Posts for tag: lumbar
Doctors of chiropractic are known for treating low back pain – and preventing its recurrence – and recent research emphasizes the science underlying their effectiveness. A recent study suggests chiropractic care (spinal manipulation) can reduce LBP, but it also suggests chiropractic can increase spinal disc height.
Why is that important? Well, loss of intervertebral disc height is one of the traits of low back pain. Discs are the ligaments between the bony vertebrae that act as shock absorbers for the spine. As we get older, our discs have a tendency to get smaller, which can lead to all kinds of problems, including pain. Fortunately, as this study suggests, chiropractic can help.
That's good to know no matter your age and the condition of your spine. Talk to your doctor of chiropractic for more information. A healthy spine means a healthy you!
Steroids for Sciatica: More Trouble Than They're Worth
By Deborah Pate, DC, DACBR
Use of epidural steroid injections has increased dramatically in recent years, despite the fact that studies have failed to demonstrate evidence this procedure is clinically helpful (while other studies suggest it may actually be dangerous). Considering that lack of evidence – not to mention the terrible 2012 outbreak of fungal meningitis / infections caused by contaminated vials used for epidural corticosteroid injections – it is prudent at least to take a critical look at this procedure as it relates to sciatica or pain affecting the sciatic nerve, which extends from the lower back down the back of each leg.
Small Relief, Big Potential Side Effects
In a recent meta-analysis of 23 randomized trials involving more than 2,000 patients in which epidural steroid injections were compared with placebo for sciatica, epidural steroid injections produced small, statistically insignificant short-term improvements in leg pain and disability (but not less back pain) compared to placebo. This improvement also was only over a short period of time – two weeks to three months. Beyond 12 months, there was no significant difference between groups.
Besides infection, there are other side effects associated with epidural steroid injections: bleeding, nerve damage and dural puncture. Then there are side effects associated with the steroid medication, which include the following: a transient decrease in immunity, high blood sugar, stomach ulcers, cataracts and increased risk of fracture.
This last complication is certainly not emphasized in clinical circles. Therapeutic steroids may reduce pain, however the use of steroid injections seem to promote deterioration of skeletal quality, which is not surprising since other forms of steroid medication have long been associated with osteoporosis.
A retrospective study published in the Journal of Bone and Joint Surgery looked at lumbar epidural steroid injection (LESI), and the potential impact on bone fragility and vertebral fractures (spinal fractures). Researchers identified a total of 50,345 patients who had medical diagnosis codes involving the spine; within that group, a total of 3,415 patients had received at least one LESI.
Three thousand patients were randomly selected from the 3,415 injected population and 3,000 additional patients were selected from the non-injected group as a control group. There was no significant difference between the injected and non-injected groups with respect to age, sex, race, hyperthyroidism or corticosteroid use.
When incidence of vertebral fractures was assessed, researchers discovered that an increasing number of injections was associated with an increasing likelihood of fractures, and each successive injection increased the risk of spinal fracture by 21 percent. Based on this evidence, LESIs clearly exacerbate skeletal fragility. They promote deterioration of skeletal quality similar to the use of exogenous steroids, which is the leading cause of secondary osteoporosis. In fact, the rate of vertebral fracture following epidural steroid injections may be underestimated.
Both European and American guidelines, based on systemic reviews, conclude that epidural corticosteroid injections may offer temporary relief of sciatica, but do not reduce the rate of subsequent surgery. This conclusion is based on multiple randomized trials comparing epidural steroid injections with placebo injections, and monitoring of subsequent surgery rates. Facet joint injections with corticosteroids seem no more effective than saline injections.
Rising Costs, Limited Benefits
Despite the limited benefits of epidural injections, Medicare claims show a 271 percent increase during a recent seven-year interval. Earlier Medicare claims analyses also demonstrated rapid increases in spinal injection rates. For patients with axial back pain without sciatica, there is no evidence of benefit from spinal injections; however, many injections given to patients in the Medicare population seem to be for axial back pain alone.
Charges per injection have risen 100 percent during the past decade (after inflation), and the combination of increasing rates and charges has resulted in a 629 percent increase in fees for spinal injections. Yet during this time, the Medicare population increased by only 12 percent.
It all begs the question: Why such a huge increase in the use of a procedure that has limited benefit?
Talk to your doctor of chiropractic for more information on sciatica and nondrug alternatives to your pain.
Deborah Pate, DC, DACBR, is a San Diego chiropractor specializing in radiological assessment of the spine and musculoskeletal system. In fact, she was the first chiropractor accepted into a fellowship in osteoradiology at the University of California at San Diego. Contact her with questions and comments regarding this article at [email protected] .
Although chiropractors care for more than just back pain, many patients visit chiropractors looking for relief from this pervasive condition. In fact, 31 million Americans experience low-back pain at any given time.1
A few interesting facts about back pain:
- Low back pain is the single leading cause of disability worldwide, according to the Global Burden of Disease 2010.
- One-half of all working Americans admit to having back pain symptoms each year.2
- Back pain is one of the most common reasons for missed work. In fact, back pain is the second most common reason for visits to the doctor’s office, outnumbered only by upper-respiratory infections.
- Most cases of back pain are mechanical or non-organic—meaning they are not caused by serious conditions, such as inflammatory arthritis, infection, fracture or cancer.
