Living with chronic pain is not easy, and with time, can really affect one’s lifestyle. In fact, the psychological effects of chronic pain are often times just as significant as the painful physical condition itself. Emotional effects of chronic pain include irritability, depression, and anxiety.  Chronic pain can also affect one’s ability to interact with others and maintain stable relationships. To help overcome these common effects I have included some coping strategies which I hope you find useful.

Emotional effects of chronic pain include:

• Losing the ability to do the things normally enjoyed
• Altering the way one interacts with others
• Difficulty maintaining stable relationships
• Depression and anxiety
• Difficulty concentrating
• Irritability and short temper
• Weight gain

Patients with chronic pain are not necessarily diagnosed with depression or anxiety, but dealing with a condition leading to chronic pain can cause a patient to feel depressed and anxious.

5 Helpful Tips When Dealing with Chronic Pain

It is very important to develop coping skills. Some people are able to live a relatively healthy lifestyle despite the pain, and others are unable to do so. It is very important to understand that you are not alone.  In order to deal with chronic pain, these are a few tips to keep in mind…

1. Exercise
Although this may be difficult, under the guidance of a certified physical therapist, a proper home exercise regimen can be tailored to an individual.

2. Eat healthy
Proper nutrition can add to a healthy life-style in general.

3. Learn to relax
Take some time to relax completely (although this can be difficult at times). Meditation and yoga are great modalities to help one relax, especially while listening to your favorite peaceful music.

4. Get a proper night’s sleep
Sleep disturbance is very common amongst patients with chronic pain. It is important to try to relax, to not eat heavy meals prior to going to bed, and to wind down after a long day.

5. Try alternative treatments
Transcutaneous electrical nerve stimulation (TENS units), massages, acupuncture, and other modalities are often useful.

Pain psychologists and counselors can be beneficial for most patients with chronic pain. Although narcotics are very useful in treating many painful conditions, they are only part of treating chronic pain.   It is important to realize that medications do not cure pain, but rather are there to allow one to function better than they would without medications.

Speak with your doctor or pain specialist if you are having a hard time coping with chronic pain. If chronic pain starts affecting your personal life and self image, or interfering with your work and relationships, it is important to seek the proper medical assistance.

Talk to us, which coping strategies do you find most successful in dealing with chronic pain?

Shovel Away Your Low Back Pain This Winter. Snow shoveling often leads to low back injuries, so it is important to practice proper shoveling techniques to avoid these injuries.

1. PROPER STRETCHING:

• Warm Up: Think of shoveling like exercise; never start shoveling without a quick warm up! Get your heart rate up with a short walk or jog on the tread-mill or with a bike ride on a stationary bike.

• Stretch: Focus on stretching the areas that are most engaged during shoveling: hamstrings, shoulders, and low back.
  • Stretch #1: Touch your fingers to the ground (or as far as you can go without bending your knees)
  • Stretch #2:  Raise your arms straight above your head and slowly stretch your neck on each side.

2. SELECT THE RIGHT SHOVEL

• Sharp Blade: Just like a good knife, a sharp shovel blade allows you to move the most amount of snow efficiently.
• Light Weight: A light snow shovel will alleviate much of the weight required for lifting (don’t underestimate the weight of snow by itself – it can get dangerously heavy).
• Correct Length: When choosing the length of the shovel, make sure you are not bending forward, or leaning back too much.
  • Pick a shovel that has an adjustable handle length (so you can share the duty with other family members!).
  • Before purchasing your shovel, try it out at the store by simulating the act of shoveling.

3. LIFTING TECHNIQUES

• Only lift when absolutely necessary! If you can push the snow to the side for a plow to pick up or for it to melt.
• Bend at the hips and knees – never the low back.
• Engage your abdominal muscles and keep your back straight; Don’t twist your back when changing positions
• Position one hand on the handle and the other near the shovel blade.
• Don’t throw large amounts of snow from the shovel; rather walk to the location where you want the snow deposited.
• Wear boots with proper gripping and apply sand or salt on the snow to prevent falls.

LISTEN TO YOUR BODY

• Just like when you lift weights, take breaks during sets, ie; shovel for 10-15 minutes, and then take a 5 minute break.
• Let your body dictate how many breaks you need and always stretch during them.
• STOP shoveling if you feel short of breath, dizzy, or experience chest pain. If these symptoms do not subside, go to the nearest emergency room or call 911.
• STOP if you experience sudden sharp low back pain or pain shooting into your legs.

