Spine-Health.com - Back Pain Relief Information: Sciatica, Spinal Stenosis, Osteoporosis...

Study by Spine-health reveals lack of spinal fracture awareness.

CHICAGO, IL. – May 15, 2008 – A study by Spine-health.com, the leading health website for people with back pain and other pain conditions, reveals that women with back pain underestimate their risk of spinal fractures.

The study, based on a recent survey conducted on www.spine-health.com, showed that only 48% of women over age 50 thought they were at risk, but 98% actually had more than one risk factor for a spinal fracture due to osteoporosis (n = 594).

Why would women not consider themselves at risk for a spinal fracture from osteoporosis? Three main reasons: Symptoms from a spinal fracture are often thought to be just general back pain due to aging and, therefore, are not diagnosed; some people with spinal fractures don’t experience any pain at all; and many people are not aware of the risk factors for sustaining a spinal fracture from osteoporosis.

“This poll indicates that even with the efforts of the National Osteoporosis Foundation and other organizations to better educate the public about osteoporosis-related fractures, significant work remains to help patients and their doctors proactively identify and discuss potential risk factors for painful and debilitating fractures,” said Dr. Scott D. Boden, Director of the Emory Spine Center in Atlanta, Georgia, and a Medical Advisor to Spine-health.com.

Spondylosis refers to a situation where there is degeneration of the spine. It could describe degeneration in the neck portion of the spine (cervical spondylosis) or degeneration in the lower back (lumbar spondylosis). Patients are often confused by the term because, like many other spine terms, doctors tend to use the term spondylosis differently. For example:

• Some doctors use it to refer to general back pain in which there is degeneration of the spine but no known cause for the back pain.

• Other doctors use the term as an “umbrella” term to describe any patient who has both degeneration of the spine and low back pain.

Because of its broad definition, the term is more useful to describe MRI and X-ray findings than it is as a diagnosis for patients.

Degeneration of the spine is a natural phenomenon that occurs as people age. In fact, it is more common for people over age 60 to have degeneration of the spine than not. It is important to note that evidence of spondylosis on an MRI or a computed tomography scan (CT scan) does not mean that the patient’s neck or back pain is being caused by the degeneration.

The Problem with Spondylosis as a Diagnosis

The real problem with the term spondylosis, especially when it is used as a diagnosis, is that it does not address what specifically is creating the patient’s pain.

• There could be spinal stenosis, an abnormal narrowing of the spinal canal, that is creating leg pain when the patient walks.

• The patient may have pain from osteoarthritis of the facet (spinal) joints, causing back pain during times of high activity.

• The pain could be caused by degenerative disc disease, a degenerated disc that becomes dehydrated and loses some of its function, causing low back pain and possibly leg pain.

These are only a few of the many possible contributors to a patient’s pain.
The treatment for the above conditions is vastly different and thus just saying there is spondylosis, or degeneration of the spine, does not give the doctor or the patient any direction in how to treat the pain. Most doctors arrive at a diagnosis by combining findings of:

• The patient’s medical history, which focuses on a complete description of the pain, the pain’s location, severity, and any activities or positions that improve or worsen the pain

• A physical exam, which can further isolate the cause of the pain

• When warranted, further tests to confirm the diagnosis, which may include one or a combination of a radiographic test (such as an MRI scan, CT scan or X-ray), or an injection to a specific area of the spine to see if it eases the pain.

After arriving at a confirmed diagnosis for the cause of a patient’s pain (rather than just the finding that there is degeneration in the spine, which may or may not be causing the pain) physicians then usually use more specific terms for the diagnosis (such as degenerative disk disease, or spinal stenosis) because those terms more effectively describe what is causing the pain.

Questions to Ask

As with many other spine terms, spondylosis is more of a descriptive term than it is a diagnosis. Literally it can be translated to mean that one has both back pain and spine degeneration, regardless of what is causing the pain or where the degeneration is occurring. In order to better focus their treatment, patients should inquire as to which part of the spine is degenerating. For example:

• If it is degeneration of the discs it is likely to be degenerative disc disease.

• If it is degeneration in the facet joints, there is likely osteoarthritis.

Patients should also ask whether or not any related conditions, such as spinal stenosis, require attention. If a person can get these questioned answered, he or she may get a better idea as to what exactly is causing their pain.

The following provides a more comprehensive list of different types of NSAIDs. Please see Most Common Types of NSAIDs for a more in-depth review of the common NSAIDs.

In addition to the above, certain NSAIDS may also be taken in non-oral forms, such as intravenously or as a transdermal patch. A patch is an adhesive patch applied to the skin – at the area of pain - that slowly releases medication through the skin. The patch that contains the NSAID Diclofenac epolamine is called the Flector Patch.

As with any medication, there are a number of potential risks, side effects and complications that it patients need to be aware of prior to starting to take the any form of the medication.

