NSAIDS, Steroids for Back Pain: Is Too Much of Them a Bad Thing?

NSAIDS, Steroids for Back Pain: Is Too Much of Them a Bad Thing?

THURSDAY, May 12, 2022 (HealthDay News) — Persistent use of steroids and non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen to treat acute lower back pain may actually turn it into a chronic condition, a new study warns.

However, some experts who expressed concerns about the study published in the journal Science Translational Medicine pointed out that it was not a clinical trial, which is the gold standard for medical research, The New York Times reported.

The findings by the team at McGill University in Montreal are based on observations of patients, an analysis of a large patient database and an animal study.

The study results suggest we “need to think further about how to treat our patients,” lead investigator Dr. Luda Diatchenko, a professor who specializes in human pain genetics, told the Times.

Back pain is the most common type of pain, according to the U.S. Centers for Disease Control and Prevention.

The research is “intriguing, but requires further study,” Dr. Steven Atlas, director of primary care practice-based research and quality improvement at Massachusetts General Hospital, told the Times.

That opinion was echoed by Dr. Bruce Vrooman, a pain specialist at Dartmouth Hitchcock Medical Center in New Hampshire. But Vrooman also told the Times that the study was “impressive in its scope” and added that if the findings hold up in a clinical trial, it could “force reconsideration of how we treat acute pain.”

The study represents a “paradigm shift,” Dr. Thomas Buchheit, director of the regenerative pain therapies program at Duke University, told the Times.

“There is this unspoken rule: If it hurts, take an anti-inflammatory, and if it still hurts, put a steroid on it,” he said. But this study shows that “we have to think of healing, and not suppression of inflammation.”

Current guidelines advise people with back pain to begin with exercise, physical therapy, heat or massage, which can be as effective as pain medications but don’t cause the same side effects.

If those approaches don’t work, patients can try NSAIDs like ibuprofen, the guidelines advise. Acetaminophen (best known as Tylenol) is not an anti-inflammatory.

More information

Visit the National Library of Medicine for more on back pain.

SOURCE: The New York Times
Copyright ©2022 HealthDay. All rights reserved.
DON’T LET COLD WEATHER CAUSE JOINT PAIN IN HANDS AND WRISTS

DON’T LET COLD WEATHER CAUSE JOINT PAIN IN HANDS AND WRISTS

As the weather gets cooler, many people are affected by joint pain in the hands and wrists due to arthritis or injury. Bodily extremities are prone to “shutting down” circulation to maintain core body temperature. This might save your life in extreme situations; however, it just causes pain under most circumstances. Anyone with hand and wrist joint arthritis will tell you the harsh reality of increased body aches in the winter months.

Why Do My Hands Hurt More in Winter?

Cold weather joint pain doesn’t always indicate a new or more significant problem. People with arthritis often have chronic pain from inflammation and swelling, and the pain is much worse in cold weather. Scientists think that barometric pressure may be to blame. When the temperature goes down, the barometric pressure drops. As a result, the tissues in your hands and wrists expand, creating internal pressure and pain.

Fortunately, there are ways you can prevent and minimize your joint pain. If your hands and wrists ache during cold weather, here are ten ways to manage and avoid pain.

10 Ways to Manage Cold Weather Joint Pain in Winter

You probably won’t be surprised to learn that heat and a healthy lifestyle are critical when you’re trying to manage cold weather joint pain in the hands and wrists. A few small changes could make a big difference in your quality of life!

1. Stay Active

As tempting as it is to snuggle up and watch Netflix all winter, movement can significantly ease hand and wrist pain during cold weather.

Staying active with regular stretching and exercise keeps your muscles and joints healthy and your circulation strong. Not moving leads to stiffness and increased pain. General movements, like walking, yoga, or house cleaning, stimulate blood flow and boost circulation throughout your body. To exercise your hands and wrists, stretch and move your fingers and bend and rotate your wrists. Here are nine exercises for your hands and wrists from the Arthritis Foundation you can try.

