Arthritis sets in as people get older. Along with the spinal arthritis comes potential overgrowth of the soft tissues and bone as a result. This may begin to pinch on the amount of space available for the nerve roots and dural sac. If it’s bad enough, people may start having buttock, back, and leg pain. This is actually a structural problem. Thankfully, most individuals with spinal stenosis do not have severe resulting pain.

Resulting symptoms can occur from this overgrowth leading to reduced blood flow or excitement of nerve roots from the inflammation. This may result in several levels being affected. They symptoms vary between individuals depending on the region of pinching and the person’s reaction. In spite of all this, lumbar spinal stenosis is the most common reason for spine surgery in individuals over the age of 65.

What if pain exists, should surgery be done? This question has been debated for decades since spinal stenosis really is a quality of life condition. It doesn’t kill anyone, and the severity of symptoms should guide treatment. If the symptoms do not improve despite nonoperative pain management for 3 to 6 months, a decompressive surgery may be considered. Some evidence has shown limited effectiveness overall for this surgery.

A recent Spine article looked at numerous high quality studies in the literature to determine how well laminectomy decompressions work for stenosis. The results showed that in those who failed nonsurgical measures, surgery helped with pain, quality of life, and function more than simply conservative treatment. It did not, however, statistically help with walking ability.

These benefits slightly decreased over the years, but did not go away completely, even up to a decade. Beyond a decade was not reviewed. These results continued despite obesity, older age, lung issues, or other medical issues. The addition of comorbidities raised the risks of complications from surgery, so they should be weighed into the mix to decide the benefits versus the risks and whether or not to proceed with surgery.

The results were similar among almost every study evaluated, including whether or not the patient had one vertebra slipped on another, known as spondylolisthesis. The main issue is it’s a quality of life decision, and substantial conservative treatment should be attempted first.

Surgical risks in this age range cannot be ignored, even though they are small. At that point when nonoperative treatment fails, however, a number of high quality studies support the decision for a simple lumbar decompressive laminectomy.

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Homeopathic remedies may actually be more effective than conventional treatments without having horrible side effects. Traditional medicine is designed to stimulate, kill, or inhibit. Homeopathic medications contain diluted substances and hit has been shown in research that these meds may reverse disease.

Acupuncture is about energy flow through the body in the form of chi. There are 12 meridiens and energy flows through them. The blockages of energy are alleviated through acupuncture.

Herbs can bring the body back into balance through normalization, rather than traditional medications which can promote imbalance.

Homeopathic remedies are often termed alternative medicines or techniques. However, as they become more mainstream, the term alternative will start shifting to conventional. Grouped together they are known as CAM, which is complementary and alternative medicine, with the boundaries between mainstream and CAM medicine becoming more blurred every year.

Holistic medicine, integrated medicine, alternative medicine, are all terms that refer to treatments that are non-conventional. Some people mistakenly assume this means they do not work. This is a falsehood. There is plenty of research to back up treatments such as acupuncture, chiropractic treatment, and reiki for instance.

Research has shown that alternative medicine in developed countries like the US is growing steadily and is now well over 40% utilization. Most individuals using alternative and complementary medicine choose to treat themselves, however, fifteen percent sought out treatment from a licensed holistic doctor.

Over 37% of US hospitals are offering holistic treatments, which is more than ever. There are a lot of traditional medical providers who criticize holistic medicine since for a lot of it there have not been big studies done. The research is mostly anecdotal, which is not Level I scientific evidence. This does not mean it’s “snake oil”, it just means more research is necessary for a significant amount of the alternative treatments.

For now, the incidence of alternative, holistic, and complementary therapies is on the steady rise. If it was all hocus pocus, would this be occurring so consistently?

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Why does this occur? Precisely why are therapies, for example osteopathy, physiotherapy and chiropractors failing to give long lasting results?

When you have eliminated things that are definitely wrong physically with your back, what about considering it might be there’s things you happen to be doing during your every day activities that is resulting in the back pain finding its way back?

It may be there’s something not right about your posture whenever you are sitting down, standing up along with walking. In all probability you think this is having a detrimental influence on your back pain, but don’t know what you should do about this. Most certainly you make way too much effort and hard work to perform activities which is making muscular tension.

Lots of people in reality perform a large amount of effort to do the most basic of tasks whilst not even noticing this fact. This degree of muscular effort is simply ineffective and also something that knocks your back out of alignment, takes you away from balance and significantly contracts your spine. It really is the reason why your current treatments do not have a lasting result.

It definitely is very easy to create additional effort to do things but how easy is it to do much less?

You should look into getting the assistance of the Alexander Technique. It is a simple but advanced self-help method that you can be trained in by a qualified teacher.

