by admin | Jan 21, 2015 | Uncategorized
It’s been a hard day, and Joe’s back is killing him.
His wife has some Percocet left over from a trip to the dentist, and there’s that big bottle of Tylenol under the sink, so Joe grabs a couple of each and washes them down with a slug of beer.
Luckily for Joe, he’s a fictional character invented for this article. But there are a lot of real-life Joes out there making big mistakes with over-the-counter and prescription pain pills.
Can you spot Joe’s mistakes? Joe didn’t make every mistake in the book. But he made quite a few.
Here’s WebMD’s list of common pain pill mistakes, compiled with the help of pharmacist Kristen A. Binaso, RPh, spokeswoman for the American Pharmacists Association; and pain specialist Eric R. Haynes, MD, founder of Comprehensive Pain Management Partners in Trinity, Fla.
Pain Medications Mistake No.1:
If 1 Is Good, 2 Must Be Better
Doctors prescribe pain pills at the doses they believe will offer the greatest benefit at the least risk. Doubling or tripling that dose won’t speed relief. But it can easily speed the onset of harmful side effects.
“The first dose of a pain medication may not work in five minutes the way you want. But this does not mean you should take five more,” Binaso says. “With some pain drugs, if you take additional doses, it makes the first dose not work as well. And with others, you end up in the emergency room.”
If you’ve given your pain medication time to work, and it still does not control your pain, don’t double down. See your doctor about why you’re still hurting.
“This ‘one is good so two must be better’ thing is a common problem,” Haynes says. “Patients should follow the instructions their doctor gives. Ask before leaving the office: Can I take an extra pill if I still hurt? What is the upper limit for this medication?”
Another bad idea is trying to boost the effect of one kind of pain pill by taking another.
“There may be ibuprofen, acetaminophen, and naproxen in the house, and a person may take them all,” Binaso says.
This can escalate into a very bad situation, Haynes says.
Pain Medications Mistake No. 2:
Duplication Overdose
People often take over-the-counter pain drugs — and even prescription pain drugs — without reading the label. That means they often don’t know which drugs they’re taking. That’s never a good idea.
And if they take another over-the-counter drug — either for extra pain relief or for other reasons — they may be getting an overdose. That’s because many OTC drugs are combination pills that carry a full dose of pain pill ingredients.
In Joe’s case, he’s taken a prescription pain pill that contains acetaminophen along with a second full dose of acetaminophen from Tylenol, putting him at risk of injury.
Pain Medications Mistake No. 3:
Drinking While Taking Pain Drugs
Pain medications and alcohol generally enhance each other’s effect. That’s why many of these prescription medications carry a “no alcohol” sticker.
That sticker shows a martini glass covered by the international “No” sign of a circle with a slash. But it applies to wine and beer just as much as it does to spirits.
“A common misperception is people see that sticker and think, ‘I’m OK as long as I don’t drink liquor — I can have a beer.’ But no alcohol means no alcohol,” Binaso says.
“The patient should heed that alcohol warning, because it can be a major problem if they do not,” Haynes says. “Alcohol can make you inebriated, and some pain medications can make you have that feeling as well. You can easily get yourself into trouble.”
Drinking alcohol can be a problem even with over-the-counter pain drugs.
Pain Medications Mistake No. 4:
Drug Interactions
Before taking any pain pill, think about what other medicines, herbal remedies, and supplements you are taking. Some of these drugs and supplements may interact with pain medications or increase the risk of side effects.
For example, aspirin can affect the action of some non-insulin diabetes drugs; codeine and oxycodone can interfere with antidepressants.
You should give your doctor a complete list of all the drugs, herbs, and supplements you take — before getting any prescription.
If buying over-the-counter medications, Binaso recommends showing a list of everything else you’re taking to the pharmacist.
Pain Medications Mistake No. 5:
Drugged Driving
Pain medications can make you drowsy. Different people react differently to different drugs.
“How I react to a pain medication is different from how you react,” Binaso says. “It may not make me drowsy, but may make you drowsy. So I recommend trying it at home first, and see how you feel. Don’t take two pills and go out driving.”
Pain Medications Mistake No. 6:
Sharing Prescription Medicines
Unfortunately, it’s very common for people to share prescription medications with friends, relatives, and co-workers. Not smart, Haynes and Binaso say — particularly when it comes to pain medications.