2. Apply Heat

Heat helps soothe the pain of arthritis in hands and wrists that cold weather brings on. Use a heating pad or heated gloves to keep your hands and wrists nice and toasty. As a preventative measure, keep your hands and wrists warm all the time in cold weather. Invest in clothing with deep pockets and high-quality mittens. Mittens do a better job of trapping heat than gloves.

3. Eat Healthy

Joint health is tied to overall health. Maintaining a healthy diet can help reduce pressure and keep inflammation down in the hands and wrists. Consider adopting a diet rich in foods that mitigate joint pain. As a bonus, the foods that help are heart-healthy and delicious. Check with your doctor before making any diet changes if you have a condition that includes dietary restrictions.

4. Warm Up with Turmeric Tea

Is there anything more comforting than a hot cup of tea on a cold day? Turmeric (or curcumin) is a natural anti-inflammatory used for centuries in Chinese medicine. Flavor your tea with honey, lemon, or your favorite flavors, and wrap your aching hands around a warm, soothing mug.

5. Wear Compression Gloves

Compression gloves apply gentle pressure to achy joints and keep your hands warm. Good quality compression gloves are soft and flexible enough to wear all the time, and fingerless compression gloves are available if you prefer your fingertips uncovered.

6. Hydrate

Even slight dehydration can make you more sensitive to pain. Make sure you drink plenty of water every day, but especially when the temperature starts to drop. Your hands and wrists will thank you.

7. Take Vitamin D

Vitamin D plays a significant role in making you feel good, and that includes managing your joint pain. Unfortunately, vitamin D deficiency is common in the winter months, as people are outside much less and getting less sunshine. A vitamin D supplement might mitigate cold weather hand and wrist joint pain when sun exposure is limited. Check with your doctor before taking any supplements and get advice on how much vitamin D supplement you should take.

8. Wash Dishes

It may sound nutty, but washing dishes in a sink filled with hot, soapy water involves movement and is relaxing and soothing. Use a moisturizing dishwashing liquid to leave your skin silky and soft. Other options include soaking your hands and wrists in a warm Epsom salt solution or taking a hot bath.

9. Use a Topical Pain Relief Cream

A wide variety of over-the-counter and prescription analgesic creams are available to help minimize cold weather joint pain in the hands and wrists.

OTC medicated creams may contain:

  • Capsaicin
  • Salicylates (aspirin)
  • Counterirritants such as camphor and menthol
  • An anesthetic (typically lidocaine)

Topical prescription options include NSAID creams or steroid-based ointments.

10. Stay Positive

The winter months are often hard on mental health. Research has shown that people who experience negative moods and depression are more susceptible to pain. Their perception of pain levels is often magnified beyond expected levels. In the winter months, it’s important to stay active, healthy, and social—all aspects that help improve mental and physical health.

When to Call Your Orthopedic Specialist for Winter Joint Pain

At CompOrtho, we believe everybody deserves to live a comfortable life and have the best possible care. When you have hand and wrist pain, the orthopedic team will help you get back to living your active lifestyle. Call us immediately if you have:

  • Persistent swelling
  • Redness
  • Difficulty putting pressure on or using the joint
  • Constant or severe pain in the joints
How to Prevent Carpal Tunnel Syndrome

How to Prevent Carpal Tunnel Syndrome

Carpal tunnel can be a painful and even debilitating orthopedic condition. But it’s one that can be prevented with some simple lifestyle changes.

Carpal tunnel syndrome, a progressive condition marked by pain, numbness and tingling in the hands and wrists, is an extremely common condition. While it is most often associated with typing on a computer, carpal tunnel syndrome can strike anyone who performs repetitive tasks with their hands, such as cashiers, knitters, and assembly line workers. Or it can occur after an injury to the wrist or hand. Some pre-existing conditions, like diabetes and rheumatoid arthritis, are also associated with a greater incidence of carpal tunnel syndrome. Additionally, women tend to suffer from the condition at higher rates than men because their carpal tunnels are smaller.