The Alexander Technique has been around for a century and it’s customarily been employed by actors, music artists together with sports professionals to boost their functioning. It will get you to undertake everything more efficiently! An Alexander Technique instructor helps guide you to reverse undesirable habits that cause tensing and stiffening within your back.

You can discover how you can move by using expansion, freedom and release as an alternative to contracting and tensing.

Your back pain will go along with your posture undoubtedly being enhanced. Imagine obtaining the ability to relieve tension and strain for yourself every time you want.

The Alexander Technique has been scientifically tested by an important research project which has been highly acclaimed.

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One of the standard reasons for legalizing medical cannabis is the condition of chronic pain. This is by far the number one reason in every state its been legalized. Why?

First off, let’s look at the substantial numbers for chronic pain. The Institute of Medicine had a recent research project showing that over one hundred million Americans suffer from some sort of chronic pain. The cost directly and indirectly is over five hundred billion annually between lost work time, medical care disability, etc. The statistic is truly mind blowing.

There are two well known types of treatment for chronic pain that exist in the US – traditional and alternative. Traditional includes those treatments that are mainstream, typically reimbursed by insurance, and have significant peer reviewed research backing up their usage. Also traditional treatments often have FDA approval for their use, but not always.

Alternative treatments are those not usually reimbursed by insurance, and may not have considerable research backing them up. This does not negate their potential assistance with chronic pain, particularly when used along with traditional treatments. It is just a way of categorizing the two. Some alternative methods including holistic, herbal, acupuncture, naturopathic, biofeedback, and some still include chiropractic and massage in this category. This is changing as more insurance companies cover them along with studies being done.

People end up with chronic pain for many reasons. It may be a peripheral neuropathy without a surgical answer, or a failed back surgery that only helped alleviate 20% of a person’s pain. An individual may have rheumatoid arthritis or scleroderma, that encompasses diffuse pain that may or may not be helped by narcotics.

One ubiquitous issue that is seen with chronic pain is narcotics. Most patients, if they are legitimate hard working individuals, despise taking narcotics. They hate having to take more to get the same pain relief (tolerance), and want to be productive, pain free, and able to stay away from a mind altering and addictive substance to do it.

It is not horrible to see such a substantial number of chronic pain folks turning to an alternative pain relief method, medical marijuana. The only really bad part about it is when faking patients start using it (think the young male faking back pain to get cannabis). The amount of times this happens is a small number of the total.

With the large amount of individuals in the US suffering from chronic pain, and the number of reasons as to why these folks got to that situation, means the applicant pool for medical cannabis cards will be substantially bigger than for the other reasons. Supplying them with a non-addictive option that is natural and allowed legally will open up a path of hope and optimism than continuing the bad situation of opiate despair and addiction.

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Here are five of the more considerable evolutions (or regressions) in pain management treatment that we have seen:

1. Refinement in pain management interventions. Over the past few years, there have been some improvements in pain procedure technology that have allowed physicians to get better results. One of these is transforaminal epidural injections. The initial type of epidural injection that was established was called intra-laminar injections. Now pain doctors are able to accurately place their needle into the area where the nerve root travels, getting the pain medication more accurately where it is needed. A second improvement is with radiofrequency ablation machines. When they were first established, they were only able to treat 2 anatomical areas at a time. Now they can do 4, decreasing the patient procedure time.

2. Biologic treatments. Regenerative therapy is not just on the horizon, but is becoming reality. There are now injection materials that contain a number of regenerative ingredients, including hyaluronic acid, stem cells, and specific cytokines. This will hopefully show to be helpful in treating arthritis, soft tissue and cartilage injuries, and disc problems.

3. Disk treatments have reduced in numbers. As literature has been produced showing that intradiscal electrothermy and percutaneous discectomies have suboptimal results, their use is going down. Along with this, there is some initial data showing that diskography may promote disk degeneration. So its use is going down too. The disc is a true treament enigma. Surgery is a roll of the dice half the time, and interventional nonsurgical pain management treatments are a question mark as well. If there is one area along that could use a better therapeutic option, it is degenerative disk disease.

4. Performing vertebroplasty and kyphoplasty. These treatments are done as an outpatient, and do not entail incisions. They take about forty five minutes, and can have very extremely quick pain relief for individuals with spine compression fractures. More pain physicians are learning how to do these procedures.

5. Comprehensive pain management centers. As more literature is produced showing the benefits of multiple specialists treating patients, comprehensive pain centers are becoming more common. This has benefited individuals substantially by having more medical providers with varied training backgrounds lining up for the benefit of the individual. Patients can end up necessitating fewer narcotics and becoming much more functional.

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Clinical research out of UCSD shows a dose effect may occur, with higher marijuana doses actually increasing pain rather than helping. The UCSD study consisted of capsaicin injections into the forearms of healthy volunteers. Capsaicin is known as pepper cream and is rubbed on to the skin to produce a numbing response with pain relief. But in this study it was injected under the skin, where it becomes painful.