“If a fairly healthy person is taking a medicine because she is in pain, and wants to give some pills to Uncle Joe because he is hurting — well, this is a potential problem,” Haynes says. “Uncle Joe may have a problem that keeps his body from eliminating the drug, or he may have an allergic reaction, or the drug may interact with a medication he is taking, with life-threatening results.”
Pain Medications Mistake No. 7:
Not Talking to the Pharmacist
It’s not easy to read drug labels, even if you can make out the small print. If you have a question about either a prescription or OTC drug, ask the pharmacist.
“That’s why I’m in the store,” Binaso says. “You may have to wait a couple of minutes for me to finish what I’m doing. But you’ll get the information you need to take the right medicine the right way. Just say, ‘Tell me about this medicine; what should I be on the lookout for?'”
Pain Medications Mistake No. 8:
Hoarding Dead Drugs
Joe’s wife is actually to blame for one of his mistakes. She should have disposed of those extra pain pills once she was over her dental pain.
Why? One reason is that pills stored at home start breaking down soon after their expiration date. That’s especially true of drugs kept in the moist environment of the bathroom medicine cabinet.
“People say, “That drug is only a year past its expiration date; isn’t it good?” But if you take a pill that’s broken down, it may not work — or you may end up in the emergency room because of reaction to a breakdown product. That is really common,” Binaso says.
Another reason that it’s dangerous to hoard is that the drugs may tempt someone else into making a very bad choice.
“Teen drug abuse is really up, especially with pain medications,” Binaso says. “It is not uncommon for kids to go to their parents’ or grandparents’ medicine cabinet and then go to a party and put the drugs in a bowl.”
Pain Medications Mistake No. 9:
Breaking Unbreakable Pills
Pills are actually little drug-delivery machines. They don’t work the way they’re supposed to when taken apart the wrong way.
Scored pills should be cut only across the line, Binaso says. Those without scoring should not be cut at all, unless you’re specifically instructed to do so.
“When you start chopping up pills like that, the pill may not work,” she says. “We find more and more people are doing this. And then they say, “Oh, that pill had a really bad taste. That is because they cut away the coating.”
Source: Web MD
By Daniel J. DeNoon
Reviewed By David T. Derrer, MD
by admin | Jan 20, 2015 | Uncategorized
Sitting is one of the worst positions for the body to maintain. After just 20 minutes hunched over in a chair, blood pools in the legs and immense pressure builds on the spine. Now, imagine the effects of sedentary workdays long term.
For employees at and tech companies, our jobs are desk-bound (that is, until treadmill desks are affordable in bulk). So, it’s a good thing that expert’s tips to prevent serious injury are rather simple — take frequent breaks and stand as often as possible.
Prolonged sitting causes discomfort, numbness and spine misalignment. Holding the body upright also increases tension in major muscles and joints. All that means stationary time at work can lead to cardiovascular disease (because of less blood flow), tightened hip flexors, shortened hamstrings, pinched nerves and many physical injuries in the long run.
Why Is Sitting So Unnatural?
New York City chiropractor Dr. Jan Lefkowitz treats pinched nerves, spilled discs, carpal tunnel, back pain and stiff necks full time. His chiropractic office resides in the corporate heart of Midtown NYC. The majority of his clients work 50 to 80 hours weekly.
Body pain, herniated discs, nerve problems and painful joints are direct results of long office hours, says Dr. Lefkowitz. When you’re sitting, the spine is under a lot of pressure. Our bodies were made to stand, so maintaining the seated position is physically stressful.
“The weight is distributed in a standing position,” says Kelly McGonigal, Ph. D., a health psychologist at Stanford University and a leading expert in neck and back pain.
That’s not the case with sitting. McGonigal explains, “When you sit, you distort the natural curve of the spine, which means your back muscles have to do something to hold your back in shape because you’re no longer using the natural curves of the spine to lift yourself up against gravity.”
Around 80% of Americans will experience chronic pain in their lifetime as a result, she says. Desk work is putting a huge mental and physical stress on our bodies.
Bad posture makes the sitting disease even worse. Slipped discs is a direct result.
“When the posture breaks down, it causes a lot of spinal problems,” Lefkowitz says. “If you are sitting down with bad posture and you’re slouching, you can only handle 20 minutes of that before it deforms your ligaments.”
How to Prevent Back and Neck Injuries
Good posture when sitting maintains the three natural curves of a healthy spine. The neck is forward, the upper back has an outward curve and the lower back is inward. Elbows are at the sides of the body and shoulders are relaxed — holding shoulders upright for a long time will strain the area.
