People who get prompt physical therapy for pain in the knee, shoulder or lower back may have less need for opioid painkillers, new research suggests.
The study, of nearly 89,000 U.S. patients, found that people given physical therapy for their pain were 7 percent to 16 percent less likely to fill a prescription for an opioid.
The researchers said the findings suggest that early physical therapy is one way to reduce Americans’ use of the risky, potentially addictive painkillers.
“For people dealing with these types of musculoskeletal pain, it may really be worth considering physical therapy — and suggesting that your health care provider give you a referral,” said lead researcher Dr. Eric Sun. He is an assistant professor of anesthesiology, perioperative and pain medicine at Stanford University.
Dr. Houman Danesh, a pain management specialist who was not involved in the study, agreed.
“This study shows how important physical therapy can be,” said Danesh, who directs the division of integrative pain management at Mount Sinai Hospital, in New York City.
Physical therapy does require a much bigger investment than taking pain medication — and, he said, patients may have to travel to find a therapist who is the best fit for them.
“Physical therapy is highly variable,” Danesh said. “Not all physical therapists are equal — just like not all doctors are.”
But the effort can be worth it, according to Danesh, because unlike painkillers, physical therapy can help people get at the root of their pain — such as imbalances in muscle strength.
“You can take an opioid for a month, but if you don’t get at the underlying issue [for the pain], you’ll go back to where you started,” he explained.
The findings, published online Dec. 14 in JAMA Network Open, come amid a growing national opioid epidemic. While many people who abuse opioids are hooked on illegal versions — like heroin and illicitly manufactured fentanyl — prescription opioid abuse remains a major concern.
Medical guidelines, from groups like the American College of Physicians, now urge doctors to first offer non-drug options for muscle and joint pain. Opioids, such as Vicodin and OxyContin, should be reserved as a last resort.
The new findings support those guidelines, according to Sun’s team.
The results are based on insurance records from nearly 89,000 Americans who were diagnosed with pain affecting the lower back, knee, shoulder or neck.
All of the patients had a second doctor visit within a month of the diagnosis, and an opioid prescription within 90 days. So the group included only people with significant pain, the researchers said.
Overall, 29 percent of the patients started physical therapy within 90 days of being diagnosed. Compared with those who did not have physical therapy, the therapy patients were 7 percent to 16 percent less likely to fill an opioid prescription — depending on the type of pain they had.
And when physical therapy patients did use opioids, they tended to use a little less — about 10 percent less, on average, the researchers found.
The findings do not prove that physical therapy directly prevented some opioid use.
Sun explained that, “since physical therapy is more work than simply taking an opioid, patients who are willing to try physical therapy may be patients who are more motivated in general to reduce opioid use.”
But his team did account for some other factors — such as a patient’s age and any chronic medical conditions. And physical therapy was still linked to less opioid use.
While this study focused on physical therapy, Danesh said, there are other opioid alternatives with evidence to support them.
Depending on the cause of the pain, he said, people may find relief from acupuncture; exercises to strengthen particular muscle groups; injections of anti-inflammatory steroids or other medications; platelet-rich plasma — where a patient’s own platelets (a type of blood cell) are injected into an injured tendon or cartilage; and nerve ablation, where precisely controlled heat is used to temporarily disable nerves causing the pain.
It’s also possible that some simple lifestyle adjustments will help, Danesh pointed out. An old worn-out mattress could be part of your back pain woes, for instance. Ill-fitting, non-supportive or worn shoes could be feeding your knee pain.
What’s important, Danesh said, is to get at the underlying issues.
“We have to match patients with the right treatment for them,” he said.
The U.S. National Center for Complementary and Integrative Health has more on managing pain.
SOURCES: Eric Sun, M.D., Ph.D., assistant professor, anesthesiology, perioperative and pain medicine, Stanford University School of Medicine, Stanford, Calif.; Houman Danesh, M.D., assistant professor, anesthesiology, perioperative and pain medicine, and director, division of integrative pain management, Mount Sinai Hospital, New York City; Dec. 14, 2018, JAMA Network Open, online
TUESDAY, Nov. 27, 2018 (HealthDay News) –What if a simple zap to the spine could relieve the debilitating lower back and leg pain brought on by a herniated disk?
Such is the promise of “pulse radiofrequency” therapy (pRF), which sends inflammation-reducing pulses of energy to nerve roots in the spine, a new study claims.
The therapy is not new, having first received U.S. Food and Drug Administration approval in the 1980s.