That’s relevant to the condition because, as the name suggests, carpal tunnel syndrome is directly related to the carpal tunnel. In carpal tunnel syndrome, your median nerve, which spans the length of your arm and ends in the wrist, becomes compressed due to any of the reasons described above. That median nerve passes through the carpal tunnel, a narrow pathway of bone and ligament at the base of your hand, which is the reason for the condition’s name. Because the nerve controls the movements of your fingers apart from the pinky, the first sign of carpal tunnel syndrome is typically a tingling or numb sensation in the fingers. Some people may also experience pain and a burning sensation radiating up their arm to their elbow in addition to a weak grip.

6 Tips to Prevent Carpal Tunnel Syndrome

Obviously it is best to avoid carpal tunnel syndrome if at all possible. The good news is that you don’t have to switch jobs or give up your hobbies to avoid carpal tunnel syndrome. You can take measures to ward off the condition before the pain starts. Check out these 6 tips for ways to stop carpal tunnel syndrome in its tracks:

Go for a Neutral Wrist Position. Avoid bending your wrists sharply up or down whenever possible, including when you’re at work or simply in your daily life. Such exaggerated positions stress the nerve. Lift the pressure off by keeping your wrist in a straight, neutral alignment.

Lighten Up. You probably don’t realize it, but you may be striking your keyboard too hard. Go for a lighter touch and relax your hand and wrist as you type.

Take a Break to Stretch. Stopping your task for 10 to 15 minutes gives your hand and wrist a chance to rest. But make good use of your break time by stretching your wrist! One good exercise to try is to make a fist then release your fingers and fan them out. Stretch them as far as possible. Repeat 5 to 10 times.

Switch Hands. If you always perform a task with one hand, switch to the other if you can. This gives each hand and wrist a break from a continual and stressful motion. Of course this isn’t always possible, but make a point of switching wherever you can.

Change Your Desk Setup. How your desk and chair are arranged may be causing extra strain on your wrists. Ideally, you want your desk, chair, and keyboard to be arranged so that your forearms line up with your work surface. The idea is to avoid bending your wrists as much as possible. Also try to keep your elbows tucked to your sides when working at a desk.

Stay Warm. Cold air stiffens up joints and muscles. Although you may be unable to control the office thermostat, you can slip on a pair of fingerless gloves to keep your hands warm and limber.

Treating Carpal Tunnel Syndrome

If you suspect you have carpal tunnel syndrome, it’s time to go to the orthopedist for a proper diagnosis and treatment. Your orthopedist will begin by performing a number of physical tests to assess any nerve damage. Once they’ve assessed the extent of the condition, treatment can begin.

Carpal tunnel syndrome treatments typically begin with recommendations of conservative therapies including:

  • Avoiding repetitive motions for two weeks or more.
  • Applying ice packs to reduce swelling.
  • Taking non-steroidal anti-inflammatories medications.
  • Wearing a brace for four to six weeks to keep the hand and wrist immobile.
  • Working with a physical therapist on strengthening and stretching exercises after pain subsides.

In severe cases not helped by conservative treatments, your doctor may recommend carpal release surgery. In this procedure, the transverse carpal ligament is dissected to release pressure on the median nerve and enlarge the carpal tunnel.

Don’t Live with Wrist Pain

Healthy hands and wrists are critical when it comes to performing important functions in your everyday life. So don’t let pain stop you from doing your job or enjoying your hobbies! If you believe you may have carpal tunnel syndrome, it’s important to see a specialist right away to get to the bottom of the condition. The orthopedists at Comprehensive Orthopaedics can diagnose your condition and discuss treatment options with you to get you pain-free once again.

Why Does My Back Spasm?

Why Does My Back Spasm?