“The main point is avoid slouching, you have to sit up straight and sit all the way back in your chair,” Lefkowitz says. “The chair should be tucked in close to desk. And, you need lumbar (lower back) support.”
Inexpensive remedies are available. Either roll up a thick sweater or use a small pillow behind your back to allow your lower back to curve inward. Aim to insert it in between the small of your back and the chair.
Another recommendation to avoid pulling muscles or causing pain is simply standing every 20 minutes or so. It’s the most important thing desk workers can do to give the body a break from a long held position.
“That will push the blood out of your legs and will prevent ligaments from getting strained,” Lefkowitz says. “It starts to stretch out your ligaments.”
Simple stretches at your desk such as twisting, turning the head from side-to-side and chin tucks upward towards the ceiling will also help.
“Those movements, doing them very regularly, at least once an hour, for 60 seconds will do more to relieve chronic pain than going to a yoga class once a week,” McGonigal says.
General Tips
- Stand at least every hour at your desk.
- Do simple stretches throughout the day such as placing your hands on your lower back and stretching backwards.
- Get moving! Make conference calls on your feet or suggest a moving meeting — walk up and down the hall.
- When seated, make sure you maintain good posture with your butt all the way back to the chair, feet flat on the floor, head straight and with lower back naturally arched inward.
by admin | Jan 15, 2015 | Uncategorized
If you have been injured at work or in an auto accident, Dr. Hanna provides EXPERT pain management treatment.
As an industrial medicine and personal injury practice, Dr. Hanna not only treats state injured workers and accident victims, but also federal injured workers. Patients are seen from Florida as well as Washington state..
by admin | Jan 14, 2015 | Uncategorized
Introduction
Low back pain is an extremely common problem that is often poorly managed. Back pain is a particular challenge because it is so common, demanding of medical resources and a major cause of physical, psychological and social disability. Most back pain is simple and self-limiting but it is important to recognise that which is not.
The aims of back pain assessment are:
– To recognise serious pathology
– To relieve pain
– To improve function
– To recognise and assess level of disability
– To identify barriers to recovery
– To prevent recurrence or persistence of symptoms
Most backache (85-90%) will be so-called simple low back pain (or ‘mechanical low back pain’) in which the symptoms by definition cannot be ascribed to a particular pathology (infection, tumour, osteoporosis, fracture, radicular syndrome, cauda equina syndrome (CES)). Simple low backache is also called uncomplicated or nonspecific low back pain and will vary with posture, activity, time and treatment.
Radicular (or nerve root pain) may occur with low back pain. Sciatica is a lay term for pain extending into the leg (buttock, thigh, calf or heel).
The classification into acute (less than 6 weeks), subacute (6-12 weeks) and chronic (more than 12 weeks) has been used in research but is less useful clinically because of the variable and recurrent nature of symptoms.
Recurrent low back pain has been defined as a new episode of pain after a symptom-free period of 6 months.
Epidemiology
Back pain is extremely common. 60-80% of people in the UK report back pain at some time in their lives.
Low back pain has an estimated lifetime prevalence of 84% worldwide. The worldwide prevalence of chronic low back pain is about 23%.
Simple back pain tends to affect those between 30 and 60 years of age, starting between 30 and 50. First onset outside this range should arouse suspicion of a sinister cause.
Back pain is second only to the common cold as a cause of lost days at work. In 2005 the Trades Union Congress (TUC) estimated that 4.9 million working days per year are lost due to back pain. Research by the British Chiropractic Association found that 48% of people in Britain suffer from back or neck pain at any one time, possibly associated with spending an increasing amount of time seated at office desks.
Highly demanding jobs, prolonged standing and awkward lifting are the most consistent factors predisposing to low back pain. A systematic review did not identify occupational carrying as an independent risk factor.Psychosocial work-related stress is an associated factor. Genetics may play a part. Smoking and obesity increase risk.
Presentation
History should include:
– Establishing when the pain started.
– Confirming whether pain was sudden or gradual in onset.
– Identifying the location of the pain.
– Enquiring whether there is pain radiation to anywhere else.
– Establishing whether there are aggravating or relieving factors.
– Confirming whether the patient has had this problem previously.
– Noting the patient’s occupation, what it involves and hobbies or sport.
– Asking the patient to confirm what they think caused the pain.
– Noting past medical history. Steroid use predisposes to osteoporosis. Establish whether there has been malignancy that metastasises to bone (lung, breast, prostate, thyroid, kidney) or myeloma.
– Asking the patient to confirm how they have been managing the condition. This includes analgesics taken, whether they have been adequate and the patient’s attitude to the condition.