Two of the more common potential risks and complications of NSAIDs include:

• Kidney damage. NSAIDs are cleared from the blood stream by the kidney, so it is very important that patients over 65 years of age or patients with kidney disease consult a physician prior to taking the medication. If patients take an NSAID for an extended period of time (e.g. six months or more), a blood test needs to be performed to check for early signs of kidney damage.
• Stomach problems. NSAIDs may also cause stomach upset or possibly ulcers. Patients with stomach ulcers or a history of stomach ulcers should first consult with their physician. Signs of stomach ulceration and intestinal bleeding typically include one or a combination of the following symptoms: abdominal pain, black tarry stools, weakness, or dizziness upon standing.

Most types of NSAIDs have a variety of other potential risks and complications associated with them. While most side effects are rare, some can be serious and even potentially fatal, so it is important for patients to remain aware of them and under supervision by a health professional.

As a general rule, patients with any of the following factors should be sure to meet with their doctor before taking any type of NSAID:

• Thyroid problems
• Diabetes
• Heart disease
• High blood pressure
• Allergy or reaction to aspirin, other NSAIDs or pain relievers
• Pregnant, about to become pregnant, or breast feeding
• Consume three or more alcoholic beverages a day
• About to have surgery or other invasive procedures (including dental surgery)

In order to ensure that NSAIDs are used safely, patients should meet with a physician to evaluate their individual risk factors (e.g. the patient’s likelihood for developing certain health problems, including heart attack, stroke and gastrointestinal problems) and to determine the most appropriate dosages, type of NSAID, and treatment options.

In general, it is recommended that patients avoid taking over-the-counter NSAIDs for more than 10 days in a row without consulting their physician.

As with all medications, patients should discuss with their doctor medications taken (including herbal remedies, supplements, etc), all other medical conditions and allergies. Patients should strictly follow label directions for all pain medications, including non-prescription medications.

May is National Osteoporosis Month, so now is a good time to take a look at your diet and figure out if you're getting enough calcium and Vitamin D to keep your bones strong and back straight for decades after you get your AARP card.

In general, the recommended daily allowance (RDA) of calcium (for women -- who need more than men and tend to be the hardest hit by osteoporosis) is between 1,000 and 1,200 mg. A serving of milk is about 300mg of calcium, so you're supposed to be drinking three glasses of milk per day. If you're not, then you're probably not getting enough calcium.

But what should you do if you don't care for milk… or if you're lactose intolerant? What if you're counting calories and just can't squeeze the extra into your diet?

Don't fret. Here are 10 tips for adding and keeping that important calcium in your daily routine.

1. Quit drinking soft drinks. High phosphate levels in the blood (which can be caused by consuming large quantities of pop) leach calcium from your bones and prevent the absorption of new calcium.
   
   
2. Get enough Vitamin D. Calcium is absorbed by the body and used only when there is enough vitamin D in your system. A balanced diet should provide an adequate supply of vitamin D from sources such as eggs and liver. Since most people don’t care for liver, go ahead and enjoy your omelets (and add some spinach!)
   
   Don’t forget that sunlight also helps the body naturally absorb vitamin D, and with enough exposure to the sun, additional food sources may not be necessary.
   
   
3. Eat your beans (baked). One cup of baked beans has 154mg calcium (remember the target is 1,200mgs/day).
   
   
4. Canned Salmon. Three ounces of canned salmon contain 181mg calcium. Salmon also is an excellent source of omega-3 fatty acids.
   
   
5. Calcium fortified foods. Many foods are now calcium-fortified. You can find calcium fortified soy milk, almond milk, rice milk, orange juice, cranberry juice, breakfast cereals, breakfast bars at almost every grocery store.
   • An 8oz glass of calcium-fortified orange juice provides about 300mg of calcium – which is about the same as a single serving of milk.
   • One cup of calcium fortified soy milk has nearly 300mgs of calcium AND can be used over calcium fortified cereal. Two great sources of calcium in one meal.
     
     
6. Oatmeal isn't just for breakfast. One cup of oatmeal not only provides 100–150mg of calcium, it is also a versatile add-in to many other foods and can be used to goose up the calcium quotient in your breakfast cereal, added to yogurt, or even mixed in with your favorite baking recipes.
   
   
7. Eat your veggies... especially spinach, broccoli and dark green leafy vegetables. Kale, parsley, broccoli, spinach and other dark green leafy veggies each provide about 100mgs of calcium per serving. In addition to just making an effort to eat your greens, you can also try substituting raw spinach for iceberg lettuce on your sandwiches and in your salads.
   
   
8. Go Nuts. Almonds and brazils nuts contain about 100mgs of calcium per serving and are both recommended snacks for people on low carb diets.
   
   
9. Drink your latte. My personal favorite! A Starbucks Grande latte provides almost half your daily calcium needs and is such a pleasure. If you’re lactose intolerant, you can get your latte made w/ soy instead of cow milk.
   
