Chronic Back Pain – PushAsRx Athletic Training Centers El Paso, TX https://www.pushasrx.com Chiropractic Science & Functional Fitness Fri, 07 Aug 2020 02:09:14 +0000 en-US hourly 1 https://wordpress.org/?v=5.4.2 https://i2.wp.com/www.pushasrx.com/wp-content/uploads/2019/06/IMG_8806_500_x_500.png?fit=32%2C32&ssl=1 Chronic Back Pain – PushAsRx Athletic Training Centers El Paso, TX https://www.pushasrx.com 32 32 111105572 Swimming Non-Impact Exercise for Back Pain, Injury, and Rehabilitation https://www.pushasrx.com/swimming-non-impact-exercise/ Fri, 07 Aug 2020 02:09:14 +0000 https://www.pushasrx.com/?p=25863 11860 Vista Del Sol, Ste. 128 Swimming Non-Impact Exercise for Back Pain, Injury, and Rehabilitation

Studies reveal that swimming and aquatic exercises can help in relieving back pain. Done properly it is a highly recognized form of cardio exercise as well as injury recovery and rehabilitation, especially when dealing with back pain. Other types of cardiovascular exercise/s are great and are recommended for individuals with back pain that is already […]

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11860 Vista Del Sol, Ste. 128 Swimming Non-Impact Exercise for Back Pain, Injury, and Rehabilitation Studies reveal that swimming and aquatic exercises can help in relieving back pain. Done properly it is a highly recognized form of cardio exercise as well as injury recovery and rehabilitation, especially when dealing with back pain. Other types of cardiovascular exercise/s are great and are recommended for individuals with back pain that is already being managed. This could be light walking and mild aerobics. However, those in severe pain and more than likely not in the best shape, cardio can be hard on the body. Swimming is great for all body types, those with weight issues that contribute to their back pain, those that have trouble moving, the young, elderly plus it burns calories, builds muscle, and is very refreshing.
11860 Vista Del Sol, Ste. 128 Swimming Non-Impact Exercise for Back Pain, Injury, and Rehabilitation
 
Swimming has been utilized as a non-impact form of exercise and is recommended for individuals in injury recovery, surgery, and for those where performing high-impact exercise/s like running would be painful and dangerous. The buoyancy or upthrust of the water counters gravity decreasing the compression on the spine. Aqua or hydrotherapy allows cardio activity without increasing or worsening pain, which is very therapeutic. Regular cardiovascular exercises/activities are beneficial for pain reduction. Figuring out and determining the right exercise/stroke for the patient’s specific ailment and length of time those exercises should be done without causing fatigue or increased pain is the objective. Strengthening the paraspinal muscles is essential to help with spinal support and reducing back pain. Utilizing the up-thrust of the water, enables patients to exercise these muscle groups more efficiently and effectively.  
 

Preparation

Wherever the swimming therapy will take place, it is vital that the individual feels comfortable at the location, in the water, knows how to swim as this puts an individual at ease, not worrying about their surroundings and able to focus completely on their therapy/rehab. If an individual is not a confident swimmer, the therapy can be done in shallow water or a rehabilitation pool and if cleared with a doctor taking swimming lessons with back pain in mind could be part of a therapy program. Once confident in the water warm-up in the shallow end or do some walking/cycling before actual swimming.

Therapeutic Strokes

Strokes for the therapeutic workout will be determined by the doctor, specialist, chiropractor, therapist, etc. These strokes are recommended to protect the spine while keeping pain at bay. Although individual cases are completely unique, and a doctor/therapist could recommend other strokes, the safest strokes found for back pain are the freestyle and the backstroke. Strokes like the butterfly or breaststroke cause a natural extension/arch in the low back, which can be quite painful. So a patient does not have to lift their heads, which could cause them to arch their backs as well, could benefit using a center snorkel.  

Regimen Frequency, Length

Like all forms of exercise, especially when dealing with back pain moderation is the way to go avoiding repetitive/overuse injuries. Soreness after the workout that goes away within a few hours is normal. But if the soreness lasts to the next day, this could the body warning the patient they are doing too much. For swimming, therapists usually recommend three days a week 20 to 30-minute workout. With activity response being used as a guide to progress or decrease the intensity or volume of the exercise. A gradual increase in activity until the patient reaches a workout regimen that fits:
  • Age
  • Condition level
  • Physical ability

Considerations

When swimming or performing any exercise/s the benefits are completely dependent on the individual and back condition. It is difficult to determine how well therapeutic swimming will work, as every individual and the condition/s they are dealing with are different. Individuals with arthritis or spinal stenosis have been shown to do well using hydrotherapy because of decreased spinal compression. Each patient might have to make certain adjustments based on their condition and the doctor’s, chiropractor, specialist’s treatment plan. For example, someone with cervical spine arthritis or stenosis could have a difficult time lifting their head to breathe. In this case, they could be instructed to swim using only the backstroke or using a customized stroke so they don’t have to lift the head. Every patient needs to try and see what works for their specific condition. What works for one patient, may not work for another. Find out if swimming could be a treatment option for your back condition. With this in mind, finding a form of aqua/swimming exercise that suits you can be achieved.  
11860 Vista Del Sol, Ste. 128 Swimming Non-Impact Exercise for Back Pain, Injury, and Rehabilitation

 

Lower Back Pain Injury Rehabilitation and 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*

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%%title%% %%excerpt%% back,chiropractic,exercise,health,injury,no-impact,pain,rehabilitation,swimming,wellness,swimming 11860 Vista Del Sol, Ste. 128 Swimming Non-Impact Exercise for Back Pain, Injury, and Rehabilitation 11860 Vista Del Sol, Ste. 128 Swimming Non-Impact Exercise for Back Pain, Injury, and Rehabilitation 25863
Self-Care Practice When Back Pain Flares Up https://www.pushasrx.com/self-care-practice-back-pain/ Wed, 29 Jul 2020 02:22:24 +0000 https://www.pushasrx.com/?p=25790 11860 Vista Del Sol, Ste. 128 Self-Care Practice When Back Pain Flares Up

Self-care practice when back pain flares up is a way for individuals to give themselves self-therapy attention in the midst of crazy schedules. It’s never been more important than now to be able to take care of oneself when back or any type of pain presents. For a few minutes, daily physical and mental health […]

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11860 Vista Del Sol, Ste. 128 Self-Care Practice When Back Pain Flares Up Self-care practice when back pain flares up is a way for individuals to give themselves self-therapy attention in the midst of crazy schedules. It’s never been more important than now to be able to take care of oneself when back or any type of pain presents. For a few minutes, daily physical and mental health activities can make a difference. Self-care is the ability to self-manage pain and take care of our constantly changing needs daily. Regular self-care is essential to our families, and friends well being. Pain is emotionally and physically taxing on the body. It brings and encourages mental/emotional and physical balance, which helps, especially when there is a condition that causes pain. There is a connection between self-care and chronic pain that is being studied currently. Studies are finding that individuals practicing self-care in addition to regular medical care have significant reductions in pain and reduction in disability. So, alleviate back pain with a few self-care tips.  
11860 Vista Del Sol, Ste. 128 Self-Care Practice When Back Pain Flares Up
 

Hot Bath

Hydrotherapy better known as a hot bath can provide pain relief. Adding Epsom salt for these baths contains magnesium which can help relax muscles and the body.

Self-Massage

Self-massage is a great way to care for oneself. Applying gentle pressure to painful spots or use massage devices like foam rollers and tennis balls to massage the pain away.

Music Therapy

Music can be an effective way to ease back pain. Research has shown that music can be a complementary treatment when addressing chronic pain. It helps especially when an individual is experiencing back pain along with a low/negative mood.

More Sleep

Poor sleep has been proven to increased back pain. Getting the proper amount of sleep is essential in addressing pain. Healthy sleep hygiene and bedtime routines will significantly help with the body’s recovery, healing, and general health.  
 

Yoga

Yoga stretching is highly effective in relieving and avoiding/preventing back pain completely. Poses like the cat, cow, triangle, and child’s pose will generate relief along with improving balance.

Healthy Diet

Diet and lifestyle changes have been proven to reduce inflammation, which can cause chronic pain. Go with whole foods that are minimally processed. This will help reduce inflammation. Healthy weight along with healthy body mass keeps the spine healthy and free of the added stress from the weight. Therefore a sensible diet is the single most important factor in weight loss.

Connection

Isolation can exacerbate pain. Loneliness can be a significant risk factor in the development of pain, and with time, depression, and fatigue. Simply reaching out and connecting with loved ones, friends, co-workers, etc, could help in soothing the pain away.

Mindfulness

Mind-body therapy as a method to treat pain has been proven in various studies. Individuals taking part have reported significantly lower pain than those who only received traditional medical care. What happens is you are training your mind senses to be present and focused on what you are doing, the surroundings, etc, and not focusing, and getting lost in the pain. However, sitting down and meditating is not for everybody.

Drink the Proper Amount of Water

Hypohydration, which is not enough water can increase pain. Therefore, drink up.  
 

Stretching

Stretching will definitely decrease pain and allow for practicing mindfulness. It doesn’t matter when the stretching happens so long as, the individual sticks with it and continues development to further their ability and flexibility. Core abdominal exercises are very helpful for back pain and strengthening.

Go Outside

Many of us know that getting out in nature feels good mentally and physically, and it can actually relieve pain, too. Nature therapy or ecotherapy has shown to improve the psychological and physiological symptoms associated with chronic pain. Connecting to nature can have tremendous benefits for optimal health.

Heat Therapy

Heat, whether from a topical agent or heating pad can soothe the mind and spine. Check with a doctor before trying any type of heat treatment.

Frequent Breaks

Taking breaks is essential for the mind in keeping stress levels balanced. This can lessen back pain. Just a few minutes to stop whatever and take a few minutes for yourself and your health. Taking proper physical and mental rests throughout the day to stretch out, move around, and do something else. This will help keep things open and fresh, as opposed to going through the same thing over and over with less than optimal results. The mind needs to reflect.  
11860 Vista Del Sol, Ste. 128 Self-Care Practice When Back Pain Flares Up
 

Go Easy

Go easy on yourself, this is probably the most important form of self-care. If the pain is too intense, do not force yourself to work through it. Use the various techniques mentioned and go slowly, with the fundamentals of combating pain and chronic pain. Slow down whenever you feel the need.
 

 Lower Back 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*

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%%title%% %%sep%% PUSH as Rx %%excerpt%% back,care,chiropractic,flare,health,pain,practice,self,ups,wellness,self care 11860 Vista Del Sol, Ste. 128 Self-Care Practice When Back Pain Flares Up 11860 Vista Del Sol, Ste. 128 Self-Care Practice When Back Pain Flares Up 25790
Chiropractic Testing and Treatment for Chronic Pain https://www.pushasrx.com/chiropractic-testing-treatment-chronic-pain/ Thu, 23 Jul 2020 01:54:47 +0000 https://www.pushasrx.com/?p=25737 11860 Vista Del Sol, Ste. 128 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 […]

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11860 Vista Del Sol, Ste. 128 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.

Chiropractic Sports Injury 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*

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%%title%% %%excerpt%% auto,chiropractic,chronic,clinic,health,injury,manage,medical,pain,personal,proper,sports,testing,treatment,wellness,work,chiropractic testing 11860 Vista Del Sol, Ste. 128 Chiropractic Testing and Treatment for Chronic Pain 11860 Vista Del Sol, Ste. 128 Chiropractic Testing and Treatment for Chronic Pain 25737
Chronic Pain Treatment/Management https://www.pushasrx.com/chronic-pain-treatment-management/ Wed, 22 Jul 2020 03:02:37 +0000 https://www.pushasrx.com/?p=25729 11860 Vista Del Sol, Ste. 128 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. That is why a complete treatment plan can sometimes […]

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11860 Vista Del Sol, Ste. 128 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 Nerve Pain 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*

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%%title%% %%sep%% PUSH as Rx %%excerpt%% chiropractic,chronic,customized,health,management,pain,plan,relief,treatment,wellness,treatment/management 11860 Vista Del Sol, Ste. 128 Chronic Pain Treatment/Management hands of woman holding opioids 11860 Vista Del Sol, Ste. 128 Chronic Pain Treatment/Management 25729
Chronic Pain Diagnosis https://www.pushasrx.com/chronic-pain-diagnosis/ Tue, 21 Jul 2020 02:14:17 +0000 https://www.pushasrx.com/?p=25721 11860 Vista Del Sol, Ste. 128 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 […]

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11860 Vista Del Sol, Ste. 128 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.

Sciatica Pain 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*

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Chronic Pain Diagnosis | PushAsRx Athletic Training Centers El Paso, TX %%excerpt%% ability,adjustment,alignment,chiropractic,chronic pain,diagnosis,health,relief,wellness,chronic pain diagnosis 11860 Vista Del Sol, Ste. 128 Chronic Pain Diagnosis biomarker el paso tx. 11860 Vista Del Sol, Ste. 128 Chronic Pain Diagnosis neurological studies el paso tx. 25721
Anybody Can Have Chronic Pain https://www.pushasrx.com/anybody-can-have-chronic-pain/ Sat, 18 Jul 2020 01:41:07 +0000 https://www.pushasrx.com/?p=25704 11860 Vista Del Sol, Ste. 128 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 […]

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11860 Vista Del Sol, Ste. 128 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.

