Which Exercise Regimen Works Best to Ease Lower Back Pain?

Which Exercise Regimen Works Best to Ease Lower Back Pain?

Chronic lower back pain can make the most routine tasks difficult. But a new study suggests patients can learn new, practical and less painful ways to move through individualized “motor skills training,” or MST.

A two-year study of nearly 150 patients found that MST appears to better relieve disability from lower back pain than a more common but less-tailored exercise regimen broadly focused on improving strength and flexibility.

“Our findings suggest that motor skill training in functional activities is an effective and efficient treatment that results in important short-term and long-term improvement in function in people with chronic low back pain,” said study lead author Linda Van Dillen. She’s a professor of physical therapy at Washington University in St. Louis School of Medicine.

Lower back pain is incredibly common, and the No. 1 cause of disability, according to Van Dillen. It is the most frequent cause of chronic pain among American adults.

Van Dillen notes that at least 60% to 80% of adults will experience lower back pain, and “almost half of them will have had a major episode by age 30.”

Yet there is no accepted standard of care for chronic lower back pain patients, nor a clear sense of what type of exercise intervention might work best, researchers said.

To get a better handle on the issue, Van Dillen’s team focused on a pool of patients diagnosed with what is known as “non-specific” lower back pain. That means they have tension, stiffness and/or soreness in the lower back area for which there is no clear cause.

Before the study began in December 2013, all participants had struggled with lower back pain for at least a year.

Participants, who ranged in age from 18 to 60, were randomly divided into two groups. One group received “strength and flexibility treatment for the trunk and lower limbs” — a common exercise intervention, according to Van Dillen.

The other group took part in MST, which teaches patients new ways to carry out everyday tasks rendered difficult by back pain.

MST aims to zero in on each patient’s personal posture and movements throughout an entire day, and then to tailor pain-free movement strategies to their specific routines.

Both groups received six weeks of training for one hour per week. Half of each group also received three “booster” treatment sessions six months later. Disability questionnaires were completed at the outset, and at six months and one year out.

While both groups’ ability to perform daily functions without pain improved, the MST group achieved “significantly” better gains (meaning lower disability scores) over the study period.

MST patients were more satisfied with their care and less likely to use drugs for back pain. They were also less fearful of addressing work-related needs, and less likely to avoid normal daily activities, the study found.

Six months out, MST patients had fewer acute back pain flare-ups and were more likely to keep up with their exercises. And after a year, when their back pain flared up, it was less severe, researchers said.

Dr. Daniel Park, an associate professor of orthopedic surgery at Oakland University William Beaumont School of Medicine in Rochester, Mich., reviewed the findings.

He said it remains to be seen just how much better MST is compared to more common interventions.

While Park said the findings appear to be statistically significant and support the benefit of therapy on back pain, he stopped short of saying the researchers had shown “meaningful improvement.”

“I think any structured therapy can be beneficial, because you want the muscles moving and working to help with back pain,” Park said. “We used to think rest and relaxation was better. But studies show only short-term rest is beneficial, and actually if you rest too long, you can have worse outcomes.”

As a result, he added, many doctors advise patients to rest for the short term and then to begin exercising to help the muscles.

The findings were published Dec. 28 online in JAMA Neurology.

More information

Learn more about lower back pain at the U.S. National Institute of Neurological Disorders and Stroke.

SOURCES: Linda Van Dillen, PT, PhD, professor, physical therapy and orthopedic surgery, Washington University School of Medicine in St. Louis, Mo.; Daniel Park, MD, associate professor, orthopedic spine surgery, Oakland University William Beaumont School of Medicine, Rochester, Mich., director, minimally invasive orthopedic spine surgery, William Beaumont Hospital-Royal Oak, Rochester, Mich.; JAMA Neurology, Dec. 28, 2020, online

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How to Talk to Your Doctor About Arthritis Pain

How to Talk to Your Doctor About Arthritis Pain

SUNDAY, Dec. 20, 2020 (HealthDay News) – Chronic pain can be excruciating, debilitating and hard to describe.

Yet the best way to get the right treatment for the exact pain you’re experiencing is to put those symptoms into words, so your doctor can pinpoint a diagnosis and help you find relief.

The Arthritis Foundation created a guide with suggestions for communicating your discomfort. Included are questions ranging from, “What does the pain feel like?” to “How does the pain affect your life?” and specific details to share.

When describing what the pain feels like, be as specific as possible. If you describe it as aching or dull, that may point to muscle strains or arthritis. A description of shooting, tingling or burning might point to nerve pain as the cause. Sharp or stabbing pain might suggest injuries to a bone, muscle or ligament. Throbbing could be a headache, abscess or gout. Tightness may be a muscle spasm.

