Dealing with Joint Pains Positively

People suffering constantly from joint pains live miserable lives.  Joint pains have become regular fixtures in their everyday lives so much so that they have learned to live with it.  If you suffer from joint pains, you need to educate yourself concerning the disease condition so that you will be able to learn how to manage it and live a better life where you are in control and not the joint pains controlling you.

Pains associated with arthritis include the severe pain from the inflammation of the joints, acute pain from damaged joints, and exacerbated pain brought by chronic suffering from joint pains.

People with arthritis will, in many ways. experience all these forms of pain. Without proper treatment, medical intervention and pain management, people will suffer for an entire lifetime.

When people who suffer from constant joint pains learn to arm themselves with the knowledge of the disease and how it can be effectively managed, then they are able to better control joint pains which will go a long way to living the life you desire and not a life which is handicapped by joint pains.

So what makes an effective management program to meet joint pains head-on?

Educate yourself. Read, ask, and understand the enemy, in this case, it’s your joint pain. Study how it works and what happens inside the body and why is there so much pain.  Arm yourself with coping and life management skills and learn methods on harnessing the power of your mind to promote wellness and comfort such as the one promoted by bio-feedback or cognitive-behavioral therapy.

Don’t wallow in self-pity. When joint pains strike, treat it as a call for action. Don’t give up and suffer in silence. You deserve to have a better life than the one you have now. Do something to help you for this can increase your self-confidence and determination to fight the disease condition.

There are also some tools to help you in your quest to effectively manage and eventually conquer joint pains.

Take pain relievers right on time before the pain will flare up. Be careful, though, of side effects which are linked to long term use of certain painkillers.

Do yoga and other activities that promote meditation to relax the body and mind. It can help relieve pain and reduce stress that is bombarding your body.

Keep busy.  Don’t dwell on the pain. Don’t let pain dominate you. Do something to keep your mind and body busy.

Have a heat and cold therapy as well as a good old massage. These are time-proven and tested treatments that can give you quick relief for joint pains.

Arthrits Relief with Simple Dietary Changes

The best course of action to take sometimes isn’t clear until you’ve listed and considered ALL of your alternatives. The following paragraphs should help clue you in to what changes the experts think are significant when trying to control the pain of Arthritis..

Arthritis is one of the most prevalent health problems facing today’s aging population.

The most common form of arthritis is osteoarthritis, which usually strikes weight-bearing joints such as the ankles, knees and hips. Pain is caused by the gradual breakdown of cartilage, the soft “padding” material that cushions the joints.

About 85% of adults who reach the age of 85 will have osteoarthritis–unless they take a proactive approach to prevent it.

Exercise is very important. But what about diet?

For a long time, doctors doubted there could be any link between diet and osteoarthritis. They saw the disease as a natural result of wear and tear on the joints, something inevitable as we age.

But new research is making them reconsider that idea.

It now appears that nutrition plays a vital role in helping to prevent or ease the effects of osteoarthritis. One key element is vitamin C.

Vitamin C is a powerful antioxidant, and may protect the joints from the damaging effects of free radicals (unstable molecules that can cause joint inflammation).

Recent research is showing that vitamin C can help prevent bone loss and cartilage inadequacies associated with aging. Specifically, when your joint has cartilage that needs to be repaired, vitamin C is needed for such repairs. It helps to keep your cartilage “young”.

The information about Arthritis presented here will do one of two things: either it will reinforce what you know about Arthritis or it will teach you something new. Both are good outcomes.

According to Dr. Timothy McAlindon of the Boston University School of Medicine, “Vitamin C may also help generate collagen, which enhances the body’s ability to repair damage to the cartilage.”

When scientists at the Boston University School of Medicine studied the eating habits of people with osteoarthritis of the knee, they found that those getting the most vitamin C–more than 200 milligrams a day–were three times less likely to have the disease get worse than those who got the least vitamin C (less than 120 milligrams a day).

Dr. McAlindon recommends that people get a least 120 milligrams of vitamin C every day. “That’s the amount in a couple of oranges,” he says.

Dr. Michael F. Roizen and Dr. Mehmet C. Oz, co-authors of “You: The Owner’s Manual”, recommend even more. “Shoot for 1200 milligrams of vitamin C a day–spread between your diet and supplements throughout the day.”

Be careful not to overdo it. Some data suggest that more than 2,500 milligrams a day can have the opposite effect and actually increase the risk of osteoarthritis.

Dr. Eve Campanelli, a holistic family practitioner in Beverly Hills, CA, recommends black cherry juice. She advises her patients to drink two glasses, twice a day, of four ounces of the juice diluted with four ounces of water.

Other fruits and vegetables rich in vitamin C include oranges, cantaloupe, broccoli, strawberries, peppers and cranberry juice.

A healthy diet, rich in fruits and vegetables, has been recommended by nutritionists for years. Now there’s another reason to pay attention–it can help your joints to stay young!

Hopefully the sections above have contributed to your understanding of Arthritis. Share your new understanding about Arthritis with others. They’ll thank you for it.

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Arthritis Diet – Relieve Your Pain

People who suffer from arthritis are always looking for ways to relieve their pain.  One way to ease or even prevent it is through an arthritis diet.  There are some arthritis diets that some people will swear by, but have never been proven to make a difference.  There are some diets that make a definite difference according to health experts.

