Sunday, May 17, 2009

KISS principle for treating back pain

Back pain is a common ailment in our society. Millions of individuals develop back pain each year and the majority remain dis-satisfied with available treatments. There are many treatments for acute back pain and most do not work. The majority of health care workers believe that the latest treatments are always the best- so most individuals end up with prescriptions for fancy treatments and end up spending thousands of dollars- at the end of the day there is only one person that benefits from all this- the health care provider.

So are all these fancy novel therapies great? Can they really help decrease or prevent back pain?

Recently, a study from Australia provided some very interesting results. Australian investigators followed 240 adults who had developed acute back pain with or with radiation to the lower legs. All patients received advice and acetaminophen (Tylenol). In addition, other individuals were randomized to receive spinal manipulation or Non steroidal anti inflammatory drugs like diclofenac. In this blind study, some individuals also received mock (false) manipulations of the spine.

So what was the result?

Neither diclofenac nor spinal manipulations hastened recovery. Individuals who received both spinal manipulations and NSAIDS did not recover any quicker than those who received neither.

So what does the study tell us?

The study strongly suggests that health care pros should stop mucking around with the back with complicated hodge podge of therapies. Keep it simple, stupid (KISS). Bed rest and Tylenol are the best treatment in most cases of acute back pain. The less one “screws” around with the back, the better the results.

http://www.medscape.com/viewarticle/566980

Saturday, May 16, 2009

Failed Back Surgery: part 4

There are other causes of failed back pain including neuropathic pain that can occur from injury to the nerve. Other causes of failed back pain syndrome include infection and psychosocial issues.

For all individuals with back pain, surgery is rarely ever the first treatment. If your surgeon recommends surgery for your back; you need to get a new surgeon or a 2nd opinion. While there are some decent orthopedic surgeons, there are just as many bad ones. Some back surgeons are in too much of a rush to make money and fail to adequately work the patient up. This often leads to complications afterwards.

The majority of patients who have failed back syndrome usually seek multiple opinions from different doctors in search for an answer to their back problem. This often confuses the issue because many physicians simply ascribe it to psychosocial issues and never bother to investigate. So if you have failed back syndrome, go seek help from a reputable health care worker.

Remember, always try non-surgical methods to treat your back pain. When a surgeon screws up your back with surgery, there are no other options except to live a life in agony and pain,

Failed Back surgery; part 3

So why does surgery for back fail so frequently? There are many reasons for this. Some of them include:

Bad surgeon and this is a common reason for many patients. Many surgeons are simply in a rush to make money and fail to work up the patient. Most of these surgeons are just technically poor surgeons.

Undertaking surgery as a first resort for back pain is a big NONO. Surgery should never be the first choice for back pain. There are rare circumstances when surgery is undertaken for back pain such as when bowel or bladder incontinence is present, but the majority of patients do not need surgery as the initial treatment.

Poor technical surgery which means the nerve compression is not effectively relieved. The surgeon also induces a lot of trauma from poor skills.

Inadequate surgery is often a common reason for continuing back pain.

Wrong surgery is often a cause of recurrent back pain. Sometimes the patient needs a different treatment and surgery is not the answer.

Doing unnecessary surgery can also worsen back pain.

Painful disc disease which could be due to ongoing disease in the discs above or below the vertebrae operated upon. The numbers of individuals who have this problem is close to 17%. These patients need to be initially treated with medical therapy before undertaking surgery

Pseudoarthrosis: Sometimes fusion of vertebrae may have been inadequate leaving the discs still mobile. A history of smoking before and after surgery is often associated with this problem. About 15% of cases have this problem.

In some cases, the recurrent pain is due to excessive healing or fibrosis. The diagnosis is made by MRI and occurs in about 10% of individuals.

Failed Back Surgery- part 2

The other problem with evaluating failed back surgery is that each surgeon has different criteria on how to evaluate the treatment as a failure. Some surgeons base failure because of recurrent pain, other uses inability to return to work and others include inability to move. Some surgeons think that once they operate, everyone does great and never assess their patients (applies to majority of orthopedic surgeons)

Many orthopedic surgeons report a success rate of about 98% but this number is overtly exaggerated. Less than 1%-3% of patients ever benefit from back surgery

As far as back pain relief is concerned, the majority of patients find no relief after surgery. After surgery many individuals require more pain medication than before. It really does not matter what type of back procedure is done, the results are terrible. The majority of orthopedic surgeons have no respect for tissues and simply chisel their way through bone and nerves- any wonder why the results are so bad!

