Professional guidelines already advise against using common medications such as steroids or NSAIDs such as Ibuprofen as a first line treatment for acute or chronic back pain.

Now a new study has been published which associates early use of these medicines with development of chronic back pain.

Lower back pain is a leading driver of disability across the globe, so the idea that what people commonly reach for to get some relief may be leading to worse outcomes and increased misery for millions of people should be taken seriously.

Hopefully more studies will be done, including clinical trials, which can provide evidence for causation.

In the meantime, it is already the position of numerous professional organizations, including the American Academy of Family Physicians, that non-drug treatment options such as superficial heat, massage, spinal manipulation, and other non-drug treatments should be tried before medications.

Nonpharmacologic treatment, including superficial heat, massage, acupuncture, or spinal manipulation, should be used initially for most patients with acute or subacute low back pain.

Which begs the question, if a bunch of different treatments are all shown to be equally effective for the treatment of a common condition, which treatment do you choose?Chiropractic Care Versus Medication For Chronic Lower Back Pain In Elderly PatientsThe evidence increasingly favors spinal manipulation over prescription drugs when considering patient satisfaction and…medium.com

I’d propose you pick the treatments which are both cost effective and offer the least adverse side effects. While over the counter NSAIDs are certainly cost effective, this study provides some evidence that they may not be as benign in terms of side effects as many people assume.

The tendency to use nonsteroidal anti-inflammatories persists despite their unimpressive performance. An analysis of randomized clinical trials found that these drugs had almost no benefit over placeboes in reducing low back pain.

Chiropractic care often involves several modalities recommended as first line treatments in the care of acute and subacute back pain. Typically a visit to the chiropractor will involve some superficial heat, patient education, reassurance, soft tissue treatment such as massage, spinal manipulation (chiropractic adjustment), stretching, lifestyle modification advice, or home exercise recommendations.When Your Back Hurts, Sometimes It’s Better Not Knowing Exactly WhyYou want an answer, but there are hidden costs to finding out.medium.com

While usually not as inexpensive as a $7 bottle of Advil, chiropractic care is often given some of the highest marks for patient satisfaction and appears comparable in cost effectiveness to standard medical care.

It Can Be Overwhelming

There are so many options when trying to decide what to do about a case of acute back pain. It can feel like you’re in a supermarket with too many options. Not everyone is going to respond the same way to a treatment, further confusing things. Some people love a visit to the chiropractor, other people hate getting adjusted. My wife doesn’t like acupuncture, I find it helps.

What I recommend to my patients is what I understand to be effective, low-risk, and evidence based. It is not in my scope of practice to tell a patient what medications to take or not to take, but as an aspect of informed consent I do tell my patients what other options they have for their care.

If they are in my office I am going to be biased and recommend a trial of chiropractic care for most cases of acute back pain, but they have other options such as yoga, acupuncture, exercise, topical analgesics, medications, et cetera.

Does this recent study pointing out there may be more risk involved in taking common medications confirm my bias towards conservative non-pharmacological interventions for pain? Yes. Does it mean I will stop taking Ibuprofen when I have pain? Probably not, but I might think twice the next time I reach for when my shoulder or back feels cranky.

Works Consulted:

DOI: 10.1126/scitranslmed.abj9954Common Medications Can Prolong Back Pain, Study SaysA clinical trial will be needed to verify the research, which offered a warning about taking steroids or…www.nytimes.com

doi.org/10.7326/M16–2367

Haas, Mitchell et al. “Cost-effectiveness of medical and chiropractic care for acute and chronic low back pain.” Journal of manipulative and physiological therapeutics vol. 28,8 (2005): 555–63. doi:10.1016/j.jmpt.2005.08.006

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When a patient comes in complaining of lower back pain they want answers. They may be scared and anxious. My patients often search online for their symptoms and what that ache or stabbing in their back can mean, they read horror stories and anecdotes which heighten their dread. When they ask me what could be causing their pain they often want an MRI to confirm a diagnosis.

A good doctor who takes a detailed history, listens to you, performs a competent exam, and gives reasonable advice and a treatment plan that aligns with your goals and expectations…this approach has been well studied and there is much evidence to demonstrate it’s superiority over expensive MRI scans and cookie cutter treatments.

The Need To Know

Yet, there is the human desire to KNOW what is going on inside our bodies. There are also costs to knowing that you have a disc protrusion, or osteoarthritis, or degenerative disc disease.

