Showing posts with label Fractures. Show all posts
Showing posts with label Fractures. Show all posts

Wednesday, January 01, 2014

UNDERSTANDING CHRONIC PAIN

Your life is only as good as the memories you make.
This is so true and I have so many good memories. I am sure I have at least an equal number of bad memories, but I will not dwell on them. If you find yourself wallowing in bad memories STOP.

It may be hard but just stop it. Think of something good that happened. Then think of something else good that happened during your life. Search your past for those great moments.
Then repeat often.

Your life is only as good as the memories you make.  I forgot what life is all about, why we are here. I was to busy living in bad times of the physical pain I am feeling right now. The guilt I feel for not being strong enough for my family to keep things the way they were. The way things were before that split second changed everything in my life and the life of my family.

I vow to remember the good I have done, the good I have seen
and to enjoy the good yet to be.

Will You?

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

The Right (and Wrong) Way to Treat Pain

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 finish the story 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....
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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.


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
Pain Pump (Intrathecal Drug Pump)

Saturday, November 02, 2013

Patient's Bill-of-Rights

American Academy of Pain Management
  1. The patient has the right to considerate and respectful care.


  2. The patient has the right to obtain, from their certified provider, complete current information regarding their diagnosis, treatment, and prognosis in terms the patient can reasonably be expected to understand. When it is not advisable to give such information to the patient, the information should be made available to an appropriate person on their behalf.


  3. The patient has the right to receive from their certified provider information to make informed consent prior to the start of any procedure and/or treatment. This shall include such information as: the medically significant risks involved with any procedure and probable duration of incapacitation. Where medically appropriate, alternatives for care or treatment should be explained to the patient.


  4. The patient has the right to refuse any and all treatment to the extent permitted by law, and to be informed of any of the medical consequences of their action.


  5. The patient has the right to every consideration of privacy concerning their own medical care program limited only by state statutes, rules, regulations, or imminent danger to the individual or others.


  6. The patient has the right to be advised if the clinician, hospital, clinic, etc. proposes to engage in or perform human experimentation affecting their care or treatment. The patient has the right to refuse to participate in such research projects.


  7. The patient has the privilege to examine and receive an explanation of the bill.

Friday, February 22, 2013

The Human Pain Effect


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 realise 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.

Thursday, February 09, 2012

Weights Effect on The Spine

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).

Friday, February 03, 2012

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
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'’s a journey with many phases. The ACPA describes these phases as Ten Steps. The ACPAÂ’s 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.

Tuesday, January 03, 2012

Back Pain And Fractures






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?
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 DiagnosedSpineuniverse.com

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.

Thursday, November 03, 2005

Understanding How The Back Works

The spine, which connects the skull to the pelvis, is also called the vertebral column. It consists of 24 segments of block-shaped bone called vertebrae and an additional 9 fused vertebrae that make up the lowest part of the spine, the sacrum and tailbone. Each vertebrae of the vertebral column has protruding bony areas for the attachment of muscles that are important for the spine to move. The spinal column protects the spinal cord and its emerging nerves that run down most of the length of the spine.

The vertebrae have two major functions: To bear the weight of the body To house the spinal cord or spinal nerve roots (cauda equina) within the spinal column. The spine is arranged in three natural curves:The neck region or cervical spine, made up of 7 vertebrae - where the vertebrae curve forward.The trunk region or thoracic spine, made up of 12 vertebrae - where the vertebral column curves backward, and to which the ribs attach. The low back region or lumbar spine, made up of 5 vertebrae - which curves forward in the same direction as the cervical spine. When these curves are in their normal alignment, the body is in a balanced position. This distributes weight evenly throughout the vertebrae so one is in a less vulnerable position for strain and injury.

There are two major parts to each vertebra:
Vertebral body - The vertebral body is the front portion of the vertebrae. It is shaped like a cylinder and is greater in height than the back portion.
Vertebral arch - The vertebral arch is the back portion of the vertebrae. It is an irregularly shaped structure.