Rehabilitation for 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*

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%%title%% %%sep%% PUSH as Rx Fitness %%excerpt%% accident,anybody,chiropractic,chronic pain,condition,health,injury,relief,sports,treatment,wellness,work,anybody 11860 Vista Del Sol, Ste. 128 Anybody Can Have Chronic Pain chiropractor takes notes on lady with back pain in gym 11860 Vista Del Sol, Ste. 128 Anybody Can Have Chronic Pain 25704
Causes of Chronic Pain https://www.pushasrx.com/causes-of-chronic-pain/ Fri, 17 Jul 2020 01:56:28 +0000 https://www.pushasrx.com/?p=25698 11860 Vista Del Sol, Ste. 128 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   Fibromyalgia […]

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11860 Vista Del Sol, Ste. 128 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.

Best Injury Chiropractic Therapy

 
 

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*

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Causes of Chronic Pain | PushAsRx Athletic Training Centers El Paso, TX %%excerpt%% causes,chiropractic,chronic pain,conditions,health,injuries,nerves,relief,wellness,causes 11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain facetogenic neuropathic, osteoarthritis and headaches pain el paso tx. 11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain 11860 Vista Del Sol, Ste. 128 Causes of Chronic Pain 25698
How Does Pain Become Chronic? https://www.pushasrx.com/how-does-pain-become-chronic/ Thu, 16 Jul 2020 01:40:22 +0000 https://www.pushasrx.com/?p=25693 11860 Vista Del Sol, Ste. 128 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 […]

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11860 Vista Del Sol, Ste. 128 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 Pain Chiropractic

 
 

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*

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%%title%% %%sep%% PUSH as Rx Rehabilitation %%excerpt%% becomes,chiropractic,chronic,complex,condition,health,how,injury,pain,physiological,psychological,wellness,become chronic 11860 Vista Del Sol, Ste. 128 How Does Pain Become Chronic? 11860 Vista Del Sol, Ste. 128 How Does Pain Become Chronic? 25693
Chronic Pain and Chronic Pain Syndrome https://www.pushasrx.com/chronic-pain-syndrome/ Wed, 15 Jul 2020 01:51:33 +0000 https://www.pushasrx.com/?p=25679 11860 Vista Del Sol, Ste. 128 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 […]

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11860 Vista Del Sol, Ste. 128 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.

Rehabilitation for 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*

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%%title%% %%sep%% PUSH as Rx %%excerpt%% brain,chiropractic,chronic,common,condition,health,pain,psychogenic,wellness,chronic 11860 Vista Del Sol, Ste. 128 Chronic Pain and Chronic Pain Syndrome 11860 Vista Del Sol, Ste. 128 Chronic Pain and Chronic Pain Syndrome cranial el paso tx. 25679
Chronic Pain Throughout the United States https://www.pushasrx.com/chronic-pain-united-states/ Tue, 14 Jul 2020 01:46:02 +0000 https://www.pushasrx.com/?p=25673 11860 Vista Del Sol, Ste. 128 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. […]

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11860 Vista Del Sol, Ste. 128 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 and 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*

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11860 Vista Del Sol, Ste. 128 Chronic Pain Throughout the United States 11860 Vista Del Sol, Ste. 128 Chronic Pain Throughout the United States 25673
A Few Ways to Manage Chronic Back Pain During Summer https://www.pushasrx.com/manage-chronic-pain-during-summer/ https://www.pushasrx.com/manage-chronic-pain-during-summer/#respond Sat, 27 Jun 2020 02:18:38 +0000 https://www.pushasrx.com/?p=25577 11860 Vista Del Sol, Ste. 128 A Few Ways to Manage Chronic Back Pain During Summer

Chronic back pain does not have to ruin the summer season. The best approach is planning ahead remembering a few self-care warm/hot weather tips. The hot weather can worsen pain symptoms. With all the family activities going on, maintaining back pain wellness can be difficult. This is where the planning/preparing for chronic pain comes in. […]

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11860 Vista Del Sol, Ste. 128 A Few Ways to Manage Chronic Back Pain During Summer Chronic back pain does not have to ruin the summer season. The best approach is planning ahead remembering a few self-care warm/hot weather tips. The hot weather can worsen pain symptoms. With all the family activities going on, maintaining back pain wellness can be difficult. This is where the planning/preparing for chronic pain comes in. Individuals should begin thinking around April what they will be doing once the hot months arrive and plan accordingly. However, self-care should be implemented for all seasons.  
11860 Vista Del Sol, Ste. 128 A Few Ways to Manage Chronic Back Pain During Summer
 

Water Therapy

Depending on the condition, water can be a friendly sanctuary from the pain with the ability to do some spine exercises. Light stretching can bring relief and keeps the muscles and ligaments stretched. Outside of the pool, a misting fan can create a relaxing atmosphere along with ice packs during summer pain flares.  
11860 Vista Del Sol, Ste. 128
 

Avoid high heat

Sunburn or prolonged heat exposure can cause burning nerve pain. The changes in temperature and barometric pressure can trigger joint pain. Plan on doing activities in the morning or after the sun has set. Keep a hand-held fan close-by whenever going out. Wear loose light sun friendly clothing, comfortable shoes, possibly a hat to shield the face and keep an ice-cold water bottle with you.  
11860 Vista Del Sol, Ste. 128 A Few Ways to Manage Chronic Back Pain During Summer
 

Proper seating

Summer activities typically include uncomfortable seating, like small chairs, bleachers, and activities where everyone sits on the ground. Plan ahead for these situations and store a comfortable possibly therapeutic folding or travel chair that fits in an automobile. Add a lumbar cushion to support the lower back.  
prevent migraine headaches chiropractic el paso tx.
 

Immune system health

Fruits and vegetables can boost the body’s vitamin and mineral bank. Better quality food will make you feel so much better. Whatever you can get at the market, get it and turn it into a cold healthy smoothie. The USDA found that cherries contain pain-fighting and inflammation-reducing compounds that can help reduce pain, specifically arthritis.  
nutritional epigenetics el paso tx.
 

Air quality

Pay attention to the air quality rating during the summer. Studies have shown that air pollution can increase inflammation, specifically for individuals with: Before heading outside, check the Air Quality Index or the AQI just as a precaution.  
11860 Vista Del Sol, Ste. 128
 

Don’t delay healthcare

Don’t let summer vacation or road trips get in the way of your chiropractic treatment plan. Check-in before you go and ask for help to navigate the adventure with as little pain as possible. Self-sufficiency can be achieved by planning ahead. Reduce stress and increase your independence.

Why Chiropractic Works


 

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*

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What is Degenerative Disc Disease (DDD)?: An Overview https://www.pushasrx.com/what-is-degenerative-disc-disease-ddd-an-overview/ https://www.pushasrx.com/what-is-degenerative-disc-disease-ddd-an-overview/#respond Tue, 23 Jun 2020 22:49:57 +0000 https://www.pushasrx.com/?p=25563 What is Degenerative Disc Disease (DDD)?: An Overview | El Paso, TX Chiropractor

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. […]

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What is Degenerative Disc Disease (DDD)?: An Overview | El Paso, TX Chiropractor

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 6ᵒ 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. (Battié, Michele C.) Nicotine has been implicated in twin studies to cause impaired blood flow to the intervertebral disc, leading to disc degeneration. (BATTIÉ, 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, YRJÖ 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, Björn 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.

 

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Disc Bulge & Herniation Chiropractic Care Overview https://www.pushasrx.com/disc-bulge-herniation-chiropractic-care-overview/ https://www.pushasrx.com/disc-bulge-herniation-chiropractic-care-overview/#respond Fri, 19 Jun 2020 20:27:25 +0000 https://www.pushasrx.com/?p=25546 Disc Bulge & Herniation Chiropractic Care Overview | El Paso, TX Chiropractor

Disc bulge and disc herniation are some of the most common conditions that can affect the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician for the treatment of spinal disorders. Approximately $ 7.1 billion alone is lost due to the time away […]

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Disc Bulge & Herniation Chiropractic Care Overview | El Paso, TX Chiropractor

Disc bulge and disc herniation are some of the most common conditions that can affect the spine of both young and middle-aged patients. It is estimated that approximately 2.6% of the US population annually visits a clinician for the treatment of spinal disorders. Approximately $ 7.1 billion alone is lost due to the time away from work.

 

Disc herniation is when the whole or part of the nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. This is also known as the slipped disc and frequently occurs in the lower back sometimes also affecting the cervical region. Herniation of the intervertebral disc is defined as a localized displacement of disc material with 25% or less of the disc circumference on an MRI scan according to the North American Spine Society 2014. The herniation may consist of nucleus pulposus, annulus fibrosus, apophyseal bone or osteophytes, and the vertebral endplate cartilage in contrast to disc bulge.

 

There are also mainly two types of disc herniation. Disc protrusion is when a focal or symmetrical extension of the disc comes out of its confines in the intervertebral space. It is situated at the level of the intervertebral disc and its outer annular fibers are intact. A disc extrusion is when the intervertebral disc extends above or below the adjacent vertebrae or endplates with complete annular tear. In this type of disc extrusion, there is a neck or base which is narrower than the dome or the herniation.

 

A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. Here, the displacement is more than 25% of the circumference of the intervertebral disc. It also does not extend below or above the margins of the disc because it is limited by the annulus fibrosus attachment. It differs from disc herniation because it involves less than 25% of the circumference of the disc. Usually, the disc bulge is a gradual process and is broad. The disc bulge can be divided into 2 types. In circumferential bulge, the whole disc circumference is involved. In asymmetrical bulging, more than 90 degrees of the circumference is involved in an asymmetric way.

 

Normal Intervertebral Disc Anatomy

 

Before going into detail into the definition of disc herniation and disc bulge, we need to take a look at how the normal intervertebral disc looks like. According to spine guidelines in 2014, a normal disc is something that has a normal shape without any evidence of degenerative disc changes. Intervertebral discs are responsible for one third to one-fourth of the height of the spinal column.

 

One intervertebral disc is about 7 – 10 mm thick and measures 4 cm in anterior-posterior diameter in the lumbar region of the spine. These spinal discs are located between two adjacent vertebral bodies. However, no discs can be found between the atlas and axis and in the coccyx. About 23 discs are found in the spine with 6 found in the cervical spine, 12 in the thoracic spine, and only 5 found in the lumbar spine.

 

Intervertebral discs are made of fibro cartilages and they form a fibrocartilaginous joint. The outer ring of the intervertebral disc is known as the annulus fibrosus while the inner gel-like structure in the center is known as the nucleus pulposus. The cartilage endplates sandwich the nucleus pulposus superiorly and inferiorly. The annulus fibrosus is made up of concentric collagen fiber sheets arranged in a radial tire-like structure into lamellae. The fibers are attached to the vertebral endplates and oriented at different angles. The endplates with its cartilaginous part, anchor the discs in its proper place.

 

The nucleus pulposus is composed of water, collagen, and proteoglycans. Proteoglycans attract and retain water hence giving the nucleus pulposus a hydrated gel-like consistency. Interestingly, throughout the day the amount of water found in the nucleus pulposus varies according to the level of activity of the person. This feature in the intervertebral disc serves as a cushion or a spinal shock-absorbing system to protect the adjacent vertebra, spinal nerves, spinal cord, brain, and other structures against various forces. Although the individual movement of the intervertebral discs is limited, some form of vertebral motion like flexion and extension is still possible due to the features of the intervertebral disc.

 

Effect of Intervertebral Disc Morphology on Structure and Function

 

The type of components presents in the intervertebral disc and how it is arranged determines the morphology of the intervertebral disc. This is important in how effectively the disc does its function. As the disc is the most important element which bears the load and allows movement in the otherwise rigid spine, the constituents it is made up of have a significant bearing.

 

The complexity of the lamellae increases with advancing age as a result of the synthetic response of the intervertebral disc cells to the variations in the mechanical load. These changes in lamellae with more bifurcations, interdigitation, and irregular size and number of lamellar bands will lead to the altered bearing of weight. This in turn establishes a self-perpetuated disruption cycle leading to the destruction of the intervertebral discs. Once this process is started it is irreversible. As there is an increased number of cells, the amount of nutrition the disc requires is also increasingly changing the normal concentration gradient of both metabolites and nutrients. Due to this increased demand, the cells may also die increasingly by necrosis or apoptosis.

 

Human intervertebral discs are avascular and hence the nutrients are diffused from the nearby blood vessels in the margin of the disc. The main nutrients; oxygen and glucose reach the cells in the disc through diffusion according to the gradient determined by the rate of transport to the cells through the tissues and the rate of demand. Cells also increasingly produce lactic acid as a metabolic end product. This is also removed via the capillaries and venules back to the circulation.

 

Since diffusion depends on the distance, the cells lying far from the blood capillaries can have a reduced concentration of nutrients because of reduced supply. With disease processes, the normally avascular intervertebral disc can become vascular and innervated in degeneration and in disease processes. Although this may increase the oxygen and nutrient supply to the cells in the disc, this can also give rise to many other types of cells that are normally not found in the disc with the introduction of cytokines and growth factors.

