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Chronic Pain

Back Clinic Chronic Pain Chiropractic Physical Therapy Team. Everyone feels pain from time to time. Cutting your finger or pulling a muscle, pain is your body’s way of telling you something is wrong. The injury heals, you stop hurting.

Chronic pain works differently. The body keeps hurting weeks, months, or even years after the injury. Doctors define chronic pain as any pain that lasts for 3 to 6 months or more. Chronic pain can affect your day-to-day life and mental health. Pain comes from a series of messages that run through the nervous system. When hurt, the injury turns on pain sensors in that area. They send a message in the form of an electrical signal, which travels from nerve to nerve until it reaches the brain. The brain processes the signal and sends out the message that the body is hurt.

Under normal circumstances, the signal stops when the cause of pain is resolved, the body repairs the wound on the finger or a torn muscle. But with chronic pain, the nerve signals keep firing even after the injury is healed.

Conditions that cause chronic pain can begin without any obvious cause. But for many, it starts after an injury or because of a health condition. Some of the leading causes:

Arthritis

Back problems

Fibromyalgia, a condition in which people feel muscle pain throughout their bodies

Infections

Migraines and other headaches

Nerve damage

Past injuries or surgeries

Symptoms

The pain can range from mild to severe and can continue day after day or come and go. It can feel like:

A dull ache

Burning

Shooting

Soreness

Squeezing

Stiffness

Stinging

Throbbing

For answers to any questions you may have please call Dr. Jimenez at 915-850-0900


The Effects of Low Laser Therapy on Repairing The Calcaneal Tendon | El Paso, TX

The Effects of Low Laser Therapy on Repairing The Calcaneal Tendon | El Paso, TX

The body is a well-working machine that can endure anything that is thrown in its way. However, when it gets an injury, the body’s natural healing process will ensure that the body can get back to its daily activities. The healing process of an injured muscle varies throughout the body. Depending on how severe the damage is and how long the healing process will take, the body can recover to a mere few days to a few months. One of the most gruelly healing processes that the body has to endure is a ruptured calcaneal tendon.

The Calcaneal Tendon

The calcaneal tendon or the Achilles tendon is a thick tendon that is located in the back of the leg. This muscle-tendon is what makes the body move while walking, running, or even jumping. Not only that, the calcaneal tendon is the strongest tendon in the body, and it connects the gastrocnemius and soleus muscles at the heel bone. When the calcaneal tendon is ruptured, the healing process can last from weeks to months until it is fully healed. 

 

 

The Healing Effects of Low Laser Therapy

One of the ways that can help the damaged calcaneal tendons’ healing process is low laser therapy. Studies have shown that low laser therapy can speed up the damaged tendon repair after a partial lesion. Not only that but the combination of ultrasound and low laser therapy has been studied to be the physical agents for treating tendon injuries. The studies showed that the combination of low laser therapy and ultrasound has beneficial properties during the recovery process of treating calcaneal tendon injuries.

 

 

The study found that when patients are being treated for their calcaneal tendons, their hydroxyproline levels around the treated area are significantly increased with ultrasound and low laser therapy. The body’s natural biochemical and biomechanical structures on the injured tendon increase, thus affecting the healing process. Another study has shown that low laser therapy can help reduce fibrosis and prevent oxidative stress in the traumatized calcaneal tendon. The study even showed that after the calcaneal tendon is traumatized, inflammation, angiogenesis, vasodilation, and the extracellular matrix are formed in the affected area. So when patients are being treated with low laser therapy for about fourteen to twenty-one days, their histological abnormalities are alleviated, reducing collagen concentration and fibrosis; preventing oxidative stress from increasing in the body.

 

Conclusion

Overall, it is said that the effects of low laser therapy can help speed up the healing process of repairing the calcaneal tendon. The promising results have been proven since low laser therapy can help repair the damaged tendon, reducing oxidative stress and preventing fibrosis from escalating, causing more problems on the injured tendon. And with the combination of ultrasound, the calcaneal tendon can recover faster so the body can continue its everyday activities without any prolonged injuries.

 

References:

Demir, Huseyin, et al. “Comparison of the Effects of Laser, Ultrasound, and Combined Laser + Ultrasound Treatments in Experimental Tendon Healing.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, 2004, https://pubmed.ncbi.nlm.nih.gov/15278933/.

Fillipin, Lidiane Isabel, et al. “Low-Level Laser Therapy (LLLT) Prevents Oxidative Stress and Reduces Fibrosis in Rat Traumatized Achilles Tendon.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, Oct. 2005, https://pubmed.ncbi.nlm.nih.gov/16196040/.

Oliveira, Fla’via Schlittler, et al. Effect of Low Level Laser Therapy (830 Nm … – Medical Laser. 2009, http://medical.summuslaser.com/data/files/86/1585171501_uLg8u2FrJP7ZHcA.pdf.

Wood, Viviane T, et al. “Collagen Changes and Realignment Induced by Low-Level Laser Therapy and Low-Intensity Ultrasound in the Calcaneal Tendon.” Lasers in Surgery and Medicine, U.S. National Library of Medicine, 2010, https://pubmed.ncbi.nlm.nih.gov/20662033/.

Chronic Pain and Nutritional Habits

Chronic Pain and Nutritional Habits

Low-back, neck, shoulder, hip, leg, and foot pain are all causes of everyday discomfort and a bad mood. Chronic pain exacerbates the discomfort and bad mood times 10. Chiropractic treatment can help realign the spine and alleviate the pain. However, to maintain pain relief, individuals need to make healthy lifestyle adjustments. One of the most important adjustments is eating habits. Those dealing with chronic pain may not realize their diet is contributing to the pain.

At Injury Medical Chiropractic and Functional Medicine Clinic, we have a combined team of chiropractors, physical therapists, a health coach, and a nutritionist to help educate, develop, and support a personalized treatment plan on spinal health, posture, physical activity/exercise, balance, and eating habits.

Chronic Pain and Nutritional Habits

Salt, Sugar, and Fat Affects the Body

A sedentary lifestyle is a significant contributor to chronic pain, but unhealthy eating habits also play a role. Poor diet adds weight to the body. This stresses the body’s biomechanical structure. It also aggravates inflammation. Too much salt, sugar, and fats ingested through processed foods, fast food, and unhealthy habits affect the body’s regulating systems. They can affect everything from the nervous system, nerves, proper circulation, even the limbic system. The inflammation and stress generate and exacerbate chronic pain symptoms.

Changing unhealthy eating habits is up to the individual.

Individuals can be advised to cut back or cut out unhealthy diet choices; however, it is easier said than done. A doctor, health coach, and nutritionist have no control over what individuals do when they leave the clinic. Individuals themselves can have little control over their own eating habits. Many have an addiction to unhealthy food, which is a disease in itself. To help change poor eating habits, individuals need to be educated on how their eating habits affect the total body and mental health.

Nutrition Discussion

Chronic pain associated with inflammation linked to a poor diet is the first step in the diagnosis and developing an optimal treatment plan. It could be as simple as informing an individual that eating cheeseburgers are causing the inflammation that is hurting their back. However, there is more to it, but individuals are more inclined to avoid the foods causing the inflammation upon hearing a full explanation. Targeting specific foods is the first step in alleviating pain.

The temptation is always there, especially when stress comes into the picture. This is why it is important to have ready-to-go adjustments/alternatives that keep the individual eating healthy, despite the chaos going on around them. A treatment plan will include quick alternatives that can happen in stages. An example could be:

  • Having one cheeseburger and not two.
  • Having a burger without cheese.
  • Eating a burger without the buns.
  • Switching to a plant-based burger.
  • There are many options to be explored to improve eating habits in small steps.

Willpower also has to be addressed in a controlled and supportive setting. This is where the whole team comes in. Many individuals’ eating habits are part of who they and adjusting them can be an uphill challenge. To educate on:

  • Methods of accountability
  • Keeping a journal
  • Having the family or friends eat healthy with them
  • These are techniques and methods to increase willpower to make healthy changes.

Body Composition


Foods Can Support Body Detoxing

The proper foods can support the body in detoxifying toxins and counter the negative effects like brain fog, neurodegenerative disorders, and chronic pain. The foods help to:

  • Neutralize oxidative stress
  • Lower inflammation
  • Increase immunity
  • Strengthen the musculoskeletal system
  • Foods and nutrients that detoxify can be a part of a healthy lifestyle.
References

Bjørklund, Geir et al. “Insights on Nutrients as Analgesics in Chronic Pain.” Current medicinal chemistry vol. 27,37 (2020): 6407-6423. doi:10.2174/0929867326666190712172015

Elma, Ömer et al. “Chronic Musculoskeletal Pain, and Nutrition: Where Are We and Where Are We Heading?.” PM & R: the journal of injury, function, and rehabilitation vol. 12,12 (2020): 1268-1278. doi:10.1002/pmrj.12346

Gómez-Pinilla, Fernando. “Brain foods: the effects of nutrients on brain function.” Nature reviews. Neuroscience vol. 9,7 (2008): 568-78. doi:10.1038/nrn2421

Extinguish Chronic Inflammation With Chiropractic

Extinguish Chronic Inflammation With Chiropractic

Chronic inflammation is quite common and can cause a variety of painful back conditions. Fortunately, chiropractic treatment can extinguish the inflammation at its core/root cause and bring long-lasting relief. Inflammation can be a significant factor in causing body and back pain. The proper and lasting treatment goes beyond anti-inflammatory medications. The objective is to extinguish the inflammation completely.  
 

Inflammation

The number of diseases associated with chronic inflammation is increasing exponentially. An estimated 60% of Americans deal with at least one chronic condition caused completely or in part by inflammation. Inflammation is the body’s immune response to something that is not right in the body. Typically, there is:
  • Swelling
  • Redness
  • Warmth/heat signaling an inflammatory response from injury or infection
Chronic inflammation can present through a series of symptoms, including:
  • General fatigue
  • Pain throughout the body
  • Off feeling/not focused
Inflammatory conditions can include:
  • Skin changes like a rash
  • Joint swelling
  • Lymph node swelling
  • Endocrine, heart, lung, and neurological complications
 
Inflammation can generate inflammatory back pain as well when this happens. This is because the immune system is trying to protect the body from whatever is trying to infiltrate. The cells and chemicals fight the attack and try to heal whatever is going on. Sometimes, there is nothing going on but the immune system becomes hyper-reactive and attacks itself. This is the case of autoimmune disease, or what becomes chronic inflammation. Chronic inflammation lasts longer than 3 months and can lead to diseases like:
  • Diabetes
  • Heart disease
  • Autoimmune inflammation can manifest in rheumatological disorders like rheumatoid arthritis

Inflammation and Inflammatory Conditions

Autoimmune inflammation that presents as ankylosing spondylitis and rheumatoid arthritis is in a different category. This is when the body begins attacking itself. This can be triggered by a viral infection, which stimulates the immune system. This can cause:
  • Joint destruction
  • Ligament pain
  • Soft tissue swelling
  • Some conditions are hereditary

Inflammatory Spinal Conditions

Inflammation can travel into the body�s spinal and neurological systems. This results in painful conditions that can affect an individual’s quality of life.

Ankylosing Spondylitis

Ankylosing spondylitis usually starts in the lower back and can spread up. It is a form of arthritis that causes the vertebrae to fuse together. It can also cause inflammation in the urological and ophthalmological systems. It is believed to have a somewhat genetic connection. There is a marker called HLA B27 that is usually positive in patients and is more common in young males.

Rheumatoid Arthritis

Rheumatoid arthritis/RA causes inflammation in synovial joints. These produce a fluid that helps lubricate and nourish the joints. RA is found most commonly in the hands, wrists, and knees, but can also present in the spine�s facet joints that connect vertebrae. There is some genetic association but is common with smoking and obesity. It is diagnosed with lab work, like inflammation markers, rheumatoid factor, and physical examination. RA pain typically presents in the cervical spine or neck region.  
11860 Vista Del Sol, Ste. 128 Extinguish Chronic Inflammation With Chiropractic
 

Transverse Myelitis and Multiple Sclerosis

These conditions are closely tied and caused by inflammation in the central nervous system/CNS. The immune system attacks the nerve cells and removes the fatty substance that insulates the nerves and helps them transmit impulses to and from the central nervous system. This causes:
  • Pain
  • Weakness
  • Numbness
  • Bladder/bowel issues
Transverse myelitis affects the spinal cord whereas multiple sclerosis can affect the brain and the spinal cord. Transverse myelitis is typically acute, whereas multiple sclerosis is long-term and can have an increasing/decreasing course of progressive symptoms. And transverse myelitis can be a symptom of multiple sclerosis. Certain lifestyle choices/habits can cause or worsen inflammation. Obesity, smoking, and an unhealthy diet can have a significant impact on chronic inflammation.  

Spinal Structures Affected

Inflammation can affect every area of the spine. From the lower back to inflammation of the vertebrae themselves. Injuries to the spine, that include the:
  • Bones
  • Discs
  • Ligaments
  • Joints
This can cause swelling and a build-up of fluid that can be found on an MRI. This is the preferred method of detecting inflammation. When the term itis is used this usually indicates a type of inflammation. For example, neuritis means inflammation of the nerve/s. This can be seen with nerve compression where the nerve is swollen on an MRI.  
11860 Vista Del Sol, Ste. 128 Extinguish Chronic Inflammation With Chiropractic
 

Extinguish Spinal Inflammation

Causes of inflammation can be traced back to lifestyle choices, but can also be alleviated through healthy lifestyle adjustments that turn into habits.

Nutritional Health Coaching

Recommended is to avoid or decrease processed foods, trans fats, and sugar. Consider supplementing vitamin D, magnesium, and omega 3s.

Quit Smoking

Quitting smoking will improve circulation and extinguish vascular inflammation.

Regular Physical Activity/Exercise

Aerobic exercises improve cardiac function and circulation as well as exercises that support the spine ergonomically. Core and pelvic stabilization are necessary for lower back pain.

Medication

For acute inflammation caused by injuries steroids and NSAIDs can help with severe pain and inflammation.  
 