At the center of each vertebra is a hole, protected by the surrounding strong bone. Placed together, the central opening of each vertebra makes up the spinal canal through which the spinal cord, cauda equina, or spinal nerve roots pass. The spinal cord is the mass of nerve that connect the brain to the rest of the body.
Each vertebra has important bony projections called processes that provide sites for the attachment of ligaments and muscles that are important for the stability and movement of the spine.The projections on either side of each vertebra are called transverse processes, and the ones at the back are called the spinous processes. The transverse processes are long and slender; the spinous processes are broad and thick.The back portion of the vertebrae, behind the transverse processes, consists of an area of bone called the laminae. On the back part of the vertebrae are two upper and two lower processes that form the joints connecting the back part of each vertebra. These are the facet joints. They are important for movement between each vertebra and for movements of the entire vertebral column as a unit.

The Discs Of The Back

Between each vertebra are spongy pads, like soft cushions, called discs - or more correctly, intervertebral discs. Each disc has a soft jelly-like center called the nucleus pulposus, which is surrounded by a fibrous outer envelope called the annulus fibrosis. Eighty percent of the disc is water, which is why it is so elastic. Together, a disc with the attached part of the vertebra above and below is considered an intervertebral joint. These joints allow the movement of the back. Healthy discs are elastic and springy. They make up 20% to 25% of the total length of the vertebral column. Initially, the disc contains about 85% to 90% water, but this amount decreases to 65% with age, resulting in disc degeneration.

The Spinal Cord And The Lower Back

The nerves that come off the spinal cord are called nerve roots. These nerve roots pass through small openings on either side of the connecting vertebrae. Various nerve roots combine to form spinal nerves. There are five pairs of lumbar (lower back) spinal nerves. The nerve roots that arise from the end of the spinal cord and continue down the spinal canal through the lower part of the spine looks like a "horse's tail" and are collectively named the cauda equina.

The Ligaments Of The Back

There are a series of ligaments that are important to the stability of the vertebral column. Important to the lumbar spine (lower back) are seven types of ligaments:Anterior longitudinal ligaments and posterior longitudinal ligaments are associated with each joint between the vertebrae. The anterior longitudinal ligament runs along the front and outer surfaces of the vertebral bodies. The posterior longitudinal ligaments run within the vertebral canal along the back surface of the vertebral bodies. The ligamentum flavum is located on the back surface of the canal where the spinal cord or caude equina runs.The interspinous ligament runs from the base of one spinous process (the projections at the back of each vertebra) to another. Intertransverse ligaments and supraspinous ligaments run along the tips of the spinous processes. Joint-related structures called capsular ligaments also play an important role in stabilization and movement.

The Muscles Of The Lower Back


The muscles and tendons of the spine have been described as being a supporting system for the spine, much like a tent supported by guide ropes. A group of back muscles called the erector spinae are an example of these muscles, which form on each side of the spine and consist of three columns. These muscles move the lower back, help straighten the back, provide resistance when a person is bending forward at the waist, and help a person return to the erect position. The multifidus is another important muscle of the lumbar region. This muscle is thick and prominent in the lumbar spine and becomes smaller at its attachments high up the spine. It is an effective lever arm that allows the lumbar spine to bend backward.The interspinales muscles, located on either side of the interspinous ligament, also are active in the backward bending of the lumbar spine. The intertransversarii muscles attach to the transverse processes. These muscles are not only active in backward bending, but also in bending from side to side. The intersegmental muscles are a series of muscles near the bottom of the spine that connect one intervertebral segment to another.The abdominal muscles, located at the front and side of the abdomen, are very important in supporting and protecting the abdominal internal organs. They also play an important role in protecting movement of the vertebral column in backward bending, forward bending, and side bending.


Wednesday, November 02, 2005

Causes of Back Pain


The most common causes of lower back pain
are sprains and strains.


Strains

Despite their size and strength, muscles of the lumbar spine can rip or tear. This is called a muscle "strain."A strain is the result of a heavy load or sudden force applied to the muscles before they are ready for activity. The muscle essentially rips, along with the blood vessels within the muscle tissue. This may cause bleeding into the injured area. It can take up to two to three hours before sufficient bleeding or irritation sets in to produce significant pain. This can help explain why many people often can tolerate finishing the task at hand, only to suffer from intense pain later.

This tear in the muscle tissue is followed by symptoms such as:

* Pain
* Swelling
* Muscle spasms


SprainsPublish

Sprains refer to an overstretching of one or more of the ligaments of the back. The ligaments can be stretched beyond their natural integrity and in some cases can completely tear. It is common to have both ligament sprains and muscle strains occurring together. This is especially the case in severe falls and motor vehicle accidents.