 

The morphology of the intervertebral disc in different parts of the spine also varies although many clinicians base the clinical theories based on the assumption that both cervical and lumbar intervertebral discs have the same structure. The height of the disc was the minimum in T4 – 5 level of the thoracic column probably due to the fact that thoracic intervertebral discs are less wedge-shaped than those of cervical and lumbar spinal regions.

 

From the cranial to caudal direction, the cross-sectional area of the spine increased. Therefore, by L5 – S1 level, the nucleus pulposus was occupying a higher proportion of the intervertebral disc area. The cervical discs have an elliptical shape on cross-section while the thoracic discs had a more circular shape. The lumbar discs also have an elliptical shape though it is more flattened or re-entrant posteriorly.

 

What is a Disc Bulge?

 

The bulging disc is when the disc simply bulges outside the intervertebral disc space it normally occupies without the rupture of the outer annulus fibrosus. The bulging area is quite large when compared to a herniated disc. Moreover, in a herniated disc, the annulus fibrosus ruptures or cracks. Although the disc bulging is more common than disc herniation, it causes little or no pain to the patient. In contrast, the herniated disc causes a lot of pain.

 

Causes for Disc Bulging

 

Bulging disc can be due to several causes. It can occur due to normal age-related changes such as seen in degenerative disc disease. The aging process can lead to structural and biochemical changes in the intervertebral discs and lead to reduced water content in the nucleus pulposus. These changes can make the patient vulnerable to disc bulges with only minor trauma. Some unhealthy lifestyle habits such as a sedentary lifestyle and smoking can potentiate this process and give rise to more severe changes with the weakening of the disc.

 

General wear and tear due to repeated microtrauma can also weaken the disc and give rise to disc bulging. This is because when the discs are strained, the normal distribution of weight loading changes. Accumulated micro-trauma over a long period of time can occur in bad posture. Bad posture when sitting, standing, sleeping, and working can increase the pressure in the intervertebral discs.

 

When a person maintains a forward bending posture, it can lead to overstretching and eventually weakness of the posterior part of the annulus fibrosus. Over time, the intervertebral disc can bulge posteriorly. In occupations that require frequent and repetitive lifting, standing, driving, or bending, the bulging disc may be an occupational hazard. Improper lifting up of items, improper carrying of heavy objects can also increase the pressure on the spine and lead to disc bulges eventually.

 

The bulging intervertebral discs usually occur over a long period of time. However, the discs can bulge due to acute trauma too. The unexpected sudden mechanical load can damage the disc resulting in micro-tears. After an accident, the disc can become weaken causing long term microdamage ultimately leading to bulging of the disc. There may also be a genetic component to the disc bulging. The individual may have a reduced density of elastin in the annulus fibrosus with increased susceptibility for disc diseases. Other environmental facts may also play a part in this disease process.

 

Symptoms of Disc Bulging

 

As mentioned previously, bulging discs do not cause pain and even if they do the severity is mild. In the cervical region, the disease will cause pain running down the neck, deep pain in the shoulder region, pain radiating along the upper arm, and forearm up to fingers.

 

This may give rise to a diagnostic dilemma as to whether the patient is suffering from a myocardial infarction as the site of referred pain and the radiation is similar. Tingling feeling on the neck may also occur due to the bulging disc.

 

In the thoracic region, there may be a pain in the upper back which radiates to the chest or the upper abdominal region. This may also suggest upper gastrointestinal, lung, or cardiac pathology and hence need to be careful when analyzing these symptoms.

 

The bulging discs of the lumbar region may present as lower back pain and tingling feeling in the lower back region of the spine. This is the most common site for disc bulges since this area holds the weight of the upper body. The pain or the discomfort can spread through the gluteal area, thighs, and to the feet. There may also be muscle weakness, numbness or tingling sensation. When the disc presses on the spinal cord, the reflexes of both legs can increase leading to spasticity.

 

Some patients may even have paralysis from the waist down. When the bulging disc compresses on the cauda equine, the bladder and bowel functions can also change. The bulging disc can press on the sciatic nerve leading to sciatica where the pain radiates in one leg from back down to the feet.

 

The pain from the bulging disc can get worse during some activities as the bulge can then compress on some of the nerves. Depending on what nerve is affected, the clinical features can also vary.

 

Diagnosis of Disc Bulging

 

The diagnosis may not be apparent from clinical history due to similar presentations in more serious problems. But the chronic nature of the disease may give some clues. Complete history and a physical examination need to be done to rule out myocardial infarction, gastritis, gastro-oesophageal reflux disease, and chronic lung pathology.

 

MRI of Disc Bulge

 

Investigations are necessary for the diagnosis. X-ray spine is performed to look for gross pathology although it may not show the bulging disc directly. There may be indirect findings of disk degeneration such as osteophytes in the endplates, gas in the disc due to vacuum phenomenon, and the loss of height of the intervertebral disc. In the case of moderate bulges, it may sometimes appear as non-focal intervertebral disc material that is protruded beyond the borders of the vertebra which is broad-based, circumferential, and symmetrical.

 

The magnetic resonance imaging or MRI can exquisitely define the anatomy of the intervertebral discs especially the nucleus pulposus and its relationships. The early findings seen on MRI in disc bulging include the loss of normal concavity of the posterior disc. The bulges can be seen as broad-based, circumferential, and symmetrical areas. In moderate bulging, the disc material will protrude beyond the borders of the vertebrae in a non-focal manner. Ct myelogram may also give detailed disc anatomy and may be useful in the diagnosis.

 

Treatment of Disc Bulging

 

The treatment for the bulging disc can be conservative, but sometimes surgery is required.

 

Conservative Treatment

 

When the disc bulging is asymptomatic, the patient does not need any treatment since it does not pose an increased risk. However, if the patient is symptomatic, the management can be directed at relieving the symptoms. The pain is usually resolved with time. Till then, potent pain killers such as non-steroidal anti-inflammatory drugs like ibuprofen should be prescribed. In unresolved pain, steroid injections can also be given to the affected area and if it still does not work, the lumbar sympathetic block can be tried in most severe cases.

 

The patient can also be given the option of choosing alternative therapies such as professional massage, physical therapy, ice packs, and heating pads which may alleviate symptoms. Maintaining correct posture, tapes, or braces to support the spine are used with the aid of a physiotherapist. This may fasten the recovery process by avoiding further damage and keeping the damaged or torn fibers in the intervertebral disc without leakage of the fluid portion of the disc. This helps maintain the normal structure of the annulus and may increase the recovery rate. Usually, the painful symptoms which present initially get resolved over time and lead to no pain. However, if the symptoms get worse steadily, the patient may need surgery.

 

If the symptoms are resolved, physiotherapy can be used to strengthen the muscles of the back with the use of exercises. Gradual exercises can be used for the return of function and for preventing recurrences.

 

Surgical Treatment

 

When conservative therapy does not work with a few months of treatment, surgical treatment can be considered. Most would prefer minimally invasive surgery which uses advanced technology to correct the intervertebral disc without having to grossly dissect the back. These procedures such as microdiscectomy have a lower recovery period and reduced risk of scar formation, major blood loss, and trauma to adjacent structures when compared to open surgery.

 

Previously, laminectomy and discectomy have been a mainstay of treatment. However, due to the invasiveness of the procedure and due to increased damage to the nerves these procedures are currently abandoned by many clinicians for disc bulging.

 

Disc bulging in the thoracic spine is being treated surgically with costotransversectomy where a section of the transverse process is resected to allow access to the intervertebral disc. The spinal cord and spinal nerves are decompressed by using thoracic decompression by removing a part of the vertebral body and making a small opening. The patient may also need a spinal fusion later on if the removed spinal body was significant.

 

Video-assisted thoracoscopic surgery can also be used where only a small incision is made and the surgeon can perform the surgery through the assistance of the camera. If the surgical procedure involved removing a large portion of the spinal bone and disc material, it may lead to spinal instability. This may need bone grafting to replace the lost portion with plates and screws to hold them in place.

 

What is a Disc Herniation?

 

As mentioned in the first section of this article, disc herniation occurs when there is disc material displaces beyond the limits of the intervertebral disc focally. The disc space consists of endplates of the vertebral bodies superiorly and inferiorly while the outer edges of the vertebral apophyses consist of the peripheral margin. The osteophytes are not considered a disc margin. There may be irritation or compression of the nerve roots and dural sac due to the volume of the herniated material leading to pain. When this occurs in the lumbar region, this is classically known as sciatica. This condition has been mentioned since ancient times although a connection between disc herniation and sciatica was made only in the 20th century. Disc herniation is one of the commonest diagnoses seen in the spine due to degenerative changes and is the commonest cause for spinal surgery.

 

Classifications of Disc Herniation

 

There are many classifications regarding intervertebral disc herniation. In focal disc herniation, there is a localized displacement of the disc material in the horizontal or axial plane. In this type, only less than 25% of the circumference of the disc is involved. In broad-based disc herniation, about 25 – 50 % of the disc circumference is herniated. The disc bulge is when 50 – 100 % of the disc material is extended beyond the normal confines of the intervertebral space. This is not considered a form of disc herniation. Furthermore, the intervertebral disc deformities associated with severe cases of scoliosis and spondylolisthesis is not classified as a herniation but rather adaptive changes of the contour of the disc due to the adjacent deformity.

 

Depending on the contour of the displaced material, the herniated discs can be further classified as protrusions and extrusions. In disc protrusion, the distance measured in any plane involving the edges of the disc material beyond intervertebral disc space (the highest measure is taken) is lower than the distance measured in the same plane between the edges of the base.

 

Imaging can show the disc displacement as a protrusion on the horizontal section and as an extrusion on the sagittal section due to the fact that the posterior longitudinal ligament contains the disc material that is displaced posteriorly. Then the herniation should be considered an extrusion. Sometimes the intervertebral disc herniation can occur in the craniocaudal or vertical direction through a defect in the vertebral body endplates. This type of herniation is known as intravertebral herniation.

 

The disc protrusion can also be divided into two as focal protrusion and broad-based protrusion. In focal protrusion, the herniation is less than 25% of the circumference of the disc whereas, in broad-based protrusion, the herniated disc consists of 25 – 50 % of the circumference of the disc.

 

In disc extrusion, it is diagnosed if any of the two following criteria are satisfied. The first one is; the distance measured between the edges of the disc material that is beyond the intervertebral disc space is greater than the distance measured in the same plane between the edges of the base. The second one is; the material in the intervertebral disc space and material beyond the intervertebral disc space is having a lack of continuity.

 

This can be further characterized as sequestrated which is a subtype of the extruded disc. It is called disc migration when disk material is pushed away from the site of extrusion without considering whether there is continuity of disc or not. This term is useful in interpreting imaging modalities as it is often difficult to show continuity in imaging.

 

The intervertebral disc herniation can be further classified as contained discs and discs that are unconfined. The term contained disc is used to refer to the integrity of the peripheral annulus fibrosus which is covering the intervertebral disc herniation. When fluid is injected into the intervertebral disc, the fluid does not leak into the vertebral canal in herniations that are contained.

 

Sometimes there are displaced disc fragments that are characterized as free. However, there should be no continuity between disc material and the fragment and the original intervertebral disc for it to be called a free fragment or a sequestered one. In a migrated disc and in a migrated fragment, there is an extrusion of disc material through the opening in the annulus fibrosus with a displacement of the disc material away from the annulus.

 

Even though some fragments that are migrated can be sequestered ones the term migrated means just to the position and it is not referred to the continuity of the disc. The displaced intervertebral disc material can be further described with regard to the posterior longitudinal ligament as submembranous, subcapsular, subligamentous, extra ligamentous, transligamentous, subcapsular, and perforated.

 

The spinal canal can also get affected by an intervertebral disc herniation. This compromise of the canal can also be classified as mild, moderate, and severe depending on the area that is compromised. If the canal at that section is compromised only less than one third, it is called mild whereas if it is only compromised less than two-third and more than one third it is considered moderate. In a severe compromise, more than two-thirds of the spinal canal is affected. For the foraminal involvement, this same grading system can be applied.

 

The displaced material can be named according to the position that they are in the axial plane from the center to the right lateral region. They are termed as central, right central, right subarticular, right foraminal, and right extraforaminal. The displaced intervertebral disc material’s composition can be further classified as gaseous, liquefied, desiccated, scarred, calcified, ossified, bony, nuclear, and cartilaginous.

 

Before going into detail on how to diagnose and treat intervertebral disc herniation, let us differentiate how cervical disc herniation differs from lumbar herniation since they are the most common regions to undergo herniation.

 

Cervical Disc Herniation vs. Thoracic Disc Herniation vs Lumbar Disc Herniation

 

Lumbar disc herniation is the commonest type of herniation found in the spine which is approximately 90% of the total. However, cervical disc herniation can also occur in about one-tenth of patients. This difference is mainly due to the fact that the lumbar spine has more pressure due to the increased load. Moreover, it has comparatively large intervertebral disc material. The most common sites of intervertebral disc herniation in the lumbar region is L 5 – 6, in the Cervical region between C7, in the thoracic region T12.

 

Cervical disc herniation can occur relatively commonly because the cervical spine acts as a pivoting point for the head and it is a vulnerable area for trauma and therefore prone to damage in the disc. Thoracic disc herniation occurs more infrequently than any of the two. This is due to the fact that thoracic vertebrae are attached to the ribs and the thoracic cage which limits the range of movement in the thoracic spine when compared to the cervical and lumbar spinal discs. However, thoracic intervertebral disc herniation can still occur.