   If the gourmet fancy coffees wreak havoc with your budget, just mix a cup of regular coffee with a cup of milk (or skim milk to reduce the calories, or soy milk to eliminate lactose) – microwave the milk first to make your homemade latte nice and hot.
   
   
10. Take an Over-the-Counter Calcium Supplement. You can add a calcium supplement like Os-Cal® or even Tums® to your daily routine to make up the calcium gap. Word of caution… Just because a single Tums has 200mgs of calcium doesn’t mean you can take 5 a day to meet your RDA. It is ultimately and primarily an antacid, not a calcium supplement, and as such it can have a detrimental effect on your digestive system if taken long term.

Sources:

• Digestive Diseases Clearinghouse – Lactose Intolerance (http://digestive.niddk.nih.gov/ddiseases/pubs/lactoseintolerance/ )
• Vegan Society – Calcium (http://www.vegansociety.com/html/food/nutrition/calcium.php )

CHICAGO, IL. April 24, 2008 -– Half of back pain sufferers reach for Advil or Aleve for relief, according to a poll conducted by Spine-health.com, a leading Web site for those with back problems.

The poll, which ran on www.spine-health.com from March to April 2008, asked 899 consumers which over-the-counter (OTC) pain reliever they prefer for treating back pain or neck pain. The respondents were offered the choice of several brand name OTC pain relievers, and a write-in option.

Ibuprofen in general (Advil, Motrin and Nuprin combined) accounted for 39% of the responses. 26% of the respondents said Advil (ibuprofen) is their first choice for OTC pain relief, while 24% selected Aleve (naproxen). Tylenol (acetaminophen) was chosen by 11%, and aspirin was selected by 5%. “Other” accounted for 15% and responses ranged from various prescription drugs to no alternative specified.

Ibuprofen, naproxen and aspirin are all non-steroidal anti-inflammatory drugs, commonly referred to as NSAIDs. Because most episodes of back pain have inflammation as a contributing factor, NSAIDs are frequently recommended by physicians as an effective treatment option because they work like aspirin by limiting the formation of inflammation, but have fewer gastrointestinal side effects (such as gastritis or ulcers) than aspirin.

“NSAIDs, like ibuprofen, are most often recommended for treating activity-related pain or discomfort (e.g. pain that follows sports, housework, shoveling snow, or other exertion), pain related to muscle strain in the low back, and neck stiffness related to muscle, ligament or tendon strains or damage,” said Dr. Stephen Hochschuler, an orthopedic spine surgeon at Texas Back Institute and a Medical Advisor for Spine-health.com.

Acetaminophen is not considered an NSAID because it does not impact inflammation, but works directly as a pain reliever, often in conjunction with anti-inflammatory medications.

More information about back pain, neck pain, and treatment options, like over-the-counter pain relievers, prescription medications, and surgical procedures, can be found on their Web site.

About Spine-health.com
Spine-health.com is the leading resource for people with back pain and chronic pain, serving nearly 1 million visitors each month. Their strict editorial standards and medical review process have earned numerous awards for consumer health content excellence. Spine-health.com publishes health and lifestyle articles about back pain, arthritis, osteoporosis, pain management, medications, surgery, fitness, depression, and insomnia. Spine-health.com also features award-winning message boards and advice columns.

Spinal stenosis is the narrowing of the lumbar spinal column causing pressure on the nerves and resulting in leg pain (sciatica), leg pain with walking (claudication), as well as tingling, weakness or numbness that radiates from the lower back into the buttocks and legs.

As we age, the degeneration of the vertebrae (bones), discs, muscles, and ligaments (connective tissues) may lead to spinal stenosis. The term “Stenosis” comes from the Greek word stenos which literally means "narrow" or "choking", and is often the result of degenerative conditions, such as osteoarthritis.

It is estimated that 400,000 Americans suffer from leg pain and/or low back pain from spinal stenosis.

Available Spinal Stenosis Videos

	Spinal Stenosis Explained Interactive Video: Spinal stenosis results from new bone and soft tissue growth on the vertebrae, which reduce the space in the spinal canal and pinch nerve roots. This causes a painful burning, tingling and/or numbing sensation felt from the lower back down through the legs... Learn more about Spinal Stenosis here.
	X-STOP Implant for Spinal Stenosis Video Interactive Video: The X-STOP procedure is designed to provide relief from back pain and numbness in the legs associated with lumbar spinal stenosis. This is a minimally invasive surgical procedure that is usually performed under local anesthesia and is used as an alternative to laminectomy or spinal fusion. Learn more about X-STOP Implant Procedure
	Lumbar Epidural Steroid Injections for Back and Leg Pain Interactive Video: Lumbar epidural steroid injections are designed to relieve low back pain and radiating leg pain. Steroids can reduce the swelling and inflammation caused by certain spinal conditions. Many patients find significant relief after only one or two injections... Learn more about Lumbar Epidural Steroid Injections for Back and Leg Pain
	Lumbar Laminectomy Interactive Video: Lumbar laminectomy is a surgical treatment for spinal stenosis in which the lamina (section of bone) is removed from one or more vertebrae to relieve pressure on the spinal cord and nerve roots. Learn more about Lumbar Laminectomy here.

