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.
Can a Standing Desk Reduce Back Pain?

Can a Standing Desk Reduce Back Pain?

Sitting at your desk all day can cause back pain. Will switching to a standing desk setup help? Read on to find out.

COVID-19 has changed many aspects of American life, and one of most pronounced is how and where we work. To stop the spread of the virus, companies allowed workers to work from home or split their hours between office and home using a hybrid work model. The result was a huge surge in employees who work from home.

As people began to work from home more regularly, they quickly realized they didn’t have a proper desk setup in their houses. Instead of an office desk and chair, they crouched on their sofa with a laptop or on a stool at their kitchen table, leading to back and neck pain. Even those who had dedicated office space in their residence with a desk and chair often suffered from lower back discomfort. To alleviate back stiffness, some workers considered purchasing a standing desk, which people frequently claim can reduce some of the health risks caused by sitting for long periods of time. But can these devices actually reduce your neck and back pain? Or might they even lead to more serious pains?

How Sitting All Day Affects Your Back

Sitting has been termed the “new smoking” due to the damage it can do to your health. While this may seem like an exaggeration, there’s no denying the health risks caused by extensive sitting. When you sit for eight hours a day at work and then more at home in front of the television, you’re not active and that can lead to serious health problems across the board.

When it comes to your back, sitting for long hours in a chair can strain the muscles in your back, neck, hips, and buttocks. Sitting can also compress the discs in your spine, leading to stiffness and pain. And if you slouch forward — as many of us do when seated — that pressure on your spine increases. In addition to simply sitting, the way you set up your desk and computer may also be causing problems. If the computer is too low or too high, you may be stressing your neck muscles in addition to your back.

How a Standing Desk Can Help

Now that you know how harmful sitting all day can be, you may want to try a standing desk or a sit-standing desk, which lets you switch between the two positions. One study found workers using a sit-standing desk reported less lower back pain. Other studies have reported standing at a desk burns more calories and results in better productivity. Generally speaking, standing may force you to improve your posture which in turn can take the pressure off your lower back.

However, a standing desk will not cure an underlying orthopedic issue, such as scoliosis or a herniated disc. And standing could exacerbate leg swelling or foot pain.

Staying Healthy When Using a Standing Desk

To avoid back pain with a standing desk, follow these tips:

Set Up Your Desk Correctly. Incorrectly setting up your standing desk or standing with poor posture could strain your back and neck more than sitting. Therefore, it’s important to rearrange your desk layout and positioning so you don’t end up with extra back pain. First, adjust your standing desk so your head, neck, and spine are aligned and your computer monitor is at eye level. As you stand, move your head slightly back and your spine in an “S” curve. Your elbows should be at a 90-degree angle, with your wrists resting flat on the desk.

Take the Pressure off Your Feet. It’s not just your back that will bear the strain of standing all day — your feet absorb most of your weight as you stand. To take the pressure off your feet, wear comfortable supportive shoes, or place a cushioned mat under your feet for extra support.

Don’t Make the Switch Overnight. Suddenly switching from a seated desk to a standing desk can be a shock to your body. Ease into your new setup by alternating between sitting and standing throughout the day until your body adapts and you find the most comfortable position.

Make a Homemade Standing Desk. Before you make a large investment in a standing desk, devise a homemade one at home. Prop up your computer on a pile of books or boxes and give it a try. You may find a standing desk isn’t helpful, or switching between standing and sitting is better for your back.

Get Moving. Whether you sit or stand all day, remember to get up and move frequently. Take a break to walk around or stretch your legs and back to unlock stiff muscles. At the end of the day, your back will feel much better if you’ve moved throughout the day.

Sit Properly. If you decide to stay seated or alternate between sitting and standing, sit properly with your lower back straight, shoulders relaxed, and feet on the floor. For more back support, insert a pillow along your lower spine.

Are You Suffering from Lower Back Pain?

For years the doctors at Comprehensive Orthopaedics have successfully treated back pain with conservative and surgical methods. We will diagnose your condition and recommend therapies so you can live pain-free.  Contact us today for a consultation.

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.

Watch Their Backs — Don’t Overload Those Schoolbags

Watch Their Backs — Don’t Overload Those Schoolbags

After more than a year at home, children are heading back to classrooms across the country. But they’re also toting heavy bags on their backs again.

A backpack that fits properly — and is not overloaded with binders and books — will help prevent injury.

“With a focus on getting back in the classroom and returning to ‘normal,’ it’s easy to overlook possible injuries caused by everyday school supplies,” said Dr. Emily Dodwell, a pediatric orthopedic surgeon at the Hospital for Special Surgery (HSS) in New York City and spokesperson for the American Academy of Orthopaedic Surgeons.

“Backpacks might not seem that high on the list of safety hazards for children, but if too heavy or worn improperly, they can cause pain or injury to muscles and joints,” she said in a hospital news release.

Backpacks should never weigh more than 10% to 20% of a kids’ body weight, the American Academy of Pediatrics advises. (For example, a child who weighs 50 pounds should carry no more than 10 pounds, max.)

Heavy backpacks are often to blame when pediatric orthopedic surgeon Dr. John Blanco sees more kids and teens with back and shoulder pain at the start of the school year.

All pain should be taken seriously, Blanco said. But, he cautioned, there is no evidence that carrying a heavy backpack could lead to long-term problems such as scoliosis or a hunchback, as some parents fear.

“It’s not uncommon for students to lug around 30 pounds, which is usually too heavy based on their body weight,” said Blanco, who practices at HSS Long Island in Uniondale, N.Y. “Most families have a scale at home and can use it to weigh the backpack and take out items that are not needed for the school day.”

Dodwell and Blanco offered these additional suggestions for selecting and using a backpack to keep kids injury-free.

  • Choose a sturdy backpack with wide, padded shoulder straps and a padded back. Tighten straps to keep the pack close to the body, which strains the back less.
  • A waist strap prevents the backpack from moving side to side.
  • Wear the pack properly, over both shoulders. This distributes the weight evenly. Put heaviest items closest to the middle of the backpack, rather than in front compartments.
  • Choose a rolling backpack if the school allows it and doesn’t have stairs.
  • Encourage kids to use their lockers, rather than lug everything throughout the day.
  • Teach young people how to pick up a backpack properly. They should bend their knees, rather than bending at the waist.

Over time, the kids’ muscles will get stronger, Blanco said.

More information

The American Academy of Pediatrics offers more back-to-school safety tips.

SOURCE: Hospital for Special Surgery, news release, Sept. 9, 2021

Copyright ©2021 HealthDay. All rights reserved.
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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