 

Cervical disc herniation gives rise to neck pain, shoulder pain, or pain radiating from neck to the arm, tingling, etc. Lumbar disc herniation can similarly cause lower back pain as well as pain, tingling, numbness, and muscle weakness seen in the lower limbs. Thoracic disc herniation can give rise to pain in the upper back radiating to the torso.

 

Epidemiology

 

Although disc herniation can occur in all age groups, it predominantly occurs in between the fourth and fifth decade of life with the mean age of 37 years. There have been reports that estimate the prevalence of intervertebral disc herniation to be 2 – 3 % of the general population. It is more commonly seen in men over 35 years with a prevalence of 4.8% and while in women this figure is around 2.5%. Due to its high prevalence, it is considered a worldwide problem as it is also associated with significant disability.

 

Risk Factors

 

In most instances, a herniated disc occurs due to the natural aging process in the intervertebral disc. Due to the disc degeneration, the amount of water that was previously seen in the intervertebral disc gets dried out leading to shrinking of the disc with narrowing of the intervertebral space. These changes are markedly seen in degenerative disc disease. In addition to these gradual changes due to normal wear and tear, other factors may also contribute to increasing the risk of intervertebral disc herniation.

 

Being overweight can increase the load on the spine and increase the risk of herniation. A sedentary life can also increase the risk and therefore an active lifestyle is recommended in preventing this condition. Improper posture with prolonged standing, sitting, and especially driving can put a strain on the intervertebral discs due to the additional vibration from the vehicle engine leading to microtrauma and cracks in the disc. The occupations which require constant bending, twisting, pulling and lifting can put a strain on the back. Improper weight lifting techniques are one of the major reasons.

 

When back muscles are used in lifting heavy objects instead of lifting with the legs and twisting while lifting can make the lumbar discs more vulnerable to herniation. Therefore patients should always be advised to lift weights with the legs and not the back. Smoking has been thought to increase disc herniation by reducing the blood supply to the intervertebral disc leading to degenerative changes of the disc.

 

Although the above factors are frequently assumed to be the causes for disc herniation, some studies have shown that the difference in risk is very small when this particular population was compared with the control groups of the normal population.

 

There have been several types of research done on genetic predisposition and intervertebral disc herniation. Some of the genes that are implicated in this disease include vitamin D receptor (VDR) which is a gene that codes for the polypeptides of important collagen called collagen IX (COL9A2).

 

Another gene called the human aggrecan gene (AGC) is also implicated as it codes for proteoglycans which is the most important structural protein found in the cartilage. It supports the biochemical and mechanical function of the cartilage tissue and hence when this gene is defective, it can predispose an individual to intervertebral disc herniation.

 

Apart from these, there are many other genes that are being researched due to the association between disc herniation such as matrix metalloproteinase (MMP) – 3, MMP – 9, cartilage intermediate layer protein, thrombospondin (THBS2), collagen 11A1, carbohydrate sulfotransferase, and asporin (ASPN). They may also be regarded as potential gene markers for lumbar disc disease.

 

Pathogenesis of Sciatica and Disc Herniation

 

The sciatic pain is originated from the extruded nucleus pulposus inducing various phenomena. It can directly compress the nerve roots leading to ischemia or without it, mechanically stimulate the nerve endings of the outer portion of the fibrous ring and release inflammatory substances suggesting its multifactorial origin. When the disc herniation causes mechanical compression of the nerve roots, the nerve membrane is sensitized to pain and other stimuli due to ischemia. It has been shown that in sensitized and compromised nerve roots, the threshold for neuronal sensitization is around half of that of a normal and non-compromised nerve root.

 

The inflammatory cell infiltration is different in extruded discs and non-extruded discs. Usually, in non extruded discs, the inflammation is less. The extruded disc herniation causes the posterior longitudinal ligament to rupture which exposes the herniated part to the vascular bed of the epidural space. It is believed that inflammatory cells are originating from these blood vessels situated in the outermost part of the intervertebral disc.

 

These cells may help secrete substances that cause inflammation and irritation of the nerve roots causing sciatic pain. Therefore, extruded herniations are more likely to cause pain and clinical impairment than those that are contained. In contained herniations, the mechanical effect is predominant while in the unconfined or the extruded discs the inflammatory effect is predominant.

 

Clinical Disc Herniation and What to Look for in the History

 

The symptoms of the disc herniation can vary to a great deal depending on the location of the pain, the type of herniation, and on the individuals. Therefore, history should focus on the analysis of the main complaint among the many other symptoms.

 

The chief complain can be neck pain in cervical disc herniation and there can be referred pain to the arms, shoulders, neck, head, face, and even to the lower back region. However, it is most commonly referred to the interscapular region. The radiation of pain can occur according to the level the herniation is taking place. When the nerve roots of the cervical region are affected and compressed, there can be sensory, motor changes with changes in the reflexes.

 

The pain that occurs due to nerve root compression is called radicular pain and it can be described as deep, aching, burning, dull, achy, and electric depending on whether there is mainly motor dysfunction or sensory dysfunction. In the upper limb, the radicular pain can follow a dermatomal or myotomal pattern. Radiculopathy usually does not accompany neck pain. There can be unilateral as well as bilateral symptoms. These symptoms can be aggravated by activities that increase the pressure inside the intervertebral discs such as Valsalva maneuver, lifting.

 

Driving can also exacerbate pain due to disc herniation due to stress because of vibration. Some studies have shown that shock loading and stress from vibration can cause a mechanical force to exacerbate small herniations but flexed posture had no influence. Similarly, the activities that decrease intradiscal pressure can reduce the symptoms as in lying down.

 

The main complaint in lumbar disc herniation is lower back pain. Other associated symptoms can be a pain in the thigh, buttocks, anogenital region which can radiate to the foot and toe. The main nerve affected in this region is the sciatic nerve causing sciatica and its associated symptoms such as intense pain in the buttocks, leg pain, muscle weakness, numbness, impairment of sensation, hot and burning or tingling sensation in the legs, dysfunction of gait, impairment of reflexes, edema, dysesthesia or paresthesia in the lower limbs. However, sciatica can be caused by causes other than herniation such as tumors, infection, or instability which need to be ruled out before arriving at a diagnosis.

 

The herniated disc can also compress on the femoral nerve and can give rise to symptoms such as numbness, tingling sensation in one or both legs, and a burning sensation in the legs and hips. Usually, the nerve roots that are affected in herniation in the lumbar region are the ones exiting below the intervertebral disc. It is thought that the level of the nerve root irritation determines the distribution of leg pain. In herniations at the third and fourth lumbar vertebral levels, the pain may radiate to the anterior thigh or the groin. In radiculopathy at the level of the fifth lumbar vertebra, the pain may occur in the lateral and anterior thigh region. In herniations at the level of the first sacrum, the pain may occur in the bottom of the foot and the calf. There can also be numbness and tingling sensation occurring in the same area of distribution. The weakness in the muscles may not be able to be recognized if the pain is very severe.

 

When changing positions the patient is often relieved from pain. Maintaining a supine position with the legs raised can improve the pain. Short pain relief can be brought by having short walks while long walks, standing for prolonged periods, and sitting for extended periods of time such as in driving can worsen the pain.

 

The lateral disc herniation is seen in foraminal and extraforaminal herniations and they have different clinical features to that of medial disc herniation seen in subarticular and central herniations. The lateral intervertebral disc herniations can when compared to medial herniations more directly irritate and mechanically compress the nerve roots that are exiting and the dorsal root ganglions situated inside the narrowed spinal canal.

 

Therefore, lateral herniation is seen more frequently in older age with more radicular pain and neurological deficits. There is also more radiating leg pain and intervertebral disc herniations in multiple levels in the lateral groups when compared to medial disc herniations.

 

The herniated disc in the thoracic region may not present with back pain at all. Instead, there are predominant symptoms due to referred pain in the thorax due to irritation on nerves. There can also be predominant pain in the body that travels to the legs, tingling sensation and numbness in one or both legs, muscle weakness and spasticity of one or both legs due to exaggerated reflexes.

 

The clinician should look out for atypical presentations as there could be other differential diagnoses. The onset of symptoms should be inquired to determine whether the disease is acute, sub-acute, or chronic in onset. Past medical history has to be inquired in detail to exclude red flag symptoms such as pain which occurs at night without activity which can be seen in pelvic vein compression, non-mechanical pain which may be seen in tumors or infections.

 

If there is a progressive neurological deficit, with bowel and bladder involvement is there, it is considered a neurological emergency and urgently investigated because cauda equine syndrome may occur which if untreated, can lead to permanent neurological deficit.

 

Getting a detailed history is important including the occupation of the patient as some activities in the job may be exacerbating the patient’s symptoms. The patient should be assessed regarding which activities he can and cannot do.

 

Differential Diagnosis

 

  • Degenerative disc disease
  • Mechanical pain
  • Myofascial pain leading to sensory disturbances and local or referred pain
  • Hematoma
  • Cyst leading to occasional motor deficits and sensory disturbances
  • Spondylosis or spondylolisthesis
  • Discitis or osteomyelitis
  • Malignancy, neurinoma or mass lesion causing atrophy of thigh muscles, glutei
  • Spinal stenosis is seen mainly in the lumbar region with mild low back pain, motor deficits, and pain in one or both legs.
  • Epidural abscess which can cause symptoms similar to radicular pain involving spinal disc herniation
  • Aortic aneurysm which can cause low back pain and leg pain due to compression can also rupture and lead to hemorrhagic shock.
  • Hodgkin’s lymphoma in advanced stages can lead to space-occupying lesions in the spinal column leading to symptoms like that of intervertebral disc herniation
  • Tumors
  • Pelvic endometriosis
  • Facet hypertrophy
  • Lumbar nerve root schwannoma
  • Herpes zoster infection results in inflammation along with the sciatic or lumbosacral nerve roots

 

Examination in Disc Herniation

 

Complete physical examination is necessary to diagnose intervertebral disc herniation and exclude other important differential diagnoses. The range of motion has to be tested but may have a poor correlation with disc herniation as it is mainly reduced in elderly patients with a degenerative disease and due to disease of the joints.

 

A complete neurological examination is often necessary. This should test the muscle weakness and sensory weakness. In order to detect the muscle weakness in small toe muscles, the patient can be asked to walk on tiptoe. The strength of muscle can also be tested by comparing the strength to that of the clinician. There may be dermatomal sensory loss suggesting the respective nerve root involvement. The reflexes may be exaggerated or sometimes maybe even absent.

 

There are many neurologic examination maneuvers described in relation to intervertebral disc herniation such as Braggart sign, flip sign, Lasegue rebound sign, Lasegue differential sign, Mendel Bechterew sign, Deyerle sign both legs or Milgram test, and well leg or Fajersztajin test. However, all these are based on testing the sciatic nerve root tension by using the same principles in the straight leg raising test. These tests are used for specific situations to detect subtle differences.

 

Nearly almost all of them depend on the pain radiating down the leg and if it occurs above the knee it is assumed to be due to a neuronal compressive lesion and if the pain goes below the knee, it is considered to be due to the compression of the sciatic nerve root. For lumbar disc herniation detection, the most sensitive test is considered to be radiating pain occurring down the leg due to provocation.

 

In the straight leg raising test also called the Lasegue’s sign, the patient stays on his or her back and keeps the legs straight. The clinician then lifts the legs by flexing the hip while keeping the knee straight. The angle at which the patient feels a pain going down the leg below the knee is noted. In a normal healthy individual, the patient can flex the hip to 80 – 90ᵒ without having any pain or difficulty.

 

However, if the angle is just 30 – 70ᵒ degrees, it is suggestive of lumbar intervertebral disc herniation at the L4 to S1 nerve root levels. If the angle of hip flexion without pain is less than 30 degrees, it usually indicates some other causes such as tumor of the gluteal region, gluteal abscess, spondylolisthesis, disc extrusion, and protrusion, malingering patient and acute inflammation of the dura mater. If pain with hip flexion occurs at more than 70 degrees, it may be due to tightness of the muscles such as gluteus maximus and hamstrings, tightness of the capsule of the hip joint, or pathology of sacroiliac or hip joints.

 

The reverse straight leg raising test or hip extension test can be used to test higher lumbar lesions by stretching the nerve roots of the femoral nerve which is similar to the straight leg raising test. In the cervical spine, in order to detect stenosis of the foramina, the Spurling test is done and is not specific to cervical intervertebral disc herniation or tension of the nerve roots. The Kemp test is the analogous test in the lumbar region to detect the foraminal stenosis. Complications due to the disc herniation include careful examination of the hip region, digital rectal examination, and urogenital examination is needed.

 

Investigation of Disc Herniation

 

For the diagnosis of intervertebral disc herniation, diagnostic tests such as Magnetic resonance imaging (MRI), Computed tomography (CT), myelography, and plain radiography can be used either alone or in combination with other imaging modalities. Objective detection of disc herniation is important because only after such finding the surgical intervention is even considered. Serum biochemical tests such as prostate-specific antigen (PSA) level, Alkaline phosphatize value, erythrocyte sedimentation rate (ESR), urine analysis for Bence Jones protein, serum glucose level and serum protein electrophoresis may also be needed in specific circumstances guided by history.

