During his 27 years as a hospital
corpsman, Richard Mettetal lifted injured people and
remained suspended by harness from helicopters for
long periods. For the 54-year-old Thurmont, Md., resident,
the legacy of those years of public service is chronic
back pain that has plagued him since 1984.
"It's been so long now, I can't
remember when I didn't feel the pain," Mettetal
says. "And I'm so angry that I can't do all that
I want because of it."
Work-related back pain is among
the most common occupational disorders in the United
States, according to the National Institute for Occupational
Safety and Health in Cincinnati, Ohio. Delay in return
to work remains an expensive component in the overall
cost of back pain for workers' compensation claims,
as well, the institute notes. And back pain is responsible
for more loss of work time and increased medical expenses
related to treatment than any other ailment, says
Robert Shields, M.D., an osteopathic physician practicing
general medicine in Plano, Texas.
"This is one of the most common
problems I see in my medical practice," he says.
"Low back pain strikes 8 out of 10 adults at
some point in their lives."
Understanding Back Pain
Back pain comes in two forms, acute
and chronic, and is most often felt in the lower back.
Acute pain comes on suddenly and intensely, usually
from doing something you shouldn't be doing or from
doing it in the wrong way. The pain usually lasts
a short while. Chronic pain is recurring; any little
movement can set it in motion and, for whatever reason,
it lingers on and on for what can seem like an eternity.
Although back pain is usually preventable
(See "Back to Exercise), experts claim that 4
out of 5 Americans will experience it at some time
in their lives, given that the lower back supports
most of the body's weight. The stability of the lower
back depends on the integrity of the vertebral bodies
and the intervertebral disks.
To understand the many ways you
can do injury to your back, consider that each of
us has between 24 and 25 bones in and around our backs,
including the neck and chest areas, which are held
together by ligaments and muscles. Throw in some major
nerves, a few disks (which act as shock absorbers),
and joints that guide the direction of movement of
the spine, and stack them all up, explains Shields.
"Expect to twist and bend them in a multitude
of directions, and try to imagine what might go wrong."
Shields says you can sprain the
ligaments, strain the muscles, rupture the disks,
and irritate the joints. While logic would point to
injuries from sports or traumatic accidents as the
cause of the pain, sometimes the simplest of movements
will have painful results. In addition, arthritis,
congenital disorders, poor posture, obesity, and psychological
problems due to stress can be the source of back pain.
Complicating the issue further is the fact that back
pain can also directly result from internal problems
such as kidney stones, kidney infections, blood clots,
or bone loss.
Even with modern technology, however,
the exact reason or cause of back pain can be found
in very few people, according to the Clinical Practice
Guideline for Understanding Acute Low Back Problems,
published in 1994 by the Department of Health and
Human Services' Agency for Health Care Policy and
Research. X-ray examinations explain only a small
proportion of the nonspecific complaints doctors receive.
Back Pain Management Options
Mettetal's troubles began 14 years
ago when he nearly collapsed from excruciating pain
searing down his leg. His initial diagnosis was a
ruptured disk. Since then, even with four major surgeries
to repair the problems, his pain has only worsened.
Out of desperation, he has tried medications, physical
therapies, and pain clinics--all in an attempt to
restore some semblance of a functional life.
The Journal of the American Medical
Association concluded in a 1996 surgical back pain
study that more than $50 billion is spent on the diagnosis
and treatment of back pain in the United States. Since
the causes are so varied, what works for one person
might fail with another.
For most people, drugs work well
to control pain and discomfort. But any medication
can have side effects. Back pain experts say that
over-the-counter, nonsteroidal anti-inflammatory drugs
(NSAIDs)--including acetaminophen (Tylenol), naproxen
(Aleve), and ibuprofen (Nuprin, Motrin IB and Advil)--can
be of value in reducing the pain. More severe pain
may require prescription medications such as oxycodone-release
(Oxycontin), acetaminophen with codeine (Tylenol with
Codeine), and meperidine (Demerol).
Peter Rheinstein, M.D., director
of the medicine staff in FDA's Office of Health Affairs,
says the many effective NSAIDs available on the market
today means there is less need for narcotics. However,
he cautions that all NSAIDs cause gastrointestinal
bleeding, and advises that patients suffering from
other medical conditions need to consult with their
doctors about other treatment options for managing
their back pain. "If you have an ulcer, for
example, or are taking a blood thinner," Rheinstein
says, "you are at an increased risk for gastrointestinal
bleeding and should have your doctor prescribe medication
that won't aggravate the ulcer or cause any kind of
drug interaction."