Using these simple guidelines can allow you to have a clean driveway and a healthy back!

Which tip did you find most useful in accomplishing  pain free shoveling?

HOW DOES NECK PAIN CAUSE HEADACHES?
The roots of the upper 3 cervical spinal nerves (located at C1, C2, and C3) share a pain nucleus (which routes pain signals to the brain) with the trigeminal nerve. The trigeminal nerve is the main sensory nerve that carries messages from your face to your brain. Because of the shared nerve tracts, pain is misunderstood and thus “felt” by the brain as being located in the head.

DIAGNOSING CERVICOGENIC HEADACHES
Determining the origin of the headache is one of the most controversial and difficult procedures to perform.  Almost all types of headaches share common symptoms of throbbing pain, nausea, sensitivity to light, and sensitivity to noise.  The signs and symptoms that could point towards cervicogenic type include tenderness at the base of the skull and possible exacerbation of symptoms with head and neck movement.

A proper diagnosis should include:

• A medical history and a physical examination
• A series of plain cervical spine x-rays, including flexion/extension views of the joints in the upper 3 cervical spinal segments
• An open-mouth view of the skull and a lateral skull x-ray may be necessary
• One or more diagnostic nerve blocks in the neck will need to be performed. Doing one diagnostic block at a time to see whether it reduces the pain will help narrow down the origin of the headache within the cervical spine. Frequently, it will take several diagnostic blocks, carefully performed and evaluated, to arrive at the understanding of the precise source of the cervicogenic headache.
• Although not mandatory, a CT or MRI may be of interest

TREATING CERVICOGENIC HEADACHES
The type of treatment a patient receives should be dependent on the type of headache they have to ensure the utmost success in relieving the headache without prolonging the pain and extra cost of erroneous treatment. As a general rule, treatment begins once the diagnosis of cervicogenic headache has been made.

Pain medications may be considered, including non-steroidal anti-inflammatory drugs (NSAIDs), anti-seizure agents such as gabapentin, tricyclic anti-depressants, and/or migraine prescriptions.

If pain medications prove unsuccessful, then injections may be considered, including occipital nerve blocks, atlantoaxial joint block administered at C1-C2, and/or facet joint blocks administered at C2-C3.

Have you been diagnosed with a cervicogenic headache? If so, which course of treatment did you take and was it successful?

BENEFITS OF ACUPUNCTURE FOR BACK PAIN.
In addition to medications, physical therapy, chiropractics, and injections, acupuncture is one of many conservative treatment options available to patients with back pain.  Benefits of acupuncture include:

1)      The art of natural healing, which uses the body’s own resources to treat the pain.

2)      Patients do not want to take pills or cannot take pain medications due to side effects such as drowsiness, nausea, and constipation.

3)      Helps patients not to become dependent or addicted to pain medications.

4)      Eliminates the need to tolerate painful injections.

IS ACUPUNCTURE EFFECTIVE IN TREATING BACK PAIN?
When performed properly by trained practitioners, acupuncture has proved to be an effective therapy for back pain as well as post surgical treatment. Several studies have found that acupuncture can help reduce chronic back pain and improve daily function. Acupuncture has been studied and is endorsed as a safe treatment by many academic centers including the Mayo Clinic and the NIH.

It is believed that acupuncture can cause the body to release its natural pain killers as well as cause a change a patient’s perception of the pain, thereby relieving their symptoms. Possible side effects and complications can occur, which include soreness, bleeding, infection, or bruising at the needle sites.

Everyone responds differently to acupuncture for their specific back pain, so every patient has an individualized treatment plan that may be modified through their course of treatment.

IS ACUPUNCTURE GOING MAINSTREAM?
Acupuncture is making its way into mainstream medicine as it becomes more recognized as an effective treatment for pain.  Some interesting examples of successful acupuncture treatment include:

1)      Mickael Pietrus (NBA player for the Phoenix Suns) sought treatment at the Shaolin Temple in China. Many current and former players on the Phoenix Suns including Grant Hill, Steve Nash and Charles Barkley have also experienced the benefits of acupuncture.

2)      Ted Lilly (Los Angeles Dodgers player) increased his range of motion after surgery through acupuncture treatments and was able to return to baseball more quickly.

3)      As a professional dancer, Paula Abdul has had a long history with pain and has undergone acupuncture treatment for pain relief.

