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.

Almost 1 in 5 Americans Plagued by Constant Pain

The poll of roughly 35,000 American households reveals almost one-fifth of Americans experience daily crippling, chronic pain according to a new report published in the October issue of the Journal of Pain.

“I wasn’t particularly surprised by our findings,” said study author Jae Kennedy, a professor of health policy and administration at Washington State University in Spokane. “But I found it sobering that so many American adults are grappling with persistent pain.”

The study authors analyzed responses to a 2010 National Center for Health Statistics survey. Those who said they had experienced serious continual pain during the prior three months were the focus of the poll, rather than participants who said they had experienced short-term pain or pain that was intermittent or moderate in nature. Overall, 19 percent of the adults polled were deemed to have experienced “chronic” and severe daily pain.

That grouping did not, for the most part, include adults who said they struggled with arthritis or back and joint pain, as those people tended to say their pain was not constant and persistent, the study authors noted.

The chronic pain figure exceeded 18% among specific groups of respondents, including those between the ages of 60 and 60, women, those who said their health was fair or poor, those who were obese or overweight, and those who had been hospitalized in the prior year.

Kennedy suggested that for those experiencing chronic, crippling pain there are a variety of potential interventions including physical and occupational therapy, exercise, dietary changes, weight loss, massage and psychotherapy, alongside alternative interventions such as acupuncture, yoga and chiropractic services.
Medicines, including narcotic painkillers like hydrocodone, oxycodone and morphine, can also be helpful, but only if long-term use is avoided, Kennedy said.

“We are clearly overusing opioids [narcotics],” he noted. “The US consumes about 60% of the world’s opioid supply, and 99% of the hydrocodone supply. These medications are effective in the short term for managing postoperative pain, but long-term use often leads to dependency or addiction.”

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.