But recent advances in CT scan technology now enable clinicians to deploy those energy pulses with much more accuracy, experts said. And the new research suggests the treatment could prove a boon to back pain patients for whom standard therapies have failed to do the trick.
“I was amazed with the results of pRF,” said study author Dr. Alessandro Napoli. “Especially having read, as a radiologist, numerous lumbar MRI scans of patients with recurrent hernia after surgery.”
And as a patient himself, Napoli added that “from personal experience I can tell you that the treatment is not painful, and the results are appreciated within days after a single treatment lasting 10 minutes.”
Napoli is a professor of interventional radiology at Sapienza University of Rome in Italy.
He and his colleagues plan to report their findings Tuesday at the Radiological Society of North America annual meeting, in Chicago. Such research is considered preliminary until published in a peer-reviewed journal.
Lower disk herniation results when the insulating disks that sit between spinal vertebrae tear open, allowing jelly-like material to protrude and exert pressure on surrounding nerve roots. Beyond lower back pain, the condition often triggers sciatica, a pain that radiates down a patient’s leg.
Standard therapies include over-the-counter pain meds, corticosteroid spinal injections, and/or invasive spine surgery that sometimes involves disk removal and vertebrae fusion.
The problem, said Napoli, is that such options entail risks without assured relief.
“Steroid injections are effective only in portion of the patients, and generally require more sessions,” he noted. And though surgery safety has “largely improved,” Napoli pointed to the risk for bleeding and infection, the need for a minimum two- to three-day hospital stay, the high cost, and the fact that some patients ultimately realize little benefit.
By contrast, pRF is scalpel-free, delivering radio signals directly to affected nerves via a CT scan-guided electrode. The process, said Napoli, requires no hospital stay, is noninvasive, far cheaper and less risky.
“The rationale for using pRF on disk herniation is that we eliminate the inflammation process of the compromised nerve root,” he explained. “Without inflammation the pain fades, and the body starts a self-healing process that allows for complete resolution of the disk herniation in a large proportion of patients.”
For the study, the Italian investigators compared 128 lumbar herniation patients who underwent a single 10-minute round of CT-guided pRF with 120 patients who received one to three rounds of steroid injections.
All the patients had already undergone standard interventions, with poor results.
By the one-year mark following either treatment, a full “perceived” recovery was reported by 95 percent of the pRF patients, compared with just 61 percent of the steroid injection patients.
Dr. Daniel Park, director of minimally invasive orthopedic spine surgery at William Beaumont Hospital in Royal Oak, Mich., offered some caution on the findings.
He noted that because “the majority of people with back pain improve with time and exercise alone,” it remains an open question as to whether the pRF procedure really cured the condition.
Still, Park noted that diagnostic uncertainty can undermine the ability of surgery to get at the true source of a patient’s pain, given that “the problem with low back pain is that there are many causes of it, and physicians have trouble identifying the cause of pain.”
Nevertheless, he remains unsure if pRF is truly ready for prime time.
“Best case, I think [pRF] could be an option for people if they [have already] failed therapy and medication,” said Park. “It may be a similar option for people if they do not or cannot have steroid injections, but they need more treatment. I think this is experimental, and should not be first-line.”
The American Academy of Orthopaedic Surgeons offers more information on herniated disks.
SOURCES: Alessandro Napoli, M.D., Ph.D., interventional radiologist and professor, interventional radiology, department of radiological, oncological and pathological science, Sapienza University of Rome, Italy; Daniel Park, M.D., orthopedic spine surgeon, associate professor, orthopedic spine surgery, and director, Minimally Invasive Orthopedic Spine Surgery, William Beaumont Hospital, Royal Oak, Mich.; Nov. 27, 2018, Radiological Society of North America annual meeting, Chicago
Copyright ©2017 HealthDay. All rights reserved.
THURSDAY, Oct. 25, 2018 (HealthDay News) — Back pain is a common problem in the United States, but there are ways to protect yourself, an expert says.
“The back is a complex structure with many delicate parts, but with good judgment and healthy lifestyle habits — including proper lifting, good posture and exercise — it’s possible to avoid common back pain caused by strained muscles,” said Dr. Lawrence Lenke. He is director of spinal deformity surgery at the Spine Hospital at New York-Presbyterian in New York City.
For more complicated spinal problems such as scoliosis, stenosis, fractures or injuries, medical intervention is usually necessary, Lenke said.
“But each person with or without spinal problems can benefit from adopting healthier lifestyle habits to keep your spine as strong as possible,” he said.
