Nutritional and dietary elements that have proven relationships to certain diseases or conditions. The right diet and dietary supplements can help you reduce your risk factors and prevention for chronic diseases.
Hepatitis A is a liver disease caused by hepatitis A virus (HAV).
HAV is spread from person to person by putting something in the mouth that has been contaminated with the stool of a person with HAV infection. This type of spread is called "fecal-oral." This can happen in a variety of ways, such as when an infected person who prepares or handles food doesn't wash his or her hands adequately after using the toilet and then touches other people's food. A person can also be infected by drinking water contaminated with HAV or drinking beverages chilled with contaminated ice. Contaminated food, water, and ice can be significant sources of infection for travelers to many areas of the world. For this reason, the virus is more easily spread in areas where there are poor sanitary conditions or where good personal hygiene is not observed.
Most infections in the United States result from contact with a household member or a sex partner who has hepatitis A; however the proportion of cases of hepatitis A among international travelers, illegal drug users, and men who have sex with men has been increasing. Casual contact, as in the usual office, factory, or school setting, does not spread the virus.
Sex involves close, intimate contact (vaginal, anal, or oral sex) and increases the risk of exposure to HAV in the feces of an infected person.
The Symptoms of Hepatitis A.
A lot of people have no symptoms at all. They do not know they have hepatitis A. Some people have a milder infection with some fatige and cold symptoms. Usually younger children have a milder infection. Some of the possible symptoms include:
Flu like symptoms;fever,chills,diarrhea
Decreased appetite
Nausea
Jaundice (yellow color in the skin and the eyes)
Dark urine (tea color)
Pale stool
Belly pain
Fatigue
HAV has an incubation period of 3 to 5 weeks. People with HAV infection might not have any signs or symptoms of the disease. Adults are more likely to have symptoms than children. About 7 out of 10 adults have symptoms, while children less than age 6 years usually have no symptoms. In some people, symptoms of hepatitis A recur in 6-9 months; this condition is called relapsing hepatitis A.
Symptoms usually last less than 2 months; however, a few people are ill for as long as 6 months.
Treatments for Hepatitis A
There is no specific treatment for hepatitis A, but supportive treatment is given to address the symptoms. Full recovery is common. Hepatitis A infection confers lifelong immunity in individuals who have been infected.
Prevention and Personal Precautions
Most travellers are at low risk of acquiring HAV infection. However, cases of hepatitis A have occurred in travellers to developing countries who stay in rural areas or in standard-level tourist accommodations where the hygienic quality of the food and water supply may be inadequate. Taking food and water precautions is the best means of preventing hepatitis A infection. Moreover, hepatitis A is a vaccine-preventable disease.
Because hepatitis A is spread through contaminated food and water. Key principles to remember are: boil it, cook it, peel it or leave it!
Eat only food that has been well-cooked and is still hot when served.
Drink only purified water that has been boiled or disinfected with chlorine or iodine, or commercially bottled water in sealed containers.
Carbonated drinks without ice, including beer, are usually safe.
Avoid ice, unless it has been made with purified water.
Boil unpasteurized milk.
Avoid unpasteurized dairy products and ice cream.
Avoid uncooked foods -- especially shellfish -- and salads. Fruit and vegetables that can be peeled are usually safe.
Avoid food from street vendors.
Wash hands before eating or drinking.
Protection against hepatitis A through immunization with a vaccine
Who should obtain the new hepatitis A vaccine?
The U.S. Centers for Disease Control and Prevention (CDC) recommends hepatitis A vaccine for:
travelers to countries with high rates of hepatitis A;
people living in communities with high rates of hepatitis A;
people in certain outbreak settings;
laboratory personnel who work with hepatitis A virus;
sexually active homosexual/bisexual men;
people with existing chronic liver disease;
injecting drug users;
all children between the ages of 1 and 2
The hepatitis vaccine is widely available and is the best protection against infection. The vaccine is recommended for persons 12 months or older in age or who belong to one of the high-risk groups mentioned above. Short-term protection against hepatitis A is available from immune globulin, which can be given before and within 2 weeks after coming in contact with a person infected with acute HAV. Proper hand washing after using the bathroom, changing a diaper, and before preparing and eating food is strongly recommended.
Can a person get infected with HAV more than once?
No. Once you recover from the infection, you develop antibodies called anti-HAV that provide life-long protection from future infections. After recovering from hepatitis A, you won’t get it again and you cannot transmit HAV to others.
How does HAV different from Hepatitis B virus (HBV) and Hepatitis C virus (HCV)?