Does your back stiffen up and ache frequently? It could be due to back spasms. Learn what they are and how to treat them.

Back pain is one of the most common orthopedic complaints among adults in the U.S. In fact, the Centers for Disease Control and Prevention found that around a quarter of adults reported lower back pain in the past three months alone. Much of that discomfort is likely caused by back spasms.

Back spasms are involuntary contractions of the back muscles. The spasms can feel like anything from a minor ache to a sudden, sharp pain or a tightening of the muscles so severe it prevents movement. Your back muscles may spasm after an acute strain, such as lifting a heavy object, or after twisting your back in an unusual way — as you might while playing a sport like golf or football. Certain underlying orthopedic conditions including arthritis, spinal stenosis (a narrowing of the spinal canal), or a herniated disc can also cause back spasms.

Fortunately, muscle spasms rarely need to be treated with surgery. Instead, the discomfort usually resolves on its own with the help of some conservative treatments.

How to Treat Back Spasms

If you experience a back spasm, it’s best to see a doctor. The doctor will begin by asking you when the pain began to determine what may have caused it. If the pain started after you moved some heavy objects, for example, your doctor will likely diagnose the spasm as resulting from a muscle injury. Knowing what caused the spasm can help you prevent others from happening in the future. If your doctor deems it necessary, they may also order imaging tests to see if there are any broken bones or arthritis that might have contributed to the muscle spasm.

Once your doctor determines what caused the spasm, they can suggest some at-home treatments suited to your condition. Treatment typically relies on reducing the pain associated with the back spasm and getting the muscles to relax. Common treatments include:

  • Rest. Working out or attempting to carry out your normal activities following a back spasm will only strain your back muscles further. Take a day off from work and give your back some time to recover. If you must exercise, take a short walk. Walking speeds blood flow to the back, which promotes healing. Make sure that when you do walk, you stroll along an even path. Avoid uphill or downhill tracks that may aggravate your back pain.
  • Hot & Cold Therapy. An alternating program of hot and cold therapy can alleviate your back pain and unlock tense muscles. To reduce inflammation, apply a cold compress to the back. To loosen tight muscles, apply heat, which will rush healing blood to the area. To avoid damaging your skin, make sure never to leave the hot or cold pads on for more than 15 minutes at a time.
  • Medications. Back pain can be treated with over-the-counter nonsteroidal anti-inflammatory medications like ibuprofen, naproxen, and aspirin. Acetaminophen is not included in this list because while it can reduce pain, it won’t address inflammation. If your pain is severe, your doctor may prescribe muscle relaxants — but relaxants should only be used for a short period of time and you should be aware that they can cause side effects such as dizziness. If you need a more intensive intervention, another option is a trigger point injection into the knot of tight muscles. No matter which option you pursue, always consult with your doctor before taking any medication (including an over-the-counter drug) to ensure it doesn’t interfere with other medications you may be taking.
  • Physical Therapy. You may not realize it, but weak abdominal muscles can contribute to back spasms. A physical therapist can model exercises to strengthen the back and abdominal muscles and prevent future spasms — but remember: you should only attempt these exercises yourself when the back spasms have passed and the muscles can endure strenuous activity. In addition to guided physical therapy, pay attention to your posture throughout the day. When you sleep, make sure your upper body is at a slight incline with a pillow propping up your knees. When you’re relaxing during the day, try to sit in a recliner with your body at a slight incline with your knees bent and your legs supported. If you’re working at your desk, avoid slouching as much as possible.
  • Some Final Tips: To maintain the health and stability of your back, avoid staying in one position for too long. Back spasms are frequently the result of spending too much time in an awkward position. Also, remember to stretch and warm up your muscles before exercising. Cold muscles can stiffen from sudden movement and injure more easily. Make sure you also stretch after your workout to prevent your muscles from tightening. And be careful to always stay hydrated, whether you’re exercising or not. Your muscles need water to stay limber and keep from spasming.

Why Suffer From Back Pain?