Lenke offered this advice:
- Maintain a healthy weight, don’t smoke, do stretching and strengthening exercises that increase back and abdomen flexibility, and get regular cardiovascular exercise. If your job involves a lot of sitting, get up and walk around every 15 to 30 minutes.
- Maintain good posture even while sitting. Don’t slouch or hold your head too far forward. Be sure your feet are supported, hips are level with or slightly above the knees and your spine is slightly reclined. There should be a small arch in the lower back.
- When sitting at a computer, your shoulders should be relaxed and away from the ears. Your elbows should be at the sides, bent to about 90 degrees, and your wrists should be neutral — not bent up, down or away from each other. Your head should face ahead without being too far forward.
- When using a mobile device for non-voice activities, hold it up instead of bending your neck to look down. At just 45 degrees, the work your neck muscles are doing is equal to lifting a 50-pound bag of potatoes.
- When lifting, make sure objects are properly balanced and packed correctly so weight won’t shift. Keep the weight close to your body. And take your time. Bend at the hips and knees and use your legs to lift. Maintain proper posture with your back straight and head up.
The U.S. Office of Disease Prevention and Health Promotion has more on preventing back pain.
SOURCE: New York-Presbyterian Hospital, news release, Oct. 16, 2018
New research pinpoints three genes responsible for skeletal development that appear to be connected to chronic back pain.
The study authors said their findings could shed new light on the biological factors involved in the development of the condition and lead to new treatments for back pain, which is the leading cause of disability around the world.
For the study, an international team of researchers conducted a genome-wide association to search for gene variants associated with back pain. The study involved 158,000 adults of European ancestry. Of these participants, more than 29,000 suffered from chronic back pain.
The scientists identified three new genetic variants linked to chronic back pain. The SOX5 gene, which is involved in nearly all phases of embryonic development, had the strongest link to the condition.
Previous animal studies have shown that deactivation of this variant is linked to defects in cartilage and skeleton formation in mice.
The study also showed that another gene, which has been associated with intervertebral disc herniation (commonly called a slipped disc), was also linked to back pain. The researchers also identified a third gene involved in spinal cord development, which could affect the risk for back pain due to its influence on pain sensation.
The findings were published Sept. 27 in the journal PLOS Genetics.
“The results of our genome-wide association study point to multiple pathways that may influence risk for chronic back pain,” said study leader Dr. Pradeep Suri, of the U.S. Department of Veterans Affairs in Seattle.
“Chronic back pain is linked to changes in mood, and the role of the central nervous system in the transition from acute to chronic back pain is well-recognized,” he said in a journal news release.
“However, the top two genetic variants we identified suggest causes implicating the peripheral structures, such as the spine,” Suri added. “We expect that further large-scale genetic studies will reveal the importance of both peripheral and central contributors to the complex experience of chronic back pain.”
The U.S. National Institute of Arthritis and Musculoskeletal and Skin Diseases provides more information on chronic back pain.
SOURCE: PLOS Genetics, news release, Sept. 27, 2018
Health Tip: Change Poor Posture
(HealthDay News) — Everyone has back pain at some point, whether due to poor posture, heavy lifting, a spinal condition present a birth, or an exercise-related injury.
While other triggers for back pain may not be as easy to prevent, poor posture is a relatively easy fix.
Harvard Medical School suggests how:
- By imagining good posture, you can help create it. Imagine a straight line passing through your body from ceiling to floor (the ears, shoulders, hips, knees, and ankles line up vertically).
- Sit up straight with hands resting on your thighs. Keep your shoulders down and your chin level. Slowly draw your shoulders back and squeeze your shoulder blades together. Hold for a count of five; relax. Repeat three or four times.
- Stand facing a corner with your arms raised, hands flat against the walls, elbows at shoulder height. Place one foot ahead of the other. Bending your forward knee, exhale as you lean your body toward the corner. Keep your back straight and your chest and head up. Hold this position for about 30 seconds. Relax.
- Raise your right arm to shoulder level in front of you and bend the arm at the elbow, keeping the forearm parallel to the floor. Grasp the right elbow with your left hand and gently pull it across your chest so you feel a stretch in the upper arm and shoulder on the right side. Hold for 20 seconds; relax both arms. Repeat three times on each side.
Copyright ©2017 HealthDay. All rights reserved.
Shoulder pain is a common symptom for athletes and office workers alike. These simple exercises can improve flexibility and prevent future injury.
The shoulder’s complex structure makes it susceptible to injury, especially from one-too-many many weightlifting exercises. Whatever the cause of your pain or discomfort, the healing process often involves physical therapy to stretch and strengthen the surrounding muscles.