Red flags from history
Red flags for possible serious spinal pathology from the history are:
– Recent violent trauma (such as a vehicle accident or a fall from a height)
– Minor trauma, or even just strenuous lifting, in people with osteoporosis
– Age at onset less than 20 or over 50 years (new back pain)
History of:
– Cancer
– Drug abuse
– HIV
– Immunosuppression
– Prolonged use of corticosteroids
– Constitutional symptoms – eg, fever, chills, unexplained weight loss
– Recent bacterial infection – eg, urinary tract infection
Pain that is:
– Worse when supine
– Severe at nighttime
– Thoracic
– Constant and progressive
– Non-mechanical without relief from bed rest or postural modification
– Unchanged despite treatment for 2-4 weeks
– Accompanied by severe morning stiffness (rheumatoid arthritis and ankylosing spondylitis)
– Severe and leaves patients unable to walk or self-care
– Accompanied by saddle anaesthesia or recent onset of difficulty with bladder or bowels
Examination
A brief examination for acute back pain is recommended with the patient undressed, revealing the spine and standing.
The brief examination should incorporate: inspection, palpation, brief neurological examination and an assessment of function.
More detailed neurological examination will be necessary if the history suggests any red flags – eg, confirming saddle anaesthesia and diminished anal tone if CES is suspected.
Passive straight leg raising is often used to assist diagnosis of nerve root pain. A Cochrane review of 16 cohort studies found that it was highly sensitive but specificity varied widely.[10]
Red flags from examination
– Structural deformity
– Severe or progressive neurological deficit in the lower extremities
– Unexpected laxity of the anal sphincter
– Perianal/perineal sensory loss
– Major motor weakness: knee extension, ankle plantar eversion, foot dorsiflexion
CES should be suspected if there is:
– Bladder dysfunction (usually retention, sometimes overflow)
– Sphincter disturbance
– Saddle anaesthesia
– Lower limb weakness
– Gait disturbance
Differential diagnosis
Red flags may suggest spinal fracture, cancer, infection or serious pathology associated with a prolapsed intervertebral disc.
Other causes of back pain include:
– Primary malignancy:
– Reticulo-endothelial system (myeloma is the most likely)
– Carcinoma of pancreas
– Osteosarcoma (this does not usually affect the spine)
Secondary cancers are usually from:
– Bronchus
– Breast
– Prostate
– Thyroid
– Kidney
Bone disorders including:
– Paget’s disease of bone (affects the pelvis in 72% of cases and the lumbar spine in 58%)
– Osteoporosis (leading to vertebral collapse)
– Spinal stenosis
– Inflammatory disease – for example:
Ankylosing spondylitis which tends to present:
– Slowly in men under the age of 40 years with a rigid back
– With aggravation by inactivity and relief with exercise
Psoriatic arthritis (rash or a family history of psoriasis)
– Reiter’s syndrome (symptoms including urethritis)
– Arthritis associated with inflammatory bowel disease (usually arthritis is peripheral)
Infection:
– Never forget tuberculosis (osteomyelitis can occur)
– HIV predisposes to infections (including tuberculosis)
– Renal tract infection (pyelonephritis can also cause referred back pain)
Causes from outside the spinal column include:
– Dissecting aortic aneurysm
– A posterior duodenal ulcer presenting as back pain, which may be difficult to diagnose. If a gastric ulcer presents for the first time over the age of 40 years, malignancy needs to be excluded.
– Nephrolithiasis
– Pyelonephritis
Traditionally, factors suggesting malignancy have included age greater than or equal to 50 years, previous history of cancer, duration of pain greater than one month, failure to improve with conservative therapy, elevated ESR and anaemia. However, a Cochrane review has sounded a note of caution with respect to interpreting individual ‘red flags’. Further research on the reliability of combinations of features are recommended.
Investigations
Note: if the diagnosis would appear to be simple back pain then no investigation is required.
If other diagnoses are entertained, appropriate investigations are in order, depending upon the suspicion.
Diagnostic imaging
This is indicated only if serious or specific pathology is likely – eg, red flags
– Plain X-ray of the lumbar spine:
– Provides the same dose of radiation as around 120 chest X-rays and, in return, offers very limited information and rarely affects management.
– Should not be used routinely. One study found that in patients with no features of serious underlying disease, early radiology made no difference to the outcome. Imaging may be appropriate in the following circumstances:
– If fracture is suspected, X-ray is of value.