Chiropractic Extinguisher

When the spine and the body’s joints are in proper alignment, and the nerves are functioning at optimal levels the body’s biomechanics return to normal. This stops neuropeptides from producing and helps extinguish inflammation.

Surgery

With the spine, surgery is not recommended as a first-line treatment unless it is an emergency or there is potential for permanent neurological damage. If medication, chiropractic, physical therapy, supplements, lifestyle changes, and/or complementary treatments like acupuncture do not help and quality of life and function are significantly impacted, then elective surgery can be considered.

Body Composition Spotlight

 

 

All-around Exercise Regimen

As individuals continue to struggle with obesity and functional fitness with age, exercise becomes more important than ever. It is crucial to combine diet and regular physical activity/exercise to lose weight, have a favorable impact on body composition and lifespan. A well-rounded exercise regimen that incorporates all types of fitness. Aerobic exercise helps maintain an elevated heart rate and helps get rid of fat-free mass. Resistance training helps to build lean muscle mass. Combining the two, with concurrent training, or utilizing a HIIT workout when there is not enough time will work wonders. Being better equipped and understanding why exercise is important for the body’s health, different types of exercise, and which ones are best suited for each individual’s needs will keep the body in top form for the long term.

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at�915-850-0900. The provider(s) Licensed in Texas& New Mexico
References
What Is Inflammation?:�StatPearls.�(November 2020) �Chronic Inflammation��https://www.ncbi.nlm.nih.gov/books/NBK493173/ Types of Inflammatory Spinal Conditions:�Current Opinion in Rheumatology.�(January 2014) �When and Where Does Inflammation Begin in Rheumatoid Arthritis?��https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033623/
Activity Modification and Chiropractic To Help With Chronic Pain

Activity Modification and Chiropractic To Help With Chronic Pain

Chronic pain and a healthy spine can require activity modification. This is so an individual can participate in activities in a way to help prevent pain from presenting. This could include:
  • Avoiding staying in static positions for too long
  • Continuous stretches throughout the day
  • Planning ahead when participating in physical activities that cause pain
  • Dietary adjustments to reduce inflammation and gain strength/flexibility
  • Customized exercise program
  • Health coaching guide
11860 Vista Del Sol, Ste. 128 Activity Modification and Chiropractic To Help With Chronic Pain
 

Activity Modification

Chiropractic treatment not only involves correcting spinal alignment but also continuing an individual’s health education. The objective is to treat the source, not the symptoms. The goal with activity modification is to change the habit into a positive technique. Rigorous spinal adjustments will only help to a point if the habit continues. Whether there are any underlying conditions or it is an individual’s lifestyle, variables like: These are the primary factors when it comes to spinal health. With recurring spinal problem/s, a chiropractor needs to trace back any kinetic behavior that could have contributed to inflammation causing pain symptoms. Recognizing poor kinetic habits and teaching activity modification are core objectives of chiropractic medicine.  
 

Identification

Poor habits need to be identified. Two common are forward head posture and anterior pelvic tilt. These are signs of bad habits that affect spine health. Misaligned biomechanics can be a first clue in understanding why the individual continues to experience pain. Consistent shifting of the body to not stay in one position for too long is recommended, but when there is recurring pain this is where a chiropractor can show an individual better methods and techniques of shifting to avoid the pain. Poor posture could be traced to sitting at a disproportionate desk with no ergonomic support. And a constant forward head position on the cervical spine, nerves, shoulders, can generate enormous strain.  

Modification

Precision adjustments will alleviate the effects of spinal misalignment. But modifications need to become second nature. Chiropractic modification approaches will correct poor posture and body mechanics. A chiropractor will educate an individual to be mindful of certain movements and reinforce proper positioning. Once an individual is familiar with a healthy way of moving/shifting to restore optimal mechanics, then the individual can learn to engage in other activities with the newfound activity modification tools. This will help break the cycle of chronic spinal misalignments.  
11860 Vista Del Sol, Ste. 128 Activity Modification and Chiropractic To Help With Chronic Pain
 

Positive Change

Corrective relief and teaching proactive wellness is the primary role of chiropractic medicine. Activity modification can be an individual’s first line of defense for changing poor habits responsible for chronic pain and recurring musculoskeletal problems. Educating individuals on how to preserve spinal adjustments and adopting long-term, healthy habits will promote overall wellness.

Chiropractic Care Crossfit Rehabilitation


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*
References
Geneen, Louise J et al. �Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews.��The Cochrane database of systematic reviews�vol. 4,4 CD011279. 24 Apr. 2017, doi:10.1002/14651858.CD011279.pub3
Chiropractic Testing and Treatment for Chronic Pain

Chiropractic Testing and Treatment for Chronic Pain

Finding ways to manage chronic pain is a priority. Chiropractic testing and treatment could be an option that is effective and affordable. Various chiropractic care can help manage chronic pain caused by a condition like herniated disc/s. Chiropractic testing involves diagnosing the root cause/origin of the pain. Getting a proper diagnosis usually involves:

  • X-rays
  • CT scan
  • MRI
  • DNA
11860 Vista Del Sol, Ste. 128 Chiropractic Testing and Treatment for Chronic Pain

Chiropractic testing

The correct diagnosis is essential to creating an optimal treatment plan. It is a complicated disorder that can be difficult to treat because it can present with no apparent cause. But, researchers are working to find answers to many of the questions surrounding chronic pain. When treating spine-related pain other tests can include:

  • Discography
  • Bone scans
  • Nerve studies
  • Electromyography
  • Nerve conduction study
  • Myelography

A pain specialist might consult with and refer the individual to a neurosurgeon or orthopedic spine surgeon to determine if the pain requires surgery. This is because untreated and not fully treated chronic pain is one of the leading causes of limited mobility and flexibility. Other associated issues are:

There are some experts that believe tests like MRIs are overused. There is a fear that too many tests could expose individuals to unnecessary radiation and increase medical expenses. However, determining the cause/s holds the key to a successful treatment plan. Therefore, choosing the right diagnostic strategy will help in:

  • Creating the most effective and optimal treatment plan
  • Quality of life improvement
  • Prevent potential complications
  • Reduce the cost of diagnosis
  • Reduce the cost of treatment

Chiropractic Management

Chronic pain does not respond to typical pain management techniques. Chiropractic management deals with chronic pain inflammation and muscle tension. Chiropractors use a variety of non-surgical techniques like:

Soft Tissue

  • Manual release therapy stretches the muscle/s while pressure is applied
  • Trigger point therapy applies pressure on the area of the tensest muscle/s
  • Instrument-assisted soft tissue therapy uses a tool/s to apply gentle pressure.
11860 Vista Del Sol, Ste. 128 Chiropractic Testing and Treatment for Chronic Pain

Manual Therapy

When the joints are not moving correctly, a chiropractor may utilize this technique to regain a full range of joint motion. This is accomplished through joint mobilization which is slow, gentle stretches of the affected joint and manipulation, which are quick but gentle movement/thrusts that stretch the joint.

Exercise Therapy combined with Self-care

A chiropractor will provide simple therapeutic exercises and stretches that can be done at home to help with the pain and to help with prevention. Also provided:

  • Safe lifting techniques
  • Posture exercises/tips
  • Dietary strategies to manage pain and prevent re-injury

Once diagnosed with a pain condition, a chiropractor will develop a unique customized treatment plan. Don’t be afraid to talk with your chiropractor. The more they know the better the treatment plan. Once the pain is fully addressed, patients will be able to gradually increase daily activities.


Piriformis Syndrome Chiropractic Treatment


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Chronic Pain Treatment/Management

Chronic Pain Treatment/Management

There are various chronic treatment/management options available. Chronic pain treatment focuses on treating and managing the root cause and underlying condition that is causing the pain. The physical and psychological aspects of chronic pain need to be balanced in order for a treatment plan to work.

 

11860 Vista Del Sol, Ste. 128 Chronic Pain Treatment/Management

That is why a complete treatment plan can sometimes be necessary to address both the physical and psychological factors generating the pain. Because of this treatment plans often involve different pain specialists working in conjunction with a customized treatment/management plan according to the individual’s needs. This can include a combination of treatment protocols, like:

  • Health coaching
  • Psychological therapy
  • Chiropractic
  • Physical therapy
  • Medication
  • Acupuncture
  • Yoga, Pilates

Treatment/Management

The focus of chronic pain treatment is to:

  • Lessen pain frequency and intensity
  • Help individuals get back to work
  • Improve mobility and flexibility
  • Maintain quality of life
  • Reduce or eliminate reliance on pain meds
  • Reduce possible re-injury or new injury
  • Reduce mental and emotional symptoms like anxiety and depression

Pain Meds

 

hands of woman holding opioids

Non-Opioids

Nonsteroidal anti-inflammatory medications are usually the first treatment for chronic mild to moderate pain. Examples are ibuprofen, aspirin, and naproxen. These medications work by blocking enzymes and reduce prostaglandins throughout the body that cause pain and swelling. Acetaminophen used in Tylenol is similar to these medications but works differently. Instead, these meds block the production of inflammatory chemicals in the brain.

Opioids

Opioids are narcotics and can be extremely powerful pain relievers. These are used to relieve severe pain symptoms temporarily. Narcotics work by blocking the pain signals before they get to the brain. However, these meds are highly addictive and can lead to abuse. Doctors prescribe narcotics when non-opioids and all forms of non-pharmacological treatment/s fail or don’t work in providing sufficient pain relief. Examples include:

  • Buprenorphine
  • Fentanyl
  • Hydrocodone
  • Oxycodone
  • Hydromorphone
  • Methadone
  • Morphine
  • Tramadol

Anticonvulsants

Anticonvulsants or anti-epileptics are used to treat seizures. They can also help in relieving pain that is associated with nerve injury/damage and fibromyalgia. Examples include:

Muscle Relaxants

Muscle relaxants can be used for chronic pain but there is division among medical experts as to how effective they are and of their addictiveness. Plus there are few studies supporting their use in individuals with chronic pain.

Corticosteroids

Corticosteroids are hormone-based medications that help reduce inflammation. They are generated naturally in the body while some are synthesized in a laboratory. Injectable steroids can help relieve pain brought on from pinched nerves or joint disorders.

Antirheumatics

Antirheumatic meds are used to control and manage rheumatoid arthritis symptoms. They prevent or inhibit the immune system and help reduce joint damage. Examples include:

  • Methotrexate
  • Leflunomide
  • Hydroxychloroquine
  • Sulfasalazine

Antidepressants

Antidepressants are used to treat anxiety disorders and depression disorders but are also used to relieve chronic pain. They are used to treat pain caused by:

  • Arthritis
  • Migraine
  • Nerve damage
  • Fibromyalgia

These medications increase the brain’s chemical levels like serotonin, dopamine, and norepinephrine. They can also be used even when an individual has no depression symptoms. Examples include:

  • Amitriptyline
  • Venlafaxine
  • Paroxetine.

Alternative Treatment

Alternative treatment/management can also help with the pain. It’s recommended to discuss any type of alternative treatment with a doctor or medical professional. Doctors encourage alternative treatments along with keeping a journal of how an individual feels after a series of treatment sessions. If the individual feels better, and the treatment is working, then consider continuing for an extended period. Here are some alternative treatments/therapies to think about.

  • Acupuncture: Works by releasing endorphins, the natural pain-relieving chemicals, and affects the brain region that controls serotonin, the chemical that regulates mood.
  • Massage: Helps relieve pain by keeping muscles, ligaments loose and proper blood flow throughout the body
  • Meditation: Has been shown to help improve pain perception and reducing depressive symptoms
  • Hypnosis: Has been found to be useful in treating cancer and back pain
11860 Vista Del Sol, Ste. 128 Chronic Pain Treatment/Management

Psychological Therapy

Psychotherapy, also known as talking therapy could be part of a chronic pain treatment plan. What it does is to help improve the associated symptoms/conditions which include:

  • Depression
  • Anxiety
  • Fear of pain

Psychotherapy has shown promising results and has various forms. They are:

Acceptance/Commitment Therapy

Acceptance commitment therapy is short-term psychotherapy. There are two approaches to pain perception. One, it teaches the individual to accept things beyond what they control. Second, it encourages the individual to feel things the way they are, work towards relief instead of questioning and being skeptical. It opens an individual’s psychological perspective. It can be used to treat low back, leg, and neck pain.

Cognitive-Behavioral Therapy

This therapy educates individuals on pain, mood, behavior, and how they all relate to each other. It also trains an individual on relaxation strategies. Individuals learn techniques to replace negative thoughts concerning their pain with positive thoughts. Cognitive-behavioral therapy has been shown to be effective in treating pain caused by:

  • Spinal cord injury
  • Chronic migraines
  • Fibromyalgia
  • Rheumatoid arthritis
  • Irritable bowel syndrome
  • Osteoarthritis
  • Multiple sclerosis
  • HIV/AIDS
  • Cancer

Early and aggressive treatment/management of chronic pain can make a significant difference. Knowledge is power so make sure you understand all options before deciding which to take.


Sciatica Pain Treatment Relief


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Chronic Pain Diagnosis

Chronic Pain Diagnosis

Getting an accurate chronic pain diagnosis is essential to creating the most optimal, highly customized treatment plan for the individual. Depending on the severity and cause of pain, individuals could require various pain specialists/therapists combined with a primary physician. These could include:

  • Chiropractor
  • Physical therapist
  • Neurosurgeon
  • Pain medicine specialist
  • Physiatrist
  • Rheumatologist
  • Orthopedic spine surgeon

Chronic Pain Diagnosis

 

11860 Vista Del Sol, Ste. 128 Chronic Pain Diagnosis

Over time chronic pain symptoms can change or alter and need reevaluation. This could mean having to adjust treatment and management but that is exactly what it is, an adjustment to the treatment plan flowing with the symptoms as they come and go while keeping to the objective of. Chronic pain diagnosis entails a series of tests, as well as, a full review of symptoms and medical history. A doctor will ask a series of questions concerning symptoms and pain triggers. These questions could include:

  • When did the pain begin?
  • Describe and rate the pain, is it shooting, electrical, burning, throbbing, dull, or sharp?
biomarker el paso tx.
  • Has there ever been an injury at or around the problem area?
  • What activities/actions/movements relieve and worsen the pain?
  • Is there a history of mental illness, like depression or anxiety?
11860 Vista Del Sol, Ste. 128 Chronic Pain Diagnosis

Labs

Tests will be ordered to identify physical/non-physical causes that could be the cause or contributor. Possible tests include:

Blood

Blood tests are used in the diagnosis of infections and inflammation. Individuals with infection/s or inflammatory disorders have high levels of white blood cells and inflammatory reactive substances like C-reactive protein. Blood tests also help determine the presence of rheumatoid arthritis, gout, or cancer. If rheumatoid arthritis is present, the blood analysis will show positive results for proteins known as rheumatoid factor.

