My Back Pain

UNDERSTANDING CHRONIC PAIN

2009-07-31T12:18:00.000-07:00

Chronic pain is a thief. It breaks into your body and robs you blind. With lightning fingers, it can take away your livelihood, your marriage, your friends, your favorite pastimes and big chunks of your personality. Left unapprehended, it will steal your days and your nights until the world has collapsed into a cramped cell of suffering.

Check out the rest of the article By CLAUDIA WALLIS
February 28, 2005 issue of Time Magazine Article.
Also here Back in Pain

Chronic pain often presents sufferers with a real "catch 22" dilemma. If they talk about their pain, they risk being perceived and labeled as hypochondriacs, or even worse, fakers or malingerers. On the other hand, if they hide their pain, others don't believe the pain is significant. It is enough to tax the patience of the most stoic person....

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This site contains resources to inform you and hopefully help lower the level of your pain. Please check out the site and let me know what you would like to see or any information you would like to know to improve the site. I have put a lot of work into this site and will add features as I can. I sincerely hope this site will help you cope with the pain and stress and I will continue trying to offer what I can to help people, if you can please help out with a donation even a small donation will be greatly appreciated and can make a big difference. If there are any questions you have I will do my best to answer or help you find the answer. I hope you get the information to help for you or someone you know.

Thank you

God Bless and good luck

*Health Disclaimer*
Any information given about conditions, treatments, and products are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health 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 on MY BACK PAIN.

Back Pain and Fractures

Compression and Wedge Fractures

Thomas A. Zdeblick, M.D.
Professor and Chairman Orthopaedic Surgery
University of Wisconsin
Madison, WI, USA

What is a Compression/Wedge Fracture?

A compression fracture is a common fracture of the spine. It implies that the vertebral body has suffered a crush or wedging injury. The vertebral body is the block of bone that makes up the spinal column.

Each vertebral body is separated from the other with a disc. When an external force is applied to the spine, such as from a fall or carrying of a sudden heavy weight, the forces may exceed the ability of the bone within the vertebral body to support the load. This may cause the front part of the vertebral body to crush forming a wedge shape. This is known as a compression fracture. If the entire vertebral body breaks, this is considered a burst fracture and is discussed elsewhere. The compression fracture may range from mild to severe in terms of severity. A mild compression fracture causes minimal pain, minimal deformity and is often treated with time and activity
modification.

Severe Pain
A severe compression fracture may be such that the spinal cord or nerve roots are involved, as they are draped over the sudden angulation of the spine. This may cause severe pain, a hunched forward deformity (kyphosis) and rarely neurologic deficit from spinal cord compression.

Risks - Osteoporosis - Trauma
The risk for spinal compression fracture increases with age. Osteoporosis is the most common risk facture for compression fractures. Osteoporosis is a condition in which there is thinning of the bones, weakening them. This may be due to a lack of calcium in the diet, certain medications, old age, inactivity or genetic factors. In general, some trauma occurs with each compression fracture. In cases of severe osteoporosis, the trauma may be minimal, such as, stepping out of a bathtub or lifting a heavy object. Moderate trauma is usually required to create a fracture in patients with mild to moderated osteoporosis. This may range from falling off a chair to an automobile accident. A normal spine may also suffer from a compression fracture when there is a severe forward bending injury. This most commonly occurs from a fall from a height or an automobile accident.

Nerve Injury
Neurologic injury is rare with compression fractures. The degree of neurologic injury is usually due to the amount of force present at the time of injury. If there is severe angulation of the spine secondary to a wedge fracture, this may stretch the spinal cord and create injury. This would then lead to loss of strength and sensation, as well as reflexes. In most patients with osteoporotic compression fractures, there is no neurologic injury but only pain from the fracture. However, if left untreated the fracture angulation may worsen and lead to late paralogic injury.

Diagnosis
A compression fracture is usually diagnosed by the history, physical exam and x-rays. In any patient over the age of 60 with the acute onset of sudden low back pain, a compression fracture should be suspected. Physical exam will usually note tenderness directly over the area of pain as well as mild kyphotic deformity (e.g., a sudden angulation forward or hunched over appearance). Plain x-rays will demonstrate the wedge shape of the vertebral body on a lateral view. A CAT scan is occasionally needed to help differentiate a compression fracture from a burst fracture.

Occasionally an MRI scan is obtained to rule out disc herniation along with a compression fracture. MRI scan may also help differentiate pathologic compression fractures, that is, those that involve a tumor, from a typical osteoporotic compression fracture. In any patient with a known history of cancer, a compression fracture should tip off the physician to look for evidence of a metastatic lesion and pathologic fracture. If osteoporosis is suspected, a Bone Mineral Density (BMD) test may be ordered. This test helps determine the severity of the bone thinning. In addition, laboratory tests to look at blood count and thyroid function may be indicated as well. A decision as to whether to treat osteoporosis should be made by the
patients' primary physician.

Burst Fractures:Defined and Diagnosed

Thomas A. Zdeblick, M.D.
Professor and Chairman Orthopaedic Surgery
University of Wisconsin
Madison, WI, USA

What is a Burst Fracture?

A burst fracture is a descriptive term for an injury to the spine in which the vertebral body is severely compressed. They typically occur from severe trauma, such as a motor vehicle accident or a fall from a height. With a great deal of force vertically onto the spine, a vertebra may be crushed.

If it is only crushed in the front part of the spine, it becomes wedge shaped and is called a compression fracture. However, if the vertebral body is crushed in all directions it is called a burst fracture. The term burst implies that the margins of the vertebral body spread out in all directions. This is a much more severe injury than a compression fracture for two reasons. With the bony margins spreading out in all directions the spinal cord is liable to be injured. The bony fragment that is spread out toward the spinal cord can bruise the spinal cord causing paralysis or partial neurologic injury.

Also, by crushing the entire margin of the vertebral body the spine is much less stable than a compression fracture.

Nerve Injury
Neurologic injury from a burst fracture ranges from no injury at all to complete paralysis. The degree of neurologic injury is usually due to the amount of force that is present at the time of the injury and the amount of compromise of the spinal canal. With a greater amount of force, more bony fragments can be forced into the spinal canal causing greater loss of spinal cord function. This may cause loss of strength, sensation or reflexes below the level of the injury.

Typically, in a burst fracture that occurs at the junction of the thoracic and lumbar spines paralysis of the legs and loss of control of the bowel and bladder may result. In an incomplete spinal cord injury only partial paralysis or reflex loss is seen. With mild burst fractures only transient symptoms may be present or no neurologic injury may be present.