First we’ll take a look at some arthritis diets where there’s little or no evidence that they actually make a difference.  One of the most common arthritis diets is to eliminate potatoes, tomatoes, eggplants, and most peppers.  While the diet won’t do any harm, it hasn’t been proven to affect arthritis at all.  Another arthritis diet seeks to reduce the acids in one’s body eliminating sugar, coffee, red meat, most grains, nuts, and citrus fruits.  It’s intended to be followed for just one month.  People may feel better because they lose weight which reduces the stress on their joints, but again there is no evidence to support this.  It also excludes many sources of vitamin C which is essential in fighting arthritis.  Drinking green tea has been shown to reduce the effects of rheumatoid arthritis in mice, but there are no conclusive results on human studies yet.  Shark cartilage is supposed to relieve arthritis.  Animal and lab studies show promise, but there are no human studies to support this yet.

Not let’s take a look at some arthritis diets that have been shown to work.  Switching fats can reduce inflammation.  Eating fats found in red meat and poultry have actually been shown to increase inflammation.  Switching to cold water fish can help reduce the inflammation.  Using corn, safflower, and sunflower oils also helps.  Another arthritis diet is the ASU (avocado-soybean unsaponifiable).  It has been shown to relieve osteoarthritis, stimulate cartilage repair, and lessen a patient’s need to NSAIDs to control pain.  Ginger has been shown to ease pain and inflammation as well as protect the stomach from gastrointestinal effects from taking NSAIDs.  Glucosamine is a supplement that relieves pain in some patients with osteoarthritis.  It helps the body rebuild cartilage, but can take up to two months to see the effects.  If you are allergic to shellfish, check with your doctor before taking this as it is derived from crab, lobster, or shrimp shells.  Before taking any supplements talk with your doctor as some can interfere with or worsen side effects from your medications.

Of course the best arthritis diet is a good old-fashioned well balanced diet.  Eat 5 to 9 servings of fruits and vegetables, and go easy on fats and cholesterol.  A heart healthy diet is especially important to patients with rheumatoid arthritis as studies have shown a link between this disease and heart failure.  Vitamin C is good for repairing body tissue.  Vitamin D helps absorb calcium, build bone mass, and prevents bone loss.  Calcium helps strengthen your bones.  If you are on medication, ask your doctor if he/she recommends taking vitamins.  Some medications can create vitamin or mineral deficiencies.  When choosing your arthritis diet, be sure to talk with your physician as different types of arthritis have different needs.

DISCLAIMER: This information is not presented by a medical practitioner and is for educational and informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read.
Since natural and/or dietary supplements are not FDA approved they must be accompanied by a two-part disclaimer on the product label: that the statement has not been evaluated by FDA and that the product is not intended to “diagnose, treat, cure or prevent any disease.”

Arthritis Pain Relief: Not Just for the Senior Citizens

There is a general misconception that arthritis is an age-related medical condition that afflicts only the senior citizens or the elderly. It may be true with osteoarthritis, the most common type of joint disorder that usually affects adults of both sexes in their middle age. But what most people don’t understand is that there are other types or causes of arthritis.

Arthritis, also known as joint inflammation, is defined as an inflammation of one or more joints and  involves the breakdown of cartilage resulting in pain, swelling, and limited movement.

Cartilage is responsible for protecting the joints and serves as a shock absorber when pressure is placed on the joint during walking or running. It allows for the smooth movement of our limbs. Without cartilage, the bones will rub together and can cause pain, swelling (inflammation), and stiffness.  Doctors usually prescribe arthritis pain relief and anti-inflammatory drugs to help alleviate the pain.

Arthritis, or joint inflammation, can be due to the following causes:
·    Broken Bones;
·    Infections that are usually caused by bacteria or viruses;
·    An autoimmune disease (the body attacks itself because the immune system believes a body part is foreign); and
·    General “wear and tear” on joints.
Generally, as soon as the injury heals, the inflammation disappears. The infection is treated and the disease is cured. However, there are some injuries and diseases wherein the inflammation remains stubbornly and continuously causing pain that may lead to deformity. This condition is known as chronic arthritis.
People suffering from arthritis experience the following symptoms:
·    Joint pain
·    Joint swelling
·    Stiffness, especially in the morning
·    Warmth around a joint
·    Redness of the skin around a joint
·    Reduced ability to move the joint
Arthritis is a condition that can occur in men and women of all ages.  Other types of arthritis include:
·    Rheumatoid arthritis (in adults)
·    Osteoarthritis ( middle age and above )
·    Juvenile rheumatoid arthritis (in children)
·    Systemic lupus erythematosus (SLE)
·    Gout
·    Scleroderma
·    Psoriatic arthritis
·    Ankylosing spondylitis
·    Reiter’s syndrome (reactive arthritis)
·    Adult Still’s disease
·    Viral arthritis
·    Gonococcal arthritis
·    Other bacterial infections (non-gonococcal bacterial arthritis)
·    Tertiary Lyme disease (the late stage)
·    Tuberculouus arthritis
·    Fungal infections such as blastomycosis
Osteoarthritis, being the most common type, is a chronic disease which causes the cartilage between the bone joints to deteriorate and may cause painful sensation and/or stiffness. New pieces of bones, called bone spurs, may grow around the joints as a result of osteoarthritis. Until now, there is no known reason yet as to the cause of osteoarthritis but it is generally being associated with aging. However, factors such as metabolism and genes can play a role in its development.
There are many factors to consider before your doctor can prescribe arthritis pain relief treatment plan such as the particular cause of arthritis, affected joints, severity of arthritis, and how the condition affects your daily activities. Age and occupation will also be taken into consideration.
Eliminating the underlying cause of the arthritis is one of the goals for treating arthritis. However, not all cause are curable like in the cases of osteoarthritis and rheumatoid arthritis. Relieving pain and  discomfort as well as prevention from further damage becomes the focus.
Lifestyle changes and exercise can greatly help in improving the condition of those suffering from arthritis.  Medications such as arthritis pain relief and anti-inflammatory drugs can be taken in addition to exercise and lifestyle changes.