The X-STOP® is a titanium-alloy implant designed to relieve back pain and numbness in the legs associated with lumbar spinal stenosis. It is a minimally invasive surgical procedure that can be performed under local anesthesia and is an alternative to laminectomy or spinal fusion.

This interactive video gives you a surgeon's view of the implant procedure.

Brand name: Lyrica (generic: pregabalin)

Overall comments
Lyrica (pronounced LEER-i-kah) is an anti-convulsant (seizure) medicine and considered by many to be a pain relief medication. It is indicated for treatment of four specific conditions, and though it is not indicated or FDA approved for use to treat pain, it is prescribed (off label) by doctors to treat certain types of chronic pain.

Drug class and mechanism of action
Lyrica is an oral medication that is classified as an anti-seizure drug (also called anti-convulsant). Lyrica binds to a part of the nerves and it is thought that this reduces the ability for nerves to send pain messages to each other; it slows down impulses in the brain that cause seizures, and affects chemicals in the brain that send pain signals across the nervous system.

Indications for use
Lyrica is an FDA-approved medication for use in adults 18 years and older to treat:

• Fibromylagia
• Diabetic peripheral neuropathy
• Seizures
• Herpes zoster pain (postherpetic neuralgia)

While Lyrica is not indicated to treat pain from conditions other than those listed above, physicians do sometimes prescribe it to treat certain forms of pain, such as back pain and chronic pain. This is known as off label prescribing.

Lyrica is believed to have low potential for abuse or addiction (a Schedule V medication). For some patients, Lyrica starts to work in as little as one week. For others, it may take several weeks before taking effect, so patients should be sure to discuss this with their doctor.

Potential risks and side effects
As with any medication, there are several reported potential risks and side effects with taking Lyrica. These include but are not limited to:

More common:

• Dizziness
• Sleepiness, drowsiness
• Weight gain and swelling of the hands

Less common:

• Blurred vision
• Fluid retention
• Loss of balance, lack of coordination
• Dry mouth
• Difficulty concentrating

Rare:

• Rash, allergic reactions
• Constipation, stomach pain
• Joint pain, muscle cramping

Lyrica may cause varying levels of sleepiness and drowsiness in certain people. For some, this may mean that they have to avoid any activity that requires them to stay alert, such as driving. Alcohol and other medicines that cause sleepiness (such as cold medicine, muscle relaxants, certain pain, seizure, depression or anxiety medications) can significantly compound Lyrica’s sedative effects.

Some patients taking Lyrica have reported allergic reactions (such as swelling of the face, lips, neck, or hives, difficulty breathing). Patients with any allergic reactions should stop taking Lyrica and contact their doctor promptly.

There are no conclusive studies about the effects of pregabalin in pregnant women, nor is known if the drug passes through the nursing mother’s breast milk or what the effect on a baby would be if a man taking this medication and fathers a child.

For patients with specific conditions, such as congestive heart failure, diabetes or kidney disease, they may not be able to take the medication, or special monitoring tests may be required.

It is always best to inform any treating health care professional that you are taking Lyrica. In case of emergency, it is best to carry an ID card or wear a medical alert bracelet stating that you are taking Lyrica.

Drug interactions
There may be other drugs not listed that can affect Lyrica. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, supplements, and medical prescriptions.

Withdrawal symptoms
It is typical to experience withdrawal symptoms when stopping Lyrica. To avoid or minimize withdrawal symptoms, the treating physician should prescribe a program for reducing the medication over time. In general, Lyrica should be discontinued gradually over one week.

Withdrawal symptoms may include flu-like symptoms, such as:

• Headache
• Sleep problems
• Nausea
• Diarrhea

This medication should be taken exactly as prescribed, following the directions on the prescription label. It should be taken with a glass of water, and may be taken with or without food. It should be taken at the same time every day.

Lyrica should be taken at the prescribed dosage. Patients should never take a double dose if a dose is missed – if it is close to the time for the next dose, skip the missed dose.

Prescription required: Yes

Generic form available: No

FDA approval: June, 2005
Capsules (mg): 25, 50, 75, 100, 150, 200, 225, 300 mg
Maintenance: Lyrica should be stored at room temperature and kept away from moisture or direct light
Information about Lyrica provided by the manufacturer is available at www.Lyrica.com.

Osteoporosis, a treatable and largely preventable disease, is defined as thinning of bones, or loss of bone mass, that causes them to become porous and brittle. The fragility caused by osteoporosis is often to blame for compression fractures of the spine, especially in post-menopausal women.