- Americans spend at least $50 billion each year on back pain—and that’s just for the more easily identified costs.3
- Experts estimate that as many as 80% of the population will experience a back problem at some time in our lives.4
What Causes Back Pain?
The back is a complicated structure of bones, joints, ligaments and muscles. You can sprain ligaments, strain muscles, rupture disks, and irritate joints, all of which can lead to back pain. While sports injuries or accidents can cause back pain, sometimes the simplest of movements—for example, picking up a pencil from the floor— can have painful results. In addition, arthritis, poor posture, obesity, and psychological stress can cause or complicate back pain. Back pain can also directly result from disease of the internal organs, such as kidney stones, kidney infections, blood clots, or bone loss.
Manipulation as a Treatment for Back Problems
Used primarily by Doctors of Chiropractic (DCs) for the last century, manipulation has been largely ignored by most others in the health care community until recently. Now, with today's growing emphasis on treatment and cost effectiveness, manipulation is receiving more widespread attention.
Chiropractic spinal manipulation is a safe and effective spine pain treatment. It reduces pain, decreases medication, rapidly advances physical therapy, and requires very few passive forms of treatment, such as bed rest.5
In fact, after an extensive study of all currently available care for low back problems, the Agency for Health Care Policy and Research—a federal government research organization—recommended that low back pain sufferers choose the most conservative care first. And it recommended spinal manipulation as the only safe and effective, drugless form of initial professional treatment for acute low back problems in adults.6
A patient information article published recently in the Journal of the American Medical Association also suggested chiropractic care as an option for people suffering from low back pain--and noted that surgery is usually not needed and should only be tried if other therapies fail.7
The American Chiropractic Association (ACA) urges you to make an informed choice about your back care. To learn more about how the services of doctors of chiropractic may help you, review the results of recent research studies and contact a Doctor of Chiropractic in your area. Search our online database of ACA members to find a doctor of chiropractic near you.
Tips to Prevent Back Pain
- Maintain a healthy diet and weight.
- Remain active—under the supervision of your doctor of chiropractic.
- Avoid prolonged inactivity or bed rest.
- Warm up or stretch before exercising or other physical activities, such as gardening.
- Maintain proper posture.
- Wear comfortable, low-heeled shoes.
- Sleep on a mattress of medium firmness to minimize any curve in your spine.
- Lift with your knees, keep the object close to your body, and do not twist when lifting.
- Quit smoking. Smoking impairs blood flow, resulting in oxygen and nutrient deprivation to spinal tissues.
- Work with your doctor of chiropractic to ensure that your computer workstation is ergonomically correct.
1. Jensen M, Brant-Zawadzki M, Obuchowski N, et al. Magnetic Resonance Imaging of the Lumbar Spine in People Without Back Pain. N Engl J Med 1994; 331: 69-116.
2. Vallfors B. Acute, Subacute and Chronic Low Back Pain: Clinical Symptoms, Absenteeism and Working Environment. Scan J Rehab Med Suppl 1985; 11: 1-98.
3. This total represents only the more readily identifiable costs for medical care, workers compensation payments and time lost from work. It does not include costs associated with lost personal income due to acquired physical limitation resulting from a back problem and lost employer productivity due to employee medical absence. In Project Briefs: Back Pain Patient Outcomes Assessment Team (BOAT). In MEDTEP Update, Vol. 1 Issue 1, Agency for Health Care Policy and Research,
4. In Vallfors B, previously cited.
5. Time to recognize value of chiropractic care? Science and patient satisfaction surveys cite usefulness of spinal manipulation. Orthopedics Today 2003 Feb; 23(2):14-15.
6. Bigos S, Bowyer O, Braen G, et al. Acute Low Back Problems in Adults. Clinical Practice Guideline No.14. AHCPR Publication No. 95-0642. Rockville, MD: Agency for Health Care Policy and Research, Public Health Service, U.S. Department of Health and Human Services, December, 1994.
7. Goodman D, Burke A, Livingston E. Low Back Pain. JAMA. 2013; 309(16):1738.
Chiropractic: The Right Choice for Low Back Pain
By Editorial Staff
Back pain is a major health issue, so much so that is was recently confirmed as the number-one cause of disability worldwide. Add to that the shocking statistic that the average person has only about a 20 percent chance of not experiencing back pain at some point during their lifetime, and you can appreciate that low back pain (LBP) has been described as "a common threat to medicine and a reasonable threat to all national health care systems."
The authors of that quote conducted a study recently, results of which suggest a simple, drug-free way to counter that "threat": spinal manipulation, a treatment technique commonly provided by doctors of chiropractic. According to the study, spinal manipulation was more effective than a nonsteroidal anti-inflammatory drug (NSAID) and placebo in patients with acute LBP. In fact, patients who received spinal manipulation showed improvement in terms of their disability due to the pain, their subjective estimation of pain and their perceived quality of life compared to patients receiving drug therapy only.
This isn't the first time we've touted the benefits of chiropractic care for back pain, and it won't be the last. That's because a growing body of evidence suggests chiropractic's effectiveness and health-care cost benefits compared to the traditional medical approach, which often involves drugs and may ultimately lead to surgery. Suffering from back pain? Then do something about it; something that doesn't involve popping pills. Give your doctor of chiropractic a call and take control of your back pain. You'll be glad you did.