After injecting the capsaicin into the forearms, the study participants smoked cannabis at three doses. The low dose did not help, while the medium dose relieved pain significantly. However, the high dose made the pain worse. What occurred?

The first issue is that no one really knows how marijuana works for chronic pain. Sure, it is understood that there are receptors for the cannabinoids of marijuana in the brain and throughout the body. But what happens exactly once the cannabinoids are attached to those receptors is a mystery. It is well understood that smoking marijuana increase heart rate by 7 to 12 beats per minute. But how does the brain receiving cannabis tell the nerves not to send pain signals?

Some studies have shown that THC (marijuana’s active component) has good pain reduction for cancer patients. Cancer patients would fall into the chronic pain category in reality, but most states with legal medicinal marijuana have a separate category for cancer. Numerous studies have shown that medical marijuana works well for chronic painful issues like cancer, but not well for acute pain issues like sunburn.

Having stated that, there has been a study looking at cannabis in conjunction with opioids for post-operative pain medication requirements. The study showed a decrease in opioid requirements as cannabis intake increased. However, that study did not go over a 15mg THC dose. Would a higher dose have made the opioid needs increase as a counter-intuitive effect?

There is a lot we know about medical marijuana for chronic pain, and a lot of unanswered questions. The more studies that come out, the better marijuana’s use for chronic pain can be aligned with specific dosing towards the condition for which it is utilized.

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Narcotics may work very well, but they are not risk free. The most concerning risk is overdose, which could be fatal. It is paramount not to take more than the prescribed dose, and also not to combine numerous sedative narcotics along with substances that can potentiate the sedating effect. This would include benzodiazepines like Valium or alcoholic beverages.

Although fatal overdoses pop up in the media with celebrity deaths, they unfortunately occur way too often in the general public. At times patients take too much on purpose, but typically it’s simply not being cognizant of the cumulative effects. If one has substantial pain, he or she may simply take more and more to help with the pain, with an unfortunate fatal result.

Less harmful side effects are very common and may include drowsiness, dizziness, lightheadedness, or nausea or vomiting (usually at first). Dry mouth is also common, which if experienced over a long period may lead to tooth decay. In addition, one may see headache, loss of appetite, restlessness, nervousness, nightmares, blurred vision, and constipation.

One major risk of narcotics is tolerance. This is when patients require increased amounts of narcotics to achieve the same effect of pain relief. This may result in a vicious cycle of narcotics with the patient needing substantially more than what their disease condition should require.

Additional narcotic potential complications can include bluish skin discoloration, clammy, cold skin, extremely small pupils, serious difficulty breathing or very slow breathing, sedation, drowsiness, decreased blood pressure or heartbeat.

In addition to these risks, patients taking these medications should inform their physician prior to taking narcotics:

Central nervous system (CNS) depressants, such as antihistamines.

Monoamine oxidase (MAO) inhibitors, like phenelzine (Nardil) and tranylcypromine (Parnate).

Tricyclic antidepressants, such as amitriptyline (Elavil).

Anti-seizure medicines, such as carbamazepine (Tegretol).

Muscle relaxants, like cyclobenzaprine (Flexeril)

Sleeping pills, like triazolam (Halcion)

Blood-thinning drugs, including warfarin (Coumadin)

Naltrexone (Trexan, Revia). Cancels the effects of opioid analgesics.

Rifampin (Rifadin)

There are numerous narcotics that include acetaminophen in them, which may harm the liver if too much is taken. So awareness should be taken not to intake over 4 grams total per day.

In addition, extreme care should be utilized with narcotics and individuals should be sure to stay under the care of a physician and only take narcotics according to the prescribed dose.

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At this juncture, over one hundred million US individuals are living in chronic pain at a cost of over $530 billion a year. Have we reached epidemic proportions? Yes that point has been reached, and front and center with this problem are narcotic prescriptions. What makes them so popular? They end up being an easy answer for pain doctors, who can perform the easy option – the quick fix prescription. Narcotics may relieve pain, but the problem is not fixed.

Opiate medications often work well by dulling the nervous system, but they may be addicting. Patients often get tolerance, which is where the individual needs additional amounts of narcotics to relieve pain adequately. Even with the pain generating condition is the same, the amount of narcotics needed for pain relief can spiral. Also, there is a disease called opioid induced hyperalgesia (OIH) where a patient may see more pain even with higher opiate dosing.

Additional narcotic usage side effects can include depression, endocrine disorders, altered sleep, or immune system suppression.

There is not an objective test available for chronic pain which identifies the amount of pain an individual is feeling. It represents a subjective experience. It can end up with an inability to socialize, play with one’s children, going to work, or enjoying recreation.