Urine

Urinalysis is commonly used to check for gout. This is a type of arthritis that causes high blood levels of uric acid. A doctor may order a urine test for a patient using prescription pain meds.

Spinal tap

A doctor inserts a needle into the lower back and a sample of cerebrospinal fluid is collected. Cerebrospinal fluid is clear and protects the brain and spinal cord. A cerebrospinal fluid analysis helps to diagnose disorders of the central nervous system and certain cancers. �

Musculoskeletal/Neurological tests

A musculoskeletal exam looks at posture, joint mobility, muscle stiffness, tightness, and swelling in or around the area, as well as the rest of the body. An example is a diagnosis of carpal tunnel syndrome. A detailed spine examination is done to identify deformities and moving/walking posture. A neurological examination is used to check:

  • Muscle strength
  • Touch reaction
  • Balance
  • Overall sensation

A neurological exam can also be used to test:

  • Memory
  • Alertness
  • Mood
  • Behavior

Imaging

Imaging provides detailed images of the body’s organs and bones. Doctors use these to:

  • Spot fractures or inflammatory alterations in the bone/s
  • Focus on details of a bone and surrounding structures
  • Differentiate between growths, infections, or fractures
  • Identify nerve/s injury or damage

X-Rays

X-rays are standard in the diagnosis of fractures. An arthrogram is an x-ray that uses a contrasting agent to check and identify joint disorders.

MRI

Magnetic resonance imaging uses a magnetic field and radio waves to create detailed images. Magnetic resonance imaging helps in diagnosing:

  • Low back pain
  • Fibromyalgia
  • Osteoarthritis
  • Migraine
  • Pelvic pain
  • Peripheral neuropathy

Electrodiagnostic

EMG – Electromyography

EMG’s are used to diagnose disorders of the muscles and nerves. Electrical activity in the muscles is recorded to see how the impulses/electrical signals are transmitting from the nerves to muscles. �

neurological studies el paso tx.

An EMG could be required if an individual has:

  • Numbness
  • Muscle weakness
  • Muscle pain
  • Tics

Electromyography is also used to identify conditions that can cause chronic pain like:

  • ALS – Amyotrophic lateral sclerosis
  • Carpal tunnel syndrome
  • Radiculopathy from pinched nerves in the spine
  • Muscular dystrophy

Nerve Conduction

A nerve conduction study measures the speed of electrical signals passing through a nerve. It can identify:

  • Carpal tunnel syndrome
  • Herniated disk disease
  • Sciatic nerve injury/damage/abnormality

A doctor can order both an EMG and NCS in combination.


Back Pain Chiropractic Care

 


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Anybody Can Have Chronic Pain

Anybody Can Have Chronic Pain

Anybody can have chronic pain. Adults typically complain of joint pain, low back pain, and neurogenic pain. While children and teenagers are more likely to have more headaches, abdominal pain, leg, and hand pain. Regardless there are individuals that have a higher risk because of their age, gender, and job. It isn’t always clear what causes chronic pain. There are several possibilities: �

 

11860 Vista Del Sol, Ste. 128 Anybody Can Have Chronic Pain
  • Injury – Even after the injury has healed, the nerves keep sending pain signals to and from the brain. Doctors are still not sure why this occurs.
  • Disease – Conditions can cause chronic pain like fibromyalgia and osteoarthritis.
  • Nerve problems – Part of the nervous system can be injured, the nerves themselves. This is called neuropathic pain.
  • Unknown Cause/s – Pain that presents with no obvious injury, disease, or nerve problem.

Military Veterans

Chronic pain is quite common in veterans according to a National Veterans Affairs Study. Around one in five veterans receiving primary care have chronic pain. While one in ten has chronic pain syndrome. Veterans recently served in a war, tend to report a variety of causes for their pain. This includes:

  • Multiple injuries
  • Brain trauma
  • Muscle injuries
  • Bone/s injuries

Athletes

Most sports require a certain level of fitness. Athletes train with all types of activities to help maintain their body’s. Unfortunately, they are still not immune to chronic pain. Chronic pain is common with:

  • Gymnasts
  • Football players
  • Soccer players
  • Runners
  • Basketball players
  • Ballet dancers

Common chronic conditions for athletes:

 

  • Low back pain
  • Leg pain
  • Stress fractures or cracks inside a bone
  • Tendinitis
  • Diabetes
  • Recurrent fractures
  • Spinal stenosis is a narrowed spinal canal, which creates added pressure on the nerves that travel through the low spine into the legs
chiropractor takes notes on lady with back pain in gym

Seniors

Age is a high-risk factor for chronic pain. Around 30-40% of individuals older than sixty-five have or are beginning to deal with chronic pain. The severity in anybody forty-five to sixty-five is the greatest. Common conditions that cause chronic pain in older adults are:

  • Cancer
  • Arthritis and gout
  • Heart disease
  • Kidney disease
  • Damaged nerves
  • Stroke
  • Shingles
11860 Vista Del Sol, Ste. 128 Anybody Can Have Chronic Pain

Women

Men and women experience pain differently. Several factors contribute to this. These include:

  • Hormones
  • Menstruation
  • Puberty
  • Reproductive health

Women have a higher risk of developing disorders that cause chronic pain. Examples include:

  • Arthritis
  • Brittle bones
  • Migraines
  • Irritable bowel syndrome

Anybody dealing with chronic pain, finding relief can be difficult and time-consuming. Individuals are often sent back and forth between primary care, specialists, and therapists for a solution.

Improved Nervous System

When there is a communication breakdown between the brain and the body�s tissues, organs, and cells it can lead to a variety of health problems. There are many chronic and even degenerative health conditions that are impacted by the nervous system. Studies have shown that chiropractic is a highly effective treatment for numerous neurological conditions which include:

  • Ataxia
  • Autism
  • Cerebral palsy
  • Epilepsy
  • Multiple sclerosis
  • Parkinson�s
  • Tourette�s Syndrome
  • Vertigo

Anybody can seek treatment and they will experience the benefits. Chiropractic provides a safe, effective treatment for an improved nervous system function. The type, frequency, and intensity of treatment depend on the patient and condition. Chiropractic positively affects the nervous system and as a result, positively affects the whole body.


Chronic Body Pain Treatment

 


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Causes of Chronic Pain

Causes of Chronic Pain

Several conditions and factors can cause chronic pain. Usually, these are conditions that accompany normal aging, which affect bones and joints. The top three are osteoarthritis, rheumatoid arthritis, and fibromyalgia. Other common causes are nerve damage and injuries that fail to heal properly.

Spinal Cord and the Nerves of the Corresponding Organs

 

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Fibromyalgia

Individuals with fibromyalgia experience unexplained pain in almost every part of their bodies. Doctors and scientists are still trying to figure out what causes fibromyalgia. Currently, scientists think a part of the condition comes from an imbalance of certain chemicals in the brain. They believe the imbalances play a critical role. Fibromyalgia can create:

  • Tender areas
  • Muscle pain
  • Headaches
  • Long-term back pain
  • Long-term neck pain

Osteoarthritis

Osteoarthritis causes severe sporadic or non-stop aches and pain in the knees, hips, spine, and feet. Associated symptoms include joint stiffness, swelling, and limited joint mobility. Individuals with osteoarthritis could have some pain throughout their lives. According to the CDC, around fifteen million adults with arthritis have severe pain in their joints.

facetogenic neuropathic, osteoarthritis and headaches pain el paso tx.

Rheumatoid Arthritis

Rheumatoid arthritis causes continual aching that affects multiple joints. The hands, wrists, and knees are the most affected joints. Individuals with rheumatoid arthritis can present alternate symptoms, like joint stiffness, swelling, and fever.

Multiple Sclerosis

Multiple sclerosis is a disease of the brain and the spinal cord. What happens is the immune system targets and damages the protective covering of the nerves themselves. The brain can’t properly and effectively communicate with the body. Multiple sclerosis causes pain in the legs, feet, arms, and hands. Associated symptoms include burning, prickling, or stabbing pain just about every day. �

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Sciatica

Sciatica can cause mild to sharp, electrical burning pain that travels from the lower back through the buttocks to the back of the leg and even into the foot. Chronic sciatica lasts for three months or more. The condition is more common in adults age 40 and older.

Carpal Tunnel Syndrome

Carpal tunnel syndrome causes pain and numbness in the:

  • Hand
  • Wrist
  • Forearm
  • Thumb
  • Index finger
  • Middle finger
  • Ring finger

Common causes include:

Injury Trauma

Around half of the cases involving chronic pain are linked to physical trauma and injury. Individuals hospitalized after a serious injury often report chronic pain symptoms within the first year. Scientists are still unsure of how injuries lead to chronic pain. They believe several factors increase the risk. These include:

  • Pre-injury depression
  • Anxiety
  • Alcohol use
  • Family history of chronic pain

Individuals that have sustained multiple injuries are at higher risk for chronic pain. �

Spinal Injuries

One of the most common causes of chronic back pain. The lower back is the area likely to be affected. Certain types of chronic pain can have more than one cause. For example, general back pain could be caused by a single factor or a combination of factors like:

  • Poor posture
  • Improper lifting of heavy objects
  • Improper carrying of heavy objects
  • Being overweight places added strain on the back and knees
  • Abnormal curvature of the spine
  • Wearing high heels too often
  • Sleeping on a worn-out mattress
  • Degenerative disc changes

Combat Injuries

More than half of combat-related injuries are the result of explosions, from landmines, and shrapnel. Nearly all injured soldiers have to deal with some type of pain and many have a traumatic brain injury. A traumatic brain injury can cause chronic headaches. Delayed treatment and repeated injuries in injured soldiers make up for most chronic pain cases. �

11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain

Sports Injuries

Sports injuries and chronic pain is nothing new. Studies found that 1 in 2 football players deal with chronic pain in their retirement. This along with sleep problems and mild-severe depression. Both can contribute to chronic pain. Athletes are continuously exposed to high-risk injury situations. Having the pressure of performing optimally and winning can take a toll on an athlete’s health. �

Weight

Obesity does not directly cause chronic pain, but it does raise the risk. Around 40% of individuals that are obese also experience mild to severe chronic pain. Plus, individuals that are severely overweight are more likely to develop a condition that can cause chronic pain like diabetes, arthritis, and fibromyalgia. �

The source of chronic pain can be very complex. It can start with an injury or illness and develop slowly without the individual realizing it until it has become a full-blown chronic condition. This fact alone makes recommending a single course of treatment risky and is why health care providers recommend a number of different types of treatment options.


Chiropractic Care on Personal Injury

 


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

How Does Pain Become Chronic?

How Does Pain Become Chronic?

How does pain become chronic? Pain can be a complex condition, as it involves both physiological and psychological components. When an individual experiences an injury, the damaged tissues trigger and send pain signals to the brain. This is how the body alerts that there is something wrong, and thus prevents further damage. Those pain signals travel to the brain, stimulate the nerves, and cause a sensation known as pain.

 

11860 Vista Del Sol, Ste. 128 How Does Pain Become Chronic?

Nerves and the brain

Nerves control the body�s functions like the organs, sensation, and movement. The nervous system receives information and generates the correct response. Two major types of nerves are sensory and motor. Sensory nerves relay information like touch, temperature, and pain to the brain and spinal cord. Motor nerves relay signals from the brain back to the muscles, which causes them to contract voluntarily or reflexively.

The peripheral nervous system is the combined millions of nerves throughout the body. The peripheral nervous system’s nerves relay signals/messages to the central nervous system, which is comprised of the brain and spinal cord. �

When pain becomes chronic the brain fails to process these signals correctly and the individual continues to feel pain after the injury has healed or improved. As time goes on the nerves that send the pain signals are more methodical in their signaling. This means more signals than normally will be sent and are far more intense. Conditions like cancer and diabetes can cause tissue and nerve damage throughout the body.

Acute vs. Chronic

Acute pain has a short duration of around three months or less. The causes are usually clear and not as difficult to diagnose. The underlying factor/s like an injury is resolved the pain also goes away. As the pain is gone, the individual no longer has problems carrying out daily activities. A few causes of acute pain are:

  • Surgical procedures
  • Dental procedures
  • Bone fractures
  • Burns
  • Open wounds
  • Childbirth

Chronic pain is defined as pain that lasts three to six months with some conditions going for years. Individuals can experience chronic pain weeks and months possibly years after the injury took place. And it can happen without any apparent cause. Many cases often involve more than one factor. This causes significant problems with daily activities. When pain becomes chronic it is often associated with conditions like cancer, diabetes, and arthritis.

CP and CPS

Chronic pain is defined as any type of pain that persists for six months or longer. Chronic pain syndrome is a collection of conditions that are associated with chronic pain. These conditions can make the pain worse or cause other complications like sleep problems, anger, anxiety, and depression. �

11860 Vista Del Sol, Ste. 128 How Does Pain Become Chronic?

Causes

Doctors don’t know exactly what causes chronic pain syndrome. It often starts with an injury or painful condition such as:

  • Arthritis
  • Broken bones
  • Back pain
  • Cancer
  • Headaches
  • Joint problems
  • Muscle strains and sprains
  • Repetitive strain injuries
  • Fibromyalgia
  • Nerve injury/damage
  • Lyme disease
  • Ulcers
  • Inflammatory bowel disease
  • Irritable bowel syndrome
  • Surgery

Diagnosis

A doctor will go over an individual’s medical history, illnesses, or injuries that could have started the pain. They will ask questions to learn more about the type of pain being felt and how long. Questions can include:

  • When did the pain begin?
  • Where on the body does it hurt?
  • What does the pain feel like – Throbbing, Pounding, Shooting, Sharp, Pinching, Stinging, Burning
  • The severity of the pain on a scale of 1 to 10
  • What sets the pain off?
  • What makes it worse?
  • Have any treatments helped?