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Occurrence and Impact of Rheumatoid Arthritis

Scientists estimate that about 1.3 million people, or about 0.6 percent of the U.S. adult population, have rheumatoid arthritis.* Interestingly, some recent studies have suggested that although the number of new cases of rheumatoid arthritis for older people is increasing, the overall number of new cases may actually be going down.

Rheumatoid arthritis occurs in all races and ethnic groups. Although the disease often begins in middle age and occurs with increased frequency in older people, children and young adults also develop it. Like some other forms of arthritis, rheumatoid arthritis occurs much more frequently in women than in men. About two to three times as many women as men have the disease.

By all measures, the financial and social impact of all types of arthritis, including rheumatoid arthritis, is substantial, both for the Nation and for individuals. From an economic standpoint, the medical and surgical treatment for rheumatoid arthritis and the wages lost because of disability caused by the disease add up to billions of dollars annually. Daily joint pain is an inevitable consequence of the disease, and most patients also experience some degree of depression, anxiety, and feelings of helplessness. For some people, rheumatoid arthritis can interfere with normal daily activities, limit job opportunities, or disrupt the joys and responsibilities of family life. However, there are arthritis self-management programs that help people cope with the pain and other effects of the disease and help them lead independent and productive lives.

*According to the National Arthritis Data Workgroup, the actual number of new cases of rheumatoid arthritis is lower than previous estimates due to changes in the classification for the condition, as cited in “Estimates of the Prevalence of Arthritis and Other Rheumatic Conditions in the United States,” Arthritis and Rheumatism, 58(1):15-25, January 2008.

Rheumatoid Arthritis

Rheumatoid arthritis is an inflammatory disease that causes pain, swelling, stiffness, and loss of function in the joints. It has several special features that make it different from other kinds of arthritis. For example, rheumatoid arthritis generally occurs in a symmetrical pattern, meaning that if one knee or hand is involved, the other one also is. The disease often affects the wrist joints and the finger joints closest to the hand. It can also affect other parts of the body besides the joints. In addition, people with rheumatoid arthritis may have fatigue, occasional fevers, and a general sense of not feeling well.

Rheumatoid arthritis affects people differently. For some people, it lasts only a few months or a year or two and goes away without causing any noticeable damage. Other people have mild or moderate forms of the disease, with periods of worsening symptoms, called flares, and periods in which they feel better, called remissions. Still others have a severe form of the disease that is active most of the time, lasts for many years or a lifetime, and leads to serious joint damage and disability.

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Features of Rheumatoid Arthritis

• Tender, warm, swollen joints
• Symmetrical pattern of affected joints
• Joint inflammation often affecting the wrist and finger joints closest to the hand
• Joint inflammation sometimes affecting other joints, including the neck, shoulders, elbows, hips, knees, ankles, and feet
• Fatigue, occasional fevers, a general sense of not feeling well
• Pain and stiffness lasting for more than 30 minutes in the morning or after a long rest
• Symptoms that last for many years
• Variability of symptoms among people with the disease

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Did you know your Blood Ph Levels could be keeping you in Pain?

Remember the litmus test from high school chemistry lab? You stuck a small strip of litmus paper into a solution, and if it turned red, it meant the solution was acidic. If it turned blue, the solution was basic (alkaline).

Well, the body has its own sort of litmus test: It’s called your pH level. And many health care professionals consider a balanced pH level to be the key to good health. The term pH stands for Potential Hydrogen, which is the concentration of hydrogen ions in a substance or solution. The pH range is 0 to 14. Human blood pH is ideally 7.35. Higher numbers indicate alkalinity; lower numbers indicate acidity.

Constricted muscles

The body simply cannot tolerate extended acid imbalances. In the early stages of an imbalance, symptoms may include such things as skin eruptions, headaches, allergies, colds and flu, and sinus problems. As things get further out of kilter, weakened systems start to give way. If tissue pH deviates too far to the acid side, oxygen levels decrease and cells die.

On the other side of the coin, it is virtually impossible for a health disorder or disease to sustain itself when your pH is in the neutral zone (7.0-7.4). At this level, the body has a strong immunity to diseases. Most Americans, however, have a pH level of 6.2 to 6.4. When your pH is out of the normal range, all sorts of bad things happen. For one thing, disease-producing organisms thrive. This explains why some people exposed to certain bacteria or viruses get sick while others don’t. Acidic conditions can cause muscles to constrict and inhibit the exchange of nutrients and waste products in muscle cells, causing fatigue, soreness, and pain. In fact, a pH imbalance affects all cellular activity in the body and can lead to a wide range of degenerative diseases and symptoms. Among other things, acidic blood blocks vitamin absorption, creates toxic buildup in clogged cells, slows organ function, prevents proper digestion, creates excess gas and bloating, causes unhealthy weight gain, and speeds the aging process. When pH is lower than 7.0, aging is accelerated because natural acid salts build up in the walls of your cells, causing them to stiffen and dry up. By the same token, aging is slowed when acid waste is removed from the body.