– With metastatic carcinoma.Those from prostate are sclerotic, those from lung, thyroid and kidney are osteolytic and those from breast may be either. Lesions below 2 cm in diameter may not be seen on plain X-ray but a scintillation scan with technetium 99m Tc is much more sensitive.
– Collapse from osteoporosis or myeloma may be seen.
– Paget’s disease of bone may be seen.
– CT scans often show stress fractures and spondylolisthesis best.
MRI:
– Gives a good picture of soft tissues, including discs and anything impinging on nerves or the spinal cord.
– Disc lesions are best displayed by MRI scans. MRI is the most useful investigation in nerve root compression, discitis and suspected neoplastic disease.
Blood and urine tests
– FBC, ESR, CRP, urine analysis if cancer, infection or inflammation is suspected.
– LFTs may be helpful. Alkaline phosphatase can be elevated in metastatic disease and Paget’s disease of bone.
– PSA will be raised particularly in carcinoma of the prostate.
– Urinary hydroxyproline will be markedly elevated (with increased bone turnover) in Paget’s disease of bone.
– Nephrolithiasis may produce red cells in the urine.
Other investigations
A wide variety of further investigations may be required when other pathologies are suspected. For example:
– CXR may show primary or secondary carcinoma or pulmonary tuberculosis.
– Ultrasound will show renal stones and is the best way to visualise the pancreas. It can also give a good picture of an aneurysm allowing it to be measured accurately and to detect possible dissection.
– Endoscopy may confirm a posterior ulcer and allow tests for Helicobacter pylori infection or malignancy.
Management
Doctors and patients can use Decision Aids together to help choose the best course of action to take.
In 1994 the Clinical Standards Advisory Group (CSAG) published a report that radically changed teaching and practice.[16] Until then, rest – perhaps with a board under the bed – was recommended for back pain. The new guidelines recommended active rehabilitation. The new principles of management involve keeping the patient active and giving analgesia to facilitate this. Now only in exceptional cases is rest allowed and then for no longer than 48 hours.
The basics of management
Recognition of those causes of back pain that are a cause for concern and taking appropriate action (red flags)
Planning a simple route for recovery with the patient, being positive and reassuring
Recognising and addressing any factors that may mitigate against a swift recovery, including negative attitudes and even compensation neurosis (yellow flags)
Relief of pain
Addressing issues that may predispose to further episodes, including poor practice at work or poor ergonomics
Management of simple low back pain
Give information, reassurance and advice.
DO NOT prescribe bed rest.
Advise the patient to stay as active as possible.
Prescribe regular pain relief (paracetamol, non-steroidal anti-inflammatory drugs) and consider a short course of muscle relaxants.
Management of suspected serious pathology or red flags
If a red flag has shown, appropriate action must be taken. This will mean referral for investigation and for treatment. In the case of CES, for example, urgent referral to a neurosurgeon or specialist orthopaedic surgeon is required.
Management of chronic pain, psychosocial factors and yellow flags
Patients may, quite reasonably, assume that pain is a warning sign that tells us that if something hurts we should not do it. Very often this is true but with back pain it is necessary to work through the pain and to overcome it. There may well be psychosocial barriers to active rehabilitation with prolongation and chronicity as risks. These are called yellow flags. They include:
– Belief that pain and activity are harmful
– Sickness behaviours, such as extended rest
– Social withdrawal
– Emotional problems such as low or negative mood, depression, anxiety and stress
– Problems and/or dissatisfaction at work
– Problems with claims or compensation, or time off work
– Overprotective family; lack of support
– Inappropriate expectations of treatment, including low expectations of active participation in treatment
Although there has been some doubt about the value of this approach, the overall evidence suggests that targeting yellow flags, particularly when they are at high levels, does seem to lead to positive results.
Discuss work and predisposing factors for back pain.
– If heavy lifting is involved, establish whether there was an induction course when techniques were taught.
– Often it is not so much the weight but a large, awkward package that causes injury.
– Seating and posture are often more important nowadays:
– Consider desks, chairs, computer screens and keyboards at work.
– Look at time spent in the car and how comfortable it is and adjustment of the seat and steering wheel.
– Fork lift trucks and large goods vehicles may transmit vibration all day.
– Discuss getting back to work.
– Discuss what improvements may be made to the workplace to reduce the risk of recurrence.
– Give the patient a positive attitude and enthusiasm to recover.
Not everyone finds that those in authority at work are sympathetic or wish to make the environment safer but where work is supportive, the prognosis is better.
