Search Results

“Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” Our nervous system is the most complex organs in our body. Because of this pain is very complex. Throughout our bodies are pain receptors, called nociceptors. These receptors are stimulated due to release of various chemicals by damaged tissue such as histamine, substance P, serotonin, bradykinin and prostaglandins. When stimulated, the nociceptors transmit the pain signal along sensory nerves to the spinal cord. In the spinal cord the impulses are processed by the dorsal horn and sent to the brain. Sometimes signals sent to the spinal cord communicate directly with motor nerves, to cause for example ones arm to quickly withdraw after touching a hot plate. This is called an automatic reflex and does not involve the brain or conscious thought. Most of the times pain signals are sent upwards in the spinal cord from the dorsal horn via ascending nociceptive tracts, such as the Spinothalamic tract. These tracts terminate in the medulla, midbrain and thalamus. Further processing in the thalamus leads to signals being sent to areas in the brain that control things such as heart rate, blood pressure and emotions. Thalamic neurons also project to regions of the cortex including the somatosensory cortex, were fine discrimination of pain occurs. We experience pain everyday when we get a paper cut, stub our toes or hit our funny bone. You may not want to believe it but pain is a protective mechanism. It tells us to pull away from a potentially damaging situation, like a hot pan. It warns us to take it easy and thus protects a damaged body part while it heals. Most of the time pain goes away once we remove the stimulus. Unfortunately sometimes pain persists despite removal of the stimulus. Other times pain starts in the absence of any detectable injury or stimulus. When pain last for prolonged periods of time and is uncontrolled it can start having a more devastating effect on ones quality of life that is far more destructive than the discomfort of the pain itself. But what is the difference in acute and chronic pain? Often acute pain has a sudden onset and is usually sharp in nature but can have other forms. It can be mild or severe in intensity and last a few seconds to months. Most of the time acute pain last less than 3 months and usually goes away once the underlying cause is treated or heals. When acute pain last longer than 3 months it is often considered chronic pain at this point. Chronic pain often persists besides the fact that there is no longer an identifiable stimulus. Pain signals in the nervous system remain active, and these effects can lead to both physical and emotional manifestations. Physically one can feel nausea, fatigue, muscle aches, decreased energy, and insomnia, among other things. Emotionally people can experience wide mood swings, depression, anger, anxiety, and a sense of being overwhelmed. These physical and emotion changes soon start affecting one’s ability to work, enjoy life, and perform activities of daily living. Patients soon become deconditioned and unable to functional.

Your doctor may often ask about changes in your function along with changes in your pain scores throughout your treatment. Often patients may report no improvement in pain scores, but when questioned further they will show a significant improvement in function, due to the treatments they received. As a patient it is important to evaluate yourself for improvement in function and not just improvement in pain. Increase in function can be a goal to focus on when deciding on treatment options to improve your overall quality of life. Having goals relating to increase in function can create more structure to ones management, as well as justification for use of medications and treatments. Goals that you set should be simple and reasonable, such as being able to complete a favorite hike, or being able to take one’s grandchildren fishing, etc.

Your excessive weight can be your enemy when it comes to managing your chronic pain, such as in low back pain. With low back pain a majority of obese people have excess body fat around the abdomen, this extra forward weight increases the lordotic curve of the spine and places additional stress on the lower back as well as your joints. Fat cells are believed to facilitate production of inflammatory factors thus weight loss not only decrease mechanical stress on the body it may also help to decrease overall inflammation and general pain. Obese people have a higher incidence of degenerative disc disease, herniated and ruptured disc, osteoporosis, stress fractures, spinal stenosis, spondylosis, spondylolisthesis, spondylolysis, spinal osteoarthritis and unhealthy posture, among many other health problems. When it comes to low back pain reducing your weight by just 10% can significantly reduce your back pain. Consider making a 10% reduction in your weight one of your goals as part of your management tools. There are many programs and tools available to help individuals achieve a healthier weight. The best way to maintain a healthy weight is with a balanced diet and exercise program.