Severe Pain
Burst fractures cause severe pain. Typically, this is pain at the level of the fracture, that is, in the back. However, pain may also be present in the legs following the distribution of the affected nerves. Many patients complain of an electric shock type sensation into their legs when there is spinal cord compression. Most patients with a burst fracture are unable to walk immediately after the injury. Seldom, the patient may walk away from an accident and still have a burst fracture. However, often the amount of pain that is present is severe enough that patients know it is a good idea not to walk.

Diagnosis
At the scene of the accident, patients complaining of severe back pain should not be placed into a seated for flexed position. They should be kept lying flat and transported in the flat position. A patient who stands or sits with a burst fracture may increase their neurologic injury. Burst fractures require immediate medical care by an orthopedic or neurosurgeon trained in spinal surgery. The patient should be transported to an emergency room and x-rays obtained.

The diagnosis of a burst fracture is usually made by x-rays and a CAT scan. Occasionally, an MRI scan may be ordered as well, in order to assess the amount of soft tissue trauma, bleeding or ligament disruption. The review of the CAT scan and x-rays allows the treating physician to make a determination as to the level of the fracture, whether it is a compression fracture, burst fracture or fracture dislocation, and to determine the amount of spinal canal compromise and spinal angulation. All of these factors enter into the treatment decision process.

The physical exam should be performed to document both spinal deformity, that is, angulation of the spine or tenderness of the spine at the level of fracture, as well as, a neurologic exam.

Neurologic exam should include testing of the muscle strength, sensation and reflexes of the lower extremities, as well as, testing of bowel and bladder sphincter control.

The Human Pain Effect
By Me

The effects of chronic pain can be devastating to the way of life not only to the person in pain but also for family and friends. Chronic pain over time can bring the strongest person to their knees. Anyone can block pain for a short period of time say a month or two to heal a broken bone or let a painful condition heal, but when the pain continues past that it can make the pain feel like it is getting worse because it takes more energy and it slowly will just wear you down. This does not make you weak it makes you human.

We can handle the pain for short periods of time because we know the pain will go away, pain always goes away. Right?

Unfortunately the answer is no sometimes pain does not go away. Chronic pain is pain that lasts well past the time of normal healing. You may have a serious injury that at first you handle without much problem (like a broken bone) because you can block the pain by keeping your mind focused elsewhere or by just biting your tongue. But the longer the pain lasts the more energy it takes to block the pain. Explained another way imagine pain as something you can see so you try to ignore the pain by not looking at it and keep your eyes looking away. But as time goes by and the pain does not go away it will take more and more effort to not look at it. Eventually the pain will wear you out. Over time instead of looking away from the pain you get to the point where all you can see is the pain, it will completely consume you before you even realize it happened. A example I use is imagine a pro football player who breaks his wrist. They set it put it in a cast and the next week he goes out and plays with the cast on. People are amazed that he can play in so much pain. But if that level of pain is still there the next year he won't be playing because it is to painful. Even though it is the same level of pain he played with before.

It will wear you down over time.
It seems that having chronic pain can actually create changes in the nervous system. What is Chronic Pain Video-ACPA So what do you do after the pain has already consumed you and you feel helpless. Get involved, the biggest mistake I think I made was not getting involved and letting the doctors take care of me. I actually thought doctors knew everything and the miracles of modern medicine could fix me. Wrong. Doctors know about anatomy but you know how your body feels better than the best doctor ever could. Get involved and get informed. Find out about your condition and talk to your doctor. Unfortunately not all doctors will listen or take your concerns as seriously as you may like. In that case you need to have a serious talk with your doctor or find a doctor who will listen which is not always easy. Also many doctors do not won't to admit that they do not have all the answers. Many seem to think they do. But I would rather have a doctor that is honest with you and tells you "I don't really know but we will find out" than have a doctor more or less guessing and contradicting other doctors "guesses". I have seen a lot of doctors over the years and have only had one doctor say "I don't know". It was unrelated to my back but I liked the honesty.

One thing that seems to be very effective at keeping your mind active and alert is debating friends family or anyone. This is something I used to do on a regular basis before my injury just because it was fun. Slowly I drifted away becoming mentally stagnant without even realizing it. After years of mental stagnation I finally woke up after a heated debate with a friend I had not seen in a while. For so long I had tried to have in depth discussions with mild success because the pain would always affect my thought process making it difficult to concentrate or hold my thoughts together. So whenever you are having a good day get comfortable and talk to someone and get your mind working. You will be glad you did.

Barriers to Seeking Pain Relief

Read the Ten Steps below for relief

Many people with chronic pain don't seek pain relief, or even tell their doctors about their pain. Most often, the reasons for keeping pain a secret are based on fears or myths:

Fear of being labeled as a "bad patient." You won't
find relief if you don't talk with your doctor about the pain
you feel.
Fear that increased pain may mean that the disease
has worsened. Regardless of the state of your disease,
the right treatment for pain may improve daily life for you
and your family.
Fear of addiction to drugs. Research has shown that
the chance of people with chronic pain becoming addicted
to pain-relieving drugs is extremely small. When taken
properly for pain, drugs can relieve pain without addiction.
Needing to take medication to control your pain is not
addiction.
Lack of awareness about pain therapy options. Be
honest about how your pain feels and how it affects your
life. Ask your doctor about the pain therapy options
available to you. Often, if one therapy isn't effectively
controlling your pain, another therapy can.
Fear of being perceived as "weak." Some believe that
living stoically with pain is a sign of strength, while seeking
help often is considered negative or weak. This perception
prevents them seeking the best treatment with available
therapies.

Don't let fears and misconceptions keep you from talking to your doctor and other members of your health care team about getting adequate pain relief. Help and relief are possible, but only if you discuss your symptoms with your doctor.

Ten Steps From Patient to Person

American Chronic Pain Association

Making the journey from patient to person takes time. The isolation and fear that can overwhelm a person with chronic pain grows over time. And the return to a fuller, more rewarding life also takes time. It a journey with many phases. The ACPA describes these phases as Ten Steps. The Ten Steps For Moving From Patient To Person.

STEP 1: Accept the Pain
Learn all you can about your physical condition. Understand that there may be no current cure and accept that you will need to deal with the fact of pain in your life.

STEP 2: Get Involved
Take an active role in your own recovery. Follow your doctor's advice and ask what you can do to move from a passive role into one of partnership in your own health care.

STEP 3: Learn to Set Priorities
Look beyond your pain to the things that are important in your life. List the things that you would like to do. Setting priorities can help you find a starting point to lead you back into a more active life.

STEP 4: Set Realistic Goals
We all walk before we run. Set goals that are within your power to accomplish or break a larger goal down into manageable steps. And take time to enjoy your successes.