In general, osteoporosis affects women more often than men, is associated with aging, and progresses more rapidly after menopause.

Available Osteoporosis Related Videos

	Osteoporosis Diagnosis and Treating Painful Fractures Interview with Dr. Jeffrey Spivak: "Very commonly, when a person has the onset of acute or severe back pain, they worry that they might have a fracture. If you have very immediate pain, or if it follows a wrenching movement like lifting a window sill, it is most likely a muscle sprain as opposed to a fracture... unless you are over 50 years old, or have a history of osteoporosis (other broken bones -- wrist fracture, hip fracture, etc) then there is a much higher likelihood your pain is related to a fracture..." Learn more about diagnosis and treatment for painful spine fractures here.
	Kyphosis (Hump in Upper Back): Symptom of Osteoporosis Fracture Interactive Video: Kyphosis is the unnatural curving of the spine, and is a disformation caused by disease or damage to the vertebrae. Kyphosis has several causes including bad posture, physical damage to the spine, or diseases like osteoporosis, Scheuermann's disease, Pott's disease, and spinal tumors. Learn more about kyphosis here.
	Kyphoplasty: Treatment for an Osteoporosis Fracture Interactive Video: Kyphoplasty is a minimally invasive surgical treatment for osteoporotic spinal fractures. It is designed to provide rapid back pain relief and help straighten the spine. Learn more about kyphoplasty here.
	Vertebroplasty: Treatment for an Osteoporosis Fracture Interactive Video: Vertebroplasty is a minimally invasive surgical treatment for spinal fractures caused by osteoporosis or cancer. It stabilizes the spine and provides rapid back pain relief, helps straighten the spine, and prevents further weakening. Learn more about vertebroplasty here.

We are providing a number of links to additional stop smoking resources because we think these are helpful. The links go to websites that are not a part of Spine-health.com and Spine-health.com is not responsible for the content on the following sites.

• American Cancer Society (www.cancer.org)

• Cigar Smoking (also available in Spanish)

• Cigarette Smoking (available in Spanish through the ACS toll-free number)

• Double Your Chances of Quitting Smoking

• Guide to Quitting Smoking (available in Spanish through the toll-free number)

• Helping a Smoker Quit: Dos and Don'ts

• Join the Quit Network

• Questions About Smoking, Tobacco, and Health (available in Spanish through the ACS toll free number)

• Quitting Smoking - Help for Cravings and Tough Situations (available in Spanish through the ACS toll-free number)

• Smokeless Tobacco

• Smoking and Cancer Mortality Table

• Smoking in the Workplace -- A Model Policy

• Women and Smoking (available in Spanish through the ACS toll-free number)

Additional informational resources:

Annals Internal Medicine – Scientific review of smoking cessation intervention strategies www.annals.org

MedlinePlus – Quitting Smoking Resources
http://www.nlm.nih.gov/medlineplus/smokingcessation.html

Smoking Cessation Informationhttp://www.smoking-cessation.org/

American Heart Association – Smoking Cessation
http://www.americanheart.org/presenter.jhtml?identifier=4731

Organizations that provide information and help for quitting smoking:

American Heart Association & American Stroke Association
Telephone: 1-800-AHA-USA-1 or 1-800-242-8721
Telephone: 1-888-4-STROKE or 1-888-478-7653
Internet address: www.amhrt.org
Internet address: www.strokeassociation.org

American Lung Association
Telephone: 1-800-LUNG-USA (1-800-548-8252)
Internet address: www.lungusa.org

Centers for Disease Control and Prevention
Office on Smoking & Health
Telephone: 1-800-CDC-INFO (1-800-232-4636)
Internet address: www.cdc.gov/tobacco

National Cancer Institute
Cancer Information Service
Telephone: 1-800-4-CANCER (1-800-422-6237)
Internet address: www.cancer.gov

Nicotine Anonymous
Telephone: 1-877-879-6422
Internet address: www.nicotine-anonymous.org

Smokefree.gov
(Online materials, including info on state telephone-based programs)
Telephone: 1-800-QUITNOW (1-800-784-8669)
Internet address: www.smokefree.gov

Smoking Cessation Leadership Center
Telephone: 1-800-QUITNOW or 1-800-784-8669
Internet address: http://smokingcessationleadership.ucsf.edu/

References

Did you know…Tobacco smoking is responsible for the deaths of approximately five million people each year (World Health Organization).

Despite educating people about the very serious health effects of smoking, approximately 22% of adults in the United States are smokers. Surveys have found that even though 80% of smokers would like to quit smoking, less than five percent are able to quit on their own due to the highly addictive properties of nicotine.