HAV, HBV, and HCV are three different viruses that attack and injure the liver and cause similar symptoms in people with acute (recently acquired) disease.
HAV is spread by getting HAV-infected fecal matter into a person’s mouth who has never had hepatitis A (e.g., an HAV-infected person who doesn’t wash his or her hands after using the bathroom and then handles food for public consumption or an infected person who has sex with a person who has never had hepatitis A). HBV and HCV are spread when an infected person's blood or blood contaminated body fluids enter another person's bloodstream.
HBV and HCV infections can cause lifelong (chronic) liver problems. HAV does not.
There are vaccines that will protect people from HAV infection and HBV infection. Currently, there is no vaccine to protect people from HCV infection.
There are medications that are approved by the Food and Drug Administration (FDA) for treatment of chronic HBV and HCV infections.
If a person has had one type of viral hepatitis in the past, it is still possible to get the other types.
Scoliosis is a medical condition in which a person's spine is curved from side to side, shaped like a "S", and may also be rotated. To adults it can be very painful. It is an abnormal lateral curvature of the spine. On an x-ray, the spine of an individual with a typical scoliosis may look more like an "S" or a "C" than a straight line. It is typically classified as congenital (caused by vertebral anomalies present at birth), idiopathic (sub-classified as infantile, juvenile, adolescent, or adult according to when onset occurred) or as having developed as a secondary symptom of another condition, such as cerebral palsy, spinal muscular atrophy or due to physical trauma.
Kyphosis is a curve seen from the side in which the spine is bent forward. Lordosis is a curve seen from the side in which the spine is bent backward. People with scoliosis develop additional curves to either side, and the bones of the spine twist on each other like a corkscrew.
The condition can be categorized based on convexity, or curvature of the spinal column, with relation to the central axis:
Dextroscoliosis is a scoliosis with the convexity on the right side.
Levoscoliosis is a scoliosis with the convexity on the left side.
Rotoscoliosis (may be used in conjunction with dextroscoliosis and levoscoliosis, e.g. levorotoscoliosis) refers to scoliosis on which the rotation of the vertebrae is particularly pronounced, or is used simply to draw attention to the fact that scoliosis is a complex 3 dimensional problem.
B. Is Scoliosis Genetic?
There is a definite genetic connection, with around 25% of those with a scoliosis have a direct relative with a curvature. 80% of adolescence idiopathic scoliosis arises in girls, and 80% of these girls have their rib prominence on the right side.
Abnormalities at birth or improper development may be the biggest ways heredity plays a role in scoliosis.
Scoliosis is not caused by a child having poor posture or carrying too much weight in a backpack.
C. Types of Scoliosis
There are three other main types of scoliosis:
Functional: In this type of scoliosis, the spine is normal, but an abnormal curve develops because of a problem somewhere else in the body. This could be caused by one leg being shorter than the other or by muscle spasms in the back.
Neuromuscular: In this type of scoliosis, there is a problem when the bones of the spine are formed. Either the bones of the spine fail to form completely, or they fail to separate from each other. This type of scoliosis develops in people with other disorders including birth defects, muscular dystrophy, cerebral palsy, or Marfan's disease. If the curve is present at birth, it is called congenital. This type of scoliosis is often much more severe and needs more aggressive treatment than other forms of scoliosis.
Degenerative: Unlike the other forms of scoliosis that are found in children and teens, degenerative scoliosis occurs in older adults. It is caused by changes in the spine due to arthritis. Weakening of the normal ligaments and other soft tissues of the spine combined with abnormal bone spurs can lead to an abnormal curvature of the spine.
Others: There are other potential causes of scoliosis, including spine tumors such as osteoid osteoma. This is a benign tumor that can occur in the spine and cause pain. The pain causes people to lean to the opposite side to reduce he amount of pressure applied to the tumor. This can lead to a spinal deformity. D. Scoliosis Causes
Doctors don't know what causes the most common type of scoliosis. When a cause can't be identified, scoliosis is called idiopathic.
Various causes have been implicated, but none has consensus among scientists as the cause of scoliosis. Scoliosis is more often diagnosed in females and is often seen in patients with cerebral palsy or spina bifida, although this form of scoliosis is different from that seen in children without these conditions. In some cases, scoliosis exists at birth due to a congenital vertebral anomaly. Occasionally, development of scoliosis during adolescence is due to an underlying anomaly such as a tethered spinal cord, but most often the cause is unknown or idiopathic. Some therapists like the referenced Hanna Somatic therapist believe that trauma to an adult can cause, not just asymmetry but an actual curve to the spine visible on x-ray, although no documentation is offered in her article. Scoliosis often presents itself, or worsens, during the adolescence growth spurt.