Imaging tests can show if there is joint damage or other problems:

  • Computed tomography is a powerful X-ray that generates detailed images.
  • Magnetic resonance imaging uses magnets and radio waves to take pictures of the organs and structures.
  • X-rays use radiation in very low doses to create images of the body’s structures.

Talk with a chiropractor to understand how a customized treatment plan for chronic pain is developed.


Chronic Hand Pain Treatment

 


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Chronic Pain and Chronic Pain Syndrome

Chronic Pain and Chronic Pain Syndrome

Chronic pain, depending on the cause, can last up to six months or even longer. Individuals with chronic pain can have physical effects that generate added stress on the body. This includes:

  • Tense muscles
  • Limited moveability
  • Lack of energy
  • Appetite change

Some examples of chronic pain are:

  • Arthritis pain
  • Cancer pain
  • Low back pain
  • Neurogenic pain comes from nerve damage to the brain or other areas of the body
  • Psychogenic pain comes from processing errors of pain signals in the brain.
11860 Vista Del Sol, Ste. 128 Chronic Pain and Chronic Pain Syndrome

Common Complaint

Chronic pain is a common complaint nowadays, especially from older individuals. And it is possible for an individual to have more than one chronic pain condition at a time. Some conditions that can cause chronic pain include:

Chronic Fatigue Syndrome

This causes extreme fatigue and pain that comes out of nowhere.

Endometriosis

This is a painful condition in females, where the cells that line the inside of the uterus, instead grow outside.

Fibromyalgia

This causes widespread pain throughout the body.

Inflammatory Bowel Disease

This is a long-term disorder that can cause inflammation in the digestive tract.

Interstitial Cystitis

This causes mild to severe pain in the bladder.

Temporomandibular Joint Dysfunction

This causes severe pain and stiffness in the jaw.

Effects: Physical and Mental

Long-term pain can severely affect work, everyday activities, and social life. It’s common for individuals to have problems with sleep, appetite, concentration, and mobility. These individuals are more likely to be depressed, anxious, and irritable. Chronic pain increases the risk of anxiety and mood disorders. �

11860 Vista Del Sol, Ste. 128 Chronic Pain and Chronic Pain Syndrome

Chronic pain syndrome is both physical and mental

Around twenty-five percent of individuals with chronic pain will continue with a condition known as chronic pain syndrome. Emotional effects that accompany chronic pain often include depression, anger, anxiety, and a fear of re-injury. This type of fear can limit an individual’s ability to return to regular work and activities.

Experts believe that there is a problem with the nerve/s system and glands used to handle stress. This makes them feel pain differently. Other experts believe that chronic pain syndrome is a learned response. This is because when in pain, individuals have a tendency to repeat bad behaviors even after the pain is gone or has reduced.

Research suggests that psychological problems on their own are not behind chronic pain syndrome. It appears to be linked to abnormalities between specific glands including the hypothalamus, pituitary, adrenal glands, and the nervous system. The abnormalities control reactions to stress, injury, and trauma. This could explain why people experience pain differently. Understanding chronic pain means understanding the anatomy of the nervous system, which is highly complex. Through the nerves, the nervous system transmits messages to and from the brain. �

cranial el paso tx.

It can affect people of all ages and sexes, but it’s most common in women. Interference in an individuals’ daily life can take a tremendous toll. Chronic pain syndrome can be challenging to treat, but it is possible.

Optimally, this will be a combination of treatments like psychological counseling for anxiety, depression, etc. Physical therapy combined with chiropractic treatments to realign the spine and work out tight and tense muscles, joints, ligaments and keep them loose, along with relaxation techniques will help relieve the pain and the other symptoms.


Chronic Pain Rehabilitation


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

Chronic Pain Throughout the United States

Chronic Pain Throughout the United States

Chronic pain is pain that does not stop and persists for weeks, months, and years. It also describes pain that continues long after the injury that caused the pain has healed. It affects millions of people with debilitating side-effects that can range from low-self esteem, depression, anger. Chronic pain costs over $600 billion each year.

Pain is subjective and is different for everyone. Regardless of how severe it is, pain that goes on for a long period can be crippling. The United States population reports having more pain than people in other countries. One in three Americans says that they experience pain often and very often. There are individuals that experience severe pain every day. �

 

11860 Vista Del Sol, Ste. 128 Chronic Pain Throughout the United States

Definition

The International Association for the Study of Pain defines pain as:

�An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.� IASP Terminology

For the layman, pain is a highly discomforting experience. It can be brought on from an injury or could be the brain is having problems processing pain signals correctly. Pain can vary in its:

  • Severity
  • Time/s when it presents
  • Location
  • Involvement of other areas of the body

Pain could be limited to where the injury occurred, but pain could affect the whole body. Terms to describe pain include:

  • Aching
  • Burning
  • Cramping
  • Dull
  • Electric
  • Intense
  • Sharp
  • Shooting
  • Stabbing
11860 Vista Del Sol, Ste. 128 Chronic Pain Throughout the United States

Causes

What causes chronic pain is not always clear and can be challenging to diagnose the root cause. There are possibilities like:

  • Injury – Even after an injury has healed, the nerves can still send pain signals to the brain. Medical experts are unsure why this happens.
  • Disease – There are conditions that can cause chronic pain. Fibromyalgia, osteoarthritis, headaches, and shingles are a few examples.
  • Nerve issues/problems – the nerves of the nervous system can be injured themselves. This type is known as neuropathic pain.
  • Unknown/Other – Pain can develop, even with no obvious injury, disease, or nerve problem.

Chronic pain is biological. As nerve impulses keep signaling to the brain. This combined with social and psychological factors can impact an individual’s treatment and health. An example is having negative emotion/s like anxiety. Emotions like this have a tendency to aggravate and exacerbate chronic pain. �

� Those who just think about their pain and discomfort seem to have greater disability than those who try to work through it and stay positive. It’s the same with work-related injuries in the United States, where those who don’t like their jobs have a much more difficult time recovering compared with those who like their jobs.

This is why the referral of a psychologist could be part of the treatment plan. A psychologist can educate a patient on how to use various relaxation techniques/tools. This can help them see and understand their pain and learn how to best combat the pain.

Living with chronic pain in the United States

Life changes are an essential part of effective treatment for chronic pain. Proper regular sleep is a must, as the body needs to heal itself and during the sleep cycle is when it happens. Living with chronic pain is a very challenging and difficult task. Taking care of yourself is the main objective.

Proper sleep, a healthy diet, moderate exercise, stress management, and proper treatment will get an individual back to as normal a life as possible with chronic pain. The aim for individuals is to figure out/learn everything they can about what is causing the pain. Understand the limits and work within them. Keep an open mind and try new ways to manage the pain. Research scientists believe that major advances in neuro medicine will generate more and better treatments for chronic pain.


Depression & Chronic pain

 

 


 

Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas& New Mexico*

What is Degenerative Disc Disease (DDD)?: An Overview

What is Degenerative Disc Disease (DDD)?: An Overview

Degenerative Disc Disease is a general term for a condition in which the damaged intervertebral disc causes chronic pain, which could be either low back pain in the lumbar spine or neck pain in the cervical spine. It is not a �disease� per se, but actually a breakdown of an intervertebral disc of the spine. The intervertebral disc is a structure that has a lot of attention being focused on recently, due to its clinical implications. The pathological changes that can occur in disc degeneration include fibrosis, narrowing, and disc desiccation. Various anatomical defects can also occur in the intervertebral disc such as sclerosis of the endplates, fissuring and mucinous degeneration of the annulus, and the formation of osteophytes.

 

Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative changes in the disk. Back pain is the second leading cause of the visit to the clinician in the USA. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. (Modic, Michael T., and Jeffrey S. Ross) Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition.

 

Anatomy of Related Structures

 

Anatomy of the Spine

 

The spine is the main structure, which maintains the posture and gives rise to various problems with disease processes. The spine is composed of seven cervical vertebrae, twelve thoracic vertebrae, five lumbar vertebrae, and fused sacral and coccygeal vertebrae. The stability of the spine is maintained by three columns.

 

The anterior column is formed by anterior longitudinal ligament and the anterior part of the vertebral body. The middle column is formed by the posterior part of the vertebral body and the posterior longitudinal ligament. The posterior column consists of a posterior body arch that has transverse processes, laminae, facets, and spinous processes. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)

 

Anatomy of the Intervertebral Disc

 

Intervertebral disc lies between two adjacent vertebral bodies in the vertebral column. About one-quarter of the total length of the spinal column is formed by intervertebral discs. This disc forms a fibrocartilaginous joint, also called a symphysis joint. It allows a slight movement in the vertebrae and holds the vertebrae together. Intervertebral disc is characterized by its tension resisting and compression resisting qualities. An intervertebral disc is composed of mainly three parts; inner gelatinous nucleus pulposus, outer annulus fibrosus, and cartilage endplates that are located superiorly and inferiorly at the junction of vertebral bodies.

 

Nucleus pulposus is the inner part that is gelatinous. It consists of proteoglycan and water gel held together by type II Collagen and elastin fibers arranged loosely and irregularly. Aggrecan is the major proteoglycan found in the nucleus pulposus. It comprises approximately 70% of the nucleus pulposus and nearly 25% of the annulus fibrosus. It can retain water and provides the osmotic properties, which are needed to resist compression and act as a shock absorber. This high amount of aggrecan in a normal disc allows the tissue to support compressions without collapsing and the loads are distributed equally to annulus fibrosus and vertebral body during movements of the spine. (Wheater, Paul R, et al.)

 

The outer part is called annulus fibrosus, which has abundant type I collagen fibers arranged as a circular layer. The collagen fibers run in an oblique fashion between lamellae of the annulus in alternating directions giving it the ability to resist tensile strength. Circumferential ligaments reinforce the annulus fibrosus peripherally. On the anterior aspect, a thick ligament further reinforces annulus fibrosus and a thinner ligament reinforces the posterior side. (Choi, Yong-Soo)

 

Usually, there is one disc between every pair of vertebrae except between atlas and axis, which are first and second cervical vertebrae in the body. These discs can move about 6? in all the axes of movement and rotation around each axis. But this freedom of movement varies between different parts of the vertebral column. The cervical vertebrae have the greatest range of movement because the intervertebral discs are larger and there is a wide concave lower and convex upper vertebral body surfaces. They also have transversely aligned facet joints. Thoracic vertebrae have the minimum range of movement in flexion, extension, and rotation, but have free lateral flexion as they are attached to the rib cage. The lumbar vertebrae have good flexion and extension, again, because their intervertebral discs are large and spinous processes are posteriorly located. However, lateral lumbar rotation is limited because the facet joints are located sagittally. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology�)

 

Blood Supply

 

The intervertebral disc is one of the largest avascular structures in the body with capillaries terminating at the endplates. The tissues derive nutrients from vessels in the subchondral bone which lie adjacent to the hyaline cartilage at the endplate. These nutrients such as oxygen and glucose are carried to the intervertebral disc through simple diffusion. (�Intervertebral Disc � Spine � Orthobullets.Com�)

 

Nerve Supply

 

Sensory innervation of intervertebral discs is complex and varies according to the location in the spinal column. Sensory transmission is thought to be mediated by substance P, calcitonin, VIP, and CPON. Sinu vertebral nerve, which arises from the dorsal root ganglion, innervates the superficial fibers of the annulus. Nerve fibers don�t extend beyond the superficial fibers.

 

Lumbar intervertebral discs are additionally supplied on the posterolateral aspect with branches from ventral primary rami and from the grey rami communicantes near their junction with the ventral primary rami. The lateral aspects of the discs are supplied by branches from rami communicantes. Some of the rami communicantes may cross the intervertebral discs and become embedded in the connective tissue, which lies deep to the origin of the psoas. (Palmgren, Tove, et al.)

 

The cervical intervertebral discs are additionally supplied on the lateral aspect by branches of the vertebral nerve. The cervical sinu vertebral nerves were also found to be having an upward course in the vertebral canal supplying the disc at their point of entry and the one above. (BOGDUK, NIKOLAI, et al.)

 

Pathophysiology of Degenerative Disc Disease

 

Approximately 25% of people before the age of 40 years show disc degenerative changes at some level. Over 40 years of age, MRI evidence shows changes in more than 60% of people. (Suthar, Pokhraj) Therefore, it is important to study the degenerative process of the intervertebral discs as it has been found to degenerate faster than any other connective tissue in the body, leading to back and neck pain. The changes in three intervertebral discs are associated with changes in the vertebral body and joints suggesting a progressive and dynamic process.

 

Degeneration Phase

 

The degenerative process of the intervertebral discs has been divided into three stages, according to Kirkaldy-Willis and Bernard, called ��degenerative cascade��. These stages can overlap and can occur over the course of decades. However, identifying these stages clinically is not possible due to the overlap of symptoms and signs.

 

Stage 1 (Degeneration Phase)

 

This stage is characterized by degeneration. There are histological changes, which show circumferential tears and fissures in the annulus fibrosus. These circumferential tears may turn into radial tears and because the annulus pulposus is well innervated, these tears can cause back pain or neck pain, which is localized and with painful movements. Due to repeated trauma in the discs, endplates can separate leading to disruption of the blood supply to the disc and therefore, depriving it of its nutrient supply and removal of waste. The annulus may contain micro-fractures in the collagen fibrils, which can be seen on electron microscopy and an MRI scan may reveal desiccation, bulging of the disc, and a high-intensity zone in the annulus. Facet joints may show a synovial reaction and it may cause severe pain with associated synovitis and inability to move the joint in the zygapophyseal joints. These changes may not necessarily occur in every person. (Gupta, Vijay Kumar, et al.)