Where does it hurt? Is it in one location or does it travel? Is it steady or does it come and go? Try to be precise about location. For example, someone might describe a shoulder pain as deep in the joint or on the muscle surface.

Rate the intensity of your pain on a scale of 0 to 10, with 0 being pain-free and 10 being unimaginable. This can help a doctor determine the type or dosage of pain medicine you may need.

“Some patients come in the door with an eight on the pain scale, and they’re functional. Other patients walk in with a three and they’re disabled,” said Dr. Thelma Wright, medical director of the Pain Management Center at the University of Maryland Rehabilitation and Orthopedics Institute. “Function is huge.”

Keep a journal tracking when you hurt and if it’s worse at certain times of day.

“If I notice that a patient has higher pain scores in the morning versus in the evening, I may tailor my medication management to that,” Wright said.

Does anything ease your pain? In your journal, make note of what you’ve tried and what helped or hurt. Options could include heat or ice, rest or over-the-counter pain medicine.

Be aware that it could take a while to find relief. Being able to communicate your pain will help get you closer to a solution.

“It’s a trial-and-error process,” Wright said. “You might go through several medications before you get the best combination.”

More information

Johns Hopkins Medicine offers more information on chronic pain.

SOURCE: Arthritis Foundation, news release, Dec. 14, 2020

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A ‘Stunning’ Alternative Rx for Arthritic Joints?

A ‘Stunning’ Alternative Rx for Arthritic Joints?

THURSDAY, Nov. 19, 2020 (HealthDay News) — A procedure that “stuns” pain-sensing nerves might offer relief to people with severe arthritis of the hip or shoulder, a small, preliminary study suggests.

The procedure is a form of radiofrequency ablation, where doctors use needles to send a low-grade electrical current to nerves that are transmitting pain signals from the arthritic joint to the brain. The current heats and damages the nerve fibers, rendering them unable to deliver those pain messages.

In the United States, a number of ablation devices are cleared for treating low back pain and knee osteoarthritis.

At this point, the procedure is slowly becoming a more established treatment, said Dr. Felix Gonzalez, a radiologist at Emory University School of Medicine in Atlanta.

But whether ablation can help patients with severe hip or shoulder arthritis is unclear.

To find out, Gonzalez and his colleagues treated 23 patients whose hip or shoulder pain had become so bad that anti-inflammatory painkillers and cortisone injections — two standard treatments — were no longer helping.

Before undergoing ablation, and again three months later, patients answered standard questionnaires gauging their pain and daily function.

In the end, the study found, patients with shoulder arthritis reported an 85% drop in their pain ratings, on average. Among hip arthritis patients, pain declined by an average of 70%.

Gonzalez called the results “promising” and said, in his experience, there have been no major complications from the procedure, such as bleeding or infections — though those are potential risks.

And before the ablation is done, Gonzalez explained, patients go through what is basically a trial run. They are given an injection of numbing medication near the nerves believed to be generating the pain signals. If the pain abates, that means targeting the same nerves with ablation will likely work, too — longer term.

It’s too soon, however, to judge the effectiveness of the approach for shoulder and hip pain, according to Dr. Rajat Bhatt, a rheumatologist who was not involved in the study.

None of the study patients received a placebo (inactive treatment) to serve as a comparison, said Bhatt, of Prime Rheumatology in Katy, Texas. So it’s possible at least some of the pain relief came from the fact that patients received a novel therapy.

“With pain, there’s generally a large placebo effect,” Bhatt pointed out.

Larger studies, with a comparison group, are still needed, he said.

Gonzalez is scheduled to present the findings at the annual meeting of the Radiological Society of North America, being held online Nov. 29 to Dec. 5. Studies reported at meetings are generally considered preliminary until they are published in a peer-reviewed journal.

Osteoarthritis is exceedingly common, affecting more than 32.5 million Americans, according to the U.S. Centers for Disease Control and Prevention.

The condition arises when the cartilage cushioning the joint breaks down over time, leading to pain, stiffness and decreased range of motion.

People with osteoarthritis often take over-the-counter painkillers, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). But besides being only moderately effective, the drugs are not without risks: Prolonged use is linked to increased risks of heart disease and kidney damage.

Corticosteroid injections, which reduce inflammation, are the next option. But their effectiveness wanes over time, Bhatt said, and there are long-term safety issues, including a risk of cartilage damage.

Beyond that, Gonzalez said, there are essentially two options for more severe pain: joint replacement surgery or opioid painkillers.

“But not everyone is a candidate for surgery, because of health reasons,” Gonzalez said. “And some patients don’t want it.”

Opioids, meanwhile, carry their own well-documented problems, including the potential for addiction.

“So we need something to fill the gap,” Gonzalez said.