Scoliosis isn't caused by poor posture, diet, exercise, or the use of backpacks.
E. Scoliosis Symtomps
The spine is an elegant structure — from the side it takes the form of an elongated S, the upper back bowing outward and the lower back curving slightly inward. Viewed from behind though, the spine should appear as a straight line from the base of the neck to the tailbone. Scoliosis is an abnormal curvature of the spine.
If a scoliosis curve gets worse, the spine will also rotate or twist, in addition to curving side to side. This causes the ribs on one side of the body to stick out farther than on the other side. Severe scoliosis can cause back pain and difficulty breathing.
The symptoms of scoliosis can include:
Uneven musculature on one side of the spine* A rib "hump" and/or a prominent shoulder blade, caused by rotation of the ribcage in thoracic scoliosis.
Uneven hip, rib cage, and shoulder levels.
Asymmetric size or location of breast in females.
Unequal distance between arms and body.
Slow nerve action (in some cases).
Different heights of the shoulders.
F. Chiropractic Care and Treatment for Scoliosis
Most children with scoliosis have mild curves — less than 20 degrees — and probably won't need treatment with a brace or surgery. Periodic checkups and X-rays are needed, though, to be sure the curve doesn't worsen (progress). Children who are still growing need checkups about every four to six months to see if there have been changes in the curvature of their spines.
The decision to treat scoliosis is based on many factors. While there are guidelines for mild, moderate and severe curves, the decision to begin treatment is always made on an individual basis. Treatment decisions depend on your child's age, maturity, sex, family history, curve size on X-rays and how much he or she is likely to grow.
There are three basic Chiropractic Care types of treatments for scoliosis: (1) observation (2) orthopaedic bracing (3) surgery.
(1) Observation
Other treatments that have been studied for treatment of scoliosis include:
Electrical stimulation of muscles
Chiropractic manipulation
Exercise
There's no evidence that any of these methods prevent spinal curvature from progressing. Although exercise alone can't stop scoliosis, exercise may have the benefit of improving overall health and well-being.
(2) Orthopaedic Bracing
If your child has a curve of 25 to 40 degrees and is still growing, your doctor may recommend using a brace. Wearing a brace won't cure scoliosis, or reverse the curve, but it usually prevents further progression of the curve. Most braces are worn all the time, during the day and night. Scoliosis braces can prevent progression and the need for surgical treatment up to 90 percent of the time. Like many treatments, scoliosis braces are only effective if they are worn as directed. Both the child and the child's family need to understand the importance of wearing the brace.
Children who wear braces can usually participate in most activities and have few restrictions. Kids can take off the brace to participate in sports or other physical activities.
Once the skeleton is mature — about 15 to 16 years old for girls and 17 to 18 years old for boys — or if the curve is too large — more than 40 to 45 degrees — a brace won't help.
Braces aren't useful for the treatment of congenital scoliosis because the curve is caused by abnormally shaped bones in the spine.
Braces are of two main types:
Underarm or low-profile brace. This type of brace is made of modern plastic materials and is contoured to conform to the body. Also called a thoracolumbosacral orthosis (TLSO), this close-fitting brace is almost invisible under the clothes, as it fits under the arms and around the rib cage, lower back and hips. A custom brace is molded to place corrective forces on the curve. Other types of braces place pads in areas to stabilize the curve.
Milwaukee brace. This full-torso brace has a neck ring with rests for the chin and for the back of the head. The brace has a flat bar in the front and two flat bars in the back. A Milwaukee brace may be used for curves in the upper spine. However, this brace is not commonly used today.
Other types of braces are being evaluated — some are worn only at night, others are made of material that is more flexible or use different mechanisms of pressure. However, there is currently no conclusive evidence available to support their effectiveness.
A brace isn't effective unless a child wears it as prescribed. A brace will feel uncomfortable and awkward at first. After an initial period of adjustment, however, wearing a brace begins to feel normal. Your child may need help building a positive attitude about wearing the brace and maintaining a healthy body image.
(3) Surgery
If your child's curve is greater than 40 to 50 degrees, your doctor will likely recommend surgery because scoliosis of this size tends to get worse throughout a child's lifetime. Scoliosis surgery involves techniques to fuse or join the vertebrae along the curve. Surgery is most commonly done through an incision in the middle of the back. For very rigid or severe curves, additional surgery may be needed through the side of the body.