What that MRI won’t tell you is that the prevalence of disk degeneration in asymptomatic individuals increases from 37% of 20-year-old individuals to 96% of 80-year-old individuals¹.

An MRI is great at showing tissue structure such as discs, cartilage, and tendons. An MRI will not show you what hurts, not definitively.

Your story, experiences, and your doctor’s exam should do a much better job in most cases in identifying the culprit. Imaging for many cases can not determine the age of these findings, sometimes providers are not skilled in identifying old versus new injuries, sometimes it is just impossible to tell. The imaging findings may correlate with your symptoms, or they may not, or they may match up with what you are feeling AND still not be the pain generator.

Say you are a runner. You’ve been running for decades and have had various minor injuries, aches, and pains. Now you are in your 50’s and your back starts hurting after a run, like it has on occasion many times over the years, but this time it lasts a little longer and is more intense than before, so you seek care with your primary doctor and they prescribe you some Ibuprofen and tell you to take it easy for a couple weeks. Two weeks pass and your back doesn’t feel much better, you go back to your doctor and they order an MRI.5 Steps To Overcome Long COVIDPost-Acute Sequelae of SARS CoV-2 infection, or PASC, is increasingly reported. Here’s what you can do to combat these…medium.com

The MRI shows a disc protrusion at L5-S1 and mild osteoarthritis at multiple levels. What the MRI doesn’t tell you is if you take 100 people without back pain off the street, on average 36 of them are going to have a disc protrusion at your age. So is the disc protrusion causing your pain? The MRI can’t tell you that, but now you know you have a disc protrusion, maybe your doctor tells you to stop running so as to not make it worse, maybe you are referred to a surgeon for an injection. There is a whole cascade of possible outcomes, none of which have been shown to be all that helpful versus a gradual return to general exercise and a wait and see approach.

All that care is very expensive though, and healthcare is a business, and lower back pain is a $100 billion a year subset of that industry.

You Can’t Unsee Your MRI

With 36% of people in their 50’s out there running around with disc protrusions and not having any symptoms, it may be hard to believe a radiologist pointed it out on your scan and it might not be important as a source of your pain.

However, many normal changes that occur with aging are routinely noted as abnormal.

Try to remember that wrinkles do not hurt, greying hair is not painful, and that rotator cuff or labrum tear, disc bulge, or torn meniscus…could just be part of the bodies normal aging process.

Find a doctor, chiropractor, physical therapist, or other licensed health care provider who takes a detailed history, performs a thorough examination, and works with you on goal setting and an individualized treatment plan.

******

Sources:

Brinjikji, W et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” AJNR. American journal of neuroradiology vol. 36,4 (2015): 811–6. doi:10.3174/ajnr.A4173

The post When Your Back Hurts, Sometimes It’s Better Not Knowing Exactly Why appeared first on Medika Life.

The global burden of disease places lower back pain (LBP) as the leading cause for years lived with disability at the top spot for the past three decades.

LBP may be treated with pharmacological therapy, surgical interventions, or rehabilitation…physical therapy, exercise, spinal manipulation, and other practices. Combination therapy and interdisciplinary approaches to LBP are considered helpful in many cases.

Everything works, but not for everyone.

Ask one hundred people what you can do to get rid of your back pain and you might get one hundred different answers. Read a hundred different articles, scientific studies, look at one hundred different videos online, you will hear and see it all.

Chiropractic care is my bias, it’s how I pay my bills, but that doesn’t make it better. Relief from pain isn’t open and shut. What works for some people won’t necessarily work for you. Doing you own research may point you in a direction, listening to experts may sway you, hearing from a friend or family member might land you in a different office. Some interventions are apparently bogus based on today’s prevailing evidence: TENS, ultrasound, and kinesiotaping for pain don’t appear to do much. Ice (cryotherapy) is also out of favor at the moment.Should Your Chiropractor Adjust Your Neck?Cervical spine manipulation is controversial, should it be abandoned?medium.com

No one has a monopoly on what works the best, because nothing works the best. There is no gold standard for effective back pain treatment. Some people respond well to one thing but aren’t going to respond well to another. Many cases will resolve on their own no matter what procedure or technique is performed.

If treating back pain is a crap shoot, why go to a chiropractor?

There are some first-line treatment recommendations that show up perennially in study after study for what works for lower back pain.