Other conditions that can cause back pain include:

* Disc Injury
* Spinal Stenosis
* Osteoarthritis of the Spine
* Spondylolisthesis
* Ankylosing Spondylitis
* Osteoporosis And Fractures Of The Lumbar Spine
* Pregnancy
* Fibromyalgia
* Disc Injury


Herniated disc, also called a "slipped disc," is a disc that bulges out from its position between two vertebrae. There are four types of disc herniation:

* Disc bulge or protrusion results when the disc bulges
out from between two vertebrae without rupturing its
surrounding envelope, the annulus fibrosis.
* Disc prolapse results when the inner jelly-like central part
of the disc ( the nucleus pulposis), seeps into the
outermost fibers of the surrounding envelope, the annulus
fibrosis.
* Disc extrusion results when a tear occurs in the
surrounding envelope of the disc, and the inner jelly-like
central part of the disc leaks out of the disc.
* Sequestrated disc is the term used when disc fragments
are separated from the disc, coming to lie well outside the
disc space in the spinal canal.

A herniated disc has the potential to cause compression against a nerve, producing what is called radicular pain. Radicular pain is also called sciatica. This pain is caused by compression of the nerves as they exit the spinal column. The pain may be felt radiating into the buttock or down the leg, and may be accompanied by a sensation of numbness or tingling in the leg.

Spinal Stenosis

Stenosis means a constriction or narrowing. Spinal stenosis refers to narrowing of the spinal canal, a condition usually affecting people over age 50. It results mostly from degenerative changes, or osteoarthritis, in the spine, particularly from bony formations called osteophytes, which form around the joints of the spine. These bony overgrowths, together with thickening of the ligaments inside the spinal canal, narrow the available space in the spinal canal for the spinal cord and its nerves, and may place pressure on these structures. The condition may cause back pain and pain in the thigh or leg, that often is made worse with long periods of standing or walking, particularly downhill, as well as weakness in the legs. When symptoms are severe and persistent, and do not respond to conservative therapy, surgical treatment may be necessary to take pressure off affected nerves.

Osteoarthritis Of The Spine

Osteoarthritis refers to joint damage that results from "wear and tear." The cartilage (the tissue that lines the joints) between the vertebrae may become increasingly damaged. This may affect a single joint or any number of the joints of the spine. These changes to the joints are also known as degenerative changes.The main features of osteoarthritis of the spine are the development of bony outgrowths, called spurs, along the junction of vertebral bodies and discs. This is believed to be a natural result of stresses applied to the spine throughout life. Other features are narrowing of the joint due to the loss of cartilage between the affected vertebrae, and sometimes small areas of erosion of the bone beneath the joint.

Spondylolisthesis

Spondylolisthesis is a condition in which one vertebra slips forward on the one beneath it. It may result from a number of causes, including trauma to the spine or osteoarthritis (wear and tear) of the spine, or it may have been acquired from birth. The amount the vertebra has slipped forward on the one beneath it may be minimal or very significant.

* There may be no symptoms or there may be back pain
and the back may feel stiff.
* If the slip has caused pressure on a nerve root, pain may
be felt in the buttocks or thigh.
* With a major slip, an increase in the bend of the lower
back can be noticed (called increased lordosis).

Treatment depends on the severity of the condition and the symptoms. This may range from simple exercises and physical therapy to spinal fusion (hyperlink glossary) to stabilize the spine.

Ankylosing Spondylitis

Ankylosing spondylitis is a type of arthritis that primarily affects the spine. "Ankylosing," in Greek, means, "causing stiffness and immobility of a joint," and "spondylitis" means inflammation of one or more vertebrae. Ankylosing spondylitis causes inflammation of the ligaments and tendons that connect the vertebrae and ultimately results in fusion of the spine. This occurs because the inflammation causes some damage to the bone, and the body heals this damage by growing new bone, which replaces the elastic soft tissue at the back of the spine. This can result in stiffness and pain. In some cases, as the fusion progresses, the spine curves forward, causing a person to stoop. Ankylosing spondylitis occurs sometimes in people with psoriasis and inflammatory bowel disease. Stiffness and pain usually begins in the pelvis and at the base of the spine, and progresses upward through the back and to the neck. The back is generally stiff in the morning and improves during the day. Early diagnosis and treatment can control the pain and stiffness.