"Fusion" means joining two pieces together. In the treatment of scoliosis, fusion involves connecting two or more of the bones in your spine (vertebrae) with new bone. The process is similar to what occurs when a broken bone heals. Eventually, the vertebrae fuse together preventing further progression of the curve. Doctors attach metal rods, hooks, screws or wires (implants) to the spine to hold the vertebrae together during the months after surgery while the bones fuse or heal together. The implants are left in the body, even after the bones have fused, to avoid another surgery. These implants can't be seen or felt. In addition to supporting the fused area, implants also apply force to the spine to help correct the deformity and help straighten the curve.
Scoliosis surgery is a complicated orthopedic surgical procedure. The operation takes several hours. Hospitalization can last five to seven days, and activities are restricted for several months. The results of surgery are usually very good, with dramatic improvement in the scoliosis curve size.
Complications may include bleeding, infection, pain, nerve damage or failure of the bone to heal. Rarely, another surgery is needed if the first one fails to correct the problem.
It is important to understand that back pain is a symptom of a medical condition, not a diagnosis itself. Medical problems that can cause back pain include the following:
Mechanical problems: A mechanical problem is a problem with the way your spine moves or the way you feel when you move your spine in certain ways. Perhaps the most common mechanical cause of back pain is a condition called intervertebral disc degeneration, which simply means that the discs located between the vertebrae of the spine are breaking down with age. As they deteriorate, they lose their cushioning ability. This problem can lead to pain if the back is stressed. Other mechanical causes of back pain include spasms, muscle tension, and ruptured discs, which are also called herniated discs.
Injuries: Spine injuries such as sprains and fractures can cause either short-lived or chronic pain. Sprains are tears in the ligaments that support the spine, and they can occur from twisting or lifting improperly. Fractured vertebrae are often the result of osteoporosis, a condition that causes weak, porous bones. Less commonly, back pain may be caused by more severe injuries that result from accidents and falls.
Acquired conditions and diseases: Many medical problems can cause or contribute to back pain. They include scoliosis, which causes curvature of the spine and does not usually cause pain until mid-life; spondylolisthesis; various forms of arthritis, including osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis; and spinal stenosis, a narrowing of the spinal column that puts pressure on the spinal cord and nerves. While osteoporosis itself is not painful, it can lead to painful fractures of the vertebrae. Other causes of back pain include pregnancy; kidney stones or infections; endometriosis, which is the buildup of uterine tissue in places outside the uterus; and fibromyalgia, which causes fatigue and widespread muscle pain.
Infections and tumors: Although they are not common causes of back pain, infections can cause pain when they involve the vertebrae, a condition called osteomyelitis, or when they involve the discs that cushion the vertebrae, which is called discitis. Tumors, too, are relatively rare causes of back pain. Occasionally, tumors begin in the back, but more often they appear in the back as a result of cancer that has spread from elsewhere in the body.
Although the causes of back pain are usually physical, it is important to know that emotional stress can play a role in how severe pain is and how long it lasts. Stress can affect the body in many ways, including causing back muscles to become tense and painful.
B. What is The Risk Factor of Back Pain?
Factors that increase your risk of developing low back pain include:
Smoking
Obesity
Older age
Female gender
Physically strenuous work
Sedentary work
Stressful job
Anxiety
Depression
C. Treatment and Drug for Back Pain
Most back pain gets better with a few weeks of home treatment and careful attention. A regular schedule of over-the-counter pain relievers may be all that you need to improve your pain. A short period of bed rest is okay, but more than a couple of days actually does more harm than good. If home treatments aren't working, your doctor may suggest stronger medications or other therapy.
Medications for Back Pain Your doctor may prescribe nonsteroidal anti-inflammatory drugs or in some cases, a muscle relaxant, to relieve mild to moderate back pain that doesn't get better with over-the-counter pain relievers. Narcotics, such as codeine or hydrocodone, may be used for a short period of time with close supervision by your doctor.
Low doses of certain types of antidepressants — particularly tricyclic antidepressants, such as amitriptyline — have been shown to relieve chronic back pain, independent of their effect on depression.
Physical therapy and exercise A physical therapist can apply a variety of treatments, such as heat, ice, ultrasound, electrical stimulation and muscle-release techniques, to your back muscles and soft tissues to reduce pain. As pain improves, the therapist can teach you specific exercises to increase your flexibility, strengthen your back and abdominal muscles, and improve your posture. Regular use of these techniques will help prevent pain from coming back.
Injections If other measures don't relieve your pain and if your pain radiates down your leg, your doctor may inject cortisone — an anti-inflammatory medication — into the space around your spinal cord (epidural space). A cortisone injection helps decrease inflammation around the nerve roots, but the pain relief usually lasts less than six weeks.