STEP 5: Know Your Basic Rights
We all have basic rights. Among these are the right to be treated with respect, to say no without guilt, to do less than humanly possible, to make mistakes, and to not need to justify your decisions, with words or pain.

STEP 6: Recognize Emotions
Our bodies and minds are one. Emotions directly affect physical well being. By acknowledging and dealing with your feelings, you can reduce stress and decrease the pain you feel.

STEP 7: Learn to Relax
Pain increases in times of stress. Relaxation exercises are one way of reclaiming control of your body. Deep breathing, visualization, and other relaxation techniques can help you to better manage the pain you live with.

STEP 8: Exercise
Most people with chronic pain fear exercise. But unused muscles feel more pain than toned flexible ones. With your doctor, identify a modest exercise program that you can do safely. As you build strength, your pain can decrease. You'll feel better about yourself, too.

STEP 9: See the Total Picture
As you learn to set priorities, reach goals, assert your basic rights, deal with your feelings, relax, and regain control of your body, you will see that pain does not need to be the center of your life. You can choose to focus on your abilities, not your disabilities. You will grow stronger in your belief that you can live a normal life in spite of chronic pain.

STEP 10: Reach Out
It is estimated that one person in three suffers with some form of chronic pain. Once you have begun to find ways to manage your chronic pain problem, reach out and share what you know. Living with chronic pain is an ongoing learning experience. We all support and learn from each other.

Helpful Hint: Consider going to a pain management clinic or a pain management specialist. NCPOA can help provide you with information about where to find these clinics and specialists. However, since we cannot evaluate the qualifications of these clinics and specialists, we can only give information, not recommendations. Our article ""Choosing a Pain Clinic or Specialist"" can help you make an educated choice best suited to your individual needs.

In My Opinion

By Me

I will give you my opinion of products and treatments I have found helpful. I will also pass along suggestions from others. I will update often so check back also click here to read the ten steps to get your life back. Ten Steps

In the future I will go into much more detail about my dealings with doctors, lawyers, insurance and courts in the meantime e-mail me with your horror stories or successes.

1. Sleeping-my first suggestion is a mattress I like the Memory Foam Mattress , the memory foam molds to your body and while being soft still gives you the support you need and the neck pillow is made of the same material and helps with headaches.
Grand King Memory Foam Mattress
Grand Queen Memory Foam Mattress
15" Grand Plush Memory Foam Mattress - Suede & Cashmere Cover - Twin

2. Back support sitting-my suggestion for lower back and upper back support is the is the Obus Backrest Orthopedic Support high back rest for home, auto or office. Check out different styles. Mine gives excellent support for the upper and lower back and supports the ribs and head and comes with a lumbar pillow that I have found can be used as pillow for the neck and head (for people with upper back problems). The back rest is available at the Relax the Back Store so depending on the severity of your back problem it will help support your back and make it easier to sit upright for longer periods.

3. Electric Mobility Scooter- I have found that a 3-Wheel Travel Scooter can really help when it comes to travel or interaction with family and friends. While I personally was very embarrassed to have to use a scooter (I still am) sometimes you have to just do it if it will help you get out and interact with your family. They can be rented for short periods if necessary. Also a Walker can be useful for stability.

4. Botox injections-It is not just for wrinkles. Botox can be used to deaden the muscles in your back which can relieve some of the pain by relaxing the muscles that are causing pain or irritating the nerves. I have only had one treatment so I cannot tell you how well it works over time. Unfortunately after one treatment the rules changed and the Workers Compensation insurance now says there is no scientific study showing benefit even though it was helping. Out of luck whether it helps or not.

5. Acupuncture-I have tried this and think it was helpful but I did not get much benefit the first time I tried it years ago. I tried it last year in conjunction with the Botox although for the same reasons as the Botox the Workers Compensation insurance changed the rules and now I am out of luck even though it helps.

6. Back Brace - I have a brace for the upper back but it does not fit correctly but if you can get one that fits and supports to keep your back immobilized then you will be able to do more. Spine- Back Realignment Device Note-you would not want to wear the brace to much because you have to work your muscles or they will atrophy.

Pain Resources
What is Chronic Pain
National Institute of Craniofacial Research
American Council for Headache Education
Amer. Pain Foundation
Chronic Pain Outreach
Pain Care Providers

Resources

* Health Encyclopedia
* Scooter Rentals
* FONAR Upright MRI
* Doctor Check

Articles on Medication

* Case for Opiates
* New Strategies for Managing Acute Pain Episodes in Patients With Chronic Pain
* Botox Injections

Medical Articles
Making Breaking Commitments
Chronic Pain and the Family
Neurostimulation-
(Spinal Cord Stimulation)
Chronic Pain in Primary Care
Acupuncture Help's Pain
PubMed
Medscape Search

Weights Effect on The Spine

2007-02-09T09:41:00.000-08:00

Weight loss for back relief

The effects of obesity

Patients who are overweight or obese and suffer from back pain may not be aware that their excess weight is actually contributing to their back pain. While it has not been thoroughly studied exactly how excess weight can cause or contribute to back pain, it is known that people who are overweight often are at greater risk for back pain, joint pain and muscle strain than those who are not obese (1).In addition to back pain, symptoms exhibited by persons who are obese or severely overweight may include fatigue, as well as difficulty breathing and shortness of breath during short periods of exercise (2). If the fatigue and shortness of breath
causes one to avoid activity and exercise, then this can indirectly lead to back pain as lack of exercise contributes to many common forms of back pain. This article examines the heightened risk and severity for certain back problems that obese or overweight patients may experience as a result of their weight. The article also provides practical tips and guidelines for how patients can use exercise, diet and weight loss to reduce their back pain.

Problems caused by obesity

According to the American Obesity Association, episodes of musculoskeletal pain, and specifically back pain, are prevalent among the nearly one-third of Americans who are classified as obese (2). The American Obesity Association also reports that more obese persons say they are disabled and less able to complete everyday activities than persons with other chronic conditions (1). Some of the most common obesity-related problems include musculoskeletal and joint related pain (1). For people who are overweight, attention to overall weight loss is important as every pound adds strain to the muscles and ligaments in the
back. In order to compensate for extra weight, the spine can become tilted and stressed unevenly. As a result, over time, the back may lose its proper support and an unnatural curvature of the spine may develop.
In particular, pain and problems in the low back may be aggravated by obesity. This occurs for people with extra weight in their stomachs because the excess weight pulls the pelvis forward and strains the lower back, creating lower back pain. According to the American Obesity Association, women who are obese or who have a large waist size are particularly at risk for lower back pain (1).Obese or overweight patients may experience sciatica and low back pain from a herniated disc. This occurs when discs and other spinal structures are damaged from having to compensate for the pressure of extra weight on the back. In addition, pinched nerves and piriformis syndrome may result when extra weight is pushed into spaces between bones in the low back area (3). Arthritis of the spine that causes back pain may be aggravated when extra body weight strains joints. Those patients with a Body Mass Index (BMI) of greater than 25 are more likely to develop osteoarthritis than those with a lower BMI. The American Obesity Association recommends modest weight loss as a treatment for some types of osteoarthritis (2).The effectiveness of back surgery may also be affected by a patient’s weight. Obese patients are at higher risk for complications and infections after surgery compared to patients who are not obese (2). For seriously overweight patients, paying attention to weight loss before undergoing back surgery may improve the healing process after surgery.