 

The nucleus pulposus is also involved in this process as its water imbibing capacity is reduced due to the accumulation of biochemically changed proteoglycans. These changes are brought on mainly by two enzymes called matrix metalloproteinase-3 (MMP-3) and tissue inhibitor of metalloproteinase-1 (TIMP-1). (Bhatnagar, Sushma, and Maynak Gupta) Their imbalance leads to the destruction of proteoglycans. The reduced capacity to absorb water leads to a reduction of hydrostatic pressure in the nucleus pulposus and causes the annular lamellae to buckle. This can increase the mobility of that segment resulting in shear stress to the annular wall. All these changes can lead to a process called annular delamination and fissuring in the annulus fibrosus. These are two separate pathological processes and both can lead to pain, local tenderness, hypomobility, contracted muscles, painful joint movements. However, the neurological examination at this stage is usually normal.

 

Stage 2 (Phase of Instability)

 

The stage of dysfunction is followed by a stage of instability, which may result from the progressive deterioration of the mechanical integrity of the joint complex. There may be several changes encountered at this stage, including disc disruption and resorption, which can lead to a loss of disc space height. Multiple annular tears may also occur at this stage with concurrent changes in the zagopophyseal joints. They may include degeneration of the cartilage and facet capsular laxity leading to subluxation. These biomechanical changes result in instability of the affected segment.

 

The symptoms seen in this phase are similar to those seen in the dysfunction phase such as �giving way� of the back, pain when standing for prolonged periods, and a �catch� in the back with movements. They are accompanied by signs such as abnormal movements in the joints during palpation and observing that the spine sways or shifts to a side after standing erect for sometime after flexion. (Gupta, Vijay Kumar et al.)

 

Stage 3 (Re-Stabilization Phase)

 

In this third and final stage, the progressive degeneration leads to disc space narrowing with fibrosis and osteophyte formation and transdiscal bridging. The pain arising from these changes is severe compared to the previous two stages, but these can vary between individuals. This disc space narrowing can have several implications on the spine. This can cause the intervertebral canal to narrow in the superior-inferior direction with the approximation of the adjacent pedicles. Longitudinal ligaments, which support the vertebral column, may also become deficient in some areas leading to laxity and spinal instability. The spinal movements can cause the ligamentum flavum to bulge and can cause superior aricular process subluxation. This ultimately leads to a reduction of diameter in the anteroposterior direction of the intervertebral space and stenosis of upper nerve root canals.

 

Formation of osteophytes and hypertrophy of facets can occur due to the alteration in axial load on the spine and vertebral bodies. These can form on both superior and inferior articular processes and osteophytes can protrude to the intervertebral canal while the hypertrophied facets can protrude to the central canal. Osteophytes are thought to be made from the proliferation of articular cartilage at the periosteum after which they undergo endochondral calcification and ossification. The osteophytes are also formed due to the changes in oxygen tension and due to changes in fluid pressure in addition to load distribution defects. The osteophytes and periarticular fibrosis can result in stiff joints. The articular processes may also orient in an oblique direction causing retrospondylolisthesis leading to the narrowing of the intervertebral canal, nerve root canal, and the spinal canal. (KIRKALDY-WILLIS, W H et al.)

 

All of these changes lead to low back pain, which decreases with severity. Other symptoms like reduced movement, muscle tenderness, stiffness, and scoliosis can occur. The synovial stem cells and macrophages are involved in this process by releasing growth factors and extracellular matrix molecules, which act as mediators. The release of cytokines has been found to be associated with every stage and may have therapeutic implications in future treatment development.

 

Etiology of the Risk Factors of Degenerative Disc Disease

 

Aging and Degeneration

 

It is difficult to differentiate aging from degenerative changes. Pearce et al have suggested that aging and degeneration is representing successive stages within a single process that occur in all individuals but at different rates. Disc degeneration, however, occurs most often at a faster rate than aging. Therefore, it is encountered even in patients of working age.

 

There appears to be a relationship between aging and degeneration, but no distinct cause has yet been established. Many studies have been conducted regarding nutrition, cell death, and accumulation of degraded matrix products and the failure of the nucleus. The water content of the intervertebral disc decreases with the increasing age. Nucleus pulposus can get fissures that can extend into the annulus fibrosus. The start of this process is termed chondrosis inter vertebralis, which can mark the beginning of the degenerative destruction of the intervertebral disc, the endplates, and the vertebral bodies. This process causes complex changes in the molecular composition of the disc and has biomechanical and clinical sequelae that can often result in substantial impairment in the affected individual.

 

The cell concentration in the annulus decreases with increasing age. This is mainly because the cells in the disc are subjected to senescence and they lose the ability to proliferate. Other related causes of age-specific degeneration of intervertebral discs include cell loss, reduced nutrition, post-translational modification of matrix proteins, accumulation of products of degraded matrix molecules, and fatigue failure of the matrix. Decreasing nutrition to the central disc, which allows the accumulation of cell waste products and degraded matrix molecules seems to be the most important change out of all these changes. This impairs nutrition and causes a fall in the pH level, which can further compromise cell function and may lead to cell death. Increased catabolism and decreased anabolism of senescent cells may promote degeneration. (Buckwalter, Joseph A.) According to one study, there were more senescence cells in the nucleus pulposus compared to annulus fibrosus and herniated discs had a higher chance of cell senescence.� (Roberts, S. et al.)

 

When the aging process goes on for some time, the concentrations of chondroitin 4 sulfate and chondroitin 5 sulfate, which is strongly hydrophilic, gets decreased while the keratin sulfate to chondroitin sulfate ratio gets increased. Keratan sulfate is mildly hydrophilic and it also has a minor tendency to form stable aggregates with hyaluronic acid. As aggrecan is fragmented, and its molecular weight and numbers are decreased, the viscosity and hydrophilicity of the nucleus pulposus decrease. Degenerative changes to the intervertebral discs are accelerated by the reduced hydrostatic pressure of the nucleus pulposus and the decreased supply of nutrients by diffusion. When the water content of the extracellular matrix is decreased, intervertebral disc height will also be decreased. The resistance of the disc to an axial load will also be reduced. Because the axial load is then transferred directly to the annulus fibrosus, annulus clefts can get torn easily.

 

All these mechanisms lead to structural changes seen in degenerative disc disease. Due to the reduced water content in the annulus fibrosus and associated loss of compliance, the axial load can get redistributed to the posterior aspect of facets instead of the normal anterior and middle part of facets. This can cause facet arthritis, hypertrophy of the adjacent vertebral bodies, and bony spurs or bony overgrowths, known as osteophytes, as a result of degenerative discs. (Choi, Yong-Soo)

 

Genetics and Degeneration

 

The genetic component has been found to be a dominant factor in degenerative disc disease. Twin studies, and studies involving mice, have shown that genes play a role in disc degeneration. (Boyd, Lawrence M., et al.) Genes that code for collagen I, IX, and XI, interleukin 1, aggrecan, vitamin D receptor, matrix metalloproteinase 3 (MMP � 3), and other proteins are among the genes that are suggested to be involved in degenerative disc disease. Polymorphisms in 5 A and 6 A alleles occurring in the promoter region of genes that regulate MMP 3 production are found to be a major factor for the increased lumbar disc degeneration in the elderly population. Interactions among these various genes contribute significantly to intervertebral disc degeneration disease as a whole.

 

Nutrition and Degeneration

 

Disc degeneration is also believed to occur due to the failure of nutritional supply to the intervertebral disc cells. Apart from the normal aging process, the nutritional deficiency of the disc cells is adversely affected by endplate calcification, smoking, and the overall nutritional status. Nutritional deficiency can lead to the formation of lactic acid together with the associated low oxygen pressure. The resulting low pH can affect the ability of disc cells to form and maintain the extracellular matrix of the discs and causes intervertebral disc degeneration. The degenerated discs lack the ability to respond normally to the external force and may lead to disruptions even from the slightest back strain. (Taher, Fadi, et al.)

 

Growth factors stimulate the chondrocytes and fibroblasts to produce more amount of extracellular matrix. It also inhibits the synthesis of matrix metalloproteinases. Example of these growth factors includes transforming growth factor, insulin-like growth factor, and basic fibroblast growth factor. The degraded matrix is repaired by an increased level of transforming growth factor and basic fibroblast growth factor.

 

Environment and Degeneration

 

Even though all the discs are of the same age, discs found in the lower lumbar segments are more vulnerable to degenerative changes than the discs found in the upper segment. This suggests that not only aging but, also mechanical loading, is a causative factor. The association between degenerative disc disease and environmental factors has been defined in a comprehensive manner by Williams and Sambrook in 2011. (Williams, F.M.K., and P.N. Sambrook) The heavy physical loading associated with your occupation is a risk factor that has some contribution to disc degenerative disease. There is also a possibility of chemicals causing disc degeneration, such as smoking, according to some studies. (Batti�, Michele C.) Nicotine has been implicated in twin studies to cause impaired blood flow to the intervertebral disc, leading to disc degeneration. (BATTI�, MICHELE C., et al.) Moreover, an association has been found among atherosclerotic lesions in the aorta and the low back pain citing a link between atherosclerosis and degenerative disc disease. (Kauppila, L.I.) The disc degeneration severity was implicated in overweight, obesity, metabolic syndrome, and increased body mass index in some studies. (�A Population-Based Study Of Juvenile Disc Degeneration And Its Association With Overweight And Obesity, Low Back Pain, And Diminished Functional Status. Samartzis D, Karppinen J, Mok F, Fong DY, Luk KD, Cheung KM. J Bone Joint Surg Am 2011;93(7):662�70�)

 

Pain in Disc Degeneration (Discogenic Pain)

 

Discogenic pain, which is a type of nociceptive pain, arises from the nociceptors in the annulus fibrosus when the nervous system is affected by the degenerative disc disease. Annulus fibrosus contains immune reactive nerve fibers in the outer layer of the disc with other chemicals such as a vasoactive intestinal polypeptide, calcitonin gene-related peptide, and substance P. (KONTTINEN, YRJ� T., et al.) When degenerative changes in the intervertebral discs occur, normal structure and mechanical load are changed leading to abnormal movements. These disc nociceptors can get abnormally sensitized to mechanical stimuli. The pain can also be provoked by the low pH environment caused by the presence of lactic acid, causing increased production of pain mediators.

 

Pain from degenerative disc disease may arise from multiple origins. It may occur due to the structural damage, pressure, and irritation on the nerves in the spine. The disc itself contains only a few nerve fibers, but any injury can sensitize these nerves, or those in the posterior longitudinal ligament, to cause pain. Micro movements in the vertebrae can occur, which may cause painful reflex muscle spasms because the disc is damaged and worn down with the loss of tension and height. The painful movements arise because the nerves supplying the area are compressed or irritated by the facet joints and ligaments in the foramen leading to leg and back pain. This pain may be aggravated by the release of inflammatory proteins that act on nerves in the foramen or descending nerves in the spinal canal.

 

Pathological specimens of the degenerative discs, when observed under the microscope, reveals that there are vascularized granulation tissue and extensive innervations found in the fissures of the outer layer of the annulus fibrosus extending into the nucleus pulposus. The granulation tissue area is infiltrated by abundant mast cells and they invariably contribute to the pathological processes that ultimately lead to discogenic pain. These include neovascularisation, intervertebral disc degeneration, disc tissue inflammation, and the formation of fibrosis. Mast cells also release substances, such as tumor necrosis factor and interleukins, which might signal for the activation of some pathways which play a role in causing back pain. Other substances that can trigger these pathways include phospholipase A2, which is produced from the arachidonic acid cascade. It is found in increased concentrations in the outer third of the annulus of the degenerative disc and is thought to stimulate the nociceptors located there to release inflammatory substances to trigger pain. These substances bring about axonal injury, intraneural edema, and demyelination. (Brisby, Helena)

 

The back pain is thought to arise from the intervertebral disc itself. Hence why the pain will decrease gradually over time when the degenerating disc stops inflicting pain. However, the pain actually arises from the disc itself only in 11% of patients according to endoscopy studies. The actual cause of back pain seems to be due to the stimulation of the medial border of the nerve and referred pain along the arm or leg seems to arise due to the stimulation of the core of the nerve. The treatment for disc degeneration should mainly focus on pain relief to reduce the suffering of the patient because it is the most disabling symptom that disrupts a patient�s lives. Therefore, it is important to establish the mechanism of pain because it occurs not only due to the structural changes in the intervertebral discs but also due to other factors such as the release of chemicals and understanding these mechanisms can lead to effective pain relief. (Choi, Yong-Soo)

 

Clinical Presentation of Degenerative Disc Disease

 

Patients with degenerative disc disease face a myriad of symptoms depending on the site of the disease. Those who have lumbar disc degeneration get low back pain, radicular symptoms, and weakness. Those who have cervical disc degeneration have neck pain and shoulder pain.

 

Low back pain can get exacerbated by the movements and the position. Usually, the symptoms are worsened by the flexion, while the extension often relieves them. Minor twisting injuries, even from swinging a golf club, can trigger the symptoms. The pain is usually observed to be less when walking or running, when changing the position frequently and when lying down. However, the pain is usually subjective and in many cases, it varies considerably from person to person and most people will suffer from a low level of chronic pain of the lower back region continuously while occasionally suffering from the groin, hip, and leg pain. The intensity of the pain will increase from time to time and will last for a few days and then subside gradually. This �flare-up� is an acute episode and needs to be treated with potent analgesics. Worse pain is experienced in the seated position and is exacerbated while bending, lifting, and twisting movements frequently. The severity of the pain can vary considerably with some having occasional nagging pain to others having severe and disabling pain intermittently.� (Jason M. Highsmith, MD)

 

The localized pain and tenderness in the axial spine usually arises from the nociceptors found within the intervertebral discs, facet joints, sacroiliac joints, dura mater of the nerve roots, and the myofascial structures found within the axial spine. As mentioned in the previous sections, the degenerative anatomical changes may result in a narrowing of the spinal canal called spinal stenosis, overgrowth of spinal processes called osteophytes, hypertrophy of the inferior and superior articular processes, spondylolisthesis, bulging of the ligamentum flavum and disc herniation. These changes result in a collection of symptoms that is known as neurogenic claudication. There may be symptoms such as low back pain and leg pain together with numbness or tingling in the legs, muscle weakness, and foot drop. Loss of bowel or bladder control may suggest spinal cord impingement and prompt medical attention is needed to prevent permanent disabilities. These symptoms can vary in severity and may present to varying extents in different individuals.