Remember, when assessing whether to refer, that motor deficits and bowel or bladder disturbances are more reliable than sensory signs.
If red flags suggest a serious condition, refer with appropriate urgency. This means immediately for CES.
If there is progressive, persistent or severe neurological deficit, refer for neurosurgical or orthopaedic assessment, preferably to be seen within one week.
If pain or disability remain problematic for more than a week or two, consider early referral for physiotherapy or other physical therapy.
If, after six weeks, sciatica is still disabling and distressing, refer for neurosurgical or orthopaedic assessment, preferably to be seen within three weeks.
If pain or disability continue to be a problem despite appropriate pharmacotherapy and physical therapy, consider referral to a multidisciplinary back pain service or a chronic pain clinic.
Summary of referral guidance
These can also still be thought of usefully as ‘immediate’, ‘urgent’ and ‘soon’ referrals:
Immediately:
CES
Urgently:
Serious spinal pathology suspected
Progressive neurological deficit
Nerve root pain not resolving after six weeks
Soon:
Inflammatory conditions suspected – eg, ankylosing spondylitis
Simple back pain and not resuming normal activities after 2-3 months
Physical, cognitive and behavioural therapies
A Cochrane review – albeit of a small number of trials – found spinal manipulation to be no better than other therapies. However, a study of men and women aged between 18 and 35 years with acute back pain found that chiropractic manipulative therapy in conjunction with standard GP care afforded significant advantages in decreasing pain and improving physical functioning compared to standard care alone. A systematic review of osteopathy for the treatment of chronic low back pain was inconclusive and recommended more research. Manipulation and acupuncture are each discussed in the separate article Complementary and Alternative Medicine. A systematic review of acupuncture found some evidence of benefit but further trials are needed. Traction is not recommended.
The evidence base for the value of physiotherapy per se is surprisingly small. However, recent evidence suggests that its effectiveness can be increased when used in conjunction with a validated tool such as the STarT Back screening tool developed at Keele University. This allocates patients to different treatment pathways based on their prognosis (low, medium, or high risk of poor outcome) and is designed for ease of use in primary care.
It is important to be active and positive to prevent back pain from becoming chronic. If it does, cognitive and behavioural therapy with relaxation therapy may be helpful. A Cochrane review reported that no type of behavioural therapy is better than any other. There may also be benefit from ‘back schools’ and from exercise therapy.
Neither motor control exercises (designed to improve control and co-ordination of trunk muscles) or graded activity (individually tailored exercises that target specific weak and dysfunctional muscles) are better than any other form of exercise therapy.
Evidence to support the use of peripheral nerve-field stimulation for the management of chronic back pain is limited. The National Institute for Health and Care Excellence (NICE) recommends that any clinician using this treatment should explain the risks and benefits to individual patients, inform the clinical governance lead of their trust and register the patient’s details with the UK Neuromodulation Register.
Complications
Acute back pain may become chronic. This may be because of failure of active management or behaviour by the patient that predisposes to chronicity rather than cure. Targeted care as described above, with the early recognition and management of yellow flags and the use of a validated tool to tailor management to prognosis, may help to minimise the risk of chronicity.
Failure to diagnose CES and to take immediate action may lead to long-term neurological damage.
Other sinister causes of back pain may have a fatal outcome. The prognosis may be improved by early and effective intervention.
Prognosis
This will depend entirely on the diagnosis. Generally for simple low back pain, if chronicity can be prevented, then recovery should be full but in a variable time. Back pain in old age probably is, as many assume, simply a feature of advancing years. Analgesics may help but it is most important to stay active.
A systematic review found that the majority of patients with acute or persistent low back pain improved within six weeks. Improvement slowed after that time and a minority of patients still had pain and disability after one year.[36]
Prevention
The prevention of back pain in the workplace depends on the nature of the work and reference has already been made to the increasing number of office-based rather than manual workers suffering from the condition. There are European guidelines for the prevention of low back pain. These were published in 2004 and there has been surprisingly little in the literature since with respect to primary prevention. There is no evidence for the effectiveness of lumbar supports or education and limited evidence for the efficacy of exercise.
Much more work has been done on secondary prevention, addressing physical and psychosocial issues, once an episode of back pain has occurred.
Further reading & references
Back Pain; Health amd Safety Executive
Hill JC, Whitehurst DG, Lewis M, et al; Comparison of stratified primary care management for low back pain with current best practice (STarT Back): a randomised controlled trial. Lancet. 2011 Oct 29;378(9802):1560-71. doi: 10.1016/S0140-6736(11)60937-9. Epub 2011 Sep 28.