How it happens

Diet and stressful lifestyle can directly affect the pH levels of all body fluids, which determines how well your immune system functions. A weakened immune system, of course, means low resistance to infections. High acid also allows LDL-cholesterol (the bad cholesterol) to build up faster in your arteries, damaging artery walls and creating plaque buildup.

High acidity enters your body when you eat processed foods, pre-packaged foods, sugary foods, pastas, dairy products (milk, cheese, ice cream, etc.), alcoholic beverages, drugs, table salt. Meats also promote acidity. Stress plays a significant role in creating excess acid. This is why Type A personalities – who tend to live in a perpetual state of tension and rigidity – are prone to develop acidic conditions. If you don’t get enough sleep or exercise or face life-changing events – loss of a job, divorce, moving to a new city, etc. – your body probably has more acid than it can handle.

Restoring the balance

Moderate changes in your diet can help restore your pH balance. For starters, try eating more fresh fruits and vegetables, almonds, and yogurt. And go lighter on cheeses, soft drinks, alcohol, processed foods, and sweeteners (use raw honey instead). Roughly 75 percent of your diet should consist of alkaline-producing foods.

If these dietary changes seem too oppressive, you might consider taking alkaline supplements. One recent study looked at whether supplementation with alkaline minerals would influence symptoms in patients with chronic low back pain. Researchers gave 82 such patients 30 grams of a lactose-based alkaline mineral supplement (Basica) daily over a period of four weeks in addition to their medication. Pain symptoms were measured using the Arbus Low Back Pain Rating Scale. Average pain scores significantly dropped by 49 percent, total blood buffering capacity was significantly improved, and blood pH increased. The conclusion: an unbalanced pH level may contribute to the symptoms of low back pain. To lower your stress level, which will help put your pH reading in the normal range, you may want to try deep-breathing exercises and eating alkaline foods or what ever type of relaxation technique works for you. Moderate exercise – even walking 10 minutes a day – can also go a long way toward reducing stress and restoring balance, the key to good health.

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Green Tea May Help Protect Against Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease that affects more than 2.1 million Americans. It is characterized by joint pain, stiffness, inflammation, swelling, and sometimes joint destruction. Nonsteroidal anti-inflammatory drugs are the standard treatment for RA, but their prolonged use is associated with adverse effects and discomfort. Natural plant alternatives like green tea are being investigated for the management of RA. Green tea is the most widely consumed beverage in the world, and its polyphenols (substances rich in antioxidants) possess anti-inflammatory properties.

NCCAM-funded investigators at the University of Maryland and Rutgers University examined the effects of green tea polyphenols on RA by using an animal model in rats. The animals consumed green tea in their drinking water (controls drank water only) for 1-to-3 weeks before being injected with a protein (Bhsp65) to induce arthritis. The researchers found that green tea significantly reduced the severity of arthritis.

The researchers suggest that green tea affects arthritis by causing changes in various arthritis-related immune responses—it suppresses both cytokine IL-17 (an inflammatory substance) and antibodies to Bhsp65, and increases cytokine IL-10 (an anti-inflammatory substance). Therefore, they recommend that green tea be furthered explored as a dietary therapy for use together with conventional treatment for managing RA.

Reference

• Kim HR, Rajaiah R, Wu QL, et al. Green tea protects rats against autoimmune arthritis by modulating disease-related immune events. The Journal of Nutrition. Nov. 2008:138(11):2111–2116.

Eating Right to Treat Hurting Joints

What Is the Difference Between Acute and Chronic Pain?

Pain that hits you suddenly – after falling from a ladder, being tackled on the football field, or lifting a load that is just too heavy, for example – is acute pain. Acute pain comes on quickly and often leaves just as quickly. To be classified as acute, pain should last no longer than 6 weeks. Acute pain is the most common type of back pain.

Chronic pain, on the other hand, may come on either quickly or slowly, and it lingers a long time. In general, pain that lasts more than 3 months is considered chronic. Chronic pain is much less common than acute pain.

How Is Back Pain Treated?

Treatment for back pain generally depends on what kind of pain you experience: acute or chronic.

Acute Back Pain: Acute back pain usually gets better on its own and without treatment, although you may want to try acetaminophen, aspirin, or ibuprofen to help ease the pain. Perhaps the best advice is to go about your usual activities as much as you can with the assurance that the problem will clear up. Getting up and moving around can help ease stiffness, relieve pain, and have you back doing your regular activities sooner. Exercises or surgery are not usually advisable for acute back pain.

Chronic Back Pain: Treatment for chronic back pain falls into two basic categories: the kind that requires an operation and the kind that does not. In the vast majority of cases, back pain does not require surgery. Doctors will nearly always try nonsurgical treatments before recommending surgery. In a very small percentage of cases – when back pain is caused by a tumor, an infection, or a nerve root problem called cauda equina syndrome, for example – prompt surgery is necessary to ease the pain and prevent further problems.

Following are some of the more commonly used treatments for chronic back pain.

