Tag Archives: back pain

The Truth About Back Pain

back pain

Back pain is ubiquitous. Because a number of things can cause back pain, almost everyone will experience it. That’s why back pain is one of the most common complaints that bring people to the doctor’s office. Perhaps because of its ubiquity, a number of myths and old-wives’ tales have sprung up around pain in the lower back.

For example, many people believe that the problem is the desk chair, and the solution is to replace the chair with something else. While it is true that until relatively recently, office chair’s design was built around the perceived status rather than the comfort, of the sitter, the solution usually proposed, sitting on an exercise ball, does little to help the back. Similarly, stretching and massage might seem like good strategies to fight pain in the back, but in fact, when there is inflammation of the nerves, stretching will only make things worse, and when the pain is caused by muscle spasms in certain areas, massage will do nothing.

The good news is that surgery is not an inevitability. In most cases, back pain can be treated medically or with simple lifestyle changes. Sometimes, over-the-counter painkillers can be enough to provide relief. Stronger medication, and anti-inflammatory drugs, are also used. Sometimes, simply avoiding heavy lifting and making sure not to sit too long can help the pain go away for good. Even exercise can help—in one study, people who were on temporary medical leave due to back pain were able to return to work in two-thirds as much time if they exercised. Exercise helps people heal faster, and the endorphins can take the edge off the pain.

Regular exercise is also suggested for avoiding back pain in the first place. Aerobic exercises help build muscle and bone strength, improves endurance, and enhances flexibility. It can also help keep weight under control, which means less strain on the back while standing and walking. Even something as simple as good posture can help ease the strain—indeed, that is what makes it good posture. Slouching contorts the back muscles and holds them in an unnatural position. Perhaps one of the most famous pieces of advice to avoid back pain is to lift with the knees. Lifting heavy objects by bending forward at the waist means the muscles in the back end up doing all of the work; crouching, grasping the object, and hoisting it while rising to a standing position buts much of the burden on the less fragile leg muscles.

Effects Of Addison’s Disease

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The adrenal glands, on top of the kidneys, produce an anti-inflammatory hormone called cortisol, which also plays an important role in the stress response and in making energy from food. Around 9,000 Americans have a chronic condition called Addison’s disease, in which the adrenal glands fail to produce cortisol, leading to problems with metabolism and inflammation. Although Addison’s disease can be life-threatening, it’s not difficult for patients to lead normal lives with proper care.

There are two basic types of Addison’s disease, called primary and secondary adrenal insufficiency. Primary insufficiency refers to a defect in the adrenal gland itself; secondary insufficiency is a defect in other parts of the body that affect the adrenal glands. A major cause of the disease—70 percent of cases—is an autoimmune response, in which the immune system mistakenly attacks the adrenal glands. People who have other autoimmune conditions are particularly likely to have Addison’s disease. Conditions such as tuberculosis, HIV infection, and some types of cancer can also damage the adrenal glands.

Symptoms are gradual, starting with fatigue and weakness. Addison’s patients also have poor appetite and weight loss. Less common symptoms include nausea and vomiting, diarrhea, low blood sugar, and salt cravings. Unexplained darkening of the skin is a symptom the requires urgent care. The disease is typically diagnosed with blood tests or imaging tests. There is no cure for Addison’s disease. Corticosteroids are sometimes used to treat it, though in some cases they can also exacerbate the condition. It is generally recommended that patients get plenty of salt.

In recent years, doctors have become more aware of the risks posed by untreated Addison’s disease. At one extreme, the back brace worn by President John F. Kennedy to help him with back pain due to adrenal insufficiency has been speculated to have kept him in the path of an assassin’s bullet. Most people have more prosaic complications, however. For many patients, lack of cortisol leaves them vulnerable to infections; these infections, in turn, can trigger an acute attack called an Addisonian crisis. Addisonian crisis requires emergency medical treatment, and can be life-threatening, with symptoms including vomiting, fainting, and psychosis.

Do You Need Back Surgery?

Back surgery is a frightening prospect to most people. Studies have found 66 percent of spine specialists surveyed believe that fear of possible treatments, including surgery, keeps people from seeking help for back pain. However, experts say not all patients who think they need surgery– or whose doctors have told them they need surgery– actually do. In fact, as many as nine in ten people with back pain can be treated successfully with less drastic interventions, such as medication, physical treatment, and exercise; some don’t even need treatment at all.