In some cases, your doctor may inject numbing medication into or near the structures believed to be causing your back pain. Early studies indicate that botulism toxin (Botox) also may help relieve back pain, perhaps by paralyzing strained muscles in spasm. Botox injections typically wear off within three to four months.
Surgery Few people ever need surgery for back pain. There are no effective surgical techniques for muscle- and soft-tissue-related back pain. Surgery is usually reserved for pain caused by a herniated disk. If you have unrelenting pain or progressive muscle weakness caused by nerve compression, you may benefit from surgery. Types of back surgery include:
Fusion. This surgery involves joining two vertebrae to eliminate painful movement. A bone graft is inserted between the two vertebrae, which may then be splinted together with metal plates, screws or cages. A drawback to the procedure is that it increases the chances of arthritis developing in adjoining vertebrae.
Disk replacement. An alternative to fusion, this surgery inserts an artificial disk as a replacement cushion between two vertebrae.
Partial removal of disk. If disk material is pressing or squeezing a nerve, your doctor may be able to remove just the portion of the disk that's causing the problem.
Partial removal of a vertebra. If your spine has developed bony growths that are pinching your spinal cord or nerves, surgeons can remove a small section of the offending vertebra, to open up the passage.
Prolotherapy (also called sclerotherapy) involves injecting painful ligaments and tendons with sugar solutions that are intended to stimulate production of connective tissue. The theory is that prolotherapy can strengthen these ligaments and tendons, and reduce pain. Studies of prolotherapy have reported conflicting evidence regarding its effectiveness in treating chronic back pain.
A review of five well-designed studies involving 366 participants concluded that prolotherapy alone was ineffective in treating chronic low back pain. However, when combined with other treatments — such as spinal manipulation and exercise — prolotherapy may improve chronic low back pain.
A typical course of prolotherapy treatment is six to 10 sessions, sometimes with multiple injections at each session. Prolotherapy is known to cause some pain at the injection site, but this is typically mild and temporary. As with any injection, there is a risk of infection, bruising, bleeding or tissue damage.
More research is needed to clarify what role, if any, prolotherapy plays in the treatment of chronic low back pain.
E. Disk Replacement
Disk replacement is a relatively new treatment option for degenerative disk disease. In this procedure, the damaged disk is removed and replaced with a metal and plastic disk.
Disk replacement appears to be as effective as spinal fusion in relieving low back pain. However, as with all emerging treatments, the indications for its use are still very limited.
Ideal candidates for disk replacement surgery:
Are between the ages of 20 and 60 years
Have only one degenerated disk
Have failed to respond to other forms of treatment
Disk replacement surgery isn't recommended for people who have systemic bone disease, such as osteoporosis, or who have had previous back surgery, including spinal fusion. It's important to note that disk replacement surgery is more difficult than spinal fusion surgery. Also, the risks of removing the artificial disk if it fails or becomes infected are potentially serious.
Inversion therapy is often promoted as a therapy for back pain. But there's no scientific evidence that it provides long-term pain relief. Inversion therapy involves hanging upside down — supported by your ankles — to allow gravity to naturally decompress disks and nerve roots in your spine. Another form of inversion therapy entails lying on a table (inversion table) that gradually tips you head down — again, supported by your ankles. Inversion therapy is one example of the many ways in which traction — stretching the spine — has been used in an attempt to relieve back pain. But traction is falling out of favor with many in the medical community. Well-designed studies that have evaluated traction for back pain have found no significant long-term benefit.
However, some people find that traction provides temporary pain relief. Those with sciatica or a pinched nerve may find traction beneficial as part of a more comprehensive treatment program.
A potential problem with inversion therapy is that it may significantly increase blood pressure in your head. For this reason, you should not try inversion therapy if you have heart disease, high blood pressure or eye diseases, such as glaucoma, or if you are pregnant.
The goal of noninvasive treatment for back pain is twofold:
Reduce but not necessarily eliminate your pain
Help you improve your function so that you can resume as closely as possible your normal routine of work and leisure
After talking to you about the particular circumstances involving your back pain, your doctor may recommend one or more of the following common treatment options:
Back brace.
Many back braces or corsets (lumbar supports) are available without a prescription at pharmacies and medical supply stories. Or, your doctor may prescribe a specific brace customized for your back. The rationale behind braces is that they may support your abdomen and take some of the load off your lower back, they may restrict motion, and they may improve posture. But there's also concern that use of braces may result in the wasting away (atrophy) of some muscles that support the spine through lack of use. If you use a brace, limit the use to intermittently several hours a day. If you have a labor-intensive job that places stress on your lower back, a back brace or corset can help you when you first return to work after a back injury by avoiding too much strain on your spine.