Identifying the need for weight loss

Body Mass Index (BMI) is a measure commonly used by medical practitioners. BMI is a mathematical formula (BMI=kg/m2) that takes into account a person’s weight in kilograms and height in meters and calculates a number. The higher a person’s BMI falls on a pre-determined range of values, the higher the likelihood for obesity.Although there is some debate over the specific meaning of BMI measurements, a BMI of 30 or higher is typically considered to be obese, while a measure of 25 to 29.9 is typically considered to be overweight (4). It is also important to evaluate where excess fat is carried on the patient’s body. Patients wh carry more weight around their midsection are at greater risk for obesity-related health problems, such as low back pain. Weight loss for health considerations is often advisable for women with a waist
measurement of more than 35 inches or men with a waist measurement of more than 40 inches (4).

What is pain?

2007-02-07T08:46:00.000-08:00

If you suffer chronic pain, you'll probably find little solace in the fact that doctors and scientists don't understand it very well, and that just popping an aspirin is clearly far form a cure-all.

In fact experts can't even agree on what pain is. "Pain is complex and defies our ability to establish a clear definition," Weiner says. "Pain is far more than neural transmission and sensory transduction. Pain is a complex mixture of emotions, culture, experience, spirit and sensation."

The American Academy of Pain Medicine isn't much help either. In its online FAQ, under the heading "What is pain?" you'll find this answer: "It is an unpleasant sensation and emotional response to that sensation."

There are several ways to define pain, however, and knowing which you have is important for considering how to treat it.

This site contains resources to inform you and hopefully help lower the level of your pain. Please check out the site and let me know what you would like to see or any information you would like to know to improve the site. I have put a lot of work into this site and will add features as I can. I sincerely hope this site will help you cope with the pain and stress and I will continue trying to offer what I can to help people, if you can please help out with a donation even a small donation will be greatly appreciated and can make a big difference. I know there are many that are worse off than me and I wish them all the best and I should probably feel lucky that I can still walk, feel lucky that I am not paralyzed or feel lucky I am not dead. So I should feel lucky. Right?
F&@# THAT. I DO NOT FEEL LUCKY I FEEL SCREWED. Whoa Where did that come from? If there are any questions you have I will do my best to answer or help you find the answer. I hope you get the information to help for you or someone you know.

Thank you
God Bless and good luck

*Health Disclaimer*

Any information given about conditions, treatments, and products are not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health 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 on MY BACK PAIN.

Back Pain and Fractures

Compression and Wedge Fractures

Thomas A. Zdeblick, M.D.
Professor and Chairman Orthopaedic Surgery
University of Wisconsin
Madison, WI, USA

What is a Compression/Wedge Fracture?

Severe Pain

A severe compression fracture may be such that the spinal cord or nerve roots are involved, as they are draped over the sudden angulation of the spine. This may cause severe pain, a hunched forward deformity (kyphosis) and rarely neurologic deficit from spinal cord compression.

Risks - Osteoporosis - Trauma

The risk for spinal compression fracture increases with age. Osteoporosis is the most common risk facture for compression fractures. Osteoporosis is a condition in which there is thinning of the bones, weakening them. This may be due to a lack of calcium in the diet, certain medications, old age, inactivity or genetic factors. In general, some trauma occurs with each compression fracture. In cases of severe osteoporosis, the trauma may be minimal, such as, stepping out of a bathtub or lifting a heavy object. Moderate trauma is usually required to create a fracture in patients with mild to moderated osteoporosis. This may range from falling off a chair to an automobile accident. A normal spine may also suffer from a compression fracture when there is a severe forward bending injury. This most commonly occurs from a fall from a height or an automobile accident.

Nerve Injury

Neurologic injury is rare with compression fractures. The degree of neurologic injury is usually due to the amount of force present at the time of injury. If there is severe angulation of the spine secondary to a wedge fracture, this may stretch the spinal cord and create injury. This would then lead to loss of strength and sensation, as well as reflexes. In most patients with osteoporotic compression fractures, there is no neurologic injury but only pain from the fracture. However, if left untreated the fracture angulation may worsen and lead to late paralogic injury.

Diagnosis

A compression fracture is usually diagnosed by the history, physical exam and x-rays. In any patient over the age of 60 with the acute onset of sudden low back pain, a compression fracture should be suspected. Physical exam will usually note tenderness directly over the area of pain as well as mild kyphotic deformity (e.g., a sudden angulation forward or hunched over appearance). Plain x-rays will demonstrate the wedge shape of the vertebral body on a lateral view. A CAT scan is occasionally needed to help differentiate a compression fracture from a burst fracture.

Occasionally an MRI scan is obtained to rule out disc herniation along with a compression fracture. MRI scan may also help differentiate pathologic compression fractures, that is, those that involve a tumor, from a typical osteoporotic compression fracture. In any patient with a known history of cancer, a compression fracture should tip off the physician to look for evidence of a metastatic lesion and pathologic fracture. If osteoporosis is suspected, a Bone Mineral Density (BMD) test may be ordered. This test helps determine the severity of the bone thinning. In addition, laboratory tests to look at blood count and thyroid function may be indicated as well. A decision as to whether to treat osteoporosis should be made by the
patients' primary physician.

Burst Fractures:Defined and Diagnosed

Thomas A. Zdeblick, M.D.
Professor and Chairman Orthopaedic Surgery
University of Wisconsin
Madison, WI, USA

What is a Burst Fracture?

Also, by crushing the entire margin of the vertebral body the spine is much less stable than a compression fracture.

Nerve Injury

Neurologic injury from a burst fracture ranges from no injury at all to complete paralysis. The degree of neurologic injury is usually due to the amount of force that is present at the time of the injury and the amount of compromise of the spinal canal. With a greater amount of force, more bony fragments can be forced into the spinal canal causing greater loss of spinal cord function. This may cause loss of strength, sensation or reflexes below the level of the injury.