So if smoking is so bad for you, why is it so hard to quit? Stopping smoking is difficult for several reasons:

Nicotine is highly addictive
Nicotine stimulates pleasure centers in the brain and is highly addictive. When nicotine is discontinued, the smoker will experience physical withdrawal symptoms, making the person want to start smoking again to stop the withdrawal symptoms. Each person experiences withdrawal from nicotine addiction a little differently.

Typical nicotine withdrawal symptoms include (but are not limited to):

• Flu-like aches and discomfort
• Cravings for a smoke
• Irritability
• Sleep problems
• Fatigue
• Difficulty concentrating
• Headache
• Cough, chest tightness
• Sore throat
• Sore tongue, gums

Rewarding Psychological Aspects of Smoking
The behavioral and social aspects of cigarette use are highly rewarding for the smoker. Smoking behavior becomes closely linked with daily activities and "cues" such as after a meal, when socializing with friends, when consuming alcohol, to "take a break", when under stress (to relax), when relaxing (to relax further), etc. The psychosocial-behavioral aspects of smoking can be just as challenging to overcome as the physical dependence

Genetic predisposition
As science advances, the effects of genetics have been found to influence a number of health issues that were thought to be the domain of behavior only (e.g. alcoholism, etc.). Studies have established a substantial genetic contribution to smoking behavior (See the article for Ho et al. 2007 for a review).

It has also been found that genetics differentially influence the multiple aspects of smoking, such as the urge to start smoking, continuing on to become a "smoker", etc. This may explain why some people cannot stand smoking at all, some can smoke occasionally with a "take it or leave it" attitude, and others will become regular smokers.

These factors explain why, even using behavioral approaches and anti-smoking medicine, the relapse rate for smoking is quite high.

After quitting smoking, the first few weeks are usually the hardest. It usually takes at least eight to twelve weeks for an individual to start feeling more comfortable without smoking.

The bottom line: Stopping smoking over the long term (e.g. becoming a true "non-smoker") is challenging but clearly worth the effort.

Smoking causes a number of significant problems for patients undergoing spinal fusion including the following:

• A significantly decreased rate of successful fusion (called non-union or pseudoarthroses)

• Markedly poorer clinical outcomes (i.e. pain reduction) regardless of whether or not a successful fusion in the spine is achieved

• Poorer functional rehabilitation after surgery

• Lower overall patient satisfaction with the spine surgery

Given these findings, quitting smoking prior to a spinal fusion (and remaining a non-smoker) can greatly enhance a patient’s chances for achieving pain reduction and a successful clinical outcome.

Importantly, the information presented in this article applies not just to cigarette smoking but to all forms of nicotine and any product that introduces nicotine into ones system, such as:

• Chewing tobacco

• Cigars

• Pipes

• Nicotine patches

• Nicotine gum

Philosophically, it is perfectly reasonable for a surgeon to not agree to do a fusion surgery until after a patient has quit smoking. Unlike many surgeries, fusion surgeries are not usually medically necessary – having the surgery is the patient’s choice. And it is an extensive surgery that requires a lot of healing. So it is reasonable to ensure that the patient is in the best healing position possible prior to proceeding with surgery. Accordingly, many spine surgeons will require their patients to have a urine test prior to a spinal fusion to ensure that there is no nicotine in their system and they have indeed quit smoking.

All of the research and clinical findings presented in this article underscore the importance of quitting smoking prior to a spine fusion and avoiding smoking post-operatively. In addition, the research shows that:

• If you smoke up until the time of surgery you are very unlikely to quit after surgery. It is best to quit at least one month prior to surgery.

• The more you smoke before surgery, the harder it will be to maintain abstinence post-operatively

• The longer you are abstinent from smoking before surgery, the more likely you will stay abstinent after surgery

Regardless of technical advances to achieve a solid fusion in smokers, the best overall outcomes, notably pain relief, are achieved in non-smokers and smokers who successfully quit smoking.

Understanding these findings can help you and your surgeon develop a treatment plan that has the highest likelihood of helping you quit smoking and having a successful spine fusion surgery outcome that includes a solid fusion as well as greater pain reduction and satisfaction with the surgery.

• References

• Resources to Help Quit Smoking

The fact that smoking is not good for your health is not exactly news, but most people do not associate smoking with pain.

Lifestyle issues such as smoking, as well as lack of exercise and obesity, hamper the patient’s ability to find sufficient pain relief over the long term. In fact, research has shown that smoking causes back pain.

In my own personal experience with treating back pain patients, I have seen that chronic smokers rarely ever recover from chronic pain conditions even with a variety of treatments.

While quitting smoking is a necessary component of any patients’ personal rehabilitation from low back pain, it is rarely a sufficient means, and other pain treatments such as injections, surgery, medication, and exercising are essential.