Nonsurgical treatments

Hot or cold: Hot or cold packs – or sometimes a combination of the two – can be soothing to chronically sore, stiff backs. Heat dilates the blood vessels, both improving the supply of oxygen that the blood takes to the back and reducing muscle spasms. Heat also alters the sensation of pain. Cold may reduce inflammation by decreasing the size of blood vessels and the flow of blood to the area. Although cold may feel painful against the skin, it numbs deep pain. Applying heat or cold may relieve pain, but it does not cure the cause of chronic back pain.

Exercise: Although exercise is usually not advisable for acute back pain, proper exercise can help ease chronic pain and perhaps reduce the risk of it returning. The following four types of exercise are important to general physical fitness and may be helpful for certain specific causes of back pain:

Flexion: The purposes of flexion exercises, which are exercises in which you bend forward, are to (1) widen the spaces between the vertebrae, thereby reducing pressure on the nerves; (2) stretch muscles of the back and hips; and (3) strengthen abdominal and buttock muscles. Many doctors think that strengthening the muscles of the abdomen will reduce the load on the spine. One word of caution: If your back pain is caused by a herniated disc, check with your doctor before performing flexion exercises because they may increase pressure within the discs, making the problem worse.

Extension: With extension exercises, you bend backward. They may minimize radiating pain, which is pain you can feel in other parts of the body besides where it originates. Examples of extension exercises are leg lifting and raising the trunk, each exercise performed while lying prone. The theory behind these exercises is that they open up the spinal canal in places and develop muscles that support the spine.

Stretching: The goal of stretching exercises, as their name suggests, is to stretch and improve the extension of muscles and other soft tissues of the back. This can reduce back stiffness and improve range of motion.

Aerobic: Aerobic exercise is the type that gets your heart pumping faster and keeps your heart rate elevated for a while. For fitness, it is important to get at least 30 minutes of aerobic (also called cardiovascular) exercise three times a week. Aerobic exercises work the large muscles of the body and include brisk walking, jogging, and swimming. For back problems, you should avoid exercise that requires twisting or vigorous forward flexion, such as aerobic dancing and rowing, because these actions may raise pressure in the discs and actually do more harm than good. In addition, avoid high-impact activities if you have disc disease. If back pain or your fitness level make it impossible to exercise 30 minutes at a time, try three 10-minute sessions to start with and work up to your goal. But first, speak with your doctor or physical therapist about the safest aerobic exercise for you.

Medications: A wide range of medications are used to treat chronic back pain. Some are available over the counter. Others require a doctor’s prescription. The following are the main types of medications used for back pain.

Analgesics: Analgesic medications are those designed specifically to relieve pain. They include over-the-counter acetaminophen (Tylenol)¹ and aspirin, as well as prescription narcotics, such as oxycodone with acetaminophen (Percocet) or hydrocodone with acetaminophen (Vicodin). Aspirin and acetaminophen are the most commonly used analgesics; narcotics should only be used for a short time for severe pain or pain after surgery. People with muscular back pain or arthritis pain that is not relieved by medications may find topical analgesics helpful. These creams, ointments, and salves are rubbed directly onto the skin over the site of pain. They use one or more of a variety of ingredients to ease pain. Topical analgesics include such products as Zostrix, Icy Hot, and BenGay.

¹ Brand names included in this booklet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

NSAIDs: Nonsteroidal anti-inflammatory drugs (NSAIDs) are drugs that relieve pain and inflammation, both of which may play a role in some cases of back pain. NSAIDs include the nonprescription products ibuprofen (Motrin, Advil), ketoprofen (Actron, Orudis KT), and naproxen sodium (Aleve). More than a dozen others, including a subclass of NSAIDs called COX-2 inhibitors, are available only with a prescription.

All NSAIDs work similarly – by blocking substances called prostaglandins that contribute to inflammation and pain. However, each NSAID is a different chemical, and each has a slightly different effect on the body.²

²Warning: NSAIDs can cause stomach irritation or, less often, they can affect kidney function. The longer a person uses NSAIDs, the more likely he or she is to have side effects, ranging from mild to serious. Many other drugs cannot be taken when a patient is being treated with NSAIDs because NSAIDs alter the way the body uses or eliminates these other drugs. Check with your health care provider or pharmacist before you take NSAIDs. Also, NSAIDs sometimes are associated with serious gastrointestinal problems, including ulcers, bleeding, and perforation of the stomach or intestine. People age 65 and older and those with any history of ulcers or gastrointestinal bleeding should use NSAIDs with caution.

Side effects of all NSAIDs can include stomach upset and stomach ulcers, heartburn, diarrhea, and fluid retention; however, COX-2 inhibitors are designed to cause fewer stomach ulcers. For unknown reasons, some people seem to respond better to one NSAID than another. It’s important to work with your doctor to choose the one that’s safest and most effective for you.

Other medications: Muscle relaxants and certain antidepressants have also been prescribed for chronic back pain, but their usefulness is questionable.

Traction: Traction involves using pulleys and weights to stretch the back. The rationale behind traction is to pull the vertebrae apart to allow a bulging disc to slip back into place. Some people experience pain relief while in traction, but that relief is usually temporary. Once traction is released, the stretch is not sustained and back pain is likely to return. There is no scientific evidence that traction provides any long-term benefits for people with back pain.

