BACK PAIN and the “chronic pain cycle”

Back pain usually starts with an injury like a sprain, joint misalignment or muscle strain. But it can start with constant

stress and being unable to relax.  Pain causes muscles to tighten and squeeze blood vessels which reduces blood

flow.  Chemicals from the injury excite the immune system.  The immune system releases powerful chemicals to

kill infections and remove damaged tissue causing inflammation (pain, warmth and swelling).  Inflammation helps heal

new injuries, but hurts old injuries.  The pain, inflammation, and tightness stimulate nerves into being more active and

more sensitive.  A REFLEX ARC can start when nerves from the spine automatically tightens the muscles in response

to tightness.  Once the reflex arc begins, you have no control unless you break the arc.  Physical force, decreased blood

flow, and inflammation can damage joints, nerves and tissues.  If a disk ruptures or protrudes it can entrap nerves.  Pain

may lead to insomnia and depression, and these increase pain.  The “chronic pain cycle” starts when these events

reinforce each other.  Sometimes pain is referred away from the back.

THINGS TO TELL YOUR DOCTOR:

  • Do you have numbness or tingling?   • What is the pain level on a scale of 1 to 10 (where 10 is the worst)?

  • Any changes in bowel or bladder functions?  • Does it change how you live or work?   • Is it worsening?

  • Does it cause electric shocks?     • Did it start slowly or suddenly?        • Does it refer pain to another area?

  • How it feels (sharp, dull, burning or achy).   • When it started.   • Is it continuous, or affected by actions or positions?

CAUSES  (If you know the cause.)

  • Turning while lifting, or heavy lifting.                         • Fall or trauma.        • Bone disorders or fractures  • Tumors.

  • Repetitive trauma (lifting, reaching or long hours)   • Ruptured disk      • Smoking decreases repair.  • Childbirth

  • Spondylosis (hardening of the spinal col­umn)         • Pre-existing injury    • Osteoporosis

 WARNING: Disks break at 2400 to 4000 pounds force (such as lifting a car tire 48” away from your waist)

RISK INCREASES WITH

  • Heroic or exceptional activity, or long hours       • Sedentary occupations.     • Lift and turn activities   • Obesity.

  • Exercise or gardening, especially if infrequent  • Smoking (decreases healing)  • Improper lifting          • Birth defect

PREVENTION

  • Enter & exit car on 2 legs • Do not enter tub sideways • Roll to side before getting out of bed. • Lose extra weight.

  • Avoid push-pull jobs (like vacuuming).  • No Heavy Lifting.  • Lift without turning at waist.   • Do not do sit-ups.

  • Use common sense  •  Resume normal activities slowly.   • Avoid positions causing pain, shocks or numbness.

  • Pelvic Tilt or Leg Raising exercises can stabilize the lumbar spine position by increasing tone of stabilizing muscles.

EXPECTED OUTCOME

Gradual recovery is typical.  Ligaments usually heal.  Nerves sometimes recover.  Injuries tend will recur unless you avoid

activities that damage nerves or ligaments.  Our goal is to help our patients heal, and to avoid re-injury.

GENERAL TREATMENTS

  • Cold (ice massage or pack) for 10-15 MINUTES at BEDTIME reduces spasm and swelling, but it hurts at first.

  • Heat for 10-15 minutes on WAKING increases flexibility & reduces pain for a short time, but it causes swelling.

  • Manual therapy (manipulation, traction, massage or physical therapy) may reduce spasms, swelling, and pain. 

  • Realignment of joints can speed ligament repair.  You will never heal completely unless the joints are aligned.

  • Breaking the “REFLEX ARC” can sometimes be done with sudden release Neuromuscular Manipulation.

    Medications cannot break the arc unless they profoundly block inflammation.  Even deep anesthesia will not break

    the reflex arc.  If the signal from the spine is stopped, the tightness decreases, disks decompress & healing begins.

  • Traction & reducing muscle tightness can take pressure off nerves, and can speed the repair of injured tissues.   

  • Specific stretches or exercises can strengthen and relax muscles to make it easier to support the spine and joints.

  • Braces or Supports for a limited time in certain cases can help sprained tissues heal and prevent re-injury. 

    Extended bracing is sometimes needed but it causes weakening of muscles and becoming dependent on the brace.

  • TENS (transcutaneous nerve stimulation) can be effectively used to relax muscles and decrease pain.

  • Disk Decompression Traction rehydrates disks and can pull unfragmented HERNIATED DISKS away from nerves.

    Consider traction before surgery for mild nerve entrapment, since it is safe, and effective more than 70% of the time.

 • Sleep with your spine supported in a neutral position.  (Pillows may be needed as props. Avoid sagging mattresses.)

  • Tests may include MRI, X-ray, EMG or laboratory blood studies to determine if there is an underlying disorder. 

  • Other options may help, such as special shoes, and heel lifts (to equalize leg lengths),

 MEDICAL TREATMENTS 

  • Tylenol (acetaminophen) can help with mild pain, but does not reduce inflammation.  Limit to 2000 mg a day or less.

  • Anti-inflammatories (like Motrin, Ibuprofen, Aleve, Ketoprofen, Mobic, etc.) reduce soreness & swelling help

    rest.  But long term use reduces joint strength & increases risk of ulcer & heart attack.

  • Muscle relaxants (Zanaflex, Tizanidine, Flexeril, Norflex, Orphenadrine, Diazepam) allow muscles to rest and

    improve blood flow (to improve healing), reduce pain, but they often cause fatigue.

  • Nerve quieting agents (lidocaine, Cymbalta, Lyrica) often reduce the pain.

  • Antidepressant medications can reduce stress and discouragement, especially if you have a long term injury.

  • Nutrition  100 mg of Vit. B6  twice a day may help nerves. If you are over 50, use 5,000 mcg of Vit. B12 under the

    tongue each morning will increase the rate of healing.   

  • Pain pills (Ultram, Tramadol, Vicodin, Hydrocodone, Codeine, Percocet) help with rest for the short term.  Prolonged

    use increases pain sensitivity and decreases effectiveness, leading to larger doses.  They never will stop all pain.

ACTIVITY    • Avoid re-injury.    • Stay active to preserve muscles.     • Rest often.    • Minimize activity for 2 weeks. 

GO TO THE EMERGENCY ROOM if

  • You lose muscle, bowel or bladder control.   • Groin, hands or legs go numb                                        rev 02/27/2012