 

Magnetic Resonance Imaging (MRI)

 

MRI is considered the best imaging modality in patients with history and physical examination findings suggestive of lumbar disc herniation associated with radiculopathy according to North American Spinal Society guidelines in 2014. The anatomy of the herniated nucleus pulposus and its associated relationships with soft tissue in the adjacent areas can be delineated exquisitely by MRI in cervical, thoracic, and lumbosacral areas. Beyond the confines of the annulus, the herniated nucleus can be seen as a focal, asymmetric disc material protrusion on MRI.

 

On sagittal T2 weighted images, the posterior annulus is usually seen as a high signal intensity area due to radial annular tear associated with the herniation of the disc although the herniated nucleus is itself hypointense. The relationship between the herniated nucleus and degenerated facets with the nerve roots which are exiting through the neural foramina are well-demarcated on sagittal images of MRI. Free fragments of the intervertebral disc can also be distinguished from MRI images.

 

There may be associated signs of intervertebral disc herniation on MRI such as radial tears on the annulus fibrosus which is also a sign of degenerative disc disease. There may be other telling signs such as loss of disc height, bulging annulus, and changes in the endplates. Atypical signs may also be seen with MRI such as abnormal disc locations, lesions located completely outside the intervertebral disc space.

 

MRI can detect abnormalities in the intervertebral discs superiorly than other modalities although its bone imaging is a little less inferior. However, there are limitations with MRI in patients with metal implant devices such as pacemakers because the electromagnetic field can lead to abnormal functioning of the pacemakers. In patients with claustrophobia, it may become a problem to go to the narrow canal to be scanned by the MRI machine. Although some units contain open MRI, it has less magnetic power and hence delineates less superior quality imaging.

 

This is also a problem in children and anxious patients undergoing MRI because good image quality depends on patient staying still. They may require sedation. The contrast used in MRI which is gadolinium can induce nephrogenic systemic fibrosis in patients who had pre-existing renal disease. MRI is also generally avoided in pregnancy especially during the first 12 weeks although it has not been clinically proven to be hazardous to the fetus. MRI is not very useful when a tumor contains calcium and in distinguishing edema fluid from tumor tissue.

 

Computed Tomography (CT)

 

CT scanning is also considered another good method to assess spinal disc herniation when MRI is not available. It is also recommended as a first-line investigation in unstable patients with severe bleeding. CT scanning is superior to myelography although when the two are combined, it is superior to both of them. CT scans can show calcification more clearly and sometimes even gas in images. In order to achieve a superior imaging quality, the imaging should be focused on the site of pathology and thin sections taken to better determine the extent of the herniation.

 

However, CT scan is difficult to be used in patients who have already undergone laminectomy surgical procedures because the presence of scar tissue and fibrosis causes the identification of the structures difficult although bony changes and deformity in nerve sheath is helpful in making a diagnosis.

 

The images will show a soft tissue mass and displaced thecal sac along with the effacement of the fat in the epidural region. An irregular, lobulated mass near the margin of the disc is seen in fragments that are not restrained by the posterior longitudinal ligament but are still in contact with the margin of the disc. The nuclear fragment of the disc that is fragmented is 80 – 120 HU.

 

The herniated intervertebral discs in the cervical disc can be identified by studying the uncinate process. It is usually projected posteriorly and laterally to the intervertebral discs and superiorly to the vertebral bodies. The uncinate process undergoes sclerosis, and hypertrophy when there is an abnormal relationship between the uncinate process and adjacent structures as seen in degenerative disc disease, intervertebral disc space narrowing, and general wear and tear.

 

Myelopathy can occur when the spinal canal is affected due to the disc disease. Similarly, when neural foramina are involved, radiculopathy occurs. Even small herniated discs and protrusions can cause impingement of the dural sac because the cervical epidural space is narrowed naturally. The intervertebral discs have attenuation a little bit greater than the sac characterized in the CT scan.

 

In the thoracic region, a CT scan can diagnose an intervertebral disc herniation with ease due to the fact that there is an increased amount of calcium found in the thoracic discs. Lateral to the dural sac, the herniated disc material can be seen on CT as a clearly defined mass which is surrounded by epidural fat. When there is a lack of epidural fat, the disc appears as a higher attenuated mass compared to the surrounding.

 

Radiography

 

Plain radiography is not needed in diagnosing herniation of the intervertebral discs, because plain radiographs cannot detect the disc and therefore is used to exclude other conditions such as tumors, infections, and fractures.

 

In myelography, there may be deformity or displacement of the extradural contrast filled thecal sac seen in herniation of the disc. There may also be featured in the affected nerve such as edema, elevation, deviation, and amputation of the nerve root seen in the myelography image.

 

Diskography

 

In this imaging modality, the contrast medium is injected into the disc in order to assess the disc morphology. If pain occurs following injection that is similar to the discogenic pain, it suggests that that disc is the source of the pain. When a CT scan is also performed immediately after discography, it is helpful to differentiate the anatomy and pathological changes. However, since it is an invasive procedure, it is indicated only in special circumstances when MRI and CT have failed to reveal the etiology of back pain. It has several side effects such as headache, meningitis, damage to the disc, discitis, intrathecal hemorrhage, and increased pain.

 

Treatment of Herniated Disc

 

The treatment should be individualized according to the patient-guided through history, physical examination, and diagnostic investigation findings. In most cases, the patient gradually improves without needing further intervention in about 3 – 4 months. Therefore, the patient only needs conservative therapy during this time period. Because of this reason, there are many ineffective therapies that have emerged by attributing the natural resolution of symptoms to that therapy. Therefore, conservative therapy needs to be evidence-based.

 

Conservative Therapy

 

Since the herniation of the disc has a benign course, the aim of treatment is to stimulate the recovery of neurological function, reduce pain, and facilitate early return to work and activities of daily living. The most benefits of the conservative treatment are for younger patients with hernias that are sequestered and in patients with mild neurological deficits due to small disc hernias.

 

Bed rest has long been considered as a treatment option in herniation of the disc. However, it has been shown that bed rest has no effect beyond the first 1 or 2 days. The bed rest is regarded as counterproductive after this period of time.

 

In order to reduce the pain, oral non-steroidal anti-inflammatory drugs such as ibuprofen and naproxen can be used. This can relieve the pain by reducing inflammation associated with the inflamed nerve. Analgesics such as acetaminophen can also be used although they lack the anti-inflammatory effect seen in NSAID. The doses and the drugs should be appropriate for the age and severity of the pain in the patient. If pain is not controlled by the current medication, the clinician has to go one step up in the WHO analgesics ladder. However, the long term use of NSAID and analgesics can lead to gastric ulcers, liver, and kidney problems.

 

In order to reduce the inflammation, other alternative methods such as applying ice in the initial period and then switching to using heat, gels, and rubs may help with the pain as well as muscle spasms. Oral muscle relaxants can also be used in relieving muscle spasms. Some of the drugs include methocarbamol, carisoprodol, and cyclobenzaprine.

 

However, they act centrally and cause drowsiness and sedation in patients and it does not act directly to reduce muscle spasm. A short course of oral steroids such as prednisolone for a period of 5 days in a tapering regime can be given to reduce the swelling and inflammation in the nerves. It can provide immediate pain relief within a period of 24 hours.

 

When the pain is not resolved adequately with maximum effective doses, the patient can be considered for giving steroid injections into the epidural space. The major indication for the steroid injection into periradicular space is discal compression causing radicular pain that is resistant to conventional medical treatment. A careful evaluation with CT or MRI scanning is required to carefully exclude extra discal causes for pain. The contraindications for this therapy include patients with diabetes, pregnancy, and gastric ulcers. Epidural puncture is contraindicated in patients with coagulation disorders and therefore foraminal approach is used carefully if needed.

 

This procedure is performed under the guidance of fluoroscopy and involves injecting steroids and an analgesic into the epidural space adjacent to the affected intervertebral disc to reduce the swelling and inflammation of the nerves directly in an outpatient setting. As much as 50% of the patients experience relief after the injection although it is temporary and they might need repeat injections at 2 weekly intervals to achieve the best results. If this treatment modality becomes successful, up to 3 epidural steroidal injections can be given per year.

 

Physical therapy can help the patient return to his previous life easily although it does not improve the herniated disc. The physical therapist can instruct the patient on how to maintain the correct posture, walking, and lifting techniques depending on the patient’s ability to work, mobility, and flexibility.

 

Stretching exercises can improve the flexibility of the spine while strengthening exercises can increase the strength of the back muscles. The activities which can aggravate the condition of the herniated disc are instructed to be avoided. The physical therapy makes the transition from intervertebral disc herniation to an active lifestyle smooth. The exercise regimes can be maintained for life to improve general well-being.

 

The most effective conservative treatment option that is evidence-based is observation and epidural steroid injection for the relief of pain in the short-term duration. However, if the patients so desire they can use holistic therapies of their choice with acupuncture, acupressure, nutritional supplements, and biofeedback although they are not evidence-based. There is also no evidence to justify the use of trans electrical nerve stimulation (TENS) as a pain relief method.

 

If there is no improvement in the pain after a few months, surgery can be contemplated and the patient must be selected carefully for the best possible outcome.

 

Surgical Therapy

 

The aim of surgical therapy is to decompress the nerve roots and relieve the tension. There are several indications for surgical treatment which are as follows.

 

Absolute indications include cauda equina syndrome or significant paresis. Other relative indications include motor deficits that are greater than grade 3, sciatica that is not responding to at least six months of conservative treatment, sciatica for more than six weeks, or nerve root pain due to foraminal bone stenosis.

 

There have been many discussions over the past few years regarding whether to treat herniation of intervertebral disc disease with prolonged conservative treatment or early surgical treatment. Much research has been conducted in this regard and most of them show that the final clinical outcome after 2 years is the same although the recovery is faster with early surgery. Therefore, it is suggested that early surgery may be appropriate as it enables the patient to return to work early and thereby is economically feasible.

 

Some surgeons may still use traditional discectomy although many are using minimally invasive surgical techniques over recent years. Microdiscectomy is considered to be in the halfway between the two ends. There are two surgical approaches that are being used. Minimally invasive surgery and percutaneous procedures are the ones that are being used due to their relative advantage. There is no place for the traditional surgical procedure known as a laminectomy.

 

However, there are some studies suggesting microdiscectomy is more favorable because of its both short term and long-term advantages. In the short term, there is a reduced length of operation, reduced bleeding, relief of symptoms, and reduced complication rate. This technique has been effective even after 10 years of follow up and therefore is the most preferred technique even now. The studies that have been performed to compare the minimally invasive technique and microdiscectomy have resulted in different results. Some have failed to establish a significant difference while one randomized control study was able to determine that microdiscectomy was more favorable.

 

In microdiscectomy, only a small incision is made aided by an operating microscope and the part of the herniated intervertebral disc fragment which is impinging on the nerve is removed by hemilaminectomy. Some part of the bone is also removed to facilitate access to the nerve root and the intervertebral disc. The duration in the hospital stay is minimal with only an overnight stay and observation because the patient can be discharged with minimal soreness and complete relief of the symptoms.

 

However, some unstable patients may need more prolonged admission and sometimes they may need fusion and arthroplasty. It is estimated that about 80 – 85 % of the patients who undergo microdiscectomy recover successfully and many of them are able to return to their normal occupation in about 6 weeks.

 

There is a discussion on whether to remove a large portion of the disc fragment and curetting of the disc space or to remove only the herniated fragment with minimal invasion of the intervertebral disc space. Many studies have suggested that the aggressive removal of large chunks of the disc could lead to more pain than when conservative therapy is used with 28% versus 11.5 %. It may lead to degenerative disc disease in the long term. However, with conservative therapy, there is a greater risk of recurrence of around 7 % in herniation of the disc. This may require additional surgery such as arthrodesis and arthroplasty to be performed in the future leading to significant distress and economic burden.

 

In the minimally invasive surgery, the surgeon usually makes a tiny incision in the back to put the dilators with increasing diameter to enlarge the tunnel until it reaches vertebra. This technique causes lesser trauma to the muscles than when seen in traditional microdiscectomy. Only a small portion of the disc is removed in order to expose the nerve root and the intervertebral disc. Then the surgeon can remove the herniated disc by the use of an endoscope or a microscope.

 

These minimally invasive surgical techniques have a higher advantage of lower surgical site infections and shorter hospital stays. The disc is centrally decompressed by either chemically or enzymatically with the use of chymopapain, laser, or plasma (ionized gas) ablation and vaporization. It can also be decompressed mechanically by using percutaneous lateral decompression or by aspirating and sucking with a shaver such as a nucleosome. Chemopapin was shown to have adverse effects and eventually withdrawn. Most of the above techniques have shown to be less effective than a placebo. Directed segmentectomy is the one that has shown some promise in being effective similar to microdiscectomy.

 

In the cervical spine, the herniated intervertebral discs are treated anteriorly. This is because the herniation occurs anteriorly and the manipulation of the cervical cord is not tolerated by the patient. The disc herniation that is due to foraminal stenosis and that is confined to the foramen are the only instances where a posterior approach is contemplated.