4)      A few years back, after Matt Damon was spotted with acupuncture ear needles, his representative admitted that, “Matt had a terrible spasm in his neck/back and he had to have acupuncture” for treatment.

Have you tried acupuncture for back pain relief? What was the outcome?

If you have further questions regarding acupuncture, check out the detailed acupuncture section on our site.

Almost everyone knows that smoking is associated with diseases, such as lung cancer and emphysema. But, it’s surprising that most people are not aware of the correlation between smoking and other conditions, like low back pain.

Recent studies show a stronger link between smoking and lower back pain. Furthermore, lumbar disc degeneration and lumbar arthritis are associated more commonly in smokers than nonsmokers. People who smoke and undergo surgery have an increased risk of poor healing, nonunion, and ongoing pain after surgery.

Additionally, a 2001 study at Johns Hopkins University reported an association with smoking history, hypertension, and coronary artery disease with low back pain. This study led to the theory that the mechanism of injury in low back is damage to the vascular structure of the discs and joints, which smoking also affects.  Smoking contributes to collagen breakdown and lowers vitamin C levels, which have negative effects on the soft tissues of the lumbar spine.

We know that smokers tend to have more skin wrinkles than nonsmokers, but why? This is likely due to the effect of smoking on the collagen in the body.  Collagen makes up many soft tissue structures, including the skin and a significant portion of the lumbar spine, including the discs. Collagen breakdown, which is worsened in smokers, leads to more skin wrinkles as well as more wear and tear of the lumbar discs.

Furthermore, Vitamin C levels in smokers are often found to be much lower than in nonsmokers. Since vitamin C is used in the healing of collagen, this lower level in smokers means that the body has a harder time trying to repair the broken down collagen.

In conclusion, smoking is one of the risk factors you can control. Smoking cessation, exercise, and a healthy diet are all aspects of a healthy lifestyle and improved physical condition. Have you considered smoking cessation to proactively take your health into your own hands and control a healthy outcome? Share your success stories with us — email them to mystory@spinemd.com.

Don’t underestimate tingling, numbness, or pain in your arms. Get to the root of the problem — it could be caused by a pinched nerve in your wrist, elbow, or neck.

Tingling in your thumb as well as index and middle fingers?
This is often related to irritation of the nerve at the wrist.  If you spend countless hours writing or typing on the computer, then you’ve probably heard of carpal tunnel syndrome. Furthermore, these symptoms can be associated with pregnancy, as there is often fluid retention and additional swelling in the hands and wrist.  We’ve all woken up during the night with our hand “falling asleep” and then have to shake it hands in order for the tingling and numbness to go away.  If that sensation is due to pinched nerves in the wrist, there should not be any pain or numbness in the elbow or shoulders.  The symptoms should be isolated to the hands or wrists.  It is often treated by resting the nerve or wrist by wearing a wrist splint, taking anti-inflammatory medications, and occasionally doing injections around the wrist to help decrease inflammation. Physical therapy can often help decrease inflammation, but if it is not effective, surgery will take pressure off the nerves and is often helpful.

Numbness in your forearm, ring & pinky finger?
If so, it may be due to a pinching of nerves around the elbow.  The ulnar nerve can often be stretched and irritated around the elbow.  This irritation is called cubital tunnel syndrome. Did you know Cubital is from the Latin term for elbow? Non-operative treatments including resting and bracing can often help. However, surgery may be indicated to decompress the nerve if non-operative treatments are not successful. .

Pain radiating down your entire arm?
If you are experiencing numbness and tingling radiating down the entire arm, often accompanied by pain around the shoulder blade, shoulder, arm, hand, and fingers, this may be related to a pinching of nerves in the neck. Some people will find that placing their hand above their head will take pressure off the nerve and relieve some of their arm and shoulder pain.  Others find that tilting their head one way or the other causes the pain to improve or worsen.  This may be a sign they are having nerve irritation due to a disc herniation or arthritic spur in the neck.  These are symptoms of cervical radiculopathy.

Initially, cervical radiculopathy is treated with non-operative, conservative treatments with a goal of decreasing inflammation with medication and/or rest.  Cervical traction can also help take pressure off the nerve briefly, which may also decrease inflammation around the nerve.  However, if the non-operative treatments are not effective, then surgical intervention may be indicated to take pressure off the nerve.

