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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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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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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All of these issues may lead to pain in the same region, therefore, delineating the exact pain cause may take some significant mental consideration. A thorough history and exam of the patient is critical to ruling in or out some of the potential diagnostic sources.

The difficulty with SI pain is finding the individuals whose exam and history match true SI joint symptoms, and then the diagnosis can be confirmed by a positive response to an anesthetic block inside the joint.

A significant amount of time more than one anesthetic block will be necessary into the SI joint to definitely rule int the joint as the pain generator. Once this diagnosis occurs, the additional treatment options may begin. At times patients will obtain relief for a while from the anesthetic blocks themselves, or it could just be short term. Should the pain block not work after a while, a radiofrequency neurotomy has been shown to work well. Pain physicians typically debate the exact techniques that are best for the joint.

The SI joint is not the easiest joint to get into for interventional techniques. Fluoroscopic assistance is crucial, as the joint is jagged and irregular. The entry into it may take an unusual angle. Knowing the exact entry point with the real time x-ray can make the difference between a successful procedure with a happy patient versus a missed joint and a patient remaining in pain.

Along with the interventional pain efforts, additional treatment options include physical therapy, anti-inflammatory medication, chiropractic treatment, and potentially acupuncture and massage. It may take a combination of efforts including both traditional and alternative medicine to help the patient improve.

There really is no great surgical option for SI joint pain. There is a new procedure for fusing the joint, but no long term data is available yet regarding its effectiveness. For the time being, it’s best to avoid operative intervention and treat the problem with outpatient techniques such as the radiofrequency technique mentioned.

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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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Spinal decompression mechanical traction treatment is a all natural therapy for the treatment of back and leg pain. There are little contraindications and can be used on most patients suffering from disc injury such as disc bulge or disc herniation, back pain and muscle spasm.

Spinal decompression therapy is performed on the therapy bench with the patient face up using secure straps and a harness around the pelvis. A separate set of straps go around the patients chest.

Spinal decompression traction functions by mildly separating the bone of the spine and spinal column relieving any associated disc pressure and joint pressure.

The spinal disc decompression motion gently separates and releases gradually. The spinal bones and related anatomy is gently stretched relieving compression forces on the spinal joints and disc pressure.

Spinal decompression mechanical traction helps relieve tight low back muscles by breaking the muscle spasm. Muscles relax and decrease the pain signal.

All patients are given a button to interrupt traction therapy any time the patient may feel pain. Most patients feel very comfortable with spinal decompression therapy and feel immediate relief when the disc related nerve pressure is reduced.

Spinal decompression mechanical traction therapy can last from 20 to 40 minutes depending on several factors such as the patients age, disc injury or any other health factors.

Contraindications not to use spinal decompression traction are: infections, tumors, fractures, loss of sensation.

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Almost all women who are reproducing experience side affects of that said reproduction time period. Although there is a common list of what they should feel typically not all women experience those generic pains, and almost all women experience their own unique side affects. Whether those are in the form of cravings, nausea or back pains.

One that hasn’t been typically common is back pain amongst pregnant women. Many doctors are starting to wonder why and are beginning to look into this are theorizing that because of the added weight and water of the womb and child affects the back and spine position which causes the discomfort. This discomfort when experience 24 hours is cause enough to send a pregnant woman to a chiropractor’s office.

Not only are these symptoms uncomfortable but they can also be dangerous to the health of the mother and the child. Causing a severe change in the spinal cord can have sever affects on the ability of motion in a person’s body. Thus it is common that many women will start going to a chiropractor during pregnancy.

For women who already have a history of back problems, they simply continue to go to their chiropractor’s office. However, they should consult their doctors as they get further in their term. And for some women they say it also helps them mentally.

For some women going to a chiropractor is mental as well as physical. They go and even if nothing is physically changed, they feel a sense of relief. This is believed that they experience what some people refer to as stress placing syndrome. This is where people believe that stress physically manifests itself into a part of their body.

Although, that’s a pretty big if. Although chiropractic is a part of the medical field there has been no scientific study that links together health benefits of pregnant women that go vs pregnant women that do not. It is recommended for women who did not already have a chiropractor and are pregnant to consult a physician before going, because not all treatments work for all people.

Most people wouldn’t put chiropractic and pregnancy together in the same sentence, let alone think of mixing the two in real life. However, some woman claim many health benefits from going. While others don’t believe in it nor do they feel they need it. Most women feel certain symptoms, while almost all women experience symptoms that are unique to them and that specific pregnancy.

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