 

The minimal disc excision is an alternative to the anterior cervical spine approach. However, the intervertebral disc stability after the procedure is dependent on the residual disc. The neck pain can be significantly reduced following the procedure due to the removal of neuronal compression although significant impairment can occur with residual axial neck pain. Another intervention for cervical disc herniation includes anterior cervical interbody fusion. It is more suitable for patients with severe myelopathy with degenerative disc disease.

 

Complications of the Surgery

 

Although the risk of surgery is very low, complications can still occur. Post-operative infection is one of the commonest complications and therefore needs more vigorous infection control procedures in the theatre and in the ward. During the surgery, due to poor surgical technique, nerve damage can occur. A dural leak may occur when an opening in the lining of the nerve root causes leakage of cerebrospinal fluid which is bathing the nerve roots. The lining can be repaired during the surgery. However, headache can occur due to loss of cerebrospinal fluid but it usually improves with time without any residual damage. If blood around the nerve roots clots after the surgery, that blood clot may lead to compression of the nerve root leading to radicular pain which was experienced by the patient previously. Recurrent herniation of the intervertebral disc due to herniation of disc material at the same site is a devastating complication that can occur long term. This can be managed conservatively but surgery may be necessary ultimately.

 

Outcomes of the Surgery

 

There has been extensive research done regarding the outcome of lumbar disc herniation surgery. Generally, the results from the microdiscectomy surgery are good. There is more improvement of leg pain than back pain and therefore this surgery is not recommended for those who have only back pain. Many patients improve clinically over the first week but they may improve over the following several months. Typically, the pain disappears in the initial recovery period and it is followed by an improvement in the strength of the leg. Finally, the improvement of the sensation occurs. However, patients may complain of feeling numbness although there is no pain. The normal activities and work can be resumed over a few weeks after the surgery.

 

Novel Therapies

 

Although conservative therapy is the most appropriate therapy in treating patients, the current standard of care does not address the underlying pathology of herniation of the intervertebral discs. There are various pathways that are involved in the pathogenesis such as inflammatory, immune-mediated, and proteolytic pathways.

 

The role of inflammatory mediators is currently under research and it has led to the development of new therapies that are directed at these inflammatory mediators causing damage to the nerve roots. The cytokines such as TNF α are mainly involved in regulating these processes. The pain sensitivity is mediated by serotonin receptor antagonists and α2 adrenergic receptor antagonists.

 

Therefore, pharmacological therapies that target these receptors and mediators may influence the disease process and lead to a reduction in symptoms. Currently, cytokine antagonists against TNF α and IL 1β have been tested. Neuronal receptor blockers such as sarpogrelate hydrochloride etc have been tested in both animal models and in clinical studies for the treatment of sciatica. Cell cycle modifiers which target the microglia that is thought to initiate the inflammatory cascade has been tested with the neuroprotective antibiotic minocycline.

 

There is also research on inhibiting the NF- kB or protein kinase pathway recently. In the future, the treatment of herniation of the intervertebral disc will be much more improved thanks to the ongoing research. (Haro, Hirotaka)

 

 

A disc bulge and/or a herniated disc is a health issue that affects the intervertebral discs found in between each vertebra of the spine. Although these can occur as a natural part of degeneration with age, trauma or injury as well as repetitive overuse can also cause a disc bulge or a herniated disc. According to healthcare professionals, a disc bulge and/or a herniated disc is one of the most common health issues affecting the spine. A disc bulge is when the outer fibers of the annulus fibrosus are displaced from the margins of the adjacent vertebral bodies. A herniated disc is when a part of or the whole nucleus pulposus is protruded through the torn or weakened outer annulus fibrosus of the intervertebral disc. Treatment of these health issues focuses on reducing symptoms. Alternative treatment options, such as chiropractic care and/or physical therapy, can help relieve symptoms. Surgery may be utilized in cases of severe symptoms. – 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.

 

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  • Jacobs, Wilco C. H. et al. “Surgical Techniques For Sciatica Due To Herniated Disc, A Systematic Review.” European Spine Journal, vol 21, no. 11, 2012, pp. 2232-2251. Springer Nature, doi:10.1007/s00586-012-2422-9.
  • Rutkowski, B. “Combined Practice Of Electrical Stimulation For Lumbar Intervertebral Disc Herniation.” Pain, vol 11, 1981, p. S226. Ovid Technologies (Wolters Kluwer Health), doi:10.1016/0304-3959(81)90487-5.
  • Weber, Henrik. “Spine Update The Natural History Of Disc Herniation And The Influence Of Intervention.” Spine, vol 19, no. 19, 1994, pp. 2234-2238. Ovid Technologies (Wolters Kluwer Health), doi:10.1097/00007632-199410000-00022.
  • “Disk Herniation Imaging: Overview, Radiography, Computed Tomography.” Emedicine.Medscape.Com, 2017,
  • Carvalho, Lilian Braighi et al. “Hérnia De Disco Lombar: Tratamento.” Acta Fisiátrica, vol 20, no. 2, 2013, pp. 75-82. GN1 Genesis Network, doi:10.5935/0104-7795.20130013.
  • Kerr, Dana et al. “What Are Long-Term Predictors Of Outcomes For Lumbar Disc Herniation? A Randomized And Observational Study.” Clinical Orthopaedics And Related Research®, vol 473, no. 6, 2014, pp. 1920-1930. Springer Nature, doi:10.1007/s11999-014-3803-7.
  • Buy, Xavier, and Afshin Gangi. “Percutaneous Treatment Of Intervertebral Disc Herniation.” Seminars In Interventional Radiology, vol 27, no. 02, 2010, pp. 148-159. Thieme Publishing Group, doi:10.1055/s-0030-1253513.
  • Haro, Hirotaka. “Translational Research Of Herniated Discs: Current Status Of Diagnosis And Treatment.” Journal Of Orthopaedic Science, vol 19, no. 4, 2014, pp. 515-520. Elsevier BV, doi:10.1007/s00776-014-0571-x.

 

 

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Spinal Injection or Nerve Block For Neck and Back Pain https://www.pushasrx.com/injection-nerve-block-neck-back-pain/ https://www.pushasrx.com/injection-nerve-block-neck-back-pain/#respond Tue, 16 Jun 2020 02:15:19 +0000 https://www.pushasrx.com/?p=25525 11860 Vista Del Sol, Ste. 128 Spinal Injection or Nerve Block For Neck and Back Pain

Spinal injections are exactly what the name says. They are administered direct injections of medicine/s in a specific location of the spine. These are used to treat various conditions affecting the spine when non-invasive treatment/s are not working. This could be an area along the upper cervical/neck spine all the way down to the sacrum. […]

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11860 Vista Del Sol, Ste. 128 Spinal Injection or Nerve Block For Neck and Back Pain Spinal injections are exactly what the name says. They are administered direct injections of medicine/s in a specific location of the spine. These are used to treat various conditions affecting the spine when non-invasive treatment/s are not working. This could be an area along the upper cervical/neck spine all the way down to the sacrum. Injections are also utilized in helping to diagnose neck or back pain that radiates or spreads into an individual’s arms and legs. These are known as:
  • Cervical radiculopathy
  • Lumbar radiculopathy
Spinal injection/s for diagnostic or treatment purposes could be a part of an overall treatment plan along with chiropractic/physical therapy and possible medication.
11860 Vista Del Sol, Ste. 128 Spinal Injection or Nerve Block For Neck and Back Pain

The medicine in the injection

The medicine could be comprised of a local anesthetic on its own, steroid on its own, or a combination of the two. Steroids are short for corticosteroid, which is a strong anti-inflammatory medication. A contrast dye like an x-ray dye could be added to the injection mix. This dye acts as a guide for precise placement of the needle using image guidance.

Spinal disorders that could benefit

Proceeding with an injection treatment plan is based on an individual’s unique factors that apply to their condition/state. This decision will be made after consultation, and diagnosis with your doctor, spine specialist, or chiropractor. Healthcare providers recommend conservative treatment first. A treatment plan typically runs around 4-6 weeks. If there is no change or improvement in the individual’s condition from the conservative therapy then injection treatment/s could be recommended. Conditions, where injection/s are used, include:
  • Disc herniation
  • Facet joint pain
  • Failed back syndrome
  • Sacroiliac joint pain
  • Sciatica
  • Spinal stenosis

Spinal injection and nerve block difference

Spinal injections are a general term that could mean any type of injection involving the spine. Nerve blocks are a precise type of injection that targets a specific nerve. As the medicine is injected into the target nerve/s, it blocks or creates a blockade of the pain signals being sent from the area (ex. neck, low back, etc.) that is generating the pain.

Injection types

Epidural

An epidural means an injection on the dura. The dura is the outermost layer that encloses the spinal cord.  
11860 Vista Del Sol, Ste. 128 Spinal Injection or Nerve Block For Neck and Back Pain
 
3 types of epidurals. They are named according to the direction and angle the needle takes to get to the dura.
  • Caudal epidural:
The spinal canal ends at an opening at the end of the sacrum called the spinal hiatus. The medicine is injected into the epidural space through the sacral hiatus. This is the method that is used to provide anesthesia to pregnant women when they’re in labor.  
StructureoftheSacrumDiagram ElPasoChiropractor
 
  • Transforaminal epidural:
There are nerve roots that come out of the spinal canal at each level through a bony opening called the intervertebral foramen or neuroforamen. The medicine is injected into the epidural space in these areas.
  • Interlaminar epidural:
The lamina is a section that forms the arch of each level and forms the spinal canal. The lamina at each level lays on top of the lamina right below. The needle is inserted between the lamina for delivery of the medicine into the epidural space.  
third and fourth lumbar vertebrae lumbar vertebra lumbar spine vertebral bone
 

Selective Nerve Root Block – SNRB

These involve the injection of a local anesthetic onto a targeted nerve. They are typically used for diagnostic purposes. For individuals with multi-spinal compression/s, these combined with:
  • Medical history
  • Physical exam
  • MRI
These can help identify the pain generator such as spinal stenosis.

Medial Branch Block – MBB

The facet joints are bony projections that connect a vertebral level to the levels above and below. These can become arthritic and is responsible for different forms of back pain. This type of spinal injection is local anesthetic injected on the medial branch nerves. These are the nerves that send pain signals from the facet joint/s. They are useful in determining if the facet joint is the pain generator.  
 

Facet Joint

These are injections directly into the facet joint itself. Much like injecting anti-inflammatory and pain meds into a knee with arthritis.

Sacroiliac Joint

The two sacroiliac joints help connect either side of the sacrum to the hip joint. Like other joints, these can get inflamed and cause painful symptoms. This is an injection directly into one or both of the sacroiliac joints.
 

Administration of the spinal injection or nerve block

Injections are only to be performed by doctors trained specifically in spinal injections. Injections are usually performed by an:
  • Anesthesiologist
  • Neurologist
  • Neurosurgeon
  • Orthopedic surgeon
  • Physiatrist
  • Radiologist

Role of these procedures

Reasons why an injection could be used:
  • Help as a diagnostic to identify the pain generator
  • Therapeutically to provide pain relief
  • As a prognostic pain predictor of the relief, an individual could expect from a more invasive procedure like nerve ablation.

How often

A maximum of 6 injections for one year is the recommended treatment protocol. Each injection should be based on the effect/s of the previous injection.

Potential benefits

The main benefit is to bring pain relief and the ability to function.

Potential risks

Spinal injections are considered safe with a low rate of complications. The most common include:
  • Bleeding
  • Headache
  • Facial flushing
Major complications include:
  • Puncture of the dura
  • Infection
  • Nerve damage
Major complications happen in less than one percent of those undergoing the treatment. Individuals with diabetes could see a temporary elevation of their blood sugar.

Lasting effects

How long the medicine lasts is different for everyone and comes with variables like:
  • Type of injection
  • Type of pathology
  • Diagnosis
  • Cause
  • How long the symptoms last
Most can expect to have one and a half to three months of relief. However, with some, they may only provide minimal relief, while others may see improvements for up to a year.

Treating Severe & Complex Sciatica Syndromes


 

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*

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Save Your Spine and Sleep Soundly with The Proper Mattress https://www.pushasrx.com/spine-sleep-proper-mattress/ https://www.pushasrx.com/spine-sleep-proper-mattress/#respond Fri, 12 Jun 2020 01:25:48 +0000 https://www.pushasrx.com/?p=25511 11860 Vista Del Sol, Ste. 128 Save Your Spine and 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 […]

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11860 Vista Del Sol, Ste. 128 Save Your Spine and 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 Save Your Spine and 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 Save Your Spine and 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.

Three Points of Weight Loss @ PUSH Fitness Center

 
 

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

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Pets Healing Power Can Be Powerful Medicine https://www.pushasrx.com/pets-healing-power/ https://www.pushasrx.com/pets-healing-power/#respond Thu, 11 Jun 2020 01:21:51 +0000 https://www.pushasrx.com/?p=25502 11860 Vista Del Sol, Ste. 128 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 […]

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11860 Vista Del Sol, Ste. 128 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.