STOP! Put down that large purse and take off those high heels! Large bags, heavy backpacks and incorrect shoes are now a major culprit for long term chronic pain such as back pain. If you use a large purse than make sure you transfer the weight often by switching shoulders and try to buy bags with wide padded double straps. Limit the bag weight to no more than 10% of your body weight. If your children use backpacks for school limit the weight to 15% of the child’s weight and do not allow them to wear the backpack on a single strap. Avoid high-heeled shoes, cowboy boots, and sandal flip flops as they fail to give enough cushion to your steps. Try to choice a well cushioned shoe that provides comfort, stability with good arch support and helps you always maintain a good posture. It is all about good POSTURE!!! Poor posture secondary to bad accessories places too much uneven wear on the discs, joints and ligaments of the back.

Routine back exercises performed correctly and regularly will go a long way to a healthier back. Start off slow and be patient and warm up your muscles with aerobics before you start your strength training. Strengthening exercises should be done about every second day; your muscles need a day off to rest and recover. NECK EXERCISES The neck exercises involve similar movements as the neck stretches with the addition of resistance. Cervical Flexion This exercise is performed by placing your hands on your forehead and gently pushing your head into your hands, without allowing movement of the head. Cervical Extension In this exercise place your hands on the back of the head and gently push the head back into your hand without allowing movement of the head. Lateral Neck Bend In this exercise place your hand on the side of the head and gently push the head into your hand like when you bring the ear to the shoulder, but without allowing movement of the head. Rotation of the Neck In this exercise place your hand on the side of the head and gently turn the head into your hand without allowing movement of the head. LOW BACK EXERCISES Straight Leg Raise Lie on your back with one leg straight and one knee bent. Then tighten your abdominal muscles to stabilize your low back and slowly lift the leg straight up about 6-10 inches and hold for 5 seconds then slowly lower the leg and repeat for other leg. Do not lift both legs at the same time as this may make your back pain worse. The Bridge Lie flat on your back with your feet flat on the floor. Bend your knees 90 degrees. Next raise your pelvis off the floor while keeping your abdominal muscles and buttocks tight. Prone Extension Start in the prone position and place your arms behind your back and keep the pelvis and legs in contact with the floor. Keep your chin tucked and then slowly lift the torso off the floor. Opposite Arm and Leg Extension Begin on all fours, hands directly under your shoulders and knees directly under your hips. Keep head aligned with spine and keep buttocks and abdomen tight. Do not let your back arch. Lift one arm up and forward until it is level with torso; simultaneously lift the opposite leg in the same manner. Wall Squats Start with your back against the wall. Slowly bend the knees and allow the back to slide down the wall until the thighs are approximately parallel to the floor. Then, slowly push with the legs to return to the starting position. Scared Cat Start with hands and knees on floor. Slowly arch the back upwards and tuck the chin by flexing the head forward and tightening the abdominal muscles. Then, lift the head upwards and extend the lower back so that the abdominal section hangs downward. Therapy Ball Balance Sit on an exercise therapy ball with both feet planted on the floor and arms on the side. Sit tall with good posture, and keep your shoulders square. Your chin should be tucked in. Slowly rock back-and-forth, side-to-side and in circular motions. This is an easy exercise to do while sitting at your desk at work or home.