From the American College of Physicians evidence-based clinical practice guideline 2017:

Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)

And:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)

So you can see that good chiropractic care covers several of these recommendations for acute, sub-acute, and chronic types of lower back pain. A competent chiropractor is going to perform a detailed history and physical exam, provide you with a working diagnosis, and form a plan based on the best available evidence, their own clinical expertise, and your preferences and values as the patient — the key player in all of this.

Chiropractic can check a lot of these boxes, but not every chiropractor will employ multiple treatment modalities. In my own office I frequently use:

1. Nonpharmacologic treatments
2. Superficial heat
3. Massage
4. Spinal manipulation
5. Exercise
6. Yoga

Final Thoughts

As a human being, there is a good chance you will develop lower back pain at some point in your life. Most cases of lower back pain will resolve on their own with time. No matter what you try or who you see first for a case of lower back pain, it may or may not improve your symptoms.

So from my professional standpoint what you do for your back pain should be based primarily on what you value in a treatment approach. Some people are comfortable with medications or injections, others are not. Some people value exercise over more passive treatments such as massage.

In the case of chiropractic treatment most patients who seek this type of care for their lower back pain are likely attracted to it being drug-free, non-invasive, hands-on, and of a low risk of side effects.Fruit Is Not Making You FatIf you go to a health professional and they tell you fruit is bad, turn and run in the other direction.medium.com

Works Consulted:

Pergolizzi, J.V., LeQuang, J.A. Rehabilitation for Low Back Pain: A Narrative Review for Managing Pain and Improving Function in Acute and Chronic Conditions. Pain Ther 9, 83–96 (2020). https://doi.org/10.1007/s40122-020-00149-5

Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians https://doi.org/10.7326/M16-2367

The post Not All Lower Back Pain Treatments Are Equal appeared first on Medika Life.

The symptoms listed below are meant to make you aware of how symptoms we often associate with other conditions, like heartburn, can actually be your body trying to warn you about your heart. Aches and pains caused by your heart, but felt in different areas of your body, like your neck and jaw, are called referred pain.

The heart shares a bundle of nerves that service our arms, chest, and upper torso, so if you feel back pain or a sore jaw, this could be your heart sounding an alarm bell, but getting its signals crossed. Of course, it could also simply be exactly what it feels like. A dodgy tooth or a strained back muscle.

That’s why it’s important to learn about all the types of referred pain and consider any symptoms you may be experiencing in the context of your current physical condition. If you’re over forty, overweight, and unfit, then back pain accompanied by, for instance, sweating and shortness of breath should send you straight in to your doctor.

It isn’t just obese and unfit over-40’s that have heart attacks though. Any person, of any age and physical condition can suffer a heart attack for a variety of reasons, so it’s best to educate yourself on the most common early warning signs.

Not only could recognizing these signs save your life, but you could also potentially save someone else’s by seeing their aches and pains for what they really are. A warning.

Shortness of breath

Trouble getting up those stairs? Have you noticed a sudden and rapid decrease in your lung capacity? Do even small exertions leave you feeling out of breath? This symptom, even experienced on its own, requires immediate examination by your doctor. Don’t put it off. Heart-related shortness of breath does not need to be accompanied by chest pain.

Feeling Dizzy

Dizziness or lightheadedness coupled with chest pain and shortness of breath may indicate a decrease in blood volume and a drop in blood pressure, which means a heart attack could be on the way.

Feeling tired and listless

A feeling of fatigue will often accompany one or more of these symptoms, particularly in women. They can experience fatigue a month before having a heart attack. The National Heart, Blood, and Lung Institute warn that this sign is especially prominent in women.

Heartburn, nausea, and indigestion

It could be that spicy curry you had for lunch or it could be something far more serious. Gastric symptoms like a queasy stomach, vomiting, or belching can develop when the heart and other areas of the body aren’t receiving enough blood supply. You can interpret this as acid reflux or heartburn, so it’s important to reach out to your doctor, especially if you’re having other heart related symptoms.

Pressure or feeling constricted, tightness

The most common and well know signal of an impending heart attack. These feelings will usually come in waves and will dissipate after a few minutes. The American Heart Association describes this symptom as “uncomfortable pressure, squeezing, fullness, or pain in the center of your chest”. This symptom can be accompanied by an increased feeling of stress and anxiety. Don’t ignore this symptom. Consult your doctor as soon as possible.

Sweating

Sweating is the body’s mechanism for cooling us down and is totally normal. In some instances, we sweat more, from excessive heat, exercise and in the case of women, the onset of menopause can trigger sweating. A heart attack triggers your nervous system, which in turn activates a “fight or flight” response that puts you in survival mode and could lead to sweating. ‘Cold sweats’ and ‘night sweats’ without the presence of fever should be taken seriously.