Metabolic Syndrome & Inflammation


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

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Spinal Stimulation and Chronic Back Pain https://www.pushasrx.com/spinal-stimulation-chronic-pain/ https://www.pushasrx.com/spinal-stimulation-chronic-pain/#respond Fri, 05 Jun 2020 23:19:46 +0000 https://www.pushasrx.com/?p=25480 11860 Vista Del Sol, Ste. 128 Spinal Stimulation and Chronic Back Pain

Spinal stimulation is a treatment option that could help bring relief from pain and improve the quality of life for individuals dealing with chronic pain, like low back, and leg pain. Spinal stimulation can help reduce and manage chronic pain that does not alleviate or reduce with physical therapy, pain medications, injections, and other non-surgical […]

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11860 Vista Del Sol, Ste. 128 Spinal Stimulation and Chronic Back Pain Spinal stimulation is a treatment option that could help bring relief from pain and improve the quality of life for individuals dealing with chronic pain, like low back, and leg pain. Spinal stimulation can help reduce and manage chronic pain that does not alleviate or reduce with physical therapy, pain medications, injections, and other non-surgical treatments/therapies.  
11860 Vista Del Sol, Ste. 128 Spinal Stimulation and Chronic Back Pain
 
It is a form of neuromodulation that works by blocking pain signals that the nerves send out from reaching the brain. A spinal stimulator is a tiny device that is implanted underneath the skin. The device delivers a very low electrical impulse that masks/changes pain signals before they reach the brain.

A Spinal Stimulation System

Neurostimulator:

This is the entire device that is implanted and sends out electrical impulses through a lead wire to the nerves in the spine.

Lead:

The thin wire that delivers the electrical impulses from the neurostimulator.

Remote control:

This turns on/off the stimulator and increases or decreases the amount of stimulation.

Charger:

Stimulators are rechargeable and normally require recharging about one hour every two weeks.

Spinal Stimulator Types:

Traditional stimulators

These produce a gentle ringing/tingling sensation that masks the pain.

Burst stimulators

These send out random interval bursts of electrical impulses designed to copy the way the body sends out nerve impulses.

High-frequency stimulators

These reduce pain without generating tingling sensations.  
 

Types of Pain Spinal Stimulation Treats

Spinal stimulation is approved by the U.S. FDA to treat chronic back and leg pain, including pain that doesn’t go away after back surgery known as failed back surgery syndrome. Chronic neuropathic back and leg pain are the most common types that stimulation treats. This means back or leg pain caused by nerve damage from:
  • Auto accident
  • Injury – personal, sports, work
  • Disease
Acute pain is like stepping on a sharp piece of glass, where the pain serves as protection letting you know something is wrong and not to continue. Whereas chronic neuropathic pain lasts for 3 months or more and does not help protect the body.  
11860 Vista Del Sol, Ste. 128 Spinal Stimulation and Chronic Back Pain
 
Spinal stimulation is also used to treat complex regional pain syndrome or CRPS. This is a rare condition that affects the arms/hands or legs/feet and is believed to be caused by damage or malfunction of the nervous system. It is also used in treating peripheral neuropathic pain. This is damage to the nerves outside of the spinal cord often in the hands/feet that is caused by an:
  • Infection
  • Trauma
  • Surgery
  • Diabetes
  • Other unknown causes

Appropriate Treatment

Spinal cord stimulation should not be used in patients that are pregnant, unable to operate the stimulation system, went through a failed trial of spinal stimulation, and are at risk for surgical complications. The decision to use spinal stimulation is based on an individual’s needs and risks. Talk to a doctor, spine specialist, chiropractor to see if spinal stimulation could be an option.

Benefits and Risks

The effects of stimulation are different for everyone. Therefore, it is important to understand that spinal stimulation can help reduce pain, but not completely eliminate it.  
 

The Benefits of Spinal Cord Stimulation

In addition to reducing pain, other benefits of spinal stimulation include:
  • Better sleep
  • Improved body function
  • Increased activity
  • Improved mobility
  • Reduced opioid medication/s use
  • Less need for other types of pain meds
  • Reduced dependence on braces/bracing

Risks

During the implantation, there is a risk for:
  • Bleeding
  • Infection
  • Pain at the site of incision
  • Nerve damage
  • Rarely paralysis
  For some individuals, scar tissue can build up over the electrode, which can block the stimulator’s electrical impulse. The lead wire could move or shift out of position. This could lead to impulses being sent to the wrong location. The device itself could shift under the skin causing pain, making it hard to re-charge or communicate with the remote. There is a risk that the lead wire could detach or break off causing a malfunction and require a replacement. Also, individuals could respond well to the stimulation at first, but later on, they develop a tolerance, and so the therapy no longer has the same impact and the pain could get worse because the nerves stop responding.

Take Precautions

Discuss with a doctor, spine specialist, or chiropractor what you can and can’t do after the stimulator is implanted and activated. Here are a few precautions:
  • Do not drive or operate heavy equipment when the stimulator is active.
  • Stimulation systems could set off metal detectors, which could require manual screening.
MRIs, electrocautery, diathermy, defibrillators, and cardiac pacemakers could have a negative interaction with certain types of stimulators. This could result in injury or damage to the spinal stimulator. Talk to your doctor to determine if a spinal stimulator is a treatment option that will work for you.

Weight Loss Techniques – Push Fitness Center

 
 

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

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CBD Oil for Back Pain and Combined Health Benefits https://www.pushasrx.com/cbd-oil-back-pain/ https://www.pushasrx.com/cbd-oil-back-pain/#respond Fri, 29 May 2020 01:24:02 +0000 https://www.pushasrx.com/?p=25431 11860 Vista Del Sol, Ste. 128 CBD Oil for Back Pain and Combined Health Benefits

CBD or cannabidiol oil is not medical marijuana and will not get an individual high, stoned, etc. It has shown to give many individuals relief from back pain. Many natural food stores offer cannabis oils or CBD oils. Marijuana dispensaries, also sell CBD oils/products. And you can also buy CBD oil and products online. What […]

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11860 Vista Del Sol, Ste. 128 CBD Oil for Back Pain and Combined Health Benefits CBD or cannabidiol oil is not medical marijuana and will not get an individual high, stoned, etc. It has shown to give many individuals relief from back pain. Many natural food stores offer cannabis oils or CBD oils. Marijuana dispensaries, also sell CBD oils/products. And you can also buy CBD oil and products online. What exactly is this type of treatment? And can it really help with back pain?

CBD Oil

CBD oil comes from the cannabis plant, that contains known two chemical compounds:
11860 Vista Del Sol, Ste. 128 CBD Oil for Back Pain and Combined Health Benefits
  Both of these compounds have shown a variety of possible health benefits, which include back pain relief. It is only the THC that can get someone high. Medical marijuana and CBD are two different compounds. Medical marijuana contains THC. CBD oils and products do not contain THC. Those that use CBD oil claim that it helps with a variety of health issues, from:
  • Anxiety
  • Headaches
  • Chronic diseases
  • Nausea
  • Sleep disorders
  • Pain
However, the quality of the oil does make a difference. There is no guarantee that what is sold in many stores actually has CBD oil. Currently, the product is unregulated. High-quality oil can be very powerful medicine. The FDA has approved one CBD compound, that treats 2 rare forms of epilepsy. Most if not all CBD products are under clinical investigation and development.

Pain Relief

Although there is anecdotal evidence of CBD oil for various disorders, there has not been a great deal of study on it and its effects. Most of the research looks at the effect of cannabinoids in general, this includes combinations of CBD and THC. In general, cannabinoids have been found to be a promising option for the relief of some chronic pain conditions. Research has explored around 30 studies on cannabinoid use in chronic non-cancer pain, including: Most of the studies found the CBD to have a positive analgesic effect. 2020 study suggests that topical CBD oil can reduce pain, cold and itchy sensations in individuals with peripheral neuropathy.  
11860 Vista Del Sol, Ste. 128 CBD Oil for Back Pain and Combined Health Benefits
 
There are even doctors and surgeons that use it after long days, after surgeries, etc, despite the minimal evidence. They found that it helps with body soreness, as there is symptomatic relief for joint and muscle pain. It works much the same way that topical muscle/sports creams help to soothe pain symptoms. These CBD products have also shown to improve those with insomnia and anxiety. These are two factors that are known to make back pain worse.

Risks

Research has shown that most CBD products are safe to use, but that does not mean they are completely safe. There are quality control issues, as CBD oil is not FDA-approved, meaning that the claims on the label might not be correct or misleading. A bottle of CBD oil could:
  • Have harmful ingredients
  • Have little to no CBD oil
  • Does not treat conditions listed
Check with your health care provider about any potential drug interactions, especially if currently taking medications for anxiety, stress, or sleep disorders. There are minor side effects, as CBD can cause drowsiness, diarrhea, decreased appetite, weight loss, and mood changes.

Taking CBD Oil

CBD oil comes in several forms with no true guidance on individual dosage. Here’s what you should know:

Capsules

Capsules are easy to take daily, once an effective dose has been established.  
man grabbing lower back in pain and a bottle of pain medication open with capsules out of bottle
 

Tinctures

These are herbal extractions made into liquids that can be taken with a dropper. These can provide faster relief than capsules. Instructions are to keep the CBD oil under the tongue for a minute or two. The tincture can take effect in 15 minutes.  
homeopathy medicine vials

Topical Applications

CBD oil also comes in lotions, creams, or ointments that could also contain ingredients in other topical pain relievers like capsaicin. Individuals will find pain relief, but the mix of ingredients makes it hard to know if it is the CBD oil that is working. Because the FDA has not set up proper dosing guidelines, individuals might have to find the proper dose through trial and error.  
  The Arthritis Foundation gives some common guidelines:
  • Begin with a low dosage and see how it feels after a week
  • Increase the dosage in small increments
  • If the CBD does not work on its own, talk to your doctor about trying out a different method/technique/options.

Quality CBD

Unregulated health treatments can come with the potential for health issues. For example, FDA testing has found that many products do not have the amount of CBD that was listed on the label. They are also investigating reports that some products have unwanted ingredients, from THC to metals. Here is some guidance on how to find quality products:

CBD oil Option

Remember this is just an option for back pain, made to be combined with physical therapy, chiropractic, massage, etc. It is not a cure-all but another tool in pain management. And there are plenty of other complementary and alternative treatments for back pain.

Peripheral Neuropathy Recovery Success Stories

 

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Hot Bath to Relax Back Tension, Soreness, and Pain https://www.pushasrx.com/hot-bath-relax-back-tension-pain/ https://www.pushasrx.com/hot-bath-relax-back-tension-pain/#respond Thu, 28 May 2020 01:15:37 +0000 https://www.pushasrx.com/?p=25427 11860 Vista Del Sol, Ste. 128 Hot Bath to Relax Back Tension, Soreness, and Pain

Chiropractor, Dr. Alex Jimenez shares some how-to advice on taking hot baths for back tension and pain. A bath can be a wonderful and fulfilling experience in self-care for back pain. There are medical benefits from taking a hot bath, as well. A hot bath can be extremely helpful when it comes to back pain. […]

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11860 Vista Del Sol, Ste. 128 Hot Bath to Relax Back Tension, Soreness, and Pain Chiropractor, Dr. Alex Jimenez shares some how-to advice on taking hot baths for back tension and pain. A bath can be a wonderful and fulfilling experience in self-care for back pain. There are medical benefits from taking a hot bath, as well. A hot bath can be extremely helpful when it comes to back pain. Dr. Jimenez helps his patients with spinal ailments and conditions that range from arthritis, degenerative disc disease to nerve compression, sciatica, auto accident injuries, sports injuries, etc. In addition to chiropractic, physical therapy, diet, and exercise, he has also seen the power of home remedies, like a hot bath. There are scientific studies that have shown how hydrotherapy can relieve back pain. Dr. Jimenez describes a hot bath as a muscle-relaxing stimulus. It opens up the muscles, which allows more blood to flow through, which in turn helps to heal injury/s, tightness, and soreness. It helps to clean out lactic acid, which is known to cause muscle pain, fatigue, and muscle cramps.  
11860 Vista Del Sol, Ste. 128 Hot Bath to Relax Back Tension, Soreness, and Pain
Here is what usually happens to the spine when soreness, tightness, aching, and pain present. A spinal structure like a nerve, disc, vertebral bone, or other tissue is injured or on the verge of injury, and the muscles around it contract closely in to prevent more damage. This is called a muscle spasm. Don’t worry the body is supposed to respond this way, as it means the damaged tissue is less likely to sustain further injury. However, muscle spasms can be painful. Much like a Charley horse, a back spasm can have the same effect. For example, someone standing or working for an extended period places the muscle/s under constant tension, which means they have a higher chance of having a spasm and developing painful symptoms. A hot bath relaxes the muscle/s and reduces/removes the aching soreness and pain. Here are some tips to help relax the back muscles.

Try Epsom Salt

Taking a bath with Epsom salt or minerals that dissolve in water can be helpful, but are not necessary. Many are fantastic skin relaxants, but if you have a hot bath with or without the salt, it’s not going to make a huge difference. What makes the bath work is the heat and the floatation. This what creates the benefits.

Soak 15-20 Minutes

It is really up to the individual, as to how long they want to stay in the tub. One question to ask is how long can you take sitting in hot water? Hot tubs are normally heated to about 102 to 103 degrees. With these types of tubs, individuals can sit for a half-hour or more. However, most of us do not have a jacuzzi, so remember that a regular bath will be warmer possibly 105 or 106 degrees. It all depends on how long you can take the heat.  
  Remember not to scald yourself with a bath that is way too hot to soak in, please. It’s ok to get the water running hot, but as it fills turn the heat down and let it cool slightly before stepping in. Most individuals don’t need more than 15 to 20 minutes of soaking time maximum. As for how often one should take a hot bath, Dr. Jimenez explains that it depends on the severity of the back pain and what type of work and activities the individual does. For most three times a week offers a balanced therapy. If an individual has a strenuous physical job like construction work, manual lifting, standing work, or doing highly repetitive work then they’ll need to do more than 3 times a week.