Stretching the muscles and tissues around your spine, pelvis and legs helps keep your spine flexible and limber. Always use proper stretching technique, which means stretching the muscles only to the point of mild tension. Holding the stretch without bouncing for at least 10-30 seconds, and then let the muscle totally relax. Repeat each stretch 3-4 times and also repeat the whole stretch routine several times a day. Stretching exercises may be done daily but every second day is usually enough. Warm up your muscles with aerobics before you start your stretch training, and start slow. NECK STRETCHES Cervical Flexion This stretch is performed by bringing your chin to your chest Cervical Extension This stretch is performed by looking up at the ceiling Lateral Neck Bend This stretch is performed by bringing your right ear close to your shoulder and repeating on the left side Rotation of the Neck This stretch is performed by turning your head to the right as far as possible. Try to touch your chin to your shoulder and repeat on the left side LOW BACK STRETCH Lumbar Flexion Stretch While seated lean forward between your legs with your arms stretched outwards towards the ground until your feel a comfortable stretch. Avoid lumbar flexion from the standing position as it may aggravate low back pain. Lumbar Extension Stretch Lie on your stomach then prop yourself up on your elbows extending your back. Continue straightening your elbows until a gentle stretch is felt. Lumbar Rotation Stretch Lie on your back then bring your left knee to your chest and slowly bring the bent leg across your body until you feel a comfortable stretch then repeat for the right side. Lumbar Lateral Flexion Stretch Place your hands along your sides and then run your left hand directly down the side of the left leg, being sure to bend laterally while avoiding forward bending, until you feel a comfortable stretch in the lateral rib cage region. Repeat on the right side. Pelvic Tilt Lie on your back with both knees bent and feet flat on the floor. Keep your legs together and cross your arms over your chest. Tilt your pelvis and push your low back to the floor then slowly lift your buttocks off the floor as far as possible without straining until a comfortable stretch is felt. Cat Stretch Position yourself on your hands and knees on a matt on the floor. Very slowly, raise your head. As you do this, allow your belly to open downward toward the floor, and your back to fall into an arch until you feel a comfortable stretch. Then stretch your spine in the opposite direction by dropping your head. Move your chin toward your chest, while your back rises toward the ceiling, until your feel a comfortable stretch. Hamstring Stretch Clasp your hands behind the thigh and pull it towards your chest. Keep the opposite leg flat on the floor, until a comfortable stretch is felt ad repeat on the other side. Hip Flexor Stretch Kneel on your right knee; consider using a pad on your kneecap for comfort. Then place your left foot in front of you, bend your knees and place your left hand on your left leg for stability. Then place your right hand on your right hip to keep you from bending at the waist. While keeping your back straight and abdominal muscles tight lean forward shifting more body weight onto your front legs until you feel a comfortable stretch. Piriformis Stretch Lie on your back. Put your left ankle on your right knee. Keep your head down on the ground. Reach around the right thigh and pull your knee towards you as you push against the left knee with your left hand, until your feel a comfortable stretch. Repeat on other side. Latissimus Dorsi Stretch Kneel on the floor then lean forwards with the arms outstretched as far as possible and hands on the floor. Push your buttocks down towards your feet keeping your hands still until you feel a comfortable stretch. Iliotibial Band Stretch Lay on your back and with your hands grasp the outside of the opposite knee. Keeping your back and shoulder flat on the floor and the arms extended for support, gently pull the knee and thigh across to the opposite side of the body until you feel a comfortable stretch along the lateral aspect of the thigh and repeat for opposite side. Calf Stretch (Gastrocnemius & Soleus) Lean forward against the wall using both your hands for support. Extend the calf to stretch behind the torso while the other leg is placed with the knee bent. To stretch the gastrocnemius, keep the back leg straight and slowly lean towards the wall allowing the front knee to bend until you feel a comfortable stretch in the calf of the rear leg. To stretch the soleus keep the back leg slightly bent and slowly lean towards the wall allowing the front knee to bend until you feel a comfortable stretch in the calf of the rear

Be mindful of your daily stress as emotional and psychological stress can make pain problems worse. Stress can cause the release of hormones that increase the perception of pain and cause back muscles to tighten up, which can lead to decreased blood flow to those muscles. Stress and back pain can become a vicious cycle, as each can lead to the other and feed off each other. So stop the cycle sooner than later by managing your stress level. Aerobic exercises decrease stress hormones while increasing your body’s natural endorphins which will help improve mood and decrease back pain. Relaxation techniques and stretching exercises can also decrease stress while improving back pain. Also remember a goodnights sleep and allowing your body to rejuvenate, will go a long way in decreasing your bodies stress levels. You can find more information about aerobic exercises, relaxation techniques, and sleep in other parts of this tutorial.