Typically, in a burst fracture that occurs at the junction of the thoracic and lumbar spines paralysis of the legs and loss of control of the bowel and bladder may result. In an incomplete spinal cord injury only partial paralysis or reflex loss is seen. With mild burst fractures only transient symptoms may be present or no neurologic injury may be present.

Severe Pain

Burst fractures cause severe pain. Typically, this is pain at the level of the fracture, that is, in the back. However, pain may also be present in the legs following the distribution of the affected nerves. Many patients complain of an electric shock type sensation into their legs when there is spinal cord compression. Most patients with a burst fracture are unable to walk immediately after the injury. Seldom, the patient may walk away from an accident and still have a burst fracture. However, often the amount of pain that is present is severe enough that patients know it is a good idea not to walk.

Diagnosis

At the scene of the accident, patients complaining of severe back pain should not be placed into a seated for flexed position. They should be kept lying flat and transported in the flat position. A patient who stands or sits with a burst fracture may increase their neurologic injury. Burst fractures require immediate medical care by an orthopedic or neurosurgeon trained in spinal surgery. The patient should be transported to an emergency room and x-rays obtained.

The diagnosis of a burst fracture is usually made by x-rays and a CAT scan. Occasionally, an MRI scan may be ordered as well, in order to assess the amount of soft tissue trauma, bleeding or ligament disruption. The review of the CAT scan and x-rays allows the treating physician to make a determination as to the level of the fracture, whether it is a compression fracture, burst fracture or fracture dislocation, and to determine the amount of spinal canal compromise and spinal angulation. All of these factors enter into the treatment decision process.

The physical exam should be performed to document both spinal deformity, that is, angulation of the spine or tenderness of the spine at the level of fracture, as well as, a neurologic exam.

Neurologic exam should include testing of the muscle strength, sensation and reflexes of the lower extremities, as well as, testing of bowel and bladder sphincter control.

The Human Pain Effect

It will wear you down over time.

It seems that having chronic pain can actually create changes in the nervous system. What is Chronic Pain Video-ACPA So what do you do after the pain has already consumed you and you feel helpless. Get involved, the biggest mistake I think I made was not getting involved and letting the doctors take care of me. I actually thought doctors knew everything and the miracles of modern medicine could fix me. Wrong. Doctors know about anatomy but you know how your body feels better than the best doctor ever could. Get involved and get informed. Find out about your condition and talk to your doctor. Unfortunately not all doctors will listen or take your concerns as seriously as you may like. In that case you need to have a serious talk with your doctor or find a doctor who will listen which is not always easy. Also many doctors do not won't to admit that they do not have all the answers. Many seem to think they do. But I would rather have a doctor that is honest with you and tells you "I don't really know but we will find out" than have a doctor more or less guessing and contradicting other doctors "guesses". I have seen a lot of doctors over the years and have only had one doctor say "I don't know". It was unrelated to my back but I liked the honesty.

One thing that seems to be very effective at keeping your mind active and alert is debating friends family or anyone. This is something I used to do on a regular basis before my injury just because it was fun. Slowly I drifted away becoming mentally stagnant without even realizing it. After years of mental stagnation I finally woke up after a heated debate with a friend I had not seen in a while. For so long I had tried to have in depth discussions with mild success because the pain would always affect my thought process making it difficult to concentrate or hold my thoughts together. So whenever you are having a good day get comfortable and talk to someone and get your mind working. You will be glad you did.

Barriers to Seeking Pain Relief

Read the Ten Steps below for relief

Many people with chronic pain don't seek pain relief, or even tell their doctors about their pain. Most often, the reasons for keeping pain a secret are based on fears or myths:

Fear of being labeled as a "bad patient." You won't
find relief if you don't talk with your doctor about the pain
you feel.
Fear that increased pain may mean that the disease
has worsened. Regardless of the state of your disease,
the right treatment for pain may improve daily life for you
and your family.
Fear of addiction to drugs. Research has shown that
the chance of people with chronic pain becoming addicted
to pain-relieving drugs is extremely small. When taken
properly for pain, drugs can relieve pain without addiction.
Needing to take medication to control your pain is not
addiction.

Lack of awareness about pain therapy options. Be
honest about how your pain feels and how it affects your
life. Ask your doctor about the pain therapy options
available to you. Often, if one therapy isn't effectively
controlling your pain, another therapy can.
Fear of being perceived as "weak." Some believe that
living stoically with pain is a sign of strength, while seeking
help often is considered negative or weak. This perception
prevents them seeking the best treatment with available
therapies.

Don't let fears and misconceptions keep you from talking to your doctor and other members of your health care team about getting adequate pain relief. Help and relief are possible, but only if you discuss your symptoms with your doctor.

Ten Steps From Patient to Person

American Chronic Pain Association

Making the journey from patient to person takes time. The isolation and fear that can overwhelm a person with chronic pain grows over time. And the return to a fuller, more rewarding life also takes time. ItÂs a journey with many phases. The ACPA describes these phases as Ten Steps. The ACPAÂs Ten Steps For Moving From Patient To Person.

STEP 1: Accept the Pain
Learn all you can about your physical condition. Understand that there may be no current cure and accept that you will need to deal with the fact of pain in your life.

STEP 2: Get Involved
Take an active role in your own recovery. Follow your doctor's advice and ask what you can do to move from a passive role into one of partnership in your own health care.

STEP 3: Learn to Set Priorities
Look beyond your pain to the things that are important in your life. List the things that you would like to do. Setting priorities can help you find a starting point to lead you back into a more active life.

STEP 4: Set Realistic Goals
We all walk before we run. Set goals that are within your power to accomplish or break a larger goal down into manageable steps. And take time to enjoy your successes.

STEP 5: Know Your Basic Rights
We all have basic rights. Among these are the right to be treated with respect, to say no without guilt, to do less than humanly possible, to make mistakes, and to not need to justify your decisions, with words or pain.

STEP 6: Recognize Emotions
Our bodies and minds are one. Emotions directly affect physical well being. By acknowledging and dealing with your feelings, you can reduce stress and decrease the pain you feel.

STEP 7: Learn to Relax
Pain increases in times of stress. Relaxation exercises are one way of reclaiming control of your body. Deep breathing, visualization, and other relaxation techniques can help you to better manage the pain you live with.

STEP 8: Exercise
Most people with chronic pain fear exercise. But unused muscles feel more pain than toned flexible ones. With your doctor, identify a modest exercise program that you can do safely. As you build strength, your pain can decrease. You'll feel better about yourself, too.