As far as spinal fusion surgery for patients with low back pain, quitting smoking prior to surgery is critical. There is a lot of research showing that smoking is detrimental to obtaining a solid fusion, but now there is also research showing that even if a smoker gets a solid fusion, their ultimate result is not nearly as good as a non-smoker. A recent study by Dr. Steven Glassman found that smokers who did not quit at least a month prior to their surgery were far more likely to return to smoking within a year. Given the expense, pain and lengthy recovery of any lumbar fusion surgery it is only reasonable to have the best biological situation for a successful outcome.

Get the Flash Player to see this player.

For many patients, there is a distinct choice between continuing to live in pain or going through the challenge and discomfort of quitting smoking. When the pain gets bad enough, the choice can be easy enough, especially if the patient realizes that smoking is very closely related to the pain.

Posted by: Peter Ullrich, Jr., MD

More reading:

• Stop Smoking to Reduce Back Pain
• Stop Smoking Message Boards

Running is an activity that involves repetitive stress and impact, sometimes for a long duration. People who have an underlying lower back problem can find running or jogging makes their pain worse or leads to additional types of pain, such as sciatica (leg pain, weakness or numbness).

When running or jogging leads to more or additional back pain it is important to know when to seek treatment and what types of treatment to expect.

Low back muscle strain for runners

Lower back pain often comes on quickly, after bending or lifting the wrong way, or perhaps after running too far before warming up.

Lower back pain comes in many different varieties, the most benign of which is muscular strains and pains. It is characterized by lower back muscle spasm and pain that is centralized in the lower back. This type of pain does not travel into the buttock or legs (sciatica, or radiculopathy).

Low back pain brought on my muscle strain is best treated by a variety of self care techniques, and perhaps stopping the running for a week or so as those symptoms resolve. Effective ways to relieve lower back pain caused by muscle strain usually include one or a combination of the following:

• A short period of rest (one or two days) if the pain is severe

• Gentle stretching

• Ice or cold packs, applied for 10 to 20 minutes at a time

• Heat therapy or moist heat

• Over the counter pain medication, such as acetaminophen (e.g. Tylenol)

• Over the counter anti inflammatory medications (e.g. ibuprofen, naprosyn)

This type of pain will often improve over the course of one to three weeks just by activity restriction.

A more problematic form of lower back pain for runners is low back pain related to structural problems in the lower back, such as:

• Herniated Disc

• Degenerative Disc Disease

The disc is the shock absorber of the lower back. When running or jogging, the repetitive impact on the spine puts stress on the disc. If one already has a damaged disc, the repetitive stress that can lead to increasing symptoms. Runners who find that they have consistent and steady lower back pain after a workout should consider getting a thorough evaluation by a spine physician.

People who live with chronic pain have long been saying that the non-stop physical pain is not the only challenge in their lives, but along with the pain comes a host of other challenges, such as:  

• Depression
• Sleep disorders
• Anxiety

Now new research findings confirm this.  The recent study, conducted at Northwestern University’s Feinberg School of Medicine, found that physical changes in the brain caused by chronic pain are likely to lead to depression as well as other pain-related symptoms.

In the study, the researchers demonstrated that the wiring in the brain of someone dealing with chronic pain is different than that of pain-free individuals.  In a the brain of a pain-free individual, all the regions of the brain exist in a complementary state, meaning that if one region of the brain is active the other regions are at rest. But in people with chronic pain, a front region of the cortex mostly associated with emotion is constantly active.

“The areas that are affected fail to deactivate when they should.” said Dante Chialvo, lead author and associate research professor of physiology at the Feinberg School. “They are stuck on full throttle, wearing out neurons and altering their connections to each other. “

‘If you are a chronic pain patient, you have pain 24 hours a day, seven days a week, every minute of your life,” Chialvo said. “That permanent perception of pain in your brain makes these areas in your brain continuously active. This continuous dysfunction in the equilibrium of the brain can change the wiring forever and could hurt the brain.”

Chialvo hypothesized: “It could be that pain produces depression and the other reported abnormalities because it disturbs the balance of the brain as a whole.”

Importantly, Chialvo notes that the research findings “show it is essential to study new approaches to treat chronic patients not just to control their pain but also to evaluate and prevent the dysfunction that may be generated in the brain by the chronic pain.” The research results are being published in the Journal of Neuroscience.

Source: http://www.chialvo.net/

More resources:

• Pain Message Boards
• Chronic Pain Health Center
• Depression Health Center

Michael E. Janssen, D.O., a Denver surgeon and a Spine-health.com Member, became the first physician in the United States to perform two cervical disc arthroplasties using the ProDisc-C Total Disc Replacement System. The ProDisc is designed to treat patients suffering from cervical disc degeneration and disc herniation, which occurs when natural shock absorbers in the cervical spine become worn and start to degenerate, often resulting in pain, discomfort, and impaired cervical mobility creating neck and upper arm pain.

One of the patients was an active 35 year old male with cervical disc degeneration that developed as a result of a traumatic hockey injury, causing pain, stiffness, and numbness in his left-hand. The second patient was a 53 year old female accountant who had been suffering with neck and upper extremity pain from a disc herniation compressing her spinal cord.