Referred Pain

Earlier we described how confused nerves can send out heart-related pain signals to other areas of your body. These can occur in places other than the chest, like the back, shoulders, arms, neck, or jaw. Women are more likely to experience pain in the neck, jaw, and back. Again, referred pain should be considered alongside the presence of other symptoms. A useful tip for back pain is the inability to localize the origin, in other words, there isn’t a specific spot you can point at for the pain.

Palpitations or irregular heartbeat

When the heart is starved of blood, it can lead to the sensation of heart palpitations or a racing heart. This is an unmistakable signal from your heart that something is amiss. If you feel like you’re having heart palpitations, make sure you contact your doctor right away, even in the absence of any other symptoms.

The post Eight Early Signs of Heart Trouble You Shouldn’t Ignore appeared first on Medika Life.

What does heart related back pain feel like?

This symptom, usually occurs in your upper back and is more likely to affect women. The pain can originate in your chest and then “move” to your back. Although most often felt in the upper back, it can also occasionally cause pain in the lower back.

Onset can be sudden and pain can wake you at night. The pain is most often described as originating between the shoulder blades. As there are many non-heart related causes for back pain, its important to consider any of the other heart attack symptoms that would indicate your pain is heart related. If you find it difficult to pinpoint the pain, this could be an indicator of heart related pain.

Why does your heart cause this symptom?

It’s a case of crossed wires. Our bodies are normally very specific when they send out pain signals. Close your finger in the door and you know which part of your body isn’t impressed with you. The heart is a little bit more complicated as it shares nerves that send out signals to our arms, head and upper body.

As a result heart related symptoms like back pain are called referred pain. In other words, although that area feels painful, it isn’t the problem. Your heart is the issue and the signals have simply gotten mixed up. The source of origin for referred pain is also more diffuse and difficult for patients to pinpoint.

Accompanying symptoms

Back pain can occur as an isolated symptom or be accompanied by pain in your neck, jaw, shoulder or chest and you may experience nausea, sweating, shortness of breath, dizziness, or lightheadedness. If your back pain is accompanied by any these symptoms, seek immediate medical help.

If you’ve recently noticed any of the following, you should also seek medical attention if your back pain is unexplained.

• feeling tired or out of breath from your normal day to day routine
• struggling for breath from activities that don’t normally tax you
• feeling tired and listless but struggling to sleep
• sudden feelings of dread or anxiousness (panic attack)

Gender prevalence for back pain

Women experience this symptom far more than men do and many women report the pain as having started in their chests and then moving to the upper back area. For women, it is a typical red flag, but men may not experience any back pain at all. Women are also more likely than men to feel their back pain while they’re resting or sleeping.

Alternate Causes of back pain

Even if you suffer from any of the conditions listed below, you may still experience back pain as a result of a heart condition. The pain may not feel the same as the pain you normally experience from an existing condition.

The most common causes of upper back pain are muscular, related to poor posture, trapped nerves or degenerative conditions of the spine and bones. These include some of the following

• Back muscle spasm, sprain or strain
• Cancers
• Degenerative disc disease
• Herniated (bulged or ruptured) disc
• Lung Cancer
• Osteoarthritis
• Osteomyelitis
• Osteoporosis
• Spinal stenosis
• Spondylitis

A life-threatening cause of back pain is an aortic dissection, a condition in which the biggest artery in your chest tears.

Are there clear signs it’s your heart?

There are a few tell tale signs that would indicate the pain in your back is related to your heart.

• Sharp pain that wakes you but you are unable to pinpoint the source of the pain
• Pain is most often described as occurring between the shoulder blades
• If the pain is accompanied by sudden excessive sweating not related to menopause
• If you find yourself suddenly short of breath from normal activities
• If your back pain is accompanied by one or more of the other heart related symptoms seek immediate medical attention

When to call your Doctor or 911

If you are experiencing upper back pain, especially pain that travels to your jaw, neck or down your arm, and are having associated symptoms of nausea, dizziness, sweating, or shortness of breath, call 911 right away.

If you are in an at risk group for heart disease (elderly, diabetic, obese, overweight, smoker or high blood pressure) then you should treat any back pain seriously. The more prolonged the discomfort or pain is, the faster you should seek medical care. Dial 911 or visit your nearest ER

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