Further many people are left with disabling deformity, a lot of metal hardware is left inside the back, and the majority of people can never resume their normal life style.

The astonishing fact is that individuals who have been referred for surgery from Workman’s compensation board have the lowest success rate after surgery. Less than 10-30% show any improvement. In fact, these individuals suffer the most from failed back surgery.

Failed Back Surgery

The treatment of back pain is very unsatisfactory. There are hundreds of non-surgical treatments of back pain and the majority are worthless. When individuals run out of options, many resort to surgery. Sometimes, patients are pushed into surgery by unscrupulous orthopedic surgeons.

Surgery for back pain has been around for many decades. There are many types of procedures for back pain. In each and every case, the principle is the same--relieve pressure of the nerve. Over the years, back surgery has been refined, newer procedures have been devised and incisions have been made smaller.

Surgeons are always bragging about their success rates. Overall, surgery for back pain has been an abysmal failure. It is fraught with severe complications- the most important being that patients are generally in a worse shape than they started out. Almost every patient has a negative story about back pain surgery and testimonials on cyberspace all attest to the fact.

The types of surgery usually performed for back pain include fusion, discectomy, or laminectomy. It is the rare individual who gets a successful result after back surgery. Numbers released by surgeons are unreliable, and do not reflect the truth. Despite so-called successful surgery, many individuals continue to have either pain or have failure to improve mobility or posture. The exact number of patients who fail back surgery is not known because surgeons do not like to brag about their complications. Judging from cyberspace testimonials, the numbers are enormous.

Thursday, May 14, 2009

Insoles for back pain: part 2

So do insoles help people with back pain?

Well, there have been a few scientific studies that have looked at people who used insoles and walked everyday. Some studies were designed to determine if insoles prevented back pain and others looked to see if insoles relieved back pain. The studies looked at healthy young males who are most prone to back injury. The study included assessment of pain, intensity, duration of pain, absenteeism and functional status. All data were analyzed independently.

So what about the results?

Insoles did absolutely squat in term of preventing back pain. BIG ZERO- diddlysquat. The type of insole, color, size or even the cost did not make any difference. People still developed back pain and no matter what type of insole was used, pain still occurred.

So what happens now?

Well, for one thing- insoles do have a role for treating certain foot disorders but they are useless for back pain. Please consumers do not be so trusting of health pros- medicine is a business and a very profitable one. So read about your condition, ask questions, get referrals and do not fall for such gimmicks.

For those who have bought many pairs of insoles for back pain, you can now use them on your chair to cushion your buttocks.

http://www.cochrane.org/reviews/en/ab005275.html

Insoles for Back pain: Real or BS?

Back pain is a major health problem in our society. There is no real answer how to best treat it. Millions of people are disabled from back pain and cost to the health care system is in billions of dollars each year. Everyday, a new theory comes up and along with it- a new treatment. There is a strong belief among certain people in the health profession that back pain may be related to posture and anatomy of feet. Podiatrists, physical therapist, orthopedists, and a whole bunch of other health professionals have now gotten into the business of feet, shoes, and insoles.

These health pros first started to correct feet to cure back pain and the result was an abysmal failure. This was followed by custom designed shoes- most custom designed shoes cost as much as a month’s rent and the public realized that perhaps this was a scam and so now these pros have started to sell insoles.

There are insoles of every type, color style, designs, and shape. Some are standard and others are custom designed. One would think that a piece of plastic or rubber that fits into a shoe would costs a few bucks- Wrong; podiatrists and all their colleagues have now learnt the art of ripping people off. Insoles can cost as much as a month’s grocery- Shocking but true. Millions of insoles are sold each year. Most people have an insole for every pair of shoe. There appears to be insole mania in society.

What is so great about insoles you ask? Well these health pros claim that insoles can align the foot, ease pressure on the back, and absorb shock when feet strike the ground- sure sounds great so far.