Sanders T, Foster NE, Bishop A, et al; Biopsychosocial care and the physiotherapy encounter: physiotherapists’ accounts of back pain consultations. BMC Musculoskelet Disord. 2013 Feb 19;14:65. doi: 10.1186/1471-2474-14-65.
Recognising inflammatory back pain, British Society for Rheumatology (June 2012)
European guidelines for the management of acute nonspecific low back pain in primary care; COST B13 Working Group (2004)
Balague F, Mannion AF, Pellise F, et al; Non-specific low back pain. Lancet. 2012 Feb 4;379(9814):482-91. doi: 10.1016/S0140-6736(11)60610-7. Epub 2011 Oct 6.
4.9 million lost work days is a pain in the back; Trades Union Congress, 2013
‘Dine at desk’ a way of life?’, British Chiropractic Association, 2013
Sterud T, Tynes T; Work-related psychosocial and mechanical risk factors for low back pain: a 3-year follow-up study of the general working population in Norway. Occup Environ Med. 2013 May;70(5):296-302. doi: 10.1136/oemed-2012-101116. Epub 2013 Jan 15.
Wai EK, Roffey DM, Bishop P, et al; Causal assessment of occupational carrying and low back pain: results of a systematic review. Spine J. 2010 Jul;10(7):628-38. doi: 10.1016/j.spinee.2010.03.027. Epub 2010 May 5.
Portune R; Psychosocial risks in the workplace: an increasing challenge for German and international health protection. Arh Hig Rada Toksikol. 2012 Jun 1;63(2):123-31. doi: 10.2478/10004-1254-63-2012-2212.
Deyo RA, Bass JE; Lifestyle and low-back pain. The influence of smoking and obesity. Spine. 1989 May;14(5):501-6.
van der Windt DA, Simons E, Riphagen II, et al; Physical examination for lumbar radiculopathy due to disc herniation in patients with low-back pain. Cochrane Database Syst Rev. 2010 Feb 17;(2):CD007431. doi: 10.1002/14651858.CD007431.pub2.
Henschke N, Maher CG, Refshauge KM; Screening for malignancy in low back pain patients: a systematic review. Eur Spine J. 2007 Oct;16(10):1673-9. Epub 2007 Jun 14.
Henschke N, Maher CG, Ostelo RW, et al; Red flags to screen for malignancy in patients with low-back pain. Cochrane Database Syst Rev. 2013 Feb 28;2:CD008686. doi: 10.1002/14651858.CD008686.pub2.
Back pain – low (without radiculopathy); NICE CKS, November 2009 (UK access only)
Sciatica (lumbar radiculopathy); NICE CKS, November 2009 (UK access only)
Andersen JC; Is immediate imaging important in managing low back pain? J Athl Train. 2011 Jan-Feb;46(1):99-102. doi: 10.4085/1062-6050-46.1.99.
Back Pain. Report of a CSAG Committee on Back Pain; 1994 HMSO. ISBN 0-11-321887-7.
Senna MK, Machaly SA; Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976). 2011 Aug 15;36(18):1427-37. doi: 10.1097/BRS.0b013e3181f5dfe0.
Lang J, Ochsmann E, Kraus T, et al; Psychosocial work stressors as antecedents of musculoskeletal problems: a systematic review and meta-analysis of stability-adjusted longitudinal studies. Soc Sci Med. 2012 Oct;75(7):1163-74. doi: 10.1016/j.socscimed.2012.04.015. Epub 2012 May 11.
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by admin | Jan 14, 2015 | Uncategorized
Dealing with Fibromyalgia on a daily basis is a trial that many have to deal and battle with in their life. Fibromyalgia is a chronic pain disorder that causes pain all throughout the body such as the muscles, and joints. The pain is intense especially when pressure is applied to these pressure points also known as tender points. These tender points are at the shoulders, back of the neck, hands, knees, around the neck, and the hip joints. Research has found that the illness may be hereditary being passed down the family line and more women than men have the disorder. Treating Fibromyalgia by providing relief of the pain and other symptoms of the illness is a tricky task but it can be done. Exercising with Fibromyalgia takes time and effort to gain relief from the pain, along with improving sleep, and alleviating other symptoms of the disorder. Weight loss may help with reducing additional pain in the body such as pain in the legs, cardiovascular functioning, Lack of exercise and conditioning of the body brings on symptoms of increased sensitivity to pain, along with osteoporosis, degenerative disc disease (DDD), rheumatoid arthritis (RA), lower back pain, weakened muscles in the back, lumbar, pelvis area, and thighs. Patients who suffer with Fibromyalgia need to exercise a minimum of two times a week for a minimum of 25 minutes each time of exercise. Doing this may help to reduce symptoms of the illness. If you’re just starting out with exercising it is best to start out slow by picking out a low to moderate intensity of exercise such as walking in the mall, water aerobics, swimming, yoga, tai chi, etc. As time goes by then increase the amount of time and intensity when you feel ready to do that type of move.