If you experience back spasms or other back pain, there’s no reason for you to keep suffering. The physicians at Comprehensive Orthopaedics have helped many patients overcome persistent back pain. We’ll create a tailored treatment plan that will reduce your discomfort and help you feel your best, so you can enjoy your daily activities once again. Contact us today for a consultation.

How to Manage Back Pain During Pregnancy

How to Manage Back Pain During Pregnancy

A sore back often comes along with pregnancy. Here’s how to get relief.

Back pain is a common complaint among pregnant women. According to the Cleveland Clinic, 80 percent of expectant mothers experience low back and pelvic pain. Although the discomfort usually subsides after delivery, it may occur again during another pregnancy.

Back pain during pregnancy is a consequence of the changes your body is going through, but you don’t have to just stick it out. At-home treatments or a trip to an orthopedist can help relieve your discomfort so you can enjoy a comfortable pregnancy.

What Causes Back Pain During Pregnancy?

As the baby grows in your abdomen, your center of gravity naturally shifts forward. The extra weight of the baby combined with your forward tilt stresses your lower back and often causes pain.

Hormones play a role as well. A hormone called relaxin released during pregnancy loosens the ligaments in the pelvic area in preparation for the delivery through the birth canal. Yet the weakening of those ligaments saps your joints and lower back of the strength needed to support your back as it adjusts to the weight of the growing baby. This results in an aching back.

How to Manage Back Pain During Pregnancy

You can manage your pregnancy-related back pain with some at-home remedies and simple lifestyle changes. Always consult with your doctor about the best solutions, but here are seven techniques that are typically safe and effective.

  • Improve Your Posture. To counter-balance your forward tilt, stand up straight and keep your chest high. Relax your shoulders and back, and don’t lock your knees. A wide stance when standing provides optimal support. When sitting, make sure the chair has a supportive back, or slip a small pillow behind your lower back.
  • Lift Properly. If you must lift a heavy object, bend from your knees and lift with your legs. Don’t pick up the object by bending at your waist as that will strain your back. A better idea is to ask someone for help if you need to carry bulky items.
  • Wear the Right Shoes. Wearing high heels will exacerbate your forward-leaning posture. Switch to low-heeled shoes with good arch support. Another option is to wear a maternity belt to support your belly and lower back.
  • Get a Massage. A good massage is a relaxing way to take away your back pain during pregnancy (or anytime). Try booking an appointment with a massage therapist who specializes in treating pregnant women.
  • Stay Active. Exercises that strengthen your core muscles or your quad muscles can relieve back pain. Prenatal yoga with its emphasis on stretching is also beneficial. Try gentle workouts such as walking or water exercises, too. Just ask your doctor before starting any new exercise routine.
  • Try Hot & Cold Therapy. Hot and cold therapy is a tried and true method for relieving back pain. When you heat your back, blood rushes to the sore muscles, which relaxes them and reduces pain. Cold has the opposite effect, but can be just as beneficial, particularly if you notice any swelling. By constricting the blood vessels, cold cuts down on the swelling and the pain.
  • Change Your Sleep Position. To help alleviate back pain, sleep on your side with your knees bent. You can slip a pillow between your knees if you’d like. If you do lie on your back, put a pillow under your back to support it, as lying straight can block blood flow to the fetus.

If you’ve experienced back pain before, it’s likely your back will be sore as you carry your child. But you can be proactive and try these measures to reduce your pain.

Could Electrode ‘Pulses’ Cut Back, Leg Pain Without Drugs?

Could Electrode ‘Pulses’ Cut Back, Leg Pain Without Drugs?

THURSDAY, Aug. 26, 2021 (HealthDay News) — A new approach to spinal cord stimulation may drastically reduce chronic back pain, a small pilot study suggests.

The study, of 20 patients with stubborn low back pain, tested the effects of implanting electrodes near the spinal cord to stimulate it with “ultra-low” frequency electrical pulses.