“It is heartbreaking to see that myths and an unnecessary fear of surgery are holding people back from getting even the most conservative help for their back pain,” said Dr. Joseph Cheng, associate professor of Neurological Surgery at Vanderbilt University Medical Center, in a statement.

Of course, the best treatment is not to have back pain in the first place. There’s no surefire way to avoid it entirely, but their are some steps you can take to reduce your risk. Being overweight can place a significant strain on your back. Regular exercise can help, as well as being beneficial in its own right. Smoking can cause back pain; one effect of nicotine is to restrict blood flow to the region, leading to painful pressure.

Posture also plays a role: standing with one foot a bit forward of the other and sitting with your knees higher than your hips ease pressure on your back. It’s best to sleep on your side; if you sleep on your back, keep your knees elevated. Lift with your knees by crouching down instead of bending over, and carry large, heavy objects as close to your body as possible.

One in eight people with back pain doesn’t see a specialist for more than three months, though doctors recommend seeing someone within six weeks. Only about one percent of cases require surgery, generally very specific ailments for which all other treatments have proven ineffective. The vast majority of the time, the pain can be treated with anti-inflammatory medications and painkillers, or chiropractic manipulation. If the pain goes away on its own, or with non-surgical treatment, surgery is not needed.

Botox as Medicine

It’s often associated with costly cosmetic procedures, but onabotulinum toxin A, or Botox, is actually an important medical treatment. It is very useful for relieving or treating several conditions, including neck pain called cervical dystonia, eye spasms, crossed eyes, chronic migraines and even underarm sweating.

The botulinum toxin is, as the name suggests, the chemical that causes botulism, a form of food poisoning. When it’s in food, it causes paralysis, but the same paralyzing effect can be harnessed to unstiffen limbs and unclench muscles. It also blocks certain bodily secretions, meaning people with excessive underarm perspiration can use it to keep that under control. Overactive bladder is another problem that botulism toxin can treat.

The use of Botox as a treatment for migraines does follow directly from its cosmetic use—patients getting Botox treatments for wrinkles noticed that their chronic migraines briefly stopped after the injection was given. Scientists aren’t sure how botulism toxin treats migraines, but one possibility is a combination of blocking the nerves activated by the pain, the way many over-the-counter painkillers work, and relaxing the muscles in the face. The injections are helpful in both treating patients who suffer migraines more than half of each month, and in preventing those frequent headaches from happening for as long as three months after each dose.

People who suffer a condition called cervical dystonia are given botulism toxin to keep that under control. There is no permanent cure for cervical dystonia, a painful and uncontrollable neck muscle twitch, which causes the patient’s head to continually jerk to one side. Injected directly into the neck, the medication relaxes the muscle, stopping the twitching for three to four months

The muscle relaxing properties of the substance are also useful in helping restore a full range of motion to stroke patients. Too often, these patients are unaware of the usefulness of the injection for their conditions—it’s a new application, and an “off-label,” or unofficial, one, so many doctors are unaware of it—and so are not able to get the benefits it provides. Botulism toxin is targeted, unlike standard treatments for post-stroke paralysis, which affect the whole body and can cause drowsiness.

Backpack Back Pain

According to a recent study, some children carry backpacks that weigh more than 15 percent of their own body weight. That’s equivalent to a 180-lb adult carrying upwards of 27 pounds on his or her back.

That’s why one in four students reported back pain over the past year, and 70 percent of them were diagnosed with curvature of the spine, known as scoliosis. Many of the students were found to have involuntary muscle contractions.

Girls and older students have it worst, the study found, and students with heavy backpacks were half again as likely to have two weeks or more of back pain than students with lighter bags.

The American Academy of Orthopedic Surgeons recommends getting a bag with a padded back and two wide, padded shoulder straps. The straps should be tightened as much as is comfortable, and students should never use just one strap alone.

Parents should encourage their children to jettison large unneeded items, and to let them know about back pain, especially if it goes on for a while. If possible, students should use their lockers during the day.

In addition, students and other people prone to back pain should avoid standing for long periods, sit with their knees a little above their hips and lift heavy items with their knees.