Osteoporosis And Fractures Of The Lumbar Spine

Osteoporosis is a condition in which bone density and bone strength decreases, making a person more susceptible to fractures. It is a major cause of bone fractures in postmenopausal women and older persons in general. Because the signs of osteoporosis are subtle and can be easily missed, many people do not know they have osteoporosis until a bone actually breaks. In many cases it is the vertebrae that fracture, causing back pain or deformity. The hip and wrist are also common sites of fractures resulting from osteoporosis. After menopause, osteoporosis is much more common in women. Bone loss in the spine results in reduced bone strength, and this can easily lead to fractures of the spine.

Pregnancy

A woman's body undergoes significant hormonal and physical changes during the nine months of pregnancy. For most women, this can lead to back pain as an unavoidable side effect during this time.Early in pregnancy, certain hormonal changes result in increased joint laxity. As a result, the spine, abdominal and back muscles,and posture of the low back change and become more relaxed.Poor posture and poor muscle tone prior to pregnancy can affect how the back adjusts. The lumbar (lower back) curve begins to increase slightly as the pelvis tilts backward. This posture begins to influence the weakened and now fatigued lower back muscles. A woman may experience mildly painful spasms, which can be the first sign of a persistent backache in early pregnancy.

As the pregnancy progresses:

* The abdomen protrudes.
* Both gravity and hormonal changes continue to relax the
muscles of the low back and abdomen.
* The increased lumbar curve places stress on the lower
back muscles and lumbar spine.
* The chance of back pain rises significantly with activity.

Without treatment, the frequency of muscle spasms and pain may increase.

Back pain during pregnancy can usually be managed with:

* Using better posture
* Learning about body mechanics (proper sitting, bending,
lifting, etc.)
* Using an external brace or support
* Following a proper exercise plan

Sciatica during pregnancy can also develop from the increased size of the baby itself. The growing fetus can place pressure directly on the nerves of the lumbar area, causing direct pressure and pain. Sciatica almost always goes away after delivery.

Fibromyalgia

Fibromyalgia may cause chronic back pain and is believed to be a result of inflammation of the body's connective tissue. The condition is characterized by widespread muscle pain, fatigue, and multiple tender points on the body. Fibromyalgia is more common than most people realize. In many sufferers, pain is present most of the time and may last for years. The severity of the pain goes up and down, and the location of the back pain as well as the generalized pain can vary. Low back pain resulting from a diagnosis of fibromyalgia is real, but can also be subjective. Many people with this condition find that emotional stress makes the pain worse. Fatigue is also a common aspect of this condition. Chronic pain, along with anxiety about the problem and how to get well, can be fatiguing by itself. In addition, the inflammatory process within the body produces chemicals that are known to cause fatigue.

SPINAL CORD STIMULATOR

Spinal cord stimulation has been successful in pain management of a subgroup of back pain patients that do not respond to minimally invasive procedures such as epidural injections, and are not candidates for Spinal surgical interventions. This modality has also been successfully used in patients with Failed Back Surgery Syndrome, Neuropathies/Neuralgias, Peripheral Vascular Disease, Arachnoiditis, Phantom Limb Pain, and Complex Regional Pain Syndromes. After initial evaluation, if you are deemed to be a good candidate, educational material in the form of a video tape and brochure will be given to you by your physician. A psychological evaluation might be necessary prior to the procedure; in some situations the insurance companies mandate this evaluation.

The procedure is performed in two stages. The first step is the trial and does not involve an incision. During this stage after an IV and antibiotic infusion is started in the preop area, you will be placed in the prone (face down) position. The area of initial injection will be numbed by local anesthetics and using live X-ray, the epidural space will be accessed by a needle. The leads will then be advanced into the epidural space to the desired level using fluoroscopic guidance.

During the procedure, your physician will ask you question about the quality of stimulation and the coverage area. If the painful areas are covered successfully, the leads will be tied to your back and connected to an external device the size of a remote control. The patient will have the ability to control the extent of stimulation with this device. The patient will be sent home after the procedure to try the device for a few days. If the trial is not successful, the leads will be taken out of your back easily in a few minutes.

Only if the trial part is beneficial the second stage will be scheduled. This part will involve two small incisions in the back and buttocks area, but all of the other steps are similar to the trial. This stage is also an outpatient procedure, and you will go home after recovery from anesthesia. The sutures will be removed in the office within one week after the procedure.