If you have tingling or numbness in the arms, it is important to specifically identify where you are experiencing pain to better understand where it is originating.  Pinching of the nerve in the wrist, elbow, or neck can all cause different symptoms and they need to be treated in with unique approaches.  In most cases these symptoms can be treated non operatively. For the surgical candidates, most are back to all activities within a couple of weeks or months and most are back at full sporting activities after a full recovery.

Causes of arm pain range from mild annoyances to severe and potentially life-threatening occurrences.  Seek a doctor’s diagnoses as treatments depend on the underlying cause.

Answer from topic expert, Dr. Christopher Good from the Virginia Spine Institute: I’m sorry to hear that chiropractic, acupuncture, physical therapy, and medications have not worked to reduce your sciatica. Because these treatments haven’t worked for you, surgery is certainly a consideration in your case.

With a herniated disc, it’s somewhat common to develop back pain and/or sciatica (which is another name for that pain that’s radiating down your legs), so you’re certainly not alone.  Fortunately, most patients with herniated discs are successfully treated without ever needing surgery.

Before making the decision to have surgery, you may want to consider these two treatments options for herniated discs and sciatica:

•    Exercise: Aerobic, strengthening, and flexibility exercises can help ease your pain. For example, yoga and pilates may be effective because they help strengthen your core and other muscles. But some exercises can make sciatica worse. Work with a physical therapist or certified personal trainer who can teach you appropriate exercises to reduce your sciatica.

•    Spinal Injections: For many patients with a pinched nerve, an injection of medication into the area can help to reduce pain and has been shown to help some patients avoid surgery.  Injections such as nerve root blocks and epidural injections involve placing medicine (usually a combination of numbing medicine and steroid medicine) into the space around an irritated nerve.  For patients who are mainly having pain without other neurologic findings (numbness / weakness) this can be very helpful.

If pain is your only symptom,which it sounds like it is, it is usually safe to delay surgery. In fact, most herniated discs in the lumbar spine (low back) will actually improve without ever requiring surgery.

Surgery is usually recommended for patients who have the following:
•   Continuous nerve damage that causes numbness and weakness
•    Intense pain that cannot be successfully treated using non-surgical techniques

As for deciding whether you should have surgery, you and your doctor will make that decision together. I typically explain to my patients that a waiting period is often beneficial. I usually try to wait between 6 to 12 weeks before recommending surgery for a herniated disc unless the patient has severe pain of progressive nerve damage.

If nerve damage has occurred, you may notice numbness or weakness in your legs, or in severe cases, loss of normal bowel and bladder control. In this case, you may need surgery to stop further nerve damage. If you have signs of nerve damage, including numbness, weakness, or loss of bowel and bladder function, call your doctor immediately.

There is no definite period of time that is too long to wait to have surgery if pain is your only symptom. However, if your sciatica caused by your herniated discs has been going on for many weeks and months and non-surgical treatments haven’t worked, surgery may be a good option for you.

Have you or are you suffering from pain caused by a herniated disk(s) or sciatica? Which treatment methods did you find most effective to treat your pain?

Many parents are not aware of the dangers in selecting the wrong backpack or carrying too much weight. These include:

•    Increased risk for falls, because your child is forced to lean forward as a result of a heavy or off-balance load
•    Muscle strain and local irritation to the ribcage and spine
•    Change in the natural curve of the spine
•    Internal rotation of the shoulders and poor posture over time

Avoid these potential health risks by referencing these useful tips and considerations on how to lighten the load in your child’s backpack. Teach your kids to wear the backpack well and promote a healthy back to school 2011.

Top 10 Tips to Lighten the Load of Your Child’s Backpack:

1.    Do the math. The American Physical Therapy Association suggests that the recommended weight limit of a backpack should be 15-20 % of a child’s body weight. For example, if your child weighs 50 pounds, then the backpack should be no more than 10 pounds (Make certain that the weight in the backpack does not cause your child to lean forward. This is a sign that the backpack is too heavy).

2.    Weight distribution. Once you have the correct weight in your child’s backpack make sure it is distributed evenly. Always pack heavy items at the bottom to ensure that the heaviest load is carried lower and closer to your child’s core area.

3.    Make sure the backpack has a padded shoulder straps and back side. You don’t want the straps digging into their shoulder or back.

4.    Tighten Up. Always adjust the straps so that the backpack fits close to the body but be careful they are not so tight they pull on the shoulders.