Back braces and corsets may also make transitional movements — such as from a sitting to a standing position — more comfortable during an episode of back pain. There's insufficient evidence that back braces are more effective at relieving back pain than no treatment at all. The best course of action may be strengthening your trunk muscles to be the primary support for your back.
Pain medications.
You can take nonprescription medications, or your doctor may suggest prescription medications to relieve your discomfort until inflammation subsides and your body heals itself. Options include:
Over-the-counter (OTC) analgesics. Analgesics are medications that relieve pain. They include nonsteroidal anti-inflammatory drugs (NSAIDs), counterirritants and topical analgesics. NSAIDs, such as aspirin, naproxen sodium (Aleve) and ibuprofen (Advil, Motrin IB, others), can relieve pain and reduce inflammation. Another option is counterirritants, which you apply to your skin as a cream or spray. These nonprescription medications — which include Bengay, Icy Hot and capsaicin (Zostrix) — stimulate your sensory receptors of heat or cold to cover up or counter pain. Counterirritant products may temporarily relieve chronic pain. Topical analgesics, many of which contain salicylates — the main ingredient in aspirin — also can reduce inflammation. NSAIDs appear to provide some relief for acute back pain, but evidence is still lacking regarding effectiveness of NSAIDs in chronic low back pain. In addition, though NSAIDs are widely used for treatment of low back pain, long-term use can have side effects, particularly effects on the gastrointestinal system and the kidneys.
Anticonvulsants. Low doses of drugs more commonly used in the treatment of seizures and epilepsy are sometimes used to help people who have low back pain in conjunction with leg pain. These medications include gabapentin (Neurontin), topiramate (Topamax), clonazepam (Klonopin), carbamazepine (Carbatrol, Tegretol) and valproate (Depacon). These drugs aren't usually useful in treating low back pain. Instead, they're sometimes directed at treating the leg pain component in people who primarily have back pain associated with leg pain.
Antidepressants. Some antidepressant medications, taken in lower doses than would be used to treat depression, may help in the treatment of low back pain. Antidepressants may work in a variety of ways. For example, they may result in a higher level in your brain of serotonin, a neurotransmitter associated with pain control. Antidepressants may also reduce anxiety and muscle tension. The evidence on the effectiveness of antidepressant medications in the treatment of low back pain is mixed. Among this group of medications, tricyclic antidepressants (TCAs) appear to be the most effective. They include such medications as nortriptyline (Aventyl, Pamelor), amitriptyline, desipramine (Norpramin), doxepin (Sinequan) and imipramine (Tofranil). Medications called selective serotonin reuptake inhibitors (SSRIs) don't appear to be as effective as TCAs for back pain.
Opioids. In select cases, doctors may use certain narcotic medications (opioid analgesics) to treat low back pain. Examples of these medications include morphine (MS Contin, Oramorph SR, others), oxycodone (OxyContin), methadone (Dolophine HCL), fentanyl (Duragesic) and levorphanol (Levo-Dromoran). There is debate regarding the use of opioids, and they're not used as a long-term treatment. Among the reasons are side effects, as well as concerns about dependence. The most common side effects that limit their use include nausea and constipation, which can be severe. In addition, other common but less known important side effects include dizziness and sedation. Before your doctor prescribes opioids, have a thorough discussion with him or her about their benefits and drawbacks.
Cold or heat therapy.
Using cold and heat therapy may relieve pain and muscle tension in the initial days after back pain begins. Some studies show that heat is an effective approach for acute nonspecific back pain. As for chronic back pain, cold and heat likely won't cause harm and may be helpful, but there isn't scientific evidence at this time to prove that cold and heat are effective treatments for chronic low back pain. Cold or ice applied to your back can reduce inflammation and swelling by constricting blood vessels. The cold also acts to slow nerve impulses and make it less likely that your muscles will contract, in this way reducing pain.
To use cold packs, wrap an ice pack or a bag of frozen vegetables in a piece of cloth. Hold it on the sore area for about 15 minutes, several times a day. To avoid frostbite, don't place ice directly on your skin. Heat therapy increases blood circulation, which can aid healing of damaged tissues. Heat also allows tissues to stretch more easily, resulting in less stiffness, greater flexibility and less pain. To use heat therapy, take a warm bath, or use warm packs, a heating pad or a heat lamp for pain relief. Be careful not to burn your skin with extreme heat. If you find that cold provides more relief than heat, you can continue using cold packs, or try a combination of the two methods.