 

The pain can also radiate to other parts of the body due to the fact that the spinal cord gives off several branches to two different sites of the body. Therefore, when the degenerated disc presses on a spinal nerve root, the pain can also be experienced in the leg to which the nerve ultimately innervates. This phenomenon, called radiculopathy, can occur from many sources arising, due to the process of degeneration. The bulging disc, if protrudes centrally, can affect descending rootlets of the cauda equina, if it bulges posterolaterally, it might affect the nerve roots exiting at the next lower intervertebral canal and the spinal nerve within its ventral ramus can get affected when the disc protrudes laterally. Similarly, the osteophytes protruding along the upper and lower margins of the posterior aspect of vertebral bodies can impinge on the same nervous tissues causing the same symptoms. Superior articular process hypertrophy may also impinge upon nerve roots depending on their projection. The nerves may include nerve roots prior to exiting from the next lower intervertebral canal and nerve roots within the upper nerve root canal and dural sac. These symptoms, due to the nerve impingement, have been proven by cadaver studies. Neural compromise is thought to occur when the neuro foraminal diameter is critically occluded with a 70% reduction. Furthermore, neural compromise can be produced when the posterior disc is compressed less than 4 millimeters in height, or when the foraminal height is reduced to less than 15 millimeters leading to foraminal stenosis and nerve impingement. (Taher, Fadi, et al.)

 

Diagnostic Approach

 

Patients are initially evaluated with an accurate history and thorough physical examination and appropriate investigations and provocative testing. However, history is often vague due to the chronic pain which cannot be localized properly and the difficulty in determining the exact anatomical location during provocative testing due to the influence of the neighboring anatomical structures.

 

Through the patient�s history, the cause of low back pain can be identified as arising from the nociceptors in the intervertebral discs. Patients may also give a history of the chronic nature of the symptoms and associated gluteal region numbness, tingling as well as stiffness in the spine which usually worsens with activity. Tenderness may be elicited by palpating over the spine. Due to the nature of the disease being chronic and painful, most patients may be suffering from mood and anxiety disorders. Depression is thought to be contributing negatively to the disease burden. However, no clear relationship between disease severity and mood or anxiety disorders. It is good to be vigilant about these mental health conditions as well. In order to exclude other serious pathologies, questions must be asked regarding fatigue, weight loss, fever, and chills, which might indicate some other diseases. (Jason M. Highsmith, MD)

 

Another etiology for the low back pain has to be excluded when examining the patient for degenerative disc disease. Abdominal pathologies, which can give rise to back pain such as aortic aneurysm, renal calculi, and pancreatic disease, have to be excluded.

 

Degenerative disc disease has several differential diagnoses to be considered when a patient presents with back pain. These include; idiopathic low back pain, zygapophyseal joint degeneration, myelopathy, lumbar stenosis, spondylosis, osteoarthritis, and lumbar radiculopathy. (�Degenerative Disc Disease � Physiopedia�)

 

Investigations

 

Investigations are used to confirm the diagnosis of degenerative disc disease. These can be divided into laboratory studies, imaging studies, nerve conduction tests, and diagnostic procedures.

 

Imaging Studies

 

The imaging in degenerative disc disease is mainly used to describe anatomical relations and morphological features of the affected discs, which has a great therapeutic value in future decision making for treatment options. Any imaging method, like plain radiography, CT, or MRI, can provide useful information. However, an underlying cause can only be found in 15% of the patients as no clear radiological changes are visible in degenerative disc disease in the absence of disc herniation and neurological deficit. Moreover, there is no correlation between the anatomical changes seen on imaging and the severity of the symptoms, although there are correlations between the number of osteophytes and the severity of back pain. Degenerative changes in radiography can also be seen in asymptomatic people leading to difficulty in conforming clinical relevance and when to start treatment. (�Degenerative Disc Disease � Physiopedia�)

 

Plain Radiography

 

This inexpensive and widely available plain cervical radiography can give important information on deformities, alignment, and degenerative bony changes. In order to determine the presence of spinal instability and sagittal balance, dynamic flexion, or extension studies have to be performed.

 

Magnetic Resonance Imaging (MRI)

 

MRI is the most commonly used method to diagnose degenerative changes in the intervertebral disc accurately, reliably, and most comprehensively. It is used in the initial evaluation of patients with neck pain after plain radiography. It can provide non-invasive images in multiple plains and gives excellent quality images of the disc. MRI can show disc hydration and morphology-based on the proton density, chemical environment, and the water content. Clinical picture and history of the patient have to be considered when interpreting MRI reports as it has been shown that as much as 25% of radiologists change their report when the clinical data are available. Fonar produced the first open MRI scanner with the ability of the patient to be scanned in different positions such as standing, sitting, and bending. Because of these unique features, this open MRI scanner can be used for scanning patients in weight-bearing postures and stand up postures to detect underlying pathological changes which are usually overlooked in conventional MRI scan such as lumbar degenerative disc disease with herniation. This machine is also good for claustrophobic patients, as they get to watch a large television screen during the scanning process. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Nucleus pulposus and annulus fibrosus of the disc can usually be identified on MRI, leading to the detection of disc herniation as contained and non contained. As MRI can also show annular tears and the posterior longitudinal ligament, it can be used to classify herniation. This can be simple annular bulging to free fragment disc herniations. This information can describe the pathologic discs such as extruded disc, protruded discs, and migrated discs.

 

There are several grading systems based on MRI signal intensity, disc height, the distinction between nucleus and annulus, and the disc structure. The method, by Pfirrmann et al, has been widely applied and clinically accepted. According to the modified system, there are 8 grades for lumbar disc degenerative disease. Grade 1 represents normal intervertebral disc and grade 8 corresponds to the end stage of degeneration, depicting the progression of the disc disease. There are corresponding images to aid the diagnosis. As they provide good tissue differentiation and detailed description of the disc structure, sagittal T2 weighted images are used for the classification purpose. (Pfirrmann, Christian W. A., et al.)

 

Modic has described the changes occurring in the vertebral bodies adjacent to the degenerating discs as Type 1 and Type 2 changes. In Modic 1 changes, there is decreased intensity of T1 weighted images and increased intensity T2 weighted images. This is thought to occur because the end plates have undergone sclerosis and the adjacent bone marrow is showing inflammatory response as the diffusion coefficient increases. This increase of diffusion coefficient and the ultimate resistance to diffusion is brought about by the chemical substances released through an autoimmune mechanism. Modic type 2 changes include the destruction of the bone marrow of adjacent vertebral endplates due to an inflammatory response and the infiltration of fat in the marrow. These changes may lead to increased signal density on T1 weighted images. (Modic, M T et al.)

 

Computed Tomography (CT)

 

When MRI is not available, Computed tomography is considered a diagnostic test that can detect disc herniation because it has a better contrast between posterolateral margins of the adjacent bony vertebrae, perineal fat, and the herniated disc material. Even so, when diagnosing lateral herniations, MRI remains the imaging modality of choice.

 

CT scan has several advantages over MRI such as it has a less claustrophobic environment, low cost, and better detection of bonny changes that are subtle and may be missed on other modalities. CT can detect early degenerative changes of the facet joints and spondylosis with more accuracy. Bony integrity after fusion is also best assessed by CT.

 

Disc herniation and associated nerve impingement can be diagnosed by using the criteria developed by Gundry and Heithoff. It is important for the disc protrusion to lie directly over the nerve roots traversing the disc and to be focal and asymmetrical with a dorsolateral position. There should be demonstrable nerve root compression or displacement. Lastly, the nerve distal to the impingement (site of herniation) often enlarges and bulges with resulting edema, prominence of adjacent epidural veins, and inflammatory exudates resulting in blurring the margin.

 

Lumbar Discography

 

This procedure is controversial and, whether knowing the site of the pain has any value regarding surgery or not, has not been proven. False positives can occur due to central hyperalgesia in patients with chronic pain (neurophysiologic finding) and due to psychosocial factors. It is questionable to establish exactly when discogenic pain becomes clinically significant. Those who support this investigation advocates strict criteria for selection of the patients and when interpreting results and believe this is the only test that can diagnose discogenic pain. Lumbar discography can be used in several situations, although it is not scientifically established. These include; diagnosis of lateral herniation, diagnosing a symptomatic disc among multiple abnormalities, assessing similar abnormalities seen on CT or MRI, evaluation of the spine after surgery, selection of fusion level, and the suggestive features of discogenic pain existence.

 

The discography is more concerned about eliciting pathophysiology rather than determining the anatomy of the disc. Therefore, discogenic pain evaluation is the aim of discography. MRI may reveal an abnormally looking disc with no pain, while severe pain may be seen on discography where MRI findings are few. During the injection of normal saline or the contrast material, a spongy endpoint can occur with abnormal discs accepting more amounts of contrast. The contrast material can extend into the nucleus pulposus through tears and fissures in the annulus fibrosus in the abnormal discs. The pressure of this contrast material can provoke pain due to the innervations by recurrent meningeal nerve, mixed spinal nerve, anterior primary rami, and gray rami communicantes supplying the outer annulus fibrosus. Radicular pain can be provoked when the contrast material reaches the site of nerve root impingement by the abnormal disc. However, this discography test has several complications such as nerve root injury, chemical or bacterial diskitis, contrast allergy, and the exacerbation of pain. (Bartynski, Walter S., and A. Orlando Ortiz)

 

Imaging Modality Combination

 

In order to evaluate the nerve root compression and cervical stenosis adequately, a combination of imaging methods may be needed.

 

CT Discography

 

After performing initial discography, CT discography is performed within 4 hours. It can be used in determining the status of the disc such as herniated, protruded, extruded, contained or sequestered. It can also be used in the spine to differentiate the mass effects of scar tissue or disc material after spinal surgery.

 

CT Myelography

 

This test is considered the best method for evaluating nerve root compression. When CT is performed in combination or after myelography, details about bony anatomy different planes can be obtained with relative ease.

 

Diagnostic Procedures

 

Transforaminal Selective Nerve Root Blocks (SNRBs)

 

When multilevel degenerative disc disease is suspected on an MRI scan, this test can be used to determine the specific nerve root that has been affected. SNRB is both a diagnostic and therapeutic test that can be used for lumbar spinal stenosis. The test creates a demotomal level area of hypoesthesia by injecting an anesthetic and a contrast material under fluoroscopic guidance to the interested nerve root level. There is a correlation between multilevel cervical degenerative disc disease clinical symptoms and findings on MRI and findings of SNRB according to Anderberg et al. There is a 28% correlation with SNRB results and with dermatomal radicular pain and areas of neurologic deficit. Most severe cases of degeneration on MRI are found to be correlated with 60%. Although not used routinely, SNRB is a useful test in evaluating patients before surgery in multilevel degenerative disc disease especially on the spine together with clinical features and findings on MRI. (Narouze, Samer, and Amaresh Vydyanathan)

 

Electro Myographic Studies

 

Distal motor and sensory nerve conduction tests, called electromyographic studies, that are normal with abnormal needle exam may reveal nerve compression symptoms that are elicited in the clinical history. Irritated nerve roots can be localized by using injections to anesthetize the affected nerves or pain receptors in the disc space, sacroiliac joint, or the facet joints by discography. (�Journal Of Electromyography & Kinesiology Calendar�)

 

Laboratory Studies

 

Laboratory tests are usually done to exclude other differential diagnoses.

 

As seronegative spondyloarthropathies, such as ankylosing spondylitis, are common causes of back pain, HLA B27 immuno-histocompatibility has to be tested. Estimated 350,000 persons in the US and 600,000 in Europe have been affected by this inflammatory disease of unknown etiology. But HLA B27 is extremely rarely found in African Americans. Other seronegative spondyloarthropathies that can be tested using this gene include psoriatic arthritis, inflammatory bowel disease, and reactive arthritis or Reiter syndrome. Serum immunoglobulin A (IgA) can be increased in some patients.

 

Tests like the erythrocyte sedimentation rate (ESR) and C- reactive protein (CRP) level test for the acute phase reactants seen in inflammatory causes of lower back pain such as osteoarthritis and malignancy. The full blood count is also required, including differential counts to ascertain the disease etiology. Autoimmune diseases are suspected when Rheumatoid factor (RF) and anti-nuclear antibody (ANA) tests become positive. Serum uric acid and synovial fluid analysis for crystals may be needed in rare cases to exclude gout and pyrophosphate dihydrate deposition.

 

Treatment

 

There is no definitive treatment method agreed by all physicians regarding the treatment of degenerative disc disease because the cause of the pain can differ in different individuals and so is the severity of pain and the wide variations in clinical presentation. The treatment options can be discussed broadly under; conservative treatment, medical treatment, and surgical treatment.

 

Conservative Treatment

 

This treatment method includes exercise therapy with behavioral interventions, physical modalities, injections, back education, and back school methods.

 

Exercise-Based Therapy with Behavioral Interventions

 

Depending on the diagnosis of the patient, different types of exercises can be prescribed. It is considered one of the main methods of conservative management to treat chronic low back pain. The exercises can be modified to include stretching exercises, aerobic exercises, and muscle strengthening exercises. One of the major challenges of this therapy includes its inability to assess the efficacy among patients due to wide variations in the exercise regimens, frequency, and intensity. According to studies, most effectiveness for sub-acute low back pain with varying duration of symptoms was obtained by performing graded exercise programs within the occupational setting of the patient. Significant improvements were observed among patients suffering from chronic symptoms with this therapy with regard to functional improvement and pain reduction. Individual therapies designed for each patient under close supervision and compliance of the patient also seems to be the most effective in chronic back pain sufferers. Other conservative approaches can be used in combination to improve this approach. (Hayden, Jill A., et al.)