Ablation stands as an additional therapy, he said, but it’s not a “cure.” For one, it addresses pain — not the underlying joint damage of arthritis. And the pain is not banished forever: The nerve fibers eventually grow back.

When ablation is used for knee osteoarthritis, Gonzalez said, the pain relief typically lasts 6 months or more — and up to two years in some patients. The procedure can be repeated.

In this early study, patients were only followed for three months. So it’s not clear how long the pain relief will last, Gonzalez said.

And while ablation is coming into wider use for certain pain conditions, people may not be able to find it locally. Gonzalez said some of his patients come from hours away to get the treatment.

More information

The Arthritis Foundation has more on osteoarthritis.

SOURCES: Felix Gonzalez, MD, assistant professor, department of radiology and imaging sciences, Emory University School of Medicine, Atlanta; Rajat Bhatt, MD, Prime Rheumatology, Katy, Texas; presentation, Radiological Society of North America virtual annual meeting, Nov. 29 to Dec. 5, 2020

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1 in 3 Americans With Arthritis Say Pain, Symptoms Persist

1 in 3 Americans With Arthritis Say Pain, Symptoms Persist

TUESDAY, Oct. 20, 2020 (HealthDay News) — About 30 million U.S. adults live with osteoarthritis and the pain and stiffness it causes, a new survey finds.

And nearly one-third of these people said their symptoms are not well-managed, according to the Arthritis Foundation survey of almost 2,000 adults. In osteoarthritis, the cartilage cushioning the joints gradually wears down, leading to swelling, and limiting a person’s abilities to do the activities they want and need to do every day.

“Pain is debilitating. My back and hip pain are so bad that I have trouble getting out of bed,” wrote one survey respondent. “Each step is excruciating, and I wonder how much longer I can deal with the pain.”

The results of the recently released survey are clear, according to a news release from the foundation. Patients want to see more treatment and care options to reduce the impact of arthritis pain on their daily lives.

Respondents said that pain was difficult to manage with few options, including anti-inflammatory medications (NSAIDs), diet, exercise, opioids, braces and canes. Some reported using meditation and prayer. Surgery was considered a last resort.

About 65% said they use NSAIDs or topical medications to manage their pain, about 29% rely on therapies like physical therapy or massage, and another 29% said total joint replacement helped. Research shows that staying physically active can improve arthritis pain, according to the foundation.

More than one-third said COVID-19 concerns had caused them to cancel or skip health care appointments. Some also reported that pain levels had increased because of COVID-19 restrictions impacting their ability to access treatment and activity.

The primary change patients want to see is for health insurance to increase coverage of new arthritis treatments, though more than half said they were only interested in a treatment for pain if it didn’t also increase their joint damage, according to the foundation.

“You spend a lot of time & effort trying not to think about it because what you focus on magnifies,” wrote one survey respondent. “You hate pain scales because how do you rate something that is always there? Oftentimes it’s not the pain’s intensity but rather the duration.”

About 82% want to invest in research to explore new ways to treat or cure osteoarthritis, the survey found. About 65% want to advocate for better access to treatments and 61% want to support the development of new products to help with daily tasks.

More information

Individuals with osteoarthritis can share experiences by taking the Live Yes! INSIGHTS assessment and learn more at the Arthritis Foundation.

SOURCE: Arthritis Foundation, news release, August 2020

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Which Exercise Regimen Works Best to Ease Lower Back Pain?

In Many Cases, Hip Replacement Also Eases Back Pain

THURSDAY, July 9, 2020 (HealthDay News) — If you have a bad hip and lower back pain, a new study suggests that hip replacement surgery may solve both issues at once.

Researchers at the Hospital for Special Surgery in New York City focused on 500 patients who underwent hip replacement surgery and followed up with them one year after the operation.

Over 40% reported pain in their lower back prior to hip surgery. Of that group, 82% saw their back pain vanish after surgery.

It was “completely gone,” said study author Dr. Jonathan Vigdorchik, a hip and knee surgeon at the hospital.

He said that experts in his field have studied the connection between the hip and back for years.

A hip replacement is a surgical procedure to replace a worn-out or damaged hip joint with an artificial one. On average, it is a highly successful operation, with 95% of patients experiencing pain relief, according to the Hospital for Special Surgery.

“It’s an outstanding procedure,” said Dr. Craig Della Valle, a professor of orthopedic surgery at Rush University Medical Center in Chicago. “There are very few things in medicine that are close to hip replacement in terms of how good of a medical procedure it is.” He wasn’t part of the study.

But Vigdorchik added that patients who have undergone some types of spinal surgery before a hip replacement face five times the rate of complications compared to the general population — for which the complication rate is less than 1%.

This knowledge prompted him to dive deeper into the hip-back interplay.

“We noticed that there are certain conditions where a hip condition can actually put undue stress on the back,” Vigdorchik explained.