5.    Use both shoulder straps. Carrying the backpack over one shoulder forces other back muscles to compensate for the uneven weight distribution, causing the spine to lean to the opposite side. With time, this muscle imbalance will cause muscle strain and back pain.  Neck muscles can also be affected, which often times leads to an increased neck pain and headaches.

6.    Placement. Rule of thumb is that the bottom of the backpack should be 2-3 inches above the waist, while the top of the backpack should be below the neck.

7.    Select a backpack that has compartments to ensure better organization. Better organization will allow your child to eliminate unnecessary items. But beware! Just because there are lots of pockets doesn’t mean you have to stuff them chock full with everything but the kitchen sink!

8.    Monitor the clutter. Kids tend to accumulate items in their backpacks without realizing it. Take the time to go through the contents of their backpack weekly and eliminate items that are not necessary.

9.    Safety. Place sharp or odd-shaped items in the front section of the backpack to avoid direct contact with your child’s back.

10.    Lift with your legs. Make sure your child lifts the backpack using his or her leg muscles and avoids bending the back.

How do you monitor the weight of your child’s backpack regularly throughout the school year? Leave us a comment to share your helpful tips on how you lighten their backpack load.

Answer from topic expert, Dr. Christopher Good from the Virginia Spine Institute: Scoliosis is an abnormal curvature of the spine that affects approximately 7 million people in the US.  Adolescent Idiopathic Scoliosis (AIS) is the most common form of scoliosis (idiopathic means it has no known cause), so I’ll refer specifically to that type throughout this article.

For patients with AIS, a parent or the child typically notices the abnormal curve, but sometimes it’s not discovered until a school screening or doctor visit. If a child is between the ages of 10 and 12, it’s important to get regular check-ups because that’s the most common age range for adolescent idiopathic scoliosis.

AIS does not always cause significant symptoms for the patient, but larger curves may cause outwardly noticeable deformities (such as a rib hump) and significant pain.  In severe cases, the curve may even begin impacting the lungs and cardiac function. When scoliosis is present, it is important to detect scoliosis early on in order to  decrease the chance of the curve progressing.

Risk Factors for the Progression of the Curve:
There are a number of factors that may be related to the risk for AIS curve progression. They include:

•    Age
•    Pattern of the scoliosis curve that is present (meaning the type or shape of the curve)
•    Gender (girls are much more likely to have scoliosis curves that progress to the point that treatment is required)
•    Skeletal maturity

Treatment for Adolescent Idiopathic Scoliosis:
Treatment options for AIS include observation, bracing, and surgery.  In most cases, only observation is needed.  This includes following up with periodic physical examinations and x-rays until the patient finishes growing.

The majority of patients with small curves will have little, if any, progression.  For patients with small scoliosis curves (those between 25° and 30°) who are undergoing observation, full activities are allowed (including playing competitive sports).

Patients with curves that are at risk for progression during periods of rapid growth (such as puberty) may need to be treated with a brace.  In general, bracing is recommended for scoliosis curves between 25° and 30º in patients who have significant growth remaining.

I recommend wearing the brace 22 to 23 hours a day. This maximizes the positive effect of wearing the brace, while still allowing the patient to remove the brace for social activities and sports.  The patient wears the brace until he or she completes growing, which is usually for two to three years.

As far as scoliosis surgery being the best treatment option, it’s difficult to say because there are so many factors that are specific to each case that the doctor must take into account.  For instance, surgery is generally reserved for patients with progressive scoliosis curves greater than 45º, or curves that do not respond to bracing treatment.

The goal of scoliosis correction surgery is to correct the spinal curvature and prevent the curve from progressing further during the patient’s life.  For patients with large scoliosis curves or significant growth remaining, surgery is the best option in order to prevent further progression of the curve.

A number of surgical advances allow for greater curve correction and spinal stability.  Because of these advances, most patients undergoing corrective surgery for AIS don’t need to wear a brace after surgery, and typical hospital stays are less than a week.  Patients begin walking immediately after surgery and can resume activities over the following months.

The decision to undergo scoliosis surgery should only be made after a very careful evaluation and detailed discussion with the patient, family, and surgeon.

We welcome your questions! Please submit your questions to blog@spinemd.com. If you’d like to submit your successful outcome story please email them to mystory@spinemd.com — we will be featuring both sections monthly right here on our blog.