 

Aerobic exercises, if performed regularly, can improve endurance. For relieving muscle tension, relaxation methods can be used. Swimming is also considered an exercise for back pain. Floor exercises can include extension exercises, hamstring stretches, low back stretches, double knee to chin stretches, seat lifts, modified sit-ups, abdominal bracing, and mountain and sag exercises.

 

Physical Modalities

 

This method includes the use of electrical nerve stimulation, relaxation, ice packs, biofeedback, heating pads, phonophoresis, and iontophoresis.

 

Transcutaneous Electrical Nerve Stimulation (TENS)

 

In this non-invasive method, electrical stimulation is delivered to the skin in order to stimulate the peripheral nerves in the area to relieve the pain to some extent. This method relieves pain immediately following application but its long term effectiveness is doubtful. With some studies, it has been found that there is no significant improvement in pain and functional status when compared with placebo. The devices performing these TENS can be easily accessible from the outpatient department. The only side effect seems to be a mild skin irritation experienced in a third of patients. (Johnson, Mark I)

 

Back School

 

This method was introduced with the aim of reducing the pain symptoms and their recurrences. It was first introduced in Sweden and takes into account the posture, ergonomics, appropriate back exercises, and the anatomy of the lumbar region. Patients are taught the correct posture to sit, stand, lift weights, sleep, wash face, and brush teeth avoiding pain. When compared with other treatment modalities, back school therapy has been proven to be effective in both immediate and intermediate periods for improving back pain and functional status.

 

Patient Education

 

In this method, the provider instructs the patient on how to manage their back pain symptoms. Normal spinal anatomy and biomechanics involving mechanisms of injury is taught at first. Next, using the spinal models, the degenerative disc disease diagnosis is explained to the patient. For the individual patient, the balanced position is determined and then asked to maintain that position to avoid getting symptoms.

 

Bio-Psychosocial Approach to Multidisciplinary Back Therapy

 

Chronic back pain can cause a lot of distress to the patient, leading to psychological disturbances and low mood. This can adversely affect the therapeutic outcomes rendering most treatment strategies futile. Therefore, patients must be educated on learned cognitive strategies called �behavioral� and �bio-psychosocial� strategies to get relief from pain. In addition to treating the biological causes of pain, psychological, and social causes should also be addressed in this method. In order to reduce the patient�s perception of pain and disability, methods like modified expectations, relaxation techniques, control of physiological responses by learned behavior, and reinforcement are used.

 

Massage Therapy

 

For chronic low back pain, this therapy seems to be beneficial. Over a 1 year period, massage therapy has been found to be moderately effective for some patients when compared to acupuncture and other relaxation methods. However, it is less efficacious than TENS and exercise therapy although individual patients may prefer one over the other. (Furlan, Andrea D., et al.)

 

Spinal Manipulation

 

This therapy involves the manipulation of a joint beyond its normal range of movement, but not exceeding that of the normal anatomical range. This is a manual therapy that involves long lever manipulation with a low velocity. It is thought to improve low back pain through several mechanisms like the release of entrapped nerves, destruction of articular and peri-articular adhesions, and through manipulating segments of the spine that had undergone displacement. It can also reduce the bulging of the disc, relax the hypertonic muscles, stimulate the nociceptive fibers via changing the neurophysiological function and reposition the menisci on the articular surface.

 

Spinal manipulation is thought to be superior in efficacy when compared to most methods such as TENS, exercise therapy, NSAID drugs, and back school therapy. The currently available research is positive regarding its effectiveness in both the long and short term. It is also very safe to administer under-trained therapists with cases of disc herniation and cauda equina being reported only in lower than 1 in 3.7 million people. (Bronfort, Gert, et al.)

 

Lumbar Supports

 

Patients suffering from chronic low back pain due to degenerative processes at multiple levels with several causes may benefit from lumbar support. There is conflicting evidence with regards to its effectiveness with some studies claiming moderate improvement in immediate and long term relief while others suggesting no such improvement when compared to other treatment methods. Lumbar supports can stabilize, correct deformity, reduce mechanical forces, and limit the movements of the spine. It may also act as a placebo and reduce the pain by massaging the affected areas and applying heat.

 

Lumbar Traction

 

This method uses a harness attached to the iliac crest and lower rib cage and applies a longitudinal force along the axial spine to relieve chronic low back pain. The level and duration of the force are adjusted according to the patient and it can be measured by using devices both while walking and lying down. Lumbar traction acts by opening the intervertebral disc spaces and by reducing the lumbar lordosis. The symptoms of degenerative disc disease are reduced through this method due to temporary spine realignment and its associated benefits. It relieves nerve compression and mechanical stress, disrupts the adhesions in the facet and annulus, and also nociceptive pain signals. However, there is not much evidence with regard to its effectiveness in reducing back pain or improving daily function. Furthermore, the risks associated with lumbar traction are still under research and some case reports are available where it has caused a nerve impingement, respiratory difficulties, and blood pressure changes due to heavy force and incorrect placement of the harness. (Harte, A et al.)

 

Medical Treatment

 

Medical therapy involves drug treatment with muscle relaxants, steroid injections, NSAIDs, opioids, and other analgesics. This is needed, in addition to conservative treatment, in most patients with degenerative disc disease. Pharmacotherapy is aimed to control disability, reduce pain and swelling while improving the quality of life. It is catered according to the individual patient as there is no consensus regarding the treatment.

 

Muscle Relaxants

 

Degenerative disc disease may benefit from muscle relaxants by reducing the spasm of muscles and thereby relieving pain. The efficacy of muscle relaxants in improving pain and functional status has been established through several types of research. Benzodiazepine is the most common muscle relaxant currently in use.

 

Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

 

These drugs are commonly used as the first step in disc degenerative disease providing analgesia, as well as anti-inflammatory effects. There is strong evidence that it reduces chronic low back pain. However, its use is limited by gastrointestinal disturbances, like acute gastritis. Selective COX2 inhibitors, like celecoxib, can overcome this problem by only targeting COX2 receptors. Their use is not widely accepted due to its potential side effects in increasing cardiovascular disease with prolonged use.

 

Opioid Medications

 

This is a step higher up in the WHO pain ladder. It is reserved for patients suffering from severe pain not responding to NSAIDs and those with unbearable GI disturbances with NSAID therapy. However, the prescription of narcotics for treating back pain varies considerably between clinicians. According to literature, 3 to 66% of patients may be taking some form of the opioid to relieve their back pain. Even though the short term reduction in symptoms is marked, there is a risk of long term narcotic abuse, a high rate of tolerance, and respiratory distress in the older population. Nausea and vomiting are some of the short term side effects encountered. (�Systematic Review: Opioid Treatment For Chronic Back Pain: Prevalence, Efficacy, And Association With Addiction�)

 

Anti-Depressants

 

Anti-depressants, in low doses, have analgesic value and may be beneficial in chronic low back pain patients who may present with associated depression symptoms. The pain and suffering may be disrupting the sleep of the patient and reducing the pain threshold. These can be addressed by using anti-depressants in low doses even though there is no evidence that it improves the function.

 

Injection Therapy

 

Epidural Steroid Injections

 

Epidural steroid injections are the most widely used injection type for the treatment of chronic degenerative disc disease and associated radiculopathy. There is a variation between the type of steroid used and its dose. 8- 10 mL of a mixture of methylprednisolone and normal saline is considered an effective and safe dose. The injections can be given through interlaminar, caudal, or trans foramina routes. A needle can be inserted under the guidance of fluoroscopy. First contrast, then local anesthesia and lastly, the steroid is injected into the epidural space at the affected level via this method. The pain relief is achieved due to the combination of effects from both local anesthesia and the steroid. Immediate pain relief can be achieved through the local anesthetic by blocking the pain signal transmission and while also confirming the diagnosis. Inflammation is also reduced due to the action of steroids in blocking pro-inflammatory cascade.

 

During the recent decade, the use of epidural steroid injection has increased by 121%. However, there is controversy regarding its use due to the variation in response levels and potentially serious adverse effects. Usually, these injections are believed to cause only short term relief of symptoms. Some clinicians may inject 2 to 3 injections within a one-week duration, although the long term results are the same for that of a patient given only a single injection. For a one year period, more than 4 injections shouldn�t be given. For more immediate and effective pain relief, preservative-free morphine can also be added to the injection. Even local anesthetics, like lidocaine and bupivacaine, are added for this purpose. Evidence for long term pain relief is limited. (�A Placebo-Controlled Trial To Evaluate Effectivity Of Pain Relief Using Ketamine With Epidural Steroids For Chronic Low Back Pain�)

 

There are potential side effects due to this therapy, in addition to its high cost and efficacy concerns. Needles can get misplaced if fluoroscopy is not used in as much as 25% of cases, even with the presence of experienced staff. The epidural placement can be identified by pruritus reliably. Respiratory depression or urinary retention can occur following injection with morphine and so the patient needs to be monitored for 24 hours following the injection.

 

Facet Injections

 

These injections are given to facet joints, also called zygapophysial joints, which are situated between two adjacent vertebrae. Anesthesia can be directly injected to the joint space or to the associated medial branch of the dorsal rami, which innervates it. There is evidence that this method improves the functional ability, quality of life, and relieves pain. They are thought to provide both short and long term benefits, although studies have shown both facet injections and epidural steroid injections are similar in efficacy. (Wynne, Kelly A)

 

SI Joint Injections

 

This is a diarthrodial synovial joint with nerve supply from both myelinated and non-myelin nerve axons. The injection can effectively treat degenerative disc disease involving sacroiliac joint leading to both long and short term relief from symptoms such as low back pain and referred pain at legs, thigh, and buttocks. The injections can be repeated every 2 to 3 months but should be performed only if clinically necessary. (MAUGARS, Y. et al.)

 

Intradiscal Non-Operative Therapies for Discogenic Pain

 

As described under the investigations, discography can be used both as a diagnostic and therapeutic method. After the diseased disc is identified, several minimally invasive methods can be tried before embarking on surgery. Electrical current and its heat can be used to coagulate the posterior annulus thereby strengthening the collagen fibers, denaturing and destroying inflammatory mediators and nociceptors, and sealing figures. The methods used in this are called intradiscal electrothermal therapy (IDET) or radiofrequency posterior annuloplasty (RPA), in which an electrode is passed to the disc. IDET has moderate evidence in relief of symptoms for disc degenerative disease patients, while RPA has limited support regarding its short term and long term efficacy. Both these procedures can lead to complications such as nerve root injury, catheter malfunction, infection, and post-procedure disc herniation.

 

Surgical Treatment

 

Surgical treatment is reserved for patients with failed conservative therapy taking into account the disease severity, age, other comorbidities, socio-economic condition, and the level of outcome expected. It is estimated that around 5% of patients with degenerative disc disease undergo surgery, either for their lumbar disease or cervical disease. (Rydevik, Bj�rn L.)

 

Lumbar Spine Procedures

 

Lumbar surgery is indicated in patients with severe pain, with a duration of 6 to 12 months of ineffective drug therapy, who have critical spinal stenosis. The surgery is usually an elective procedure except in the case of cauda equina syndrome. There are two procedure types that aim to involve spinal fusion or decompression or both. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Spinal fusion involves stopping movements at a painful vertebral segment in order to reduce the pain by fusing several vertebrae together by using a bone graft. It is considered effective in the long term for patients with degenerative disc disease having spinal malalignment or excessive movement. There are several approaches to fusion surgery. (Gupta, Vijay Kumar, et al)

 

  • Lumbar spinal posterolateral guttur fusion

 

This method involves placing a bone graft in the posterolateral part of the spine. A bone graft can be harvested from the posterior iliac crest. The bones are stripped off from its periosteum for successful grafting. A back brace is needed in the post-operative period and patients may need to stay in the hospital for about 5 to 10 days. Limited motion and cessation of smoking are needed for successful fusion. However, several risks such as non-union, infection, bleeding, and solid union with back pain may occur.

 

  • Posterior lumbar interbody fusion

 

In this method, decompression or diskectomy methods can also be performed via the same approach. The bone grafts are directly applied to the disc space and ligamentum flavum is excised completely. For the degenerative disc disease, interlaminar space is widened additionally by performing a partial medial facetectomy. Back braces are optional with this method. It has several disadvantages when compared to anterior approach such as only small grafts can be inserted, the reduced surface area available for fusion, and difficulty when performing surgery on spinal deformity patients. The major risk involved is non-union.

 

  • Anterior lumbar interbody fusion

 

This procedure is similar to the posterior one except that it is approached through the abdomen instead of the back. It has the advantage of not disrupting the back muscles and the nerve supply. It is contraindicated in patients with osteoporosis and has the risk of bleeding, retrograde ejaculation in men, non-union, and infection.

 

  • Transforaminal lumbar interbody fusion

 

This is a modified version of the posterior approach which is becoming popular. It offers low risk with good exposure and it is shown to have an excellent outcome with a few complications such as CSF leak, transient neurological impairment, and wound infection.

 

Total Disc Arthroplasty

 

This is an alternative to disc fusion and it has been used to treat lumbar degenerative disc disease using an artificial disc to replace the affected disc. Total prosthesis or nuclear prosthesis can be used depending on the clinical situation.

 

Decompression involves removing part of the disc of the vertebral body, which is impinging on a nerve to release that and provide room for its recovery via procedures called diskectomy and laminectomy. The efficacy of the procedure is questionable although it is a commonly performed surgery. Complications are very few with a low chance of recurrence of symptoms with higher patient satisfaction. (Gupta, Vijay Kumar, et al)

 

  • Lumbar discectomy

 

The surgery is performed through a posterior midline approach by dividing the ligamentum flavum. The nerve root that is affected is identified and bulging annulus is cut to release it. Full neurological examination should be performed afterward and patients are usually fit to go home 1 � 5 days later. Low back exercises should be started soon followed by light work and then heavy work at 2 and 12 weeks respectively.