Electrical stimulation.
Transcutaneous electrical nerve stimulation (TENS) delivers a tiny electrical current to key points on a nerve pathway. The current, delivered through electrodes taped to your skin, isn't painful or harmful. It's not known exactly how TENS works, but it may stimulate release of pain-inhibiting molecules (endorphins) or block pain fibers that carry pain impulses. However, it's unclear whether those who benefit from TENS achieve relief by some direct effect on their nervous system or from the belief that they will benefit from the therapy (the so-called placebo effect). Some people with chronic pain use TENS to help them function with less discomfort. But several studies have concluded that TENS has not been proved effective in relieving chronic low back pain.
Exercise and physical therapy.
Physical activity plays a strong role in recovering from back pain and particularly in helping to prevent future pain and loss of function. Physical activity can include one or many among a wide range of exercises that you do in the presence of a physical therapist, or exercises that you do on your own at home. An exercise program can include any or all of the following components: flexing, stretching, endurance training, strength building and aerobic.
Supervised programs that include stretching and strengthening exercises, which don't specifically target the back, are more beneficial in relieving chronic low back pain and improving function. Your doctor or physical therapist can tailor an exercise program to meet your individual needs. There is no one-size-fits-all approach.
Exercise programs are individualized because people have different levels of pain and differing injuries that caused the pain initially. Exercise doesn't appear to increase your risk of future back injuries and may help prevent back pain at work. Benefits of a physical activity program may include:
Pain reduction
Strengthening of weak muscles
Stretching of contracted muscles
Decreasing mechanical stress on your back
Improving your fitness to prevent injury
Stabilizing your back
Improving your posture
Improving your mobility
Decreasing the rate and severity of recurring back pain
Allowing quicker recovery from future flares of back pain
Some studies suggest that exercise therapy is more effective than are conservative or inactive treatments in people with chronic low back pain. Short-term, modest improvements were seen in such areas as pain, disability, strength and flexibility. Exercise and physical therapy are an important part of your treatment program and should become part of your permanent routine at home. Improving the strength, endurance and function of your back helps minimize the chance of recurrence of back pain. One study showed that people who didn't exercise after an initial episode of acute low back pain were more likely to experience a recurrence of low back pain than were people in the study's exercise group. Mild discomfort that you may feel as you begin an exercise program should gradually ease as your muscles become stronger. The key is to start an exercise program at a low level to ensure your comfort and proper technique, and then progress slowly as your symptoms allow.
Cognitive behavior therapy.
This type of talk therapy combines attempts to identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. It's based on the idea that your own thoughts determine how you behave. Even if an unwanted situation hasn't changed, you can change the way you think and behave in a positive way. The therapy may have a role in the case of chronic low back pain for which no specific physical cause is evident.
Your doctor may talk to you about the psychological and social issues surrounding your chronic pain, such as whether you have stress, anxiety or depression, how your family has responded, how the pain has affected your work and other activities, and what you believe causes the pain to continue. You and your doctor may also talk about your readiness to accept that the condition will improve over time without any major medical intervention. Cognitive behavior therapy has been shown to be effective in relieving pain and improving function as one component of back care.
Multidisciplinary treatment programs.
A multidisciplinary approach to treating chronic low back pain involves, as the phrase suggests, a variety of therapies. These may include a combination of exercise, physical therapy, education, cognitive behavior therapy, vocational counseling and other strategies. Reviews of studies show long-term effectiveness of multidisciplinary treatment programs in lowering pain, improving function and reducing return to work time.
If the cause of your back pain seems to be motion between segments of your vertebrae, spinal fusion may be a way to prevent motion and stop the pain. Spinal fusion involves permanently connecting — or "welding" — two or more vertebrae together. Spinal fusion was formerly used primarily for conditions such as scoliosis and other spinal deformities. Today, although most people with chronic low back pain don't need to undergo spinal fusion, it has become increasingly popular for treating low back pain. The number of spinal fusions for all causes in the United States has more than doubled since 1993. Spinal fusion has been used as a treatment for what's called discogenic pain — pain originating in the area of a particular disk and without involving leg pain (sciatica).
Evaluating your suitability
Before you and your doctor agree to surgery as an option, your doctor will want to make sure that you've given nonsurgical treatments a reasonable trial. Also, your doctor may conduct a study called a diskogram, which is a special X-ray examination that involves the use of a dye. The dye, injected into a disk, serves to make it appear better on an X-ray. The injection of dye may also produce a pain similar to your ongoing back pain, which helps your doctor pinpoint that disk as the source of your pain.
