The Good News- Bad News About Lower Back Pain

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THE GOOD NEWS:
90% of people with low back pain will recover in four to six weeks.
THE BAD NEWS:
10% of people develop chronic low back pain, an epidemic that costs society up to $100 billion a year.

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THE GOOD NEWS:
Spinal manipulation is one of the only treatments consistently recommended for dealing with acute low back pain.
THE BAD NEWS:
Far too many people don't visit a chiropractor for their pain and instead choose to pop over-the-counter pain medication at alarming rates.

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THE GOOD NEWS:
While bed rest may seem like the rational thing to do when in pain, evidence suggests proper exercises to increase mobility and reduce loss of muscle strength are key to recovery.
THE BAD NEWS:
One of the biggest predictors of chronic back pain is called "pain avoidance behavior," which means once you get the pain, you do everything you can to avoid anything that will cause pain

Back Pain: What Helps and What Doesn't

An important collection of papers published in research journal The Lancet highlight the global impact of low back pain, the ineffectiveness of current medical treatments, and the value of spinal manipulation and other nondrug options before turning to medication is receiving substantial media attention. One of the brightest spotlights: a "Health Alert" segment on a recent episode of "Good Morning America" titled "New Research on Lower Back Pain: Are Millions of People Getting Ineffective Treatment?"

"GMA" anchor Robin Roberts opened the segment with this statement to the show's estimated 4.5 million viewers regarding lower back pain: "As many as 540 million people suffer from it. According to new research, many treatments, [including surgery and pain medication] ... could be all wrong."
She then introduced Dr. Jennifer Ashton, chief health and medical editor for the show. Dr. Ashton, who described the papers as the "magnum opus on low back pain" and The Lancet as "very reputable," said the material "[draws] attention to the massive gap between evidence-based medicine and what's really going on" when it comes to the treatment of back pain.

According to Dr. Ashton, reporting on the papers, back pain is a "massive global public health burden." First-line treatments include staying active ("the worst thing you can do is get in bed") and education: learning "what works and doesn't from reputable sources." Second-line treatment options (Dr. Ashton urged viewers, "This is really what I want people to pay attention to") include superficial heat, spinal manipulation, massage and acupuncture. [Italics mine]

Dr. Ashton added that NSAID medication (nonsteroidal anti-inflammatory drugs, commonly available as over-the-counter pain meds such as Advil, Aleve, etc.) is also considered a second-line treatment according to The Lancet papers, but should be utilized "only if the other things are not working."

The Lancet content on lower back pain, published online on March 21, features two "series" papers, a "viewpoint" and a "comment," all of which are available in full-text format free of charge on the journal's website:

• "What Low Back Pain Is and Why We Need to Pay Attention" (Series 1) (Hartvigsen J., et al.)
• "Prevention and Treatment of Low Back Pain: Evidence, Challenges and Promising Directions" (Series 2) (Foster N.E., et al.)
• "Low Back Pain: A Call for Action" (Viewpoint) (Buchbinder R., et al.)
• "Low Back Pain: A Major Global Challenge" (Comment) (Clark S., et al.)

The "GMA Health Alert" on LBP is also available online in its entirety, and can be accessed by clicking here. To access the Lancet content, click the links above. To learn more about the value of chiropractic spinal manipulation for low back pain and why pain medication isn't your first option, talk to your doctor.

Can Headaches Come From The Neck?

Headaches are a very common problem that can have multiple causes ranging from stress to trauma.  To make matters worse, there are MANY different types of headaches. One such type is the “cervicogenic headache” (others include migraines, cluster headaches, etc.). "Cervicogenic" means a headache caused by problems in the neck.

The main distinction between the symptoms associated with cervicogenic headaches and those associated with migraine headaches are a lack of nausea, vomiting, aura (a pre-headache warning that a headache is about to strike), light and noise sensitivity, increased tearing with red eyes, one-sided head, neck, shoulder, and/or arm pain, and dizziness. The items listed above are primarily found in migraine headache sufferers.   The following is a list of clinical characteristics common in those struggling with cervicogenic headaches:

·        Unilateral (one-sided) head or face pain (rarely is it on both sides).

·        Pain is localized or stays in one spot, usually the back of the head, frontal, temporal (side) or orbital (eye) regions.

·        Moderate to severe pain intensity.

·        Intermittent attacks of pain that last hours to days.

·        Pain is usually deep, non-throbbing, unless migraines occur at the same time.

·        Head pain is triggered by neck movement, sustained awkward head postures, applying deep pressure to the base of the skull or upper neck region, and/or taking a deep breath, cough or sneeze can trigger head pain.

·        Limited neck motion with stiffness.

Infrequently, the cervicogenic headache sufferer can present with migraines at the same time and have both presentations making it more challenging to diagnose.

The cause of cervicogenic headaches can be obvious such as trauma (sports injury, whiplash, slip and fall), or not so obvious, like poor posture. A forward head posture can increase the relative weight applied to the back of the neck and upper back as much as 2x-4x normal. Last month, we discussed the intimate relationship between the upper two cervical vertebra (C1 & C2) and an anatomical connection to the covering of the spinal cord (the dura) as giving rise to cervicogenic headaches. In summary, the upper three nerves innervate the head and any pressure on those upper nerves can result in a cervicogenic headache. Doctors of chiropractic are trained to examine, identify, and treat these types of potentially debilitating headaches.

Smoking = Back Pain

If you're a current smoker, we hope you're speaking with a health care professional right now about how to quit. If you're not, we urge you to consider doing so, because your risk of suffering one or more of any number of diseases appears to increase dramatically if you're a smoker. In fact, even back pain occurs more frequently if you're a smoker, and the pain may lead to surgery.

Lumbar spinal stenosis, a condition characterized by spinal canal narrowing that causes low back pain due to the increased pressure on spinal nerves, appears to be more prevalent in smokers because nicotine constricts blood flow and promotes inflammation. In a study published in The Spine Journal, researchers discovered that smokers were more likely not only to suffer from lumbar spinal stenosis, but also to eventually undergo surgery for the condition. In fact, compared to nonsmokers, heavy smokers (15 or more cigarettes per day) were 46 percent more likely to undergo surgery, while moderate smokers (14 or less cigarettes daily) had a 31 percent higher risk and even former smokers had a 13 percent increased risk.

What's the takeaway? Smoking can lead to back pain requiring surgery, and the more you smoke, the worse the risk. And while even ex-smokers have a small increased risk compared to nonsmokers, it's significantly lower than the risk inherited by smokers. Just another reason to say no to smoking. Talk to your doctor about the smoking cessation program that's right for you.