STEP 9: See the Total Picture
As you learn to set priorities, reach goals, assert your basic rights, deal with your feelings, relax, and regain control of your body, you will see that pain does not need to be the center of your life. You can choose to focus on your abilities, not your disabilities. You will grow stronger in your belief that you can live a normal life in spite of chronic pain.

STEP 10: Reach Out
It is estimated that one person in three suffers with some form of chronic pain. Once you have begun to find ways to manage your chronic pain problem, reach out and share what you know. Living with chronic pain is an ongoing learning experience. We all support and learn from each other.

Helpful Hint: Consider going to a pain management clinic or a pain management specialist. NCPOA can help provide you with information about where to find these clinics and specialists. However, since we cannot evaluate the qualifications of these clinics and specialists, we can only give information, not recommendations. Our article ""Choosing a Pain Clinic or Specialist"" can help you make an educated choice best suited to your individual needs.

In My Opinion

I will give you my opinion of products and treatments I have found helpful. I will also pass along suggestions from others. I will update often so check back also click here to read the ten steps to get your life back. Ten Steps

There are many items that can make Daily Living easier. From help Dressing to Bath & Body Aids. Little things can make a big difference to those in pain

Doctors, Lawyers and Insurance Oh my.

In the future I will go into much more detail about my dealings with doctors, lawyers, insurance and courts in the meantime e-mail me with your horror stories or successes.

1. Sleeping-my first suggestion is a mattress I like the Temper-pedic the memory foam molds to your body and while being soft still gives you the support you need and the neck pillow is made of the same material and helps with headaches.
1. Free 13 week in home trial
2. Free Tempur-pedic neck pillow ($125 value)
3. Interest free financing
Just call 1-800-955-9259 and mention offer Code GP10C3 and Referral # 2229441

Also a Memory Foam and Toppers

2. Back support sitting-my suggestion for lower back and upper back support is the is the Obus high back rest for home,auto or office. It gives excellent support for the upper and lower back and supports the ribs and head and comes with a lumbar pillow that I have found can be used as pillow for the neck and head(for people with upper back problems). The back rest is available at the Relax the Back Store so depending on the severity of your back problem it will help support your back and make it easier to sit upright for longer periods.

3. Motorized Scooters- I have found that a mobility scooter can really help when it comes to travel or interaction with family and friends. While I personally was very embarrassed to have to use a scooter (I still am) sometimes you have to just do it if it will help you get out and interact with your family. They can be rented for short periods if necessary. Mobility Aids & Equipment

4. Botox injections-It is not just for wrinkles. Botox can be used to deaden the muscles in your back which can relieve some of the pain by relaxing the muscles that are causing pain or irritating the nerves. I have only had one treatment so I cannot tell you how well it works over time. Unfortunately after one treatment the rules changed and the Workers Compensation insurance now says there is no scientific study showing benefit even though it was helping. Out of luck whether it helps or not.

5. Acupuncture-I have tried this and think it was helpful but I did not get much benefit the first time I tried it years ago. I tried it last year in conjunction with the Botox although for the same reasons as the Botox the Workers Compensation insurance changed the rules and now I am out of luck even though it helps.

6. Braces & Supports-I have a brace for the upper back but it does not fit correctly but if you can get one that fits and supports to keep your back immobilized then you will be able to do more. Note-you would not want to wear the brace to much because you have to work your muscles or they will atrophy.

What is Chronic Pain

National Institute of Craniofacial Research

American Council for Headache Education

Amer. Pain Foundation

Chronic Pain Outreach

Resources

Articles on Medication

Case for Opiates

New Strategies for Managing Acute Pain Episodes in Patients With Chronic Pain

Botox Injections

Making Breaking Commitments

Chronic Pain and the Family

Neurostimulation-
(Spinal Cord Stimulation)

Chronic Pain in Primary Care

Acupuncture Help's Pain

PubMed

Medscape Search

FAQ's For Pain Management Procedures

2006-02-24T15:16:00.000-08:00

Please click on one of the topics below:

Pre-anesthetic visit
Events Before the Surgery
General Anesthesia
Spinal and Epidural Anesthesia
Regional & Local Anesthesia
Recovery Room
Post-Operative Pain Control
Labor Analgesia for Labor & Delivery
Insurance & bills
Epidural Steroid Injection Audio/Visual
Stellate Ganglion Block Audio/Visual
Facet Joint Injection
Sacro-Iliac Joint Injection
Epidurolysis (Racz Procedure)
Radiofrequency Ablations
Dorsal Column Stimulator ( Spinal Cord Stimulator)
Intrathecal Morphine Pump
Lumbar Sympathetic Block
Corticosteroids (Steroids)
Narcotics & Constipation
IntraDiscal ElectroThermal Therapy (IDET) (Annuloplasty)
Discography (Discogram)
Medial Branch Blocks for Facets

The Human Pain Effect

2006-02-22T16:09:00.000-08:00

It will wear you down over time.

Barriers to Seeking Pain Relief

2006-02-03T10:54:00.000-08:00

Read the Ten Steps below for relief

Many people with chronic pain don't seek pain relief, or even tell their doctors about their pain. Most often, the reasons for keeping pain a secret are based on fears or myths:

Fear of being labeled as a "bad patient." You won't
find relief if you don't talk with your doctor about the pain
you feel.
Fear that increased pain may mean that the disease
has worsened. Regardless of the state of your disease,
the right treatment for pain may improve daily life for you
and your family.
Fear of addiction to drugs. Research has shown that
the chance of people with chronic pain becoming addicted
to pain-relieving drugs is extremely small. When taken
properly for pain, drugs can relieve pain without addiction.
Needing to take medication to control your pain is not
addiction.

Lack of awareness about pain therapy options. Be
honest about how your pain feels and how it affects your
life. Ask your doctor about the pain therapy options
available to you. Often, if one therapy isn't effectively
controlling your pain, another therapy can.
Fear of being perceived as "weak." Some believe that
living stoically with pain is a sign of strength, while seeking
help often is considered negative or weak. This perception
prevents them seeking the best treatment with available
therapies.

Ten Steps From Patient to Person

American Chronic Pain Association

Making the journey from patient to person takes time. The isolation and fear that can overwhelm a person with chronic pain grows over time. And the return to a fuller, more rewarding life also takes time. ItÂs a journey with many phases. The ACPA describes these phases as Ten Steps. The ACPAÂs Ten Steps For Moving From Patient To Person.

STEP 1: Accept the Pain
Learn all you can about your physical condition. Understand that there may be no current cure and accept that you will need to deal with the fact of pain in your life.

STEP 2: Get Involved
Take an active role in your own recovery. Follow your doctor's advice and ask what you can do to move from a passive role into one of partnership in your own health care.