What to expect during the procedure Spinal fusion surgery requires general anesthesia. The procedure may take from two to 12 hours, depending on how extensive the surgery is and the technique your surgeon uses. Surgery may involve a large incision, or may be done using newer techniques with smaller incisions.
To fuse the spine, your doctor needs small pieces of extra bone to fill the space between two vertebrae. This bone may come from your own body (autogenous bone), usually from a pelvic bone. Or, it may come from another person (allograft bone) by way of a bone bank. If the front of your spine is fused, the disk is removed first. Bone graft substitutes, such as genetically engineered proteins, are being developed as alternatives to using bones from your body or a bone bank. Sometimes, doctors also use wires, rods, screws, metal cages or plates. As with any surgery, spinal fusion carries risks, including pain at the donor site for the bone, infection and nerve injury.
The aftermath of surgery
Expect to be in the hospital for several days after surgery. You'll also likely experience considerable pain and discomfort after surgery, but your doctor will control pain with oral and intravenous medications. It takes from several weeks to several months to heal from this surgery, depending on your age, condition and what level of activity you plan to return to. The type of healing that needs to occur after spinal fusion is comparable to recovery from a broken bone. The earliest that X-rays might reveal bone healing after spinal fusion is about six weeks.
Spinal fusion removes some spinal flexibility. This can be beneficial if movement and instability between spinal segments is what causes your pain. However, the fused spine needs to be kept in proper alignment. You'll be taught how to move, sit, stand and walk in a manner that keeps your spine properly aligned. You may be able to start a physical rehabilitation program as early as about four weeks after spinal fusion surgery.
Set realistic expectations
Beyond the immediate potential risks of spinal fusion surgery, the areas of your spine adjacent to the fusion will bear more stress. This makes those areas more likely to experience future wear and tear. That may mean you'll need to undergo surgery again. About 20 percent of people who have spinal fusion surgery need another operation within 11 years.
Also, like any treatment for back pain, don't expect spinal fusion to eliminate your pain — just to improve it. For example, if your level of pain on a scale of 0 to 10 was a 7 before surgery, your doctor might regard a reduction to a pain level of 3 or 4 to be a successful result.
More study is needed regarding the long-term efficacy of spinal fusion to treat discogenic pain. A study published in the May 2005 issue of the British Medical Journal concluded that people who are candidates for spinal fusion may obtain benefits similar to those of surgery from an intensive rehabilitation program. A 2007 systematic review of several studies, including the 2005 British Medical Journal study, stated it wasn't possible to reach a definitive conclusion about whether fusion surgery might be effective in treating discogenic pain. The review did state that the nature of nonsurgical treatment of back pain "may be critical" in determining whether it's a better approach than fusion.
A 2004 opinion article in the New England Journal of Medicine stated that "the emphasis of research efforts should shift from examining how to perform fusion to examining who should undergo fusion. The indications for this invasive and expensive procedure remain unclear despite its rapidly expanding use." A 2007 article in the New England Journal of Medicine addressed the issue of who needs back surgery, and concluded that for people with major disability or major spine trauma, surgery "may preserve life or function." However, "absent major neurologic deficits, patients with herniated disks, degenerative spondylolisthesis, or spinal stenosis do not need surgery, but the appropriate surgical procedures may provide valuable pain relief."
At the time you and your doctor discuss whether you're a good candidate for spinal fusion, he or she may mention a newer option — disk replacement therapy. The Food and Drug Administration approved this therapy in 2004. However, it's still too early to know the long-term outcome of disk replacement therapy.
Spinal manipulation: Osteopathic or chiropractic manipulation appears to be beneficial in people during the first month of symptoms. Several studies have been performed on this topic and have produced conflicting results. The use of manipulation for people with chronic back pain has been studied as well, also producing conflicting results. The effectiveness of this treatment remains unknown. Manipulation has not been found to benefit people with nerve root problems.
J. Acupunture
Current evidence does not support the use of acupuncture for the treatment of acute back pain. Scientifically valid studies are not available. Use of acupuncture remains controversial.
K. Transcutaneous electric nerve stimulation (TENS)
TENS provides pulses of electrical stimulation through surface electrodes. For acute back pain, there is no proven benefit. Two small studies produced inconclusive results, with a trend toward improvement with TENS. In chronic back pain, there is conflicting evidence regarding its ability to help relieve pain. One study showed a slight advantage at 1 week for TENS but no difference at 3 months and beyond. Other studies showed no benefit for TENS at any time. There is no known benefit for sciatica.
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