 

  • Lumbar laminectomy

 

This procedure can be performed thorough one level, as well as through multiple levels. Laminectomy should be as short as possible to avoid spinal instability. Patients have marked relief of symptoms and reduction in radiculopathy following the procedure. The risks may include bowel and bladder incontinence, CSF leakage, nerve root damage, and infection.

 

Cervical Spine Procedures

 

Cervical degenerative disc disease is indicated for surgery when there is unbearable pain associated with progressive motor and sensory deficits. Surgery has a more than 90% favorable outcome when there is radiographic evidence of nerve root compression. There are several options including anterior cervical diskectomy (ACD), ACD, and fusion (ACDF), ACDF with internal fixation, and posterior foraminotomy. (�Degenerative Disk Disease: Background, Anatomy, Pathophysiology.�)

 

Cell-Based Therapy

 

Stem cell transplantation has emerged as a novel therapy for degenerative disc disease with promising results. The introduction of autologous chondrocytes has been found to reduce discogenic pain over a 2 year period. These therapies are currently undergoing human trials. (Jeong, Je Hoon, et al.)

 

Gene Therapy

 

Gene transduction in order to halt the disc degenerative process and even inducing disc regeneration is currently under research. For this, beneficial genes have to be identified while demoting the activity of degeneration promoting genes. These novel treatment options give hope for future treatment to be directed at regenerating intervertebral discs. (Nishida, Kotaro, et al.)

 

 

Degenerative disc disease is a health issue characterized by chronic back pain due to a damaged intervertebral disc, such as low back pain in the lumbar spine or neck pain in the cervical spine. It is a breakdown of an intervertebral disc of the spine. Several pathological changes can occur in disc degeneration. Various anatomical defects can also occur in the intervertebral disc. Low back pain and neck pain are major epidemiological problems, which are thought to be related to degenerative disc disease. Back pain is the second leading cause of doctor office visits in the United States. It is estimated that about 80% of US adults suffer from low back pain at least once during their lifetime. Therefore, a thorough understanding of degenerative disc disease is needed for managing this common condition. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

 

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.* Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at 915-850-0900. The provider(s) Licensed in Texas*& New Mexico*�

 

Curated by Dr. Alex Jimenez D.C., C.C.S.T.

 

References

 

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Sleep Soundly with The Proper Mattress

Sleep Soundly with The Proper Mattress

Having the proper mattress can help reduce, prevent, and alleviate neck and back pain. Individuals spend around one-third of their life sleeping. However, when it comes to the mattress that we sleep on, there seems to be no consideration of how the mattress will affect our spines. No other piece of furniture in the house is used more often or affects overall health more than our beds. �

el paso tx lower back pain

Down to sleep

Everybody needs to sleep, as the proper amount of rest is an essential part of life. When there is a lack of sleep or sleep disorder, this contributes and leads to health issues of all types and increased/exacerbated pain.

Specifically, the spine benefits tremendously from a proper sleep cycle. The spine works all day supporting the body and its functions. Rest is essential to maintain this level of activity day in and out. But when the surface that we sleep on does not support our body and spine in the correct form, then proper sleep can be impossible to achieve.

Proper Mattress Selection

The mattress we sleep on can make a significant difference in the quality of sleep we are getting on a regular basis. A mattress that does not provide optimal support for the spine can lead to muscle fatigue and sleep deprivation.

A proper mattress keeps the spine in the same natural alignment as when standing. When the body can rest in its natural position, the muscles are relaxed and the sleep is healthy following the five stages of a full sleep cycle.

11860 Vista Del Sol, Ste. 128 Sleep Soundly with The Proper Mattress

Healthy sleep means the individual needs to cycle through five stages: 1, 2, 3, 4, and rapid eye movement or REM sleep. A full sleep cycle takes around 90 to 110 minutes to complete. Once the five stages have finished, it starts over at stage 1. Here is a look at the stages:

Stage 1

This is the lightest stage and is characterized by slow eye movement and relaxed muscle activity.

Stage 2

Eye movement stops and brain waves slow down.

Stage 3

This is the first stage of deep sleep where brain waves appear but are extremely slow. It can be quite difficult to wake someone from this stage.

Stage 4

This is the second stage of deep sleep with no eye or muscle activity. Just like stage 3, it can be more difficult to wake someone in this stage.

REM sleep

This is the dream phase where breathing quickens, heart rate, blood pressure increase, and eyes begin to move around in different directions. REM sleep could be considered the most important stage, as researchers believe REM sleep contributes to storing memories, learning, and regulating mood. Most adults spend half of their total sleep time in stage 2, 20% in REM sleep, and 30% in the other stages. �

11860 Vista Del Sol, Ste. 128 Sleep Soundly with The Proper Mattress

Mattress shopping

Here are a few considerations to keep in mind:

Type

Type of mattress include:

  • Gel
  • Innerspring
  • Latex
  • Memory Foam
  • Water bed
  • Air bed

Innerspring mattresses can offer more variety in terms of firmness and support. However, individuals find other types of mattresses just as comfortable. What makes a proper mattress the best is that it is the one that offers you the most support and the most comfort.

Foundation

This is usually called the box spring, which is just as important as the mattress. The box spring absorbs the weight along with the added stress of movement etc, from the mattress. Having the proper foundation extends the life of the mattress.

If possible try to purchase the box spring designed for the mattress. Using no box spring, an old box spring, or mixing the mattress and box spring can have a negative impact on the level of support and durability of the mattress.

Firmness

The belief that the firmer the mattress is the better is not exactly true. A too-firm mattress does not support the body in a balanced fashion. Which means that only the body’s heaviest parts are supported. A too-soft mattress can sink, preventing the spine from keeping proper alignment. Too firm or too soft does not allow the muscles to relax and rest, because they have to keep working to find a comfortable position just to maintain correct posture.

Comfort

Make sure to take the time to lie on the mattress and test it out when shopping. Lie down and position yourself the way you would when sleeping. Take turns turning/moving from side to side. If sleeping with a spouse or partner, try out the mattress together to make sure there is enough space to move around comfortably. Be sure that the mattress can support the spine and maintain its natural curve.

Beware, mattress manufacturers use different terms for comfort and firmness that could be confusing. Mattress makers will use a term like orthopedic but it does not have any actual medical merit or benefit. That is why trying out the mattress before buying is the way to go. It will definitely help to tell which one is the most supportive and comfortable.

Durability

How long the mattress and materials that it’s made of will last determines the durability. Top-quality materials are what to aim for. Especially, the core and the cover. Prices are determined by:

  • What the mattress is made out of
  • The quality of the construction
  • The size

A proper mattress and box spring should last for around 8-10 years. Therefore it is an investment in your spine and quality health. Don’t automatically go for the mattresses on sale or that are the cheapest. Instead, search for the best quality and value.

Flip or Rotate

Keeping the mattress in top form means flipping or rotating the mattress on a regular basis. This will ensure even wear and tear giving you optimal spine and body support.

Time for a new one

Even proper mattresses don’t last a lifetime. But like most of us, we wait way too long when it comes to replacing. For those who’ve had the same mattress for 10 years or more, it is definitely time for a new one. There are other signs letting you know it’s time to replace including:

  • Waking up tired and aching could signal that the mattress is no longer providing enough support for proper rest. Not feeling refreshed after sleep could be the sign it’s time for a new mattress.
  • If the mattress looks old, worn, or strained, and the box spring rocks and squeaks are all signs that the mattress and foundation are worn out.
  • The bed is no longer comfortable with the mattress sagging/sinking or leaving an impression where you sleep. Slipping or rolling toward the center along with the inability to find a comfortable position means it’s time to think about a new mattress.

Sleep position makes a difference

Sleeping on the side, with knees bent or with a pillow between the knees is considered the best way to maintain proper body posture. However, if you must sleep on your back, place a pillow under the knees to support the normal curve of the spine.

Sleeping on the stomach or with the head elevated on an oversized pillow creates an unnatural arch of the spine. This increases pressure on the diaphragm and lungs. These positions usually lead to restless tossing and turning and loss of proper sleep. �

11860 Vista Del Sol, Ste. 128 Save Your Spine and Sleep Soundly with The Proper Mattress

Don’t Worry

If there is difficulty getting the right amount of sleep or you are waking up exhausted then this could be the time to take a look at where and how you sleep. A proper mattress and box spring will generate proper comfortable rest all the while maintaining posture and protecting the spine. Remember that sleep is an essential nutrient for our bodies. Therefore, the bed that we sleep on can make a significant difference.


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Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at�915-850-0900. The provider(s) Licensed in Texas& New Mexico

Pets Healing Power Can Be Powerful Medicine

Pets Healing Power Can Be Powerful Medicine

Pets have improved the lives of those living with chronic pain and can help alleviate the depression that comes with it. There’s no doubt that having a pet or interacting with a trained therapy animal can help reduce and alleviate the pain and improve the quality of life.

Animals and the companionship they offer seems to be a natural pain reliever, and significant research supports this theory. Here are some ways that our pets can help us live optimal lives even with chronic pain. �

11860 Vista Del Sol, Ste. 128 Pets Healing Power Can Be Powerful Medicine

Ways Pets Can Relieve Pain

Our pets allow us to feel less stressed out. Research has shown even for those that are not into pets, that petting a dog for ten-fifteen minutes reduces cortisol, which is a stress hormone. In a journal for pain, researchers studied the effects of quick therapy dog visits at a pain management clinic. Over 2-months they compared the individuals’ feelings of:

  • Pain
  • Fatigue
  • Stress

Tremendous improvements were reported for pain, state of mind, and other measures of stress among the individuals after the dog visit. Improvements were also seen in family, friends, and staff after the therapy dog visits.

They Generate More Activity

Specifically, dog owners seem to be healthier than those without a dog. Cats are great but when it comes to activity/fitness, dogs require regular walks, which makes owners get up, go outside and move around. Walking a dog can help:

  • Improve balance
  • Combat fatigue
  • Improve flexibility
  • Reduce joint pain
  • Increase strength
  • Manage weight

Being active combined with walking helps to get a better night’s sleep and reduced pain.

They Make Us Feel Better Without Medication

Research has shown how the proper attitude impacts treatment outcomes. With a positive attitude, an individual is more likely to stick with a long-term pain treatment plan. Petting and playing with a furry friend can be the perfect medicine creating an improved mood literally relieving pain and reducing the need for pain meds.

They Distract The Pain Away

Individuals living with chronic pain are constantly thinking about it. Having a pet changes the focus from pain to joy and happiness. With a pet to care for gives the day structure and life purpose. Pets need attention and because of their lovability are hard to ignore. �

11860 Vista Del Sol, Ste. 128 Pets Healing Power Can Be Powerful Medicine

Animal-Assisted Therapy

This type of therapy is a legitimate option for chronic pain management. With the problems associated with opioids, doctors and patients are looking for alternative ways to treat pain. The American Academy of Family Physicians reports that nonpharmacological therapies, like animal-assisted therapy, are now included in chronic pain treatment plans. Other options for pain relief include:

Example: An individual has a pain syndrome/condition. When the pain flares up the individual becomes irritable and upset. The individual has a dog that recognizes these feelings. The dog comes over and starts playing, licking, etc. The individual picks up the dog, calming the individual, helping change the mood, and ease the pain.

Pet Time

Owning a pet is a real responsibility, for those who are not interested in adopting, there are still benefits from pet medicine. Some ideas to consider:

  • Perhaps a family member or friend owns a pet that could have regular visits. This would be a good way to get a feel for the experience and see what it’s like to have a pet without committing.
  • Cats are an option if dogs are not your cup of tea. This could be because of allergies or residing in a location that does not permit them. Cats offer companionship along with the same psychological benefits as dogs. However, there is not much activity since they don’t need to be walked. But they still need to play/pretend hunt.
  • Try spending time at a pain management clinic that has an animal therapy program. Some of these clinics allow individuals to spend time with a therapy dog a few times per week. These are usually 15-minute sessions.
  • Unable to locate a clinic in the area, try looking into other organizations that could provide therapy animals and programs. Local vets and animal shelters can be a good source of information for animal therapy programs.

Therapy and Service Dogs Are Not the Same

When it’s time you might be ready for a dog of your own. Before searching the local shelter’s website, consider everything that comes with pet ownership. Factor in costs like:

  • Veterinary care
  • Behavior classes
  • Food
  • Shelter
  • Toys
  • Travel

Think about the size of the animal and if you can safely manage a small or large pet. Remember this is a therapy for individuals with a health condition of chronic pain. An individual needs to be able to see what they can take given their level of pain at any given time.

If you’ve never owned a pet, there needs to be an understanding that housebreaking a pet can be quite a time-consuming and exhausting task. This could add more stress and worsen the pain.

It is important to remember that therapy dogs do not have the same training as assistance or service dogs. Service dogs are trained to perform and assist with specific tasks to help an individual that has a disability. This could be a seeing-eye dog helping their blind owner. Also, service dogs live with their owners and are granted special access to public places like planes, restaurants, places of business, etc.

The American Kennel Club defines therapy dogs as dogs that can accompany their owners to volunteer in schools, hospitals, and nursing homes where they work together as a team to improve the lives of other people.

There are definitely medical benefits to having pets in our lives. However, don’t expect them to remove chronic pain overnight. Pets are another tool that can bring relief and improve the quality of life for individuals living with pain.


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Dr. Alex Jimenez�s Blog Post Disclaimer

The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*

Our office has made a reasonable attempt to provide supportive citations and has identified the relevant research study or studies supporting our posts. We also make copies of supporting research studies available to the board and or the public upon request. We understand that we cover matters that require an additional explanation as to how it may assist in a particular care plan or treatment protocol; therefore, to further discuss the subject matter above, please feel free to ask Dr. Alex Jimenez or contact us at�915-850-0900. The provider(s) Licensed in Texas& New Mexico