1. Try warm water aerobics in the pool which is the perfect environment to relieve pain and stiffness in the body. The Arthritis Foundation Aquatic Program is a program that allows patients to exercise gently in the warm water which in turns helps to build up their strength and ability to be more flexible. Many patients who participate in this exercise activity will find their pain will have decreased and lessened stiffness.
2. Expand your mind and body with Yoga. Yoga allows the person to train their mind, body and spirit This type of exercise fits within the alternative and complementary medicine. There are many different types of physical yoga or also known as Hatha (poses). The different types of yoga are such as Bikram which focuses on stamina and purification using heated rooms that are over 100 degrees, or Vinyasa/power yoga which helps to increase stamina, strength and flexibility.
3. Look into applying the mind-body practices Tai Chi and Qigong into your fitness schedule. Both of these practices originated in ancient China. Anyone of any age and health condition can do these of type of movements. Tai Chi which is an exercise focused on easy movement mobility, breathing and improving relaxation. Tai Chi is a low impact type of aerobics with the focus on reducing pain, and stiffness. With Tai Chi there are 12 movements with half are basic and the other half are advanced movements. Qigong reduces stress, improves the immune system, lowers blood pressure, improves overall stamina, cardiovascular, and digestive function.
by admin | Jan 14, 2015 | Uncategorized
Fibromyalgia is a musculoskeletal disorder involving widespread pain, fatigue, sleep problems and mood disturbances. It is not known what definitively causes this disorder, and right now, there is no cure. Treatments available, though, including over-the-counter supplements, to help relieve symptoms. If you have fibromyalgia, talk to your health care provider before taking any supplements to make sure they are safe and appropriate for you to use.
Magnesium is a mineral that is needed by every organ in the human body. The University of Maryland Medical Center states that this mineral helps build strong teeth and bones; activates enzymes; plays a role in producing energy; and helps regulate calcium, copper, zinc and other nutrient levels. A 2008 study by O.F. Sendur and colleagues, published in the journal “Rheumatology International,” found that individuals with fibromyalgia had significantly lower magnesium levels. According to UMMC, preliminary studies show that magnesium and malic acid may help relieve pain and tenderness in fibromyalgia patients when taken for at least two months. Study results have been mixed, and more extensive research needs to be done.
The amino acid tryptophan is converted into 5-hydroxytryptophan, or 5-HTP, and then converted into serotonin. Serotonin affects mood and behavior, and it is thought that 5-HTP may improve sleep, mood, anxiety and pain sensation, states UMMC. Individuals with fibromyalgia are sometimes prescribed antidepressants because lower levels of serotonin have been associated with the condition. According to UMMC, while not all studies have found the same results, some studies showed that 5-HTP eased fatigue, morning stiffness, pain and anxiety associated with fibromyalgia. Talk with your doctor before using this supplement, especially if you are already taking an antidepressant.
The compound S-adenosylmethionine, or SAMe, is naturally found in nearly every tissue of the body. It helps break down neurotransmitters like dopamine, serotonin and melatonin, among other things. When used as a supplement, SAMe may help relieve some symptoms of fibromyalgia, states Rxlist.com. It has been used to help treat depression and osteoarthritis and can help with similar symptoms in sufferers of fibromyalgia. UMMC states that injectable SAMe has been effective in helping reduce depressed mood, pain and fatigue, along with joint pain, in individuals with fibromyalgia. Talk to your doctor before using SAMe to treat any medical condition.
Along with these supplements, there are medications that may be helpful in easing symptoms of fibromyalgia. According to MayoClinic.com, other treatments include anti-seizure drugs to help reduce nerve pain, analgesics to loosen stiff joints and provide pain relief, and antidepressants to help with fatigue and depression. Talk therapy, getting enough sleep and regular exercise can also ease stress and provide fibromyalgia relief. What works for one patient may not be effective for another, so it is best to find what helps you the most.