It is tough to get rid of chronic pain completely, and the focus should be improving function rather than just numbing a person’s pain. Does this mean eliminating completely one’s pain? Not necessarily, it could just mean assisting people to live with their pain.

Non-narcotic methods of helping patients function better with chronic pain include diet and exercise improvement, physical therapy, acupuncture, relaxation exercises, stress management, chiropractic treatment, and spinal decompression treatment.

These types of treatment may already exist in an integrated pain center, incorporating both alternative and traditional treatments. One of the primary issues is that the integrated treatments work, but are not covered by insurance plans all the time. In these recessionary times, individuals often rely on their insurance and do not routinely have the means to pursue alternative treatments, even if it would end up with a better outcome.

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A significant amount of research has been done over the past few decades showing laser treatments for musculoskeletal problems to be effective, non-invasive, and safe.

Animal studies have shown laser therapy may help with recovery after acute injury and reduce edema (swelling) along with increasing tissue of healing wounds. In animal studies, healing rates of injured tendons in animals have shown substantial improvement too.

One substantial finding was that wounds treated with laser displayed elevated tensile strength, and wounds on the other side not treated with laser showed benefit too. This was deemed to be due to a general effect on the body of having the laser treatment with some type of tissue growth factor being released into the blood. More research is necessary in this area to separate out exactly which factor is being released.

In human studies along with animals, laser treatment has been shown to facilitate collagen production which enhances tendon healing. Laser irradiation on a daily basis has been shown to decrease wound inflammation by 20-30%. This occurs partly by decreasing the amount of prostaglandins in the region, which are components of inflammation.

Low energy photon laser therapy has shown clinical indications for shoulder tendonitis, heel spurs, rheumatoid arthritis symptoms. One of the proven effects involved the improvement of local microcirculation, which enhances wound healing. In animals, this could explain why broken bones treated with laser healed quicker than controls.

Small scale human studies of patients with osteoarthritis in either the knee or spine displayed over a 90% excellent pain relief with low level laser therapy.

Studies in individuals with rheumatoid arthritis undergoing laser therapy have displayed that 2/3 of individuals benefit, which potentially gives it substantial advantages over steroid injections and NSAIDS. For low back pain, low level laser treatment has shown excellent results for pain emanating from a number of anatomic areas with low side effects. Compared to control group, laser was doubly effective and also came back only half the time.

Used along with chiropractic treatment, lasers may provide great results for a wide range of painful conditions such as tendonitis, osteoarthritis, rheumatoid arthritis, and even post-surgical scarring problem regions. Compared with surgical treatment, laser therapy is outpatient, low cost, and does not promote scarring.

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Who ends up with DDD? Usually it’s individuals between the ages of twenty five and sixty. In between those years, the discs start to lose fluid and as a result, the disc may start to fray and lose height. The outside part of the disk may experience irritation, and may hurt as a result. The outside part of the disc is the only part that has nerve endings and is able to feel pain – it is called the anulus fibrosus.

When people are experiencing pain from DDD, the non-surgical treatment options consist of:

1. Benign neglect

2. Physical therapy

3. Chiropractic Treatment

4. Spinal Decompression Treatment

5. Interventional Pain Management

6. Pain Medication

7. Bracing and TENS units

Nonoperative therapies work satisfactorily over 75% of the time. People are typically able to end up with good pain control and can avoid surgery. Aerobic activity has been shown to be one of the best activities possible for DDD. This could mean swimming or cycling.

If an individual tries substantial conservative treatment for over 6 months and the pain is still bad, it might be time to consider an operation. The North American Spine Society has recommended at least 6 months as a prerequisite, and even longer may be tried since it can take longer to start seeing relief. An operative decision should not be taken lightly. A discogram should probably be done prior to surgery for degenerative disc disease even though it is a highly debated procedure. This procedure may be able to tell if the disc is the source of pain.

If the patient has one level positive on the discogram and all imaging studies point to that same level as having significant degeneration, then surgery may have a high level of success. In fact, it may be a life changing “home run.” But this is not always the case as even if the diagnosis is presumed and a technically perfect surgery is performed, the patient may end up with residual pain. Getting rid of 100% of a patient’s back pain is typically unreasonable. One should expect with a one level DDD and a great surgery performed to be able to alleviate 50 to 75% of the pain.

There are 2 surgical options for DDD. The first is an artificial disk replacement, the second is a spinal fusion. Back in 2004, the FDA approved artificial disk replacement for the lumbar spine, and the hope is it would be a huge step forward for DDD. To this point, that has not been the case. Results for the surgery have been about 70% good to excellent.

However artificial disc surgery has not shown superiority yet to spinal fusion. Neither artificial disc nor spinal fusion has a success rate of ninety percent (closer to 70%), individuals should consider it heavily prior to surgery.

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