STEP 3: Learn to Set Priorities
Look beyond your pain to the things that are important in your life. List the things that you would like to do. Setting priorities can help you find a starting point to lead you back into a more active life.

STEP 4: Set Realistic Goals
We all walk before we run. Set goals that are within your power to accomplish or break a larger goal down into manageable steps. And take time to enjoy your successes.

STEP 5: Know Your Basic Rights
We all have basic rights. Among these are the right to be treated with respect, to say no without guilt, to do less than humanly possible, to make mistakes, and to not need to justify your decisions, with words or pain.

STEP 6: Recognize Emotions
Our bodies and minds are one. Emotions directly affect physical well being. By acknowledging and dealing with your feelings, you can reduce stress and decrease the pain you feel.

STEP 7: Learn to Relax
Pain increases in times of stress. Relaxation exercises are one way of reclaiming control of your body. Deep breathing, visualization, and other relaxation techniques can help you to better manage the pain you live with.

STEP 8: Exercise
Most people with chronic pain fear exercise. But unused muscles feel more pain than toned flexible ones. With your doctor, identify a modest exercise program that you can do safely. As you build strength, your pain can decrease. You'll feel better about yourself, too.

STEP 9: See the Total Picture
As you learn to set priorities, reach goals, assert your basic rights, deal with your feelings, relax, and regain control of your body, you will see that pain does not need to be the center of your life. You can choose to focus on your abilities, not your disabilities. You will grow stronger in your belief that you can live a normal life in spite of chronic pain.

STEP 10: Reach Out
It is estimated that one person in three suffers with some form of chronic pain. Once you have begun to find ways to manage your chronic pain problem, reach out and share what you know. Living with chronic pain is an ongoing learning experience. We all support and learn from each other.

Helpful Hint: Consider going to a pain management clinic or a pain management specialist. NCPOA can help provide you with information about where to find these clinics and specialists. However, since we cannot evaluate the qualifications of these clinics and specialists, we can only give information, not recommendations. Our article ""Choosing a Pain Clinic or Specialist"" can help you make an educated choice best suited to your individual needs.

The Pain Truth: How and Why We Hurt

2006-01-13T18:02:00.000-08:00

By Robert Roy Britt
LiveScience Managing Editor
posted: 31 January 2006
08:19 am ET

Some 50 million U.S. residents live with chronic pain, experts estimate. Pain forces an estimated 36 million of them to miss work every year and results in roughly 70 million doctor visits.

Yet scientists know very little about how pain works. They can't even agree on a definition.

They do agree it's a huge problem.

"Pain is a silent epidemic in the United States," says Kathryn Weiner, director of the American Academy of Pain Management.

Real numbers are hard to get at. A Gallup Poll done in 2000 found that 80 percent of American believe pain is part of getting old, and 64 percent said they'd see a doctor only if their pain became unbearable. More than a quarter of them figured there is no solution to their pain.

"Pain has significant impact on the pain sufferer and their family," Weiner says. Pain and its treatment "represents a major problem confronting our modern culture."

What is pain?

If you suffer chronic pain, you'll probably find little solace in the fact that doctors and scientists don't understand it very well, and that just popping an aspirin is clearly far form a cure-all.

In fact experts can't even agree on what pain is.

"Pain is complex and defies our ability to establish a clear definition," Weiner says. "Pain is far more than neural transmission and sensory transduction. Pain is a complex mixture of emotions, culture, experience, spirit and sensation."

There are several ways to define pain, however, and knowing which you have is important for considering how to treat it.

What we know

One way to divide pain (and perhaps conquer it) is to distinguish between acute and chronic, explains Sally Lawson, a professor of physiology at the University of Bristol in the UK.

Acute pain is what you get when you hit your thumb with a hammer, should you choose to do so. You can also achieve it with a twisted knee or a burn.

Chronic pain is long-term, continuous and far more frustrating. It can result from physical injury, viral infections of the nerve, or arthritic damage to joints and degeneration of bones, Lawson writes.

Scientists also distinguish between evoked pain (use the hammer on your thumb to demonstrate this type) and the spontaneous variety, for which there is no obvious external cause.

One type of chronic pain, called neuropathic, results from damaged nerves rather than the original injury. However, recent research by Lawson and a colleague suggests this pain may sometimes be transmitted by the undamaged nerves.

Not so simple

If it were all that simple, pain probably wouldn't hurt so much. But there's a lot more to it.

"Acute pain is usually evoked, but chronic pain can be evoked or spontaneous," Lawson explains. "Chronic pain often includes spontaneous pain, and spontaneous pain may be ongoing, unpleasant, often burning pain, or it can be an intermittent sharp stabbing or shooting pain, or both."

And that's just the half of it. There are other ways to define and discuss pain.

Meanwhile, scientists are getting closer to understanding the nature of pain by analyzing the types of nerve fibers involved in its transmission, how the signals get to your brain, and how the information is processed.

Nerves in the body serve to warn us when something is acutely dangerous, such as a hot surface, or when our body needs rest or repair. And yes, sometimes those nerves just seem to annoy.

Thousands of pain-sensing nerve endings can be packed into tiny spaces in your fingers, between the vertebrae of your back, and just about everywhere else.

There are several types of nerves that sense cold, warmth pressure, pain and more. The nerves that sense and transmit pain are called nociceptors (pronounced no-sih-SEP-turs). There are more in your fingers and toes, where injury is more likely, than in other parts of your body.

Nociceptors transmit electrical signals to your spinal column. When the cause of pain gets stronger, they fire more rapidly and intensely.

Thinking about it

In the spinal cord, the electrical pain signals trigger release of chemicals called neurotransmitters, which activate other nerve cells that process and transmit the information to the brain.

Important decisions occur in the spinal column: Acute pain like that from touching a hot surface raises a red flag and is routed to the brain immediately. Weaker messages are given less priority, so that you don't overreact to a minor scrape.

They type of pain you feel—acute or chronic—probably depends in part on the type of nociceptive fiber that is sends the initial signal, according to Lawson. "The larger fibers convey electrical impulses very rapidly to the brain, and are thought to cause sharp pricking pain, while the very fine fibers cause ongoing burning, very unpleasant sometimes called ‘unbearable' pain" because of its persistence.

Pain signals are process in the brain's thalamus, a sort of switching station. The thalamus forwards the message to three places:

Somatosensory cortex (physical sensation)

Limbic system (emotional feeling)

Frontal cortex (limbic system)

The brain can do more than just initiate a quick retreat from the source of pain. It might signal nerve cells to release painkillers, such as endorphins.

Chronic pain, for which there is often no obvious source, if often more complex and poorly understood. It's generally defined as pain that lasts more than six months.