Corsets and braces: Corsets and braces include a number of devices, such as elastic bands and stiff supports with metal stays, that are designed to limit the motion of the lumbar spine, provide abdominal support, and correct posture. Although these may be appropriate after certain kinds of surgery, there is little, if any, evidence that corsets and braces help treat chronic low back pain. In fact, by keeping you from using your back muscles, they may actually cause more problems than they solve by causing lower back muscles to weaken from lack of use.

Behavioral modification: Developing a healthy attitude and learning to move your body properly while you do daily activities – particularly those involving heavy lifting, pushing, or pulling – are sometimes part of the treatment plan for people with back pain. Other behavior changes that might help pain include adopting healthy habits, such as exercise, relaxation, and regular sleep, and dropping bad habits, such as smoking and eating poorly.

Injections: When medications and other nonsurgical treatments fail to relieve chronic back pain, doctors may recommend injections for pain relief. Following are some of the most commonly used injections, although some are of questionable value:

Nerve root blocks: If a nerve is inflamed or compressed as it passes from the spinal column between the vertebrae, an injection called a nerve root block may be used to help ease the resulting back and leg pain. The injection contains a steroid medication or anesthetic and is administered to the affected part of the nerve. Whether the procedure helps or not depends on finding and injecting precisely the right nerve.

Facet joint injections: The facet joints are those where the vertebrae connect to one another, keeping the spine aligned. Although arthritis in the facet joints themselves is rarely the source of back pain, the injection of anesthetics or steroid medications into facet joints is sometimes tried as a way to relieve pain. The effectiveness of these injections is questionable. One study suggests that this treatment is overused and ineffective.

Trigger point injections: In this procedure, an anesthetic is injected into specific areas in the back that are painful when the doctor applies pressure to them. Some doctors add a steroid medication to the injection. Although the injections are commonly used, researchers have found that injecting anesthetics or steroids into trigger points provides no more relief than “dry needling” (inserting a needle and not injecting a medication).

Prolotherapy: One of the most talked about procedures for back pain, prolotherapy is a treatment in which a practitioner injects a sugar solution or other irritating substance into trigger points along the periosteum (the tough, fibrous tissue covering the bones) to trigger an inflammatory response that promotes the growth of dense, fibrous tissue. The theory behind prolotherapy is that such tissue growth strengthens the attachment of tendons and ligaments whose loosening has contributed to back pain. As yet, studies have not verified the effectiveness of prolotherapy. The procedure is used primarily by chiropractors and osteopathic doctors.

Complementary and alternative treatments: When back pain becomes chronic or when medications and other conventional therapies do not relieve it, many people try complementary and alternative treatments. Although such therapies won’t cure diseases or repair the injuries that cause pain, some people find them useful for managing or relieving pain. Following are some of the most commonly used complementary therapies.

Manipulation: Spinal manipulation refers to procedures in which professionals use their hands to mobilize, adjust, massage, or stimulate the spine or surrounding tissues. This type of therapy is often performed by osteopathic doctors and chiropractors. It tends to be most effective in people with uncomplicated pain and when used with other therapies. Spinal manipulation is not appropriate if you have a medical problem such as osteoporosis, spinal cord compression, or inflammatory arthritis (such as rheumatoid arthritis) or if you are taking blood-thinning medications such as warfarin (Coumadin) or heparin (Calciparine, Liquaemin).

Transcutaneous electrical nerve stimulation (TENS): TENS involves wearing a small box over the painful area that directs mild electrical impulses to nerves there. The theory is that stimulating the nervous system can modify the perception of pain. Early studies of TENS suggested it could elevate the levels of endorphins, the body’s natural pain-numbing chemicals, in the spinal fluid. But subsequent studies of its effectiveness against pain have produced mixed results.

Acupuncture: This ancient Chinese practice has been gaining increasing acceptance and popularity in the United States. Acupuncture is based on the theory that a life force called Qi (pronounced chee) flows through the body along certain channels, which if blocked can cause illness. According to the theory, the insertion of thin needles at precise locations along these channels by practitioners can unblock the flow of Qi, relieving pain and restoring health.

Although few Western-trained doctors would agree with the concept of blocked Qi, some believe that inserting and then stimulating needles (by twisting or passing a low-voltage electrical current through them) may foster the production of the body’s natural pain-numbing chemicals, such as endorphins, serotonin, and acetylcholine.

A consensus panel convened by the National Institutes of Health (NIH) in 1997 concluded that there is clear evidence this treatment is effective for some pain conditions, including postoperative dental pain. Although there is less convincing evidence to support using acupuncture for back pain and some other pain conditions, the panel concluded that acupuncture may be effective when used as part of a comprehensive treatment plan for low back pain, fibromyalgia, and several other conditions.

Acupressure: As with acupuncture, the theory behind acupressure is that it unblocks the flow of Qi. The difference between acupuncture and acupressure is that no needles are used in acupressure. Instead, a therapist applies pressure to points along the channels with his or her hands, elbows, or even feet. (In some cases, patients are taught to do their own acupressure.) Acupressure has not been well studied for back pain.

Rolfing: A type of massage, rolfing involves using strong pressure on deep tissues in the back to relieve tightness of the fascia, a sheath of tissue that covers the muscles, that can cause or contribute to back pain. The theory behind rolfing is that releasing muscles and tissues from the fascia enables the back to align itself properly. So far, the usefulness of rolfing for back pain has not been scientifically proven.