After two weeks, 90% of the patients were reporting at least an 80% reduction in their pain ratings, the researchers found.

The improvement is striking, experts said. But they cautioned that the study was too small and short-term to draw conclusions.

“That improvement is almost too good to be true,” said Dr. Houman Danesh, who directs the division of integrative pain management at Mount Sinai Hospital in New York City.

Danesh, who was not involved in the study, said the results could be skewed because the patient group was so small. On the other hand, he said, it’s possible the researchers “have really caught onto something.”

Only larger, longer-term studies can answer that question, Danesh said.

It’s not that electrical stimulation, per se, is unproven for back pain: Pain management specialists, including Danesh, already offer the approach to some patients.

It can be done non-invasively, through transcutaneous electrical nerve stimulation (TENS) — where electrodes are placed on the skin over areas of pain, to deliver electrical pulses to the underlying nerves.

Another option is spinal cord stimulation. There, doctors implant electrodes near the spinal cord, along with a pulse generator that is placed under the skin of the buttocks or abdomen. Patients can then use a remote control to send electrical pulses to the spinal cord when they are in pain.

The theory is that the stimulation interrupts the spinal cord’s transmission of pain signals to the brain.

Right now, spinal cord stimulation is reserved for certain tough cases of back pain — for example, when people continue to have pain even after back surgery, Danesh said.

The effectiveness of the approach, though, varies from person to person, and researchers have been looking at ways to refine it.

For the new study, a U.K./U.S. team tested what it’s calling ultra-low frequency spinal cord stimulation.

The researchers started with lab experiments in rats, finding that the electrical pulses blocked most transmissions of pain signals along the spinal cord — in a manner that seems distinct from current spinal cord stimulation techniques.

They then moved on to 20 patients with chronic low back pain, many of whom also had pain running down the leg (commonly known as sciatica). The researchers implanted electrodes in all 20; two patients dropped out due to infection at the surgical site.

Among the 18 patients who finished the two-week study, pain ratings improved by an average of 90%. Nearly all of the patients had improvements of at least 80%.

When the electrodes were removed, patients’ back pain came roaring back, according to findings published Aug. 25 in the journal Science Translational Medicine.

“The pain improvement is dramatic — that’s one of the features of this treatment that we find so impressive,” said senior researcher Stephen McMahon, who directs the London Pain Consortium at King’s College London in the United Kingdom.

“Other successful pain therapies more typically find 30% to 50% clinical improvement,” he added.

That said, McMahon cautioned that the study was small and short-term. Further clinical studies will be needed to define the therapy’s effectiveness and how long it lasts, he said.

One of the strengths of this early study is that it “shows directly a powerful inhibition of pain-related signals,” McMahon noted.

Having identified “such a robust mechanism,” he added, it may be possible to use the technique for a range of conditions other than back pain.

The study was funded by Presidio Medical, Inc., of South San Francisco, which is developing the technology.

Danesh said, “I think this is continuing a trend of a technological jump in the use of spinal cord stimulation.”

However, he stressed, no matter what treatments people use for low back pain, some low-tech fundamentals remain key — namely, addressing bad posture habits and muscle strength imbalances.

Sitting all day, and the resulting weakening of the gluteal muscles (in the buttocks), is a big culprit, Danesh noted.

So strengthening those muscles, along with being generally active, is a must.

“You have to be mobile, when you’re in pain and when you’re not,” Danesh said. “Movement is medicine.”

More information

Johns Hopkins University has more on non-surgical treatments for low back pain.

SOURCES: Stephen McMahon, PhD, FMedSci, professor, physiology, and director, London Pain Consortium, King’s College London, U.K.; Houman Danesh, MD, associate professor, anesthesiology, perioperative and pain medicine, Icahn School of Medicine at Mount Sinai, and director, integrative pain management, Mount Sinai Hospital, New York City; Science Translational Medicine, Aug. 25, 2021, online

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