Strengthen the Body’s Core

A strong core can support and protect the spine, along with the rest of the body. Squeezing and contracting the back, side, and front muscles make the core strong and robust. It behaves like a steel beam supporting the spine when added protection is needed.  
11860 Vista Del Sol, Ste. 128 Hot Bath to Relax Back Tension, Soreness, and Pain

Stretch Out

After a hot bath is a perfect time to stretch. Toe touches can loosen tight hamstrings that can strain the lower back. Also, try out yoga’s upward-facing dog pose. Sun salutations can help the spine go through a wide range of motion. Therefore do them slowly and hold each pose for a few breaths. A long salutation or two can feel tremendous when the spine is nice and relaxed.  
11860 Vista Del Sol, Ste. 128 Hot Bath to Relax Back Tension, Soreness, and Pain

Take Care When Getting Out

Hot baths might not be a good idea or the right option for certain people. If there is instability in your spine and the vertebra move around more than they are supposed to then a hot bath might not be the best option. Instead, a hot shower with a massage setting could be equivalent to taking a hot bath. However, if a hot bath is not helping with back pain it could be a sign of something more than muscle tightness or a muscle spasm. A spine specialist or chiropractor can give you a proper diagnosis.

What Chiropractors Do & Why They Do It

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Chiropractor’s Guide to Back Spasms https://www.pushasrx.com/chiropractors-guide-to-back-spasms/ https://www.pushasrx.com/chiropractors-guide-to-back-spasms/#respond Thu, 21 May 2020 01:28:15 +0000 https://www.pushasrx.com/?p=25409 11860 Vista Del Sol, Ste. 128 The Chiropractors Guide to Back Spasms

Back spasms can be compared to a Charley horse in the back. These are a common complaint in doctors’ clinics throughout the country. Spasms can accompany back pain and neck pain, they can be the result of a traumatic event, like a slip and fall accident or an automobile accident. Here is why they occur […]

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11860 Vista Del Sol, Ste. 128 The Chiropractors Guide to Back Spasms Back spasms can be compared to a Charley horse in the back. These are a common complaint in doctors’ clinics throughout the country. Spasms can accompany back pain and neck pain, they can be the result of a traumatic event, like a slip and fall accident or an automobile accident. Here is why they occur and what to do about them.  
trapezius anatomy muscles isolated on white d illustration
 

Back Spasms

A back spasm is an involuntary and sustained contraction of one or more muscles of the spine. Spasms can occur without pain when the muscle/s shift, and pulse. But it’s when pain accompanies the spasm that it can become an issue that can lead to a chronic condition. Example: Runners get the feeling of having a Charley horse in the calf muscle. Having a back spasm is the same. Spinal muscle spasms could be an indication of something serious, like a micro tear around a spinal disc that can generate inflammation to cause the muscles to tense up. However, with most cases, a back muscle spasm is a symptom of a mild muscle injury, like a sprain. It can be hard to diagnose the pathology of a muscle spasm. One theory is that if there is a noxious stimulus coursing through the body, specifically the back, it can disrupt/disturb the muscles. When this happens the muscles brace/bunch up together to protect the spine. Here’s are five muscle spasm types that can cause back and neck pain.

Cervical Spine

If there is a spasm in the neck, it’s more than likely a contraction of the trapezius muscle. This is the muscle group that runs down the neck into the middle or thoracic spine/back.
neck anatomy
Back spasms in the cervical spine could indicate a contraction of the sternocleidomastoid. This is located at the base of the skull on both sides of the head. When these muscles spasm, the pain is usually localized or in one area that leads to muscle irritation. However, if the spasm is a symptom of underlying inflammation or nerve irritation, then the pain could radiate and spread down.

Thoracic Spine

The trapezius starts at the neck to the last vertebra of the thoracic spine or the middle-back. Therefore, a back spasm can affect the neck as well as the middle of the back as well. Spasms in the midback can also result from a contraction of the rhomboid muscle. These connect the shoulder blades to the rib cage and spine.
Because there is less movement in the middle-back, the muscles in this area are less likely to spasm, compared to the cervical/neck area and the lumbar/low area.

Lumbar Spine

Spasms in the lower back occur from a contraction of the erector spinae muscles. These are the large group of stabilizing muscles that are on either side of the spine or the latissimus dorsi. These muscles are commonly referred to as lats. They are one of the largest muscle groups in the body and cover the middle and lower back.  
Lats Graphic
 

Relieving Spasms

Treatment for muscle spasms depends on how the injury originated. A full medical history is crucial for a doctor, spine specialist, or chiropractor to be able to look at all the angles in determining and diagnosing the root cause. It could be from just leaning over and picking up a box to sleeping in an improper/uncomfortable position. This type of pain is less concerning as it is more than likely a sprain or strain, and can be treated rather quickly. However, if the spasms started after being involved in an automobile accident or falling pretty hard, then there could be serious damage to the area. Back spasms that occur after these types of situations require an immediate full neurologic and muscular examination. This along with advanced imaging, like an MRI.
11860 Vista Del Sol, Ste. 128 The Chiropractors Guide to Back Spasms
 

Specialists

A spine specialist or chiropractor wants to make sure they’re not missing any underlying injuries or instabilities of the spine that would require extensive and possible invasive treatment. Red flag situations include osteoporosis, which is the loss of bone mass or ankylosing spondylitis, which is a form of arthritis that mainly affects the spine.
  • Osteoporosis can cause an underlying compression fracture.
  • Ankylosing spondylitis can cause parts of the spine to fuse together.
Both underlying conditions can cause muscle spasms. However, conservative treatment for most cases is all that is usually needed to relieve muscle spasms of the spine. These include:
  • Anti-inflammation medications and creams
  • Chiropractic manipulation to improve spinal muscles range of motion
  • Heat and ice application
  • Light activities/exercises like walking that don’t include any bending, twisting, and lifting
  • Massage therapy
  • Physical therapy
  • Therapeutic water exercise rehabilitation program
  • Ultrasound
  • Wearing a soft collar for cervical spasms
11860 Vista Del Sol, Ste. 128 The Chiropractors Guide to Back Spasms
If results do not improve within four to six weeks of conservative treatment, then an MRI or other type of scan of the area will be needed. All that said preventing back spasms is the way to go. We’ve all heard the phrase to be heart-healthy, which concerns cardiovascular health. Now it’s about being spine healthy. Keeping the abdominal muscles, lumbar extensors, and the erector spinae muscles fit is the key. This can be accomplished with regular stretching and core exercises. Also doing yoga and Pilates will go a long way in minimizing muscle spasms and preventing injuries.
11860 Vista Del Sol, Ste. 128 The Chiropractors Guide to Back Spasms

Auto Accident Doctors & Chiropractic Treatment

 

 

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Low Back Vertebrogenic Pain and Spinal Vertebral Endplates https://www.pushasrx.com/low-back-vertebrogenic-pain/ https://www.pushasrx.com/low-back-vertebrogenic-pain/#respond Tue, 05 May 2020 01:00:43 +0000 https://www.pushasrx.com/?p=25338 11860 Vista Del Sol, Ste. 128 Chronic Low Back Vertebrogenic Pain and Spinal Vertebral Endplates

Research has found that vertebrogenic chronic low back pain could be caused by a lumbar vertebral endplate change that involves the basivertebral nerve and is not disc-related. The underlying cause of chronic low back pain can be very difficult to diagnose. The intervertebral discs are a common suspect, but when disc-related treatments don’t ease the […]

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11860 Vista Del Sol, Ste. 128 Chronic Low Back Vertebrogenic Pain and Spinal Vertebral Endplates

Research has found that vertebrogenic chronic low back pain could be caused by a lumbar vertebral endplate change that involves the basivertebral nerve and is not disc-related. The underlying cause of chronic low back pain can be very difficult to diagnose. The intervertebral discs are a common suspect, but when disc-related treatments don’t ease the pain, the root problem could be something else. Researchers are exploring an overlooked area with the vertebral endplates being the cause of vertebrogenic low back pain.

 

11860 Vista Del Sol, Ste. 128 Chronic Low Back Vertebrogenic Pain and Spinal Vertebral Endplates

 

Research has found that there are more nerves in the vertebral endplates than in the spinal discs. More nerves can mean higher potential/increase in pain. And like the other areas of the spine such as the discs and joints, vertebral endplates can also degenerate, also increasing the risk for pain.

 

Vertebral Endplates and Basivertebral Nerve

The vertebral endplates line the top and bottom of each vertebral body. These are the round, thick, weight-bearing bones in the spine. The vertebral endplates are made of cancellous or spongy bone and function as the barrier between each disc and the vertebrae.

The low back/lumbar spine takes the most weight. That can be a significant amount of pressure on the structures in the low back. The endplates are situated between a cushioned disc/s and the hard, bony vertebral body making them vulnerable to degeneration and nerve damage contributing to chronic low back pain. The endplates and vertebral bodies consist of a network of intraosseous nerves.

 

Intraosseous nerves live within the bone.

The basivertebral nerve  BVN is an intraosseous nerve that winds through the vertebral bodies. This nerve feeds into each spinal bone through the back of the vertebral body and then branches out with nerves going towards the top and bottom vertebral endplates. Research has shown that although these nerves are inside the bone they can send pain signals from a damaged vertebral endplate that could result in vertebrogenic low back pain. This is why it has been recently linked it as a possible cause of chronic low back pain.

Nerve pain in the spine has been linked with discs that have degenerated. A doctor, chiropractor/spine specialist refers to this as discogenic pain. But with new research, an understanding of the function the vertebral endplates and BVN play in the sensation of pain has been realized and this is where the term vertebrogenic pain comes from. If a doctor discovers that the endplates could be the source of your chronic low back pain, they might use this term.

 

Vertebral Endplate Pain Diagnosis

Like most back pain conditions diagnosing vertebral endplate pain can be just as challenging. This is because diagnostic imaging scans typically don’t pick up mild to moderate endplate damage. A classification scale known as Modic changes helps doctors identify vertebrogenic pain.

Modic changes or MC are areas that show up on an MRI showing bone marrow damage that has been linked to low back pain. The name comes from the doctor that classified them in 1988, Dr. Michael Modic. Modic changes help doctors and spine specialists see and understand the connection between endplate damage and chronic low back pain.

2 types were identified that show a connection between vertebral endplate damage and chronic low back pain:

Type 1

This type shows a development  in the vessels of the vertebral body, that includes:

  • Inflammation
  • Edema, which is a collection of excess fluid
  • Endplate changes like a split or crack/s in the endplate

Type 2

This type reveals changes in the bone marrow like fatty deposits that have taken the place of bone marrow.

If the lumbar MRI shows Type 1 or Type 2 MC, a doctor could recommend a conservative treatment plan that could include:

  • Physical therapy
  • Chiropractic
  • Medication
  • Massage
  • Acupuncture

These could be utilized in conjunction with spine specialist care in addressing symptoms and pain. However, if the pain does not ease or reduce with conservative treatment, a doctor could suggest an outpatient procedure.

11860 Vista Del Sol, Ste. 128 Osteoporosis and Increasing Bone Fractures El Paso, TX.

 

Treating Vertebral Endplate Pain

This treatment option is known as the Intracept® Intraosseous Nerve Ablation System which addresses BVN nerve pain and is a minimal procedure.

Candidates for this procedure usually qualify meeting the following:

  • The individual has struggled with chronic low back pain for at least 6 months
  • The pain has not reduced/eased up with at least 6 months of conservative care
  • MRI shows Type 1 or Type 2 Modic changes that correlate symptoms of vertebrogenic low back pain

The procedure uses fluoroscopy or an x-ray video. A thin tube called a cannula is inserted into a vertebral pedicle. A pedicle is a structure that sticks out from the back of the vertebra. The cannula tunnels its way to the basivertebral nerve. The doctor then runs the Intracept Radiofrequency generator into the path of the nerve and ablates destroys/removes any obstructions in the nerve with the help of the frequency generator. Since it’s a minimally invasive procedure, it can be performed in an outpatient clinic, allowing the patient to go home the same day.

The device/tool used in the procedure is not implanted in the spine. It is removed once the procedure is done.

Expectations as to how long the pain relief will last depends on:

  • The severity of the condition
  • Post-physical therapy
  • Type of work
  • Diet
  • Exercise

One study showed the benefits to last up to two years.

If nonsurgical treatment has not worked for at least six months talk to your doctor about basivertebral nerve ablation for vertebrogenic chronic low back pain. There are risks and benefits both of which should be discussed in depth.

Endplate or Disc and the Root Cause

The intervertebral discs are often the more common cause of low back pain. But they might not be the root cause of spine pain. More research is going on with the role the vertebral endplates play in spine health. As more patients are being diagnosed earlier then better long-term outcomes will follow.


 

What Chiropractors Do & Why They Do It

 


 

NCBI Resources

 

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