex again. 4. For intimacy: Youre best lying on your back or trying new positions and activities experiment, enjoy and go slow! Ask health questions at doctoroz.com. Drs. Oz and Roizen are authors of YOU Teen: Losing Weight.
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Even before injury, chronic back pain may start in the brain
Steven Cohen, an anesthesiologist and critical care doctor at the Johns Hopkins School of Medicine in Baltimore who didn’t participate in the research. Surgery, injections and scans for back pain “have all gone up pretty dramatically,” he told Reuters Health. “We have increased utilization, yet we don’t have better treatment outcomes.” The American College of Physicians and the American Pain Society recommend that people with low back pain consider treatment with Tylenol or non-steroidal anti-inflammatory drugs (NSAIDs), as well as heating pads and exercise. The groups say doctors should only order CT and other scans when they suspect nerve damage. Opioids bayview village chiropractic toronto are only recommended for patients with “severe, disabling pain” that doesn’t get better with over-the-counter medicines – and their risks, such as for abuse and addiction, should be weighed against potential benefits. For the new study, Dr. Bruce Landon from the Harvard Medical School in Boston and his colleagues tracked nationally-representative data on outpatient visits for back and neck pain collected between 1999 and 2010. The researchers had information on about 24,000 visits, which represented a total of 440 million appointments across the U.S. During that span, they found the proportion of patients prescribed Tylenol and NSAIDs dropped from 37 percent to 25 percent. At the same time, the proportion given narcotics rose from 19 percent to 29 percent. About 11 percent of people with back pain had a CT or MRI scan in 2009 and 2010, compared to seven percent in 1999 and 2000. Finally, although the rate of referrals to physical therapy held steady during the study period, the proportion of patients referred to another doctor – likely for surgery or other treatments – doubled from seven to 14 percent, the researchers reported Monday in JAMA Internal Medicine.
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One of the biggest things to realize is that when patients first present with back pain, the majority of them will have complete resolution of their symptoms within a couple of months, said Dr. Bruce Landon, an author of the study and professor of health care policy at Harvard Medical School. What works for back pain is time, and if needed, over the counter pain relievers like acetaminophen (Tylenol) and ibuprofen along with staying active and physical therapy. They don’t necessarily need expensive imaging tests such as MRIs, CT scans, and they don’t need referrals to specialists, he said. Studies have shown that these advanced imaging techniques do not lead to improvements in back pain. The researchers compared data between two periods1999 to 2000 and 2009 to 2010. They found that narcotic use increased from 19.3 percent to 29.1 during that time and use of the recommended over-the-counter pain relievers decreased from 36.9 to 24.5 percent. To me, the most worrisome findings were the rapid rise in narcotic prescriptions, Landon said. Narcotics have not been shown to improve back pain, and they can lead to addiction. In 2008, nearly 15,000 people died from narcotic prescription overdoses, he added. The study also found that the number of CT scans or MRIs increased from 7.2 percent to 11.3 percent during the study period, and the rate at which physicians referred patients to specialists, such as orthopedic surgeons, doubled from 7 to 14 percent. These referrals to specialists likely contributed to the rise in MRIs and the recent increase in back surgeries, the authors said, even though studies of lumbar fusion surgery have not shown an improvement in pain. I believe for the vast majority of patients with back pain, primary care physicians should be taking the lead on managing back pain, Landon said.
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Your Back Pain (And What It’s Trying to Tell You)
Researchers have also shown that compared to healthy patients, the brains of chronic pain sufferers are wired differently, in ways that suggest that physical sensations and emotional responses are bound more tightly together. But are those brain differences a response to chronic pain — the brain’s response to the experience of months or years of physical misery? Or do those differences predate chronic pain — nudging what for another patient would be a short-term experience of discomfort into a lifelong ordeal? The authors of the current study, working under a federal government initiative aimed at consolidating research on pain, devised a series of experiments designed to clarify which came first. They did so by recruiting 46 subjects who had experienced a first episode of back pain that had already lasted four to 16 weeks, and performing regular brain scans on those subjects for a year. Focusing largely on the bundles of axons that carry nerve impulses across the brain, they found that within two months of recruiting patients, discernible differences in the structure and integrity of that “white matter” could be used to distinguish subjects whose pain persisted from those whose pain was beginning to resolve. By the 12-month mark, the structural differences in white matter allowed researchers to distinguish — without error — subjects whose pain had disappeared from those whose pain was persistent. Compared to subjects whose pain resolved, subjects whose pain would become chronic also showed differences in the density of connections that lashed their nucleus accumbens — a central structure in the brain rewards, motivation, pleasure and reinforcement learning circuit — together with their medial prefrontal cortex, a switchboard for decision-making, emotional response and long-term memory. The authors made further comparisons between the original 46 subjects and two new groups: healthy recruits and people with a established history of chronic pain. Those comparisons showed that, from the earliest scans, the brains of subjects who would go on to become chronic pain sufferers had structural abnormalities that made them look much more like the chronic pain veterans than like healthy controls or the subjects with back pain that went away. And throughout the study period, the white matter and brain connections of subjects with back pain that went away looked much more like those of healthy control subjects than they did like the brains of subjects whose pain became chronic. The brain’s white matter normally deteriorate with age, and the Northwestern researchers made a shocking calculation to show the difference that separated subjects with and without chronic pain: Compared to healthy controls or those whose pain subsided, the white matter in the subjects whose pain went on to become chronic “exhibits 30 to 50 years of additional aging.” If this research holds up, future patients may want to know what the stakes are if they get hurt, and make their recreational and career choices accordingly.
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Doctors don’t follow back pain guidelines, study finds
Only a very small minority of back conditions require surgery. Worse still, about one-third of spinal surgeries fail to relieve back pain , often requiring reoperation. This happens so often there’s even an acronym for it: failed back surgery syndrome (FBSS). Fusion surgery is an increasingly popular type of back operation in which two or more vertebrae are fused together. Fusion surgery may be useful for slipped vertebrae or some types of fractures, but it is often prescribed for herniated discs, degenerated discs or nerve problems. One large-scale study of almost 1,500 people with back pain found that after two years, only one-fourth of people who had fusion surgery had returned to work, while two-thirds of people who hadn’t had the surgery were back on the job. There was also a 41 percent increase in the use of opiate painkillers by the surgery patients compared with those who hadn’t had surgery. Other studies have found that people who have fusion surgery for degenerative disc disease have worse outcomes than people with the same condition who choose not to have surgery. In spite of these startling numbers, fusion surgery for degenerated discs is the fastest-growing type of spinal operation. Spinal surgery should be reserved for cases where spinal nerves are compressed and are causing the loss of bladder or bowel control, or creating weakness or numbness in the legs.
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