Back Pain Patients Seek Pain Relief First, Mobility Second

When asked to choose between a treatment that would reduce back discomfort and one that would help them stand and walk, the vast majority of patients wanted to ease their pain, a new study found.

“There has long been a debate in the medical community over striking the right balance between pain relief and physical function,” said the study’s lead author, Dr. John Markman, director of the Translational Pain Research Program in the University of Rochester Department of Neurosurgery in Rochester, N.Y.

“While physicians have leaned toward the need to increase mobility, this study shows that patients have a clear preference for pain relief,” Markman said in a university news release.

The study’s authors focused on nearly 270 patients who had trouble standing and walking and suffered from chronic back pain associated with lumbar spinal stenosis. The participants were asked to choose between a therapy that reduced their pain and one that would enable them to stand and walk. Nearly 80% of the patients said they would rather have relief from their pain than greater mobility, the study published recently in Neurology found.

“Even the patients who could not stand long enough to pick up a letter from their mailbox or wash the dishes after dinner chose pain relief,” said Markman.

The authors pointed out patients are playing a greater role in setting new standards for pain relief, demanding new medications that are both safe and effective.

Wisdom Wednesday: Chronic Low Back Pain

This new patient has been suffering from left sided sciatica for three months. About six weeks ago, he was hospitalized and treated for sciatica. During the hospital stay, he developed a perforated large intestine and had surgery, removing about a foot of large intestine and installing a colostomy bag. Subsequent surgery to remove the colostomy bag was successful. However, he developed C. difficile as a result of antibiotic therapy. After a few weeks, they were able to control the diarrhea well enough to send him home. He still has radiating pain down his left leg, his bowels are still inflamed with frequent diarrhea, and he now notes body wide aches.

Compare this history with the case of acute low back pain from last week’s Wisdom Wednesday. Obviously, this case is much more complex. On reviewing his history, he describes the pain as running down the anterior aspect of the left leg to the knee with occasional radiation into the groin. This is not the course of the sciatic nerve and, in fact, he was suffering from femoral neuralgia rather than sciatica. I have no clear information on the cause of the perforated intestine. However, I do comment on the relationship between these illnesses in my conclusions.

C. difficile kills about 1600 people in the US each year as the result of electrolyte imbalances associated with the diarrhea. It is an opportunistic infection that overgrows following the use of antibiotics. Please see my blog “Serious Diarrheal Infection in Kids Linked to Antibiotics” posted on March 14, 2014. Adults commonly develop C. difficile during hospital stays.

QA evaluation revealed impairment of Autogenic Facilitation (AF). Therapy Localization (TL) was to the surgical site of the perforated colon. This was corrected by Injury Recall Technique (IRT) restoring AF. Testing for inflammation was negative for prostaglandins, leukotrienes, cytokines, and histamine. However, nitric oxide was positive with a good response to L-glutamine, a particular probiotic (Saccharomyces boularidii), and folic acid. Challenge of the ilio-lumbar ligament was positive on the left, and after IRT correction, it returned again in weight bearing. TL was positive to the L4 vertebra, but no manipulation was performed.

Insight Into The Cause Of Chronic Pain

New insights into how the human brain responds to chronic pain could eventually lead to improved treatments for patients, according to University of Adelaide researchers.
Friday, March 14, 2014

Neuroplasticity is the term used to describe the brain’s ability to change structurally and functionally with experience and use. “Neuroplasticity underlies our learning and memory, making it vital during early childhood development and important for continuous learning throughout life.” Say Dr. Ann-Maree Vallence, a postdoctoral fellow at the University of Adelaide’s Robinson Institute.

“The mechanisms responsible for the development of chronic pain are poorly understood. While most research focuses on changes in the spinal cord, this research investigates the role of brain plasticity in the development of chronic pain.”

Chronic pain is common throughout the world. More than 100 million Americans are believed to be affected by chronic pain.

The study focused on comparing motor task training on participants that suffered from chronic tension-type headaches (CTTH) from a control group with no history of chronic pain. A non-invasive brain stimulation technique was also used to obtain a measure of the participants’ neuroplasticity.

CTTH is characterized by a dull, constant feeling of pressure or tightening that usually affects both sides of the head, occurring for 15 days or more per month. Other symptoms include poor sleep, irritability, disturbed memory and concentration, depression, and anxiety.

“Typically, when individuals undertake a motor training task such as this, their performance improves over time and this is linked with a neuroplastic change in the brain,” Dr. Vallence says. “The people with no history of chronic pain got better at the task with training, and we observed an associated neuroplastic change in their brains. However, our chronic headache patients did not get better at the task and there were no associated changes in the brain, suggesting impaired neuroplasticity.

“These results provide a novel and important insight into the cause of chronic pain, and could eventually help in the development of a more targeted treatment for CTTH and other chronic pain conditions,” she says.

MY TAKE:
This is the neurological basis for the evaluation and treatment format I use in practice – Quintessential Application (QA). I evaluate current neurological function – are reflex pathways intact? If not, then there is probably an injury reflex impairing that function. Correction is easily performed by “rebooting” the nervous system, Once the reflex pathways are restored, functional neurological testing responses are predictable and can be used to evaluate and treat the body.

More importantly, correction of injury reflexes restores neuroplasticity to the brain and spinal cord. This allows injuries to begin to heal and chronic pain patterns to resolve.

After 38 years in practice, I am convinced that the most important factor in resolving chronic low back pain is resolution of the associated injury reflexes. Sure you have to reduce inflammation and improve spinal mechanics. But if neuroplasticity is not restored, the chronic pain pattern remains and the instability will remain as well.

THE BOTTOM LINE:
If you suffer from chronic pain, consider having a QA evaluation. If you Google “Quintessential Application”, you will find a web site that can direct you to a qualified practitioner.