Be sure to consult a doctor before beginning a physical therapy regimen, as shoulder pain can be a symptom of a variety of conditions, like impingement or a rotator cuff tear. The following exercises offer gentle stretching and light conditioning to get you on the road to recovery.
1. PENDULUM EXERCISE
The pendulum exercise can help you recover from a shoulder injury, as it encourages blood flow and develops your range of motion. To get started, stand near a table with your feet slightly more than shoulder width apart. Place the hand of your uninjured arm on the table, then bend over and let your injured arm dangle toward the floor. Shift your body weight in order to create movement in the arm: forward and back, side to side, or in a small circle. Do not engage your shoulder muscles, but let the arm swing freely.
Start with 30 seconds of motion, a few times per day. Over the next few weeks you can gradually increase to several minutes of movement. You can also do a variation of this exercise on a bed if leaning over is hard on your back or neck, though you may need someone else to set your arm in motion. As your recovery progresses, you may be able to use light dumbbells to further stretch the shoulder — but be careful not to engage the muscles and risk re-injury.
This exercise targets the rotator cuff, building strength in the scapula and rhomboids to prevent and relieve pain. It can also help strengthen your back and improve your posture.
Stand with your feet below your shoulders, core engaged and knees at a slight angle. With a light dumbbell in each hand, palms inward, raise your arms out in front of you in a broad V shape. Then slowly draw your shoulder blades together. Be careful not to raise your arms above your shoulders. Hold this position momentarily, then lower. Repeat about ten times, for three sets.
3. EXTERNAL AND INTERNAL SHOULDER ROTATION
The rotator cuff muscles that allow for internal rotation are the supraspinatus and subscapularis. These let you draw your arm forward, with your palm facing in, and are commonly used in gym exercises and everyday life. Overuse causes these muscles to tighten, often leading to pain.
To begin strengthening the rotator cuff, you can practice a simple towel stretch. Grasp a towel or strap with your right hand and drape it over your right shoulder so it hangs down your back. Your right hand should be level with the back of your head, or lower toward the back of your neck if it’s comfortable. Turn your left arm behind your lower back with your palm facing behind you as you raise your left hand to meet and grasp the bottom end of the towel. Don’t force the stretch, but spend 15 to 30 seconds just at your point of flexibility. Try three repetitions on each side, and over time you will be able to bring your hands closer together at your back.
The external rotator muscles in the rotator cuff are the infraspinatus and teres minor. These typically get less training, which can create an imbalance and eventually lead to pain. To strengthen these muscles, use only one- or two-pound weights until you are able to easily add more, one pound at a time. Lie on your side, with your upper arm at a 90-degree angle, elbow against your side. Slowly rotate your forearm out and up, to your side, drawing your shoulder blades together until your palm faces forward. Hold for two seconds, then lower down. Repeat 10 times on each side.
4. SHOULDER RETRACTIONS
There are a number of exercises that involve shoulder retraction, and they all aim to correct a slumped posture. If your shoulder blades, or scapulae, are constantly hunched forward, it can affect how you use your shoulder joint, lift your arms, and stand. Poor posture can even affect the blood flow and nerves in your arms and hands, and make it harder to breathe by collapsing your chest. You should perform shoulder retraction stretches as much as possible to counteract these effects, and build up the muscles to help prevent shoulder pain.
To begin this exercise, stand straight, arms at your sides, with your shoulders relaxed. Pull your shoulder blades down and back, without arching your back. Hold this for 5-10 breaths, and repeat 3-5 times.
For a more targeted exercise, lie facedown on a mat, resting your forehead on a towel. Hold your arms straight out at your sides, palms down. Use your shoulder blades to lift your arms off the floor, holding this position for a few breaths.
EXERCISES TO AVOID
As you perform these exercises, keep in mind that shoulder pain can have many underlying causes, and without a doctor’s diagnosis you risk exacerbating the issue. Take your time when introducing new exercises into your routine to give your body time to adjust. To avoid further damage, be sure to start with no weight or very light weights for any strengthening activities.
You should also avoid exercises that are counterproductive to the healing process. Stay away from common gym exercises like dips, upright rows, overhead presses, and lat pull downs done behind the neck, which can put stress on the neck and shoulders.
If you’re suffering from shoulder pain, you may want to schedule an appointment with an orthopedic specialist. At CompOrtho, specialists will help identify any underlying conditions that may be causing you discomfort.