Both surgeries were performed on January 16, 2008, and both patients pre-operative symptoms were gone the following day. The patients were discharged from the surgery center on January 17, 2008 with minimal pain.

The full story is available here.

Additional resources:

Cervical Degenerative Disc Disease

Cervical Herniated Disc Symptoms and Treatment Options

Artificial Disc Replacement or Spinal Fusion?

Disc Replacement Surgery Video

Like most of us, you probably start out each new year with the best of intentions: full of hope that THIS is the year you'll finally do "X" (fill in the blank with your #1 item). If you're like me, I dutifully make my list of New Year's Resolutions (usually at least 10 items long), only to get discouraged by late January and in pretty much full abandonment by March.

So, if we have to pick and choose a focus for our resolutions this year, I pick HEALTH. Why? As one of the most personal and potentially all-encompassing factors in our lives, there's little that is more important than our own good health. Above all else - money, careers, a home or a car, even sex - health is the one thing we can't live without and arguably the most influential factor of our quality of life. For people with chronic health conditions, such as chronic back pain, I can't think of a better focus than health and healthy living for 2008.

My top 3 picks for 2008 Health Resolutions:

1. Exercising. I don't mean just starting to exercise or saying you'll finally try yoga, I mean committing to making exercise part of your normal weekly routine for the rest of your life. The necessity of exercise in the combat of just about every kind of health issue and pain condition is well known. The tougher part is to accept that exercise won't be very helpful if done in fits and starts, and that just thinking about exercising doesn't count.

The most popular excuse for not exercising? "I'm too busy," which translates to "I won't." Keep in mind that even the President of the United States finds time to keep himself fit. The key, according to a 1/1/08 Chicago Tribune article, is "...make exercise a habit that you do every day at the same time. Pick the time that's best for you and just do it." So, if you're not a morning person, don't plan to do a 6am aerobics class. Whatever time and type of exercise you choose, remember the incredible benefits of exercise you will reap: looking and feeling better, reducing stress, reducing pain, and slowing or preventing certain diseases (e.g., osteoporosis, hypertension).

2. Quit Smoking. No brainer, right? You would think so, given the known linkages of smoking to cancer, heart disease, lung disorders, etc. Well, if you smoke and have a chronic back pain problem, you need to know two things: one is that smoking can significantly worsen your back pain, and two is that most back surgeons will refuse to operate on your back if you smoke because it inhibits the body's ability to heal after surgery. The key with smoking cessation is to surround yourself with the kind of support network you need to quit and stay smoke free. Talk to your doctor about which of the various stop smoking aids available (gums, patches, oral medications, support groups, etc.) are right for you and keep trying until you find something that works. Like exercising, the state of being called "I don't smoke" is one you need to be in for the rest of your life. Period.

3. Getting organized. Most people simply have accumulated too much stuff over the course of their lives and now have the dreaded "c" word: clutter. One of the worst impacts of clutter? Stress. Clutter stress at home can cause feelings of being overwhelmed and out of control, leading to overeating and feeling like there's no time to do other things such as exercise (see #1 above). Stress is also a known cause of back pain and can exacerbate many chronic health conditions. Eliminating household clutter can be liberating and euphoric, freeing up time (less clutter is easier to clean and organize) and space (making room for that new elliptical trainer or yoga mat). The key to de-cluttering: pick the clutter that is most bothersome and tackle it one project at a time, and then commit to keeping it that way.

One of the commonalities among all three resolutions is commitment. They will all take incredible self discipline and will power to achieve, not only initially but over the long haul too. The good news is that there is outside help available, if you need it, for each and every one of these. Best of all, I'm willing to bet that the physical, mental, and emotional health benefits will become the only motivator you need to stay the course. Best wishes for a healthy 2008!

Additional resources to help get you started:

Spine-health.com Exercise Health Center - http://www.spine-health.com/exercise/
Smoke Free 2008 (American Lung Association) - http://www.smokefree08.org/site/c.jeJSIZOsEjH/b.3761509/
Obtaining a Solid Spine Fusion - http://www.spine-health.com/topics/surg/lumbdeg/lumbdeg03.html
National Association of Professional Organizers - http://www.napo.net/public/

This interactive video provides an animated explanation of vertebroplasty. Vertebroplasty is a minimally invasive surgical procedure designed to quickly relieve pain from osteoporosis related spinal fractures.

Vertebroplasty is similar to Kyphoplasty, and both procedures can be used to treat painful spine fractures under local anesthesia.

This interactive video provides an animated explanation of laminectomy back surgery, in which bone (the lamina) is partially removed to relieve pressure (neural impingement) on nerves caused by spinal stenosis. The act of removing the small portion of bone from over the nerve root and/or disc material from under the nerve root gives the nerve more space, lessens pressure, and provides a better healing environment.