Mayo Clinic researchers say chronic pain, which might result from inflammation, can be amplified and distorted like music turned up beyond a speaker's capability, causing pain out of proportion to the source. Beyond that, however, they and other researchers admit many types of chronic pain are poorly understood.

What to do

Only specialists can give proper advice for individual conditions. But all agree that curing chronic pain requires a proactive approach on the part of the sufferer.

Educate yourself, they say, and seek advice of multiple experts. And don't rely on outdated advice.

Many people figure pills are the best way to alleviate chronic pain. But exercise can be an important aspect to treatment.

"Years ago, people who were in pain were told to rest," says Edward Laskowski, a rehabilitation specialist and co-director of the Sports Medicine Center at the Mayo Clinic in Rochester, Minn. "But now we know the exact opposite is true. When you rest, you become deconditioned—which may actually contribute to chronic pain."

Surprising Source of Chronic Pain Discovered

Golfers with Pain are Weaker, Study Finds

Chronic Pain Shrinks People's Brains

Why Women Feel More Pain

Learn More

The path to pain reduction starts with education, experts say. While extraordinary claims and unproven methods can fill a typical Internet search, here are some reliable sources:

Ouch! Why Women Feel More Pain

2006-01-10T18:10:00.000-08:00

By LiveScience Staff
posted: 24 October 2005
01:42

Women feel more pain than men, studies have shown. New research reveals one reason why.

Women have more nerve receptors, which causes them to feel pain more intensely than men, according to a report in the October issue of the journal Plastic and Reconstructive Surgery.

On average, women have 34 nerve fibers per square centimeter of facial skin. Men average just 17.

"This study has serious implications about how we treat women after surgery as well as women who experience chronic pain," said Bradon Wilhelmi, a member of the American Society of Plastic Surgeons and author of the study. "Because women have more nerve receptors, they may experience pain more powerfully than men, requiring different surgical techniques, treatments or medicine dosages to help manage their pain and make them feel comfortable."

Earlier this year, separate research found that women report more pain throughout their lifetimes, in more areas of their bodies and for longer durations.

Death Less Painful for the Rich

Fear the Dentist? You're Not Alone

Chronic Pain Shrinks People's Brains

Women Suffer More than Men

Back Pain And Fractures

2006-01-03T08:17:00.000-08:00

Thoracic Spinal Fusion

The rods are secured with
two screws in each vertebrae.
This feels very familiar.

Chronic pain often presents sufferers with a real "catch 22" dilemma. If they talk about their pain, they risk being perceived and labeled as hypochondriacs, or even worse?fakers or malingerers. On the other hand, if they hide their pain, others don't believe the pain is significant. It is enough to tax the patience of the most stoic person....

Compression and Wedge Fractures
Spineuniverse.com

Thomas A. Zdeblick, M.D.
Professor and Chairman Orthopaedic Surgery
University of Wisconsin
Madison, WI, USA

What is a Compression/Wedge Fracture?

Severe Pain

Risks - Osteoporosis - Trauma

Nerve Injury

Diagnosis

Burst Fractures:Defined and Diagnosed
Spineuniverse.com

Thomas A. Zdeblick, M.D.
Professor and Chairman Orthopaedic Surgery
University of Wisconsin
Madison, WI, USA

What is a Burst Fracture?

Nerve Injury

Severe Pain

Diagnosis

Contact Me

2006-01-01T12:56:00.000-08:00

E-Mail

Help with My Broken back Fund
To Send a donation by mail
just me for the address

mybackpain@yahoo.com

Please send a Donation of any size
to keep me going through this
Thank You.

Or use the Paypal button
on the upper right.

Thank You

Botox for Headaches

2005-11-06T07:53:00.000-08:00

From Headache

The Journal of Head and Face Pain

Botulinum Toxin Type A for the Prophylaxis of Chronic Daily Headache: Subgroup Analysis of Patients Not Receiving Other Prophylactic Medications: A Randomized Double-Blind, Placebo-Controlled Study

David W. Dodick, MD; Alexander Mauskop, MD, FAAN; Arthur H. Elkind, MD; Ronald DeGryse, MA, MS; Mitchell F. Brin, MD; Stephen D. Silberstein, MD

Abstract

Objective: To assess the efficacy and safety of botulinum toxin type A (BoNT-A; BOTOX^®, Allergan, Inc., Irvine, CA) for the prophylaxis of headaches in patients with chronic daily headache (CDH) without the confounding factor of concurrent prophylactic medications.

Background: Several open-label studies and an 11-month, randomized, double-blind, placebo-controlled study suggest that BoNT-A may be an effective therapy for the prophylaxis of headaches in patients with CDH.

Design and Methods: This was a subgroup analysis of an 11-month, randomized double-blind, placebo-controlled study of BoNT-A for the treatment of adult patients with 16 or more headache days per 30-day periods conducted at 13 North American study centers. All patients had a history of migraine or probable migraine. This analysis involved data for patients who were not receiving concomitant prophylactic headache medication and who constituted 64% of the full study population. Following a 30-day screening period and a 30-day single-blind, placebo injection, eligible patients were injected with BoNT-A or placebo and assessed every 30 days for 9 months The following efficacy measures were analyzed per 30-day periods: change from baseline in number of headache-free days; change from baseline in headache frequency; proportion of patients with at least 30% or at least 50% decrease from baseline in headache frequency; and change from baseline in mean headache severity. Acute medication use was assessed, and adverse events were recorded at each study visit.

Results: Of the 355 patients randomized in the study, 228 (64%) were not taking prophylactic medication and were included in this analysis (117 received BoNT-A, 111 received placebo injections). Mean age was 42.4 ± 10.90 years; the mean frequency of headaches per 30 days at baseline was 14.1 for the BoNT-A group and 12.9 for the placebo group ( P = .205). After two injection sessions, the maximum change in the mean frequency of headaches per 30 days was -7.8 in the BoNT-A group compared with only -4.5 in the placebo group ( P = .032), a statistically significant between-group difference of 3.3 headaches. The between-group difference favoring BoNT-A treatment continued to improve to 4.2 headaches after a third injection session ( P = .023). In addition, BoNT-A treatment at least halved the frequency of baseline headaches in over 50% of patients after three injection sessions compared to baseline. Statistically significant differences between BoNT-A and placebo were evident for the change from baseline in headache frequency and headache severity for most time points from day 180 through day 270. Only 5 patients (4 patients receiving BoNT-A treatment; 1 patient receiving placebo) discontinued the study due to adverse events and most treatment-related events were transient and mild to moderate in severity.

Conclusions: BoNT-A is an effective and well-tolerated prophylactic treatment in migraine patients with CDH who are not using other prophylactic medications.