Exercise and Physical Therapy for
Back Pain Relief
Bed rest was once thought to be
an effective treatment for back pain, but recently
its therapeutic benefit has been questioned. In a
study published in the 1996 issue of Spine, Finnish
researchers experimented to find out whether exercises
to mobilize the back worked better than bed rest.
Subjects in the mobility test, who were encouraged
to continue normal activities and have no daytime
rest, appeared to have better back flexibility by
the seventh day than their immobile counterparts,
who remained in bed for the duration of the experiment.
"Most people think that a week
of bed rest will take away the pain," says David
Lehrman, M.D., chief of orthopedic surgery at St.
Francis Hospital and founder of the Lehrman Back Center
in Miami. "But that's not so. For every week
of bed rest, it takes two weeks to rehabilitate."
Vert Mooney, M.D., professor of
orthopedic surgery at the University of California,
San Diego School of Medicine, says that bed rest for
low back pain should be limited to one day and exercise
should begin immediately. He explains that exercises
which increase flexibility and tone and strengthen
muscles can get back pain sufferers up and around
by hydrating disks that become painful from loss of
fluid. "Exercise can actually pump fluid back
into the disk," Mooney says, "and it is
important to keep the patient moving so that the disk
remains fully hydrated."
|
However, FDA's Rheinstein says,
"For some people, bed rest is just the most comfortable
position for the first couple of days."
Spinal manipulation, or osteopathic
manipulative therapy and chiropractic, are therapies
commonly practiced for correcting abnormalities that
are thought to eventually cause disease and inhibit
recovery. Shields uses this type of manual manipulation
technique on the majority of his patients. Occasionally,
however, the spasm is too great or the muscles are
too traumatized--for example, following an automobile
accident or a fall--and the pain or swelling must
be "calmed down" using a muscle relaxer
for a day or two before manipulation.
Surgical Procedures - Back Pain
Treatment
Doctors recommend back surgery much
less often now than in the past, and only for certain
conditions that do not improve after other treatments
have been tried. FDA has approved or cleared medical
devices such as the Intervertebral Body Fusion device,
Anterior Spinal Implant, and Posterior Spinal Implant
to treat degenerative disk disease and stabilize and
fuse the spine.
Implantable spinal cord stimulation
devices are another aid in the management of chronic
pain of the trunk and limbs. These devices electrically
stimulate the spinal cord by discharging a one-time
or continuous stream of electrical pulses. The implanted
portion of the device consists of a pulse generator
(which contains an internal power source similar to
that used in a cardiac pacemaker) and lead extensions
that are connected to electrodes placed in the spinal
canal. The nonimplanted components of the system include
the programming device and screening pulse generator,
which are controlled by the physician or patient.
Acupuncture - Back Pain Treatment
Acupuncture is a centuries-old Chinese
healing technique that employs needles placed at specified
points on the body. FDA classified acupuncture needles
in 1996 as medical devices for "general use"
by trained professionals.
The needles are required to have
proper labeling, and good manufacturing practices
must be followed. Manufacturers must include on the
label the statement "for single use only"
and provide information about device material sterility
and compatibility with the body. The needles must
also bear a prescription label restricting use to
qualified practitioners as determined by individual
states.
Harold Pellerite, assistant to the
director of compliance in FDA's Center for Devices
and Radiological Health says, "I think today's
society is more receptive to alternative medicine.
This just points to the need for our agency to be
able to have some degree of control over what the
American public is exposed to."
Complicating the evaluation of effectiveness
of treatment is the fact that most back problems clear
spontaneously. How can you tell if the problem was
relieved by a particular treatment or if it would
have gone away in the same period without treatment?
"You really can't," says Shields.
Out of all these options, only two
things have given Mettetal any measure of relief--the
Spinal Cord Stimulation System and acupuncture. But,
as Shields points out, "One of the most important
things to keep in mind is that pain is caused by a
variety of underlying problems, and it is naive to
think that one modality will help improve all back
pain."
Carol Lewis is a writer in FDA's
Office of Consumer Affairs.
FDA Consumer magazine (March-April
1998)
>>
Click here for Jesse Cannone's Lose The Back Pain
System and eliminate your back pain!
About Lose the Back Pain
System:
- The four "physical dysfunctions"
that are responsible for over 90% of all back pain
- Simple "self assessments"
you can perform in just minutes, anywhere to help
you pinpoint which dysfunctions you have
- 4 Step-by-Step "Corrective
Action Plans" that show you exactly what you
need to do to balance your body and eliminate your
back pain
- the facts about back pain and
other conditions like sciatic nerve pain and arthritis
- how to strengthen your lower
back and abs to prevent injuries
>>
Click here to order Jesse Cannone's Lose The Back Pain System
and eliminate your back pain! |