Surgical treatments

Depending on the diagnosis, surgery may either be the first treatment of choice – although this is rare – or it is reserved for chronic back pain for which other treatments have failed. If you are in constant pain or if pain reoccurs frequently and interferes with your ability to sleep, to function at your job, or to perform daily activities, you may be a candidate for surgery.

In general, two groups of people may require surgery to treat their spinal problems. People in the first group have chronic low back pain and sciatica, and they are often diagnosed with a herniated disc, spinal stenosis, spondylolisthesis, or vertebral fractures with nerve involvement. People in the second group are those with only predominant low back pain (without leg pain). These are people with discogenic low back pain (degenerative disc disease), in which discs wear with age. Usually, the outcome of spine surgery is much more predictable in people with sciatica than in those with predominant low back pain.

Some of the diagnoses that may need surgery include:

Herniated discs: In this potentially painful problem, the hard outer coating of the discs, which are the circular pieces of connective tissue that cushion the bones of the spine, are damaged, allowing the discs’ jelly-like center to leak, irritating nearby nerves. This causes severe sciatica and nerve pain down the leg. A herniated disc is sometimes called a ruptured disc.

Spinal stenosis: Spinal stenosis is the narrowing of the spinal canal, through which the spinal cord and spinal nerves run.

It is often caused by the overgrowth of bone caused by osteoarthritis of the spine. Compression of the nerves caused by spinal stenosis can lead not only to pain, but also to numbness in the legs and the loss of bladder or bowel control. Patients may have difficulty walking any distances and may have severe pain in their legs along with numbness and tingling.

Spondylolisthesis: In this condition, a vertebra of the lumbar spine slips out of place. As the spine tries to stabilize itself, the joints between the slipped vertebra and adjacent vertebrae can become enlarged, pinching nerves as they exit the spinal column. Spondylolisthesis may cause not only low back pain but also severe sciatica leg pain.

Vertebral fractures: These fractures are caused by trauma to the vertebrae of the spine or by crumbling of the vertebrae resulting from osteoporosis. This causes mostly mechanical back pain, but it may also put pressure on the nerves, creating leg pain.

Discogenic low back pain (degenerative disc disease): Most people’s discs degenerate over a lifetime, but in some, this aging process can become chronically painful, severely interfering with their quality of life.

Following are some of the most commonly performed back surgeries:

For Herniated Discs:

Laminectomy/discectomy: In this operation, part of the lamina, a portion of the bone on the back of the vertebrae, is removed, as well as a portion of a ligament. The herniated disc is then removed through the incision, which may extend two or more inches.

Microdiscectomy: As with traditional discectomy, this procedure involves removing a herniated disc or damaged portion of a disc through an incision in the back. The difference is that the incision is much smaller and the doctor uses a magnifying microscope or lenses to locate the disc through the incision. The smaller incision may reduce pain and the disruption of tissues, and it reduces the size of the surgical scar. It appears to take about the same amount of time to recuperate from a microdiscectomy as from a traditional discectomy.

Laser surgery: Technological advances in recent decades have led to the use of lasers for operating on patients with herniated discs accompanied by lower back and leg pain. During this procedure, the surgeon inserts a needle in the disc that delivers a few bursts of laser energy to vaporize the tissue in the disc. This reduces its size and relieves pressure on the nerves. Although many patients return to daily activities within 3 to 5 days after laser surgery, pain relief may not be apparent until several weeks or even months after the surgery. The usefulness of laser discectomy is still being debated.

For Spinal Stenosis:

Laminectomy: When narrowing of the spine compresses the nerve roots, causing pain or affecting sensation, doctors sometimes open up the spinal column with a procedure called a laminectomy. In a laminectomy, the doctor makes a large incision down the affected area of the spine and removes the lamina and any bone spurs, which are overgrowths of bone, that may have formed in the spinal canal as the result of osteoarthritis. The procedure is major surgery that requires a short hospital stay and physical therapy afterwards to help regain strength and mobility.

For Spondylolisthesis

Spinal fusion: When a slipped vertebra leads to the enlargement of adjacent facet joints, surgical treatment generally involves both laminectomy (as described above) and spinal fusion. In spinal fusion, two or more vertebrae are joined together using bone grafts, screws, and rods to stop slippage of the affected vertebrae. Bone used for grafting comes from another area of the body, usually the hip or pelvis. In some cases, donor bone is used.

Although the surgery is generally successful, either type of graft has its drawbacks. Using your own bone means surgery at a second site on your body. With donor bone, there is a slight risk of disease transmission or rejection. In recent years, a new development has eliminated those risks for some people undergoing spinal fusion: proteins called bone morphogenic proteins are being used to stimulate bone generation, eliminating the need for grafts. The proteins are placed in the affected area of the spine, often in collagen putty or sponges.

Regardless of how spinal fusion is performed, the fused area of the spine becomes immobilized.

For Vertebral Osteoporotic Fractures³

Vertebroplasty: When back pain is caused by a compression fracture of a vertebra due to osteoporosis or trauma, doctors may make a small incision in the skin over the affected area and inject a cement-like mixture called polymethylacrylate into the fractured vertebra to relieve pain and stabilize the spine. The procedure is generally performed on an outpatient basis under a mild anesthetic.

³ Used only if standard care, rest, corsets and braces, and analgesics fail.