He and his fellow researchers wanted to find out how effective a hip replacement can be in eliminating low back pain, and determine which patients are more likely to benefit.

The patients whose low back pain resolved after the surgery were those with “flexible spines,” according to Vigdorchik. When a person’s spine is flexible, a stiff or poorly functioning hip can drive the spine to move more than usual, causing pain.

Those with normal flexibility in their spine were also highly likely to have their pain resolved.

“Those are the patients whose back pain went away completely after their hip replacement, because their back pain was probably caused by their hip not functioning properly to begin with,” said Vigdorchik.

But the back pain in patients with stiff spines did not go away. Patients with stiff spines already have serious arthritis of the spine, and replacing the hip is unlikely to relieve their pain.

But how can you know if your back pain could be resolved with a hip replacement?

It’s not easy to figure that out on your own, according to Vigdorchik. “It really relies on a good physical exam, and then good X-rays,” he said.

Before a patient undergoes a hip replacement, surgeons will typically take an X-ray of the patient lying down.

In this study, researchers took X-rays of their patients standing up and sitting down, both before and after the surgery.

These X-rays allowed them to see how the hip and spine moved in relation to each other, and assessed the flexibility of their spine, as the patient switched from a standing position to a seated position.

Vigdorchik encouraged other surgeons to utilize these X-rays to identify patients whose ailing backs may be relieved by a hip replacement.

He also advised surgeons in the field to “look beyond just the hip.”

“Anytime they’re looking at the hip, they should also look at the back, and anytime they’re looking at the knee, they should also look at the hip,” Vigdorchik said.

The existence of an interplay between the hip and back is well known to experts, but Della Valle said that this study showed how consistent it is.

He said the study gives surgeons in the field “some tools to try to predict which patients you can tell, ‘Yeah, your back pain will get better,’ and others, well, maybe it won’t.”

The study was published online recently during a virtual meeting of the American Academy of Orthopaedic Surgeons.

More information

There’s more about low back pain at the U.S. National Institutes of Health.

SOURCES: Jonathan Vigdorchik, M.D., orthopedic surgeon, hip and knee replacement, Hospital for Special Surgery, New York City; Craig Della Valle, M.D., professor, orthopedic surgery, Rush University Medical Center, Chicago; AAOS 2020 Virtual Education Experience, March 26, 2020, online

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Which Surgery Works Best for Lower Back Pain?

Which Surgery Works Best for Lower Back Pain?

TUESDAY, June 16, 2020 (HealthDay News) — Patients with lower back problems often worry about how much time they’ll need to recover if they have surgery. A new study finds similar results for two common minimally invasive spine procedures.

Surgery may be recommended for degenerative conditions of the lower spine, such as a herniated disc or spinal stenosis.

Researchers at Hospital for Special Surgery in New York City compared 117 patients who had minimally invasive lumbar decompression surgery and 51 who had minimally invasive lumbar spine fusion surgery. All the procedures were performed by the same orthopedic surgeon.

“Our study is the first of its kind to look at return to activities and discontinuation of narcotic pain medication after single-level lumbar decompression or single-level lumbar spine fusion performed with a minimally invasive technique,” said senior investigator Dr. Sheeraz Qureshi, a spine surgeon at the hospital.

It took the 117 decompression patients a median of three days before they no longer required narcotic pain medication, and seven days for the 51 spinal fusion patients.

Among patients who drove before their surgery, decompression patients took a median of 14 days to resume driving, and 18 days for the fusion patients.

There was no statistically significant difference between the two groups in how long they took to return to work, according to the study.

The findings are important because standard open spinal fusion surgery generally requires a much longer recovery and slower return to activities than standard lumbar decompression, Qureshi noted.

“In our study, all the patients in both groups were able to resume driving and return to work within three weeks of surgery,” he said in a hospital news release.

“When you compare this time frame to that of standard open spinal fusion surgery, it’s really striking. Patients having a standard spinal fusion could take six months or longer for a full recovery,” Qureshi said.

Degenerative conditions of the lower spine are common causes of pain and disability, and surgery may be considered when initial treatments such as medication and physical therapy don’t provide relief.

Lumbar decompression surgery involves removal of a small section of bone or part of a herniated (bulging) disc that is pressing on a nerve. Spinal fusion is a more extensive surgery in which surgeons join two or more vertebrae together, sometimes using screws and connecting rods.

The findings were presented online earlier this year at a virtual meeting of the American Academy of Orthopaedic Surgeons. Data and conclusions released at meetings are usually considered preliminary until peer-reviewed for publication in a medical journal.

More information

The American Academy of Family Physicians has more on low back pain.

SOURCE: Hospital for Special Surgery, news release, June 15, 2020

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