Kyphoplasty: Much like vertebroplasty, kyphoplasty is used to relieve pain and stabilize the spine following fractures due to osteoporosis. Kyphoplasty is a two-step process. In the first step, the doctor inserts a balloon device to help restore the height and shape of the spine. In the second step, he or she injects polymethylacrylate to repair the fractured vertebra. The procedure is done under anesthesia, and in some cases it is performed on an outpatient basis.

For Discogenic Low Back Pain (Degenerative Disc Disease)

Intradiscal electrothermal therapy (IDT): One of the newest and least invasive therapies for low back pain involves inserting a heating wire through a small incision in the back and into a disc. An electrical current is then passed through the wire to strengthen the collagen fibers that hold the disc together. The procedure is done on an outpatient basis, often under local anesthesia. The usefulness of IDT is debatable.

Spinal fusion: When the degenerated disc is painful, the surgeon may recommend removing it and fusing the disc to help with the pain. This fusion can be done through the abdomen, a procedure known as anterior lumbar interbody fusion, or through the back, called posterior fusion. Theoretically, fusion surgery should eliminate the source of pain; the procedure is successful in about 60 to 70 percent of cases. Fusion for low back pain or any spinal surgeries should only be done as a last resort, and the patient should be fully informed of risks.

Disc replacement: When a disc is herniated, one alternative to a discectomy – in which the disc is simply removed – is removing the disc and replacing it with a synthetic disc. Replacing the damaged one with an artificial one restores disc height and movement between the vertebrae. Artificial discs come in several designs. Although doctors in Europe had performed disc replacement for more than a decade, the procedure had been experimental in the United States until the Food and Drug Administration approved the Charité artificial disc (http://www.fda.gov/cdrh/pdf4/p040006.html).

What Kind of Research Is Being Done?

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is currently supporting a number of studies to better understand and treat back pain. Goals of current research include the following:

To compare the effectiveness of surgery versus nonsurgical treatment for low back pain. Although the percentage of people having spinal surgery in the United States has increased sharply over time, there is not much information on whether back surgery is better than nonsurgical treatments. One study is comparing the most commonly used surgical treatments to the most commonly used nonsurgical treatments for three common back problems: herniated discs of the lumbar spine, spinal stenosis, and spinal stenosis from spondylolisthesis. The study, being conducted at 12 medical centers, will follow patients for at least 24 months after treatment to determine the medical and cost-effectiveness of treatments.

To identify the best treatments for certain patients with low back pain. Just as certain treatments are effective for some back problems and not others, the same treatment may be effective for some people and not others – even if those people have the same medical problem. Researchers at several centers will study more than 3,000 patients who have one of three common causes of back pain – herniated discs, spinal stenosis, and spondylolisthesis – and who respond well to specific treatments. Extensive testing and surveys will allow doctors to identify the best treatments for these patients.

To test the effectiveness of lumbar fusion and other treatments for disc-derived pain. Discogenic pain is low back pain due to the wearing away of a disc between the vertebrae. Although treatment for this condition is often lumbar spinal fusion, its effectiveness, as well as that of other treatments, has not been established. A new study will compare the results of spinal fusion with those of nonsurgical care for patients with similar disc degeneration. Researchers will also try to find out (1) what distinguishes people who choose surgery from those who do not; (2) the consequences of common complications of spinal fusion surgery and how often they occur; (3) what predicts a good response to surgical therapy but not to other treatments; and (4) what are the characteristics and outcomes of patients who have repeat back surgery for this condition.

To measure the frequency of complications in lumbar fusion surgery. Lumbar spinal fusion is a commonly performed procedure for several back problems, including disc degeneration, spondylolisthesis, spinal stenosis, and scoliosis, but the procedure can have complications. A new study will follow 1,000 people who have spinal fusion for one of these diagnoses to find out (1) how often complications occur after surgery, (2) how the rates of specific serious complications vary with different types of lumbar fusion, (3) the consequences of specific types of complications, and (4) the characteristics of treatments or patients that predict particularly severe complications. The information will help doctors better assess the benefits versus the risks of the procedure.

To better understand the relationship between the loss of motor control and low back pain. Compared to people without back problems, those with low back pain show losses in motor control, including problems with trunk muscle response and posture. Some researchers believe that losses in motor control may predispose people to falls that result in back pain. Other researchers think losses in motor control may result from damage sustained by tissue during a fall. To explore the relationship between motor control loss and back pain, scientists will study varsity athletes to determine whether poor motor control of the lumbar spine increases the risk of low back injury. They will also study changes in the lumbar spine motor control of people with low back pain after they complete rehabilitation programs that emphasize motor control training.

To develop and evaluate a psychosocial program for people with acute low back pain. Acute low back pain is a common problem that affects people’s abilities to work and function, and it contributes to high health care costs. There are few studies, however, that prove whether or not a treatment truly reduces limitation and prevents the recurrence of pain. One new project will develop a program to enhance the social support and self-efficacy of people with acute low back pain. After developing and testing the program, researchers will evaluate its effectiveness by comparing the results of 160 participants with those of 160 people receiving usual care.

To evaluate the nervous system mechanisms of low back pain. Scientists think that when a disc ruptures, material leaking from its jelly-like filling leads to inflammation and the release of chemicals that irritate cells within the spinal canal. Scientists believe that the effects of these chemicals on the nerve endings in discs and adjacent tissue lead to low back pain, while the effects on dorsal nerve roots lead to sciatica. One study will test these ideas using a variety of techniques. A better understanding of pain mechanisms related to herniated discs will allow researchers to develop better treatments.

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