Pain often keeps one from getting proper nights sleep and the sleeplessness makes the pain worse, it’s a vicious cycle. Studies have reported that 50%-80% of patients with chronic pain do not get proper sleep. Poor sleep also affects your mood by increasing depression which worsens your pain. Pain often disrupts the normal sleep cycle causing one not get enough deep and REM sleep which are important parts of the sleep cycle. They are vital in order to get a good nights rest. Chronic pain patients are known to have microarousals that affect their overall sleep. These microarousals often do not affect non chronic pain patients. Some pain medications can increase sleep disturbances, however other pain medications can aid in a good nights sleep, therefore it is important to discuss with your doctor your pain medications if you have poor sleep. Undiagnosed sleep apnea can sometimes be the cause of poorly controlled pain. If you suspect you might have sleep apnea consult with your doctor. Treating sleep apnea can often improve your quality of life. Making proper sleep a priority in your management goals is very important. Some important tips to help improve your sleep include: Review your pain medications to with your doctor to see if any of the medications you are taking could be affecting your sleep. Avoid stimulants at night such as caffeine, alcohol, or nicotine Avoid watching TV in bed, and try to make your bedroom a sleep friendly environment. Consider using ear plugs, eye mask, and a colder room temperature. Create a routine of relaxation before your bed time. Don’t do high activity things before bed; instead consider things such as reading a book, taking a hot bath, and using relaxation techniques. Don’t let you mind wonder on the day’s event, focus on one non-stressful thought. Often counting sheep can be very effective in getting your mind off a stressful day. If you take naps take them early and avoid long late afternoon naps. Review your diet as a balanced diet can help induce a more good and natural sleep. Keep a diary of your sleep habits and consider consulting with a sleep specialist if these simple tips do not help you get proper nights sleep.

Can your diet affect your chronic pain? The simple answer is yes: A balanced diet that produces a health weight can have a great impact on your pain. Throughout history there have been many nutrients and foods that have been used to treat many ailments including pain. Some have been tested scientifically and other’s secret to “heal” have been passed down from generation to generation. We do not endorse any food or nutrient as being a treatment or cure to your pain, however we review below the nutrients and food that have been considered by some to be beneficial for individuals in chronic pain. Please consult with a dietician for more information. Often pain is due secondary to inflammation that your body experiences. Certain foods can increase this inflammation while others help to reduce it. Certain cells in your body such as fat cells are believed to facilitate production of more inflammatory factors. Thus weight loss not only decreases mechanical stress on the body it may also help to decrease the overall inflammation. The proper diet combined with an aerobic exercise program allows appropriate nutrients to reach painful areas aiding the healing and recovery process. Aerobic exercises are also known to improve blood flow. A healthy and back friendly diet not only may help decrease inflammation, it can also improve blood flow by decreasing the formation of hardened arteries (atherosclerosis). There have been many scientific studies showing that patients with atherosclerosis have a high incidence of low back pain. Just as atherosclerosis can decrease blood flow to the heart and brain, it can also decrease blood flow to the back leading to increased back pain and poor healing. A back friendly diet can decrease the level of bad cholesterol in your body thus decreasing the amount of atherosclerotic plaque formation. Some Helpful Tips: Eat Power Foods Power foods are foods that provide your body with energy slowly rather than quickly. Power foods usually are those that are high in complex carbohydrates and proteins and low in simple sugars. Avoid Starchy Foods, Unnecessary Carbohydrates, & Foods with High Glycemic Index Drink Plenty of Liquids: Water, Milk or Juices Avoid Soda Soda contains both caffeine and phosphoric acid both of with reduce calcium and can weaken bones and increase back pain. Take Your Vitamins & Minerals Daily Important Supplements in Pain Management Include: Calcium, Vitamin D3, Vitamin C, Vitamin B Complex, Antioxidant, Magnesium and Omega 3 Fatty Acids, Choice Healthier Snacks: Fresh Fruits, Nuts and Vegetables. Use Oils Sparingly Use extra virgin olive oil, rather than other oils or dressings on salads, as it has been known to have anti-inflammatory properties, Eat Clean & Lean Meats: Poultry, Fish and Eggs. Eat Less & More Often Try to eat 5-6 small meals throughout the day instead of 2-3 large meals as we traditionally do. This maintains a more constant metabolic rate. Also try not to over eat and only eat balanced meal. Also remember to eat a healthy breakfast it can give your body a good start in the morning. Void Excessive Caffeine Caffeine can increase muscle tension, as well as decrease calcium. Avoid Excessive Sodium Watch your sodium intake and keep your blood pressure under control. Other Supplements and Creams Believed To Be Beneficial Methylsulfonylmethane Glucosamine Chondroitin Sulfate Capsaicin Topical Cream Anti-inflammatory Herbs There are many herbs that have been throughout the years that have been shown to be beneficial in treating pain. However these herbs are not often tested by the FDA so their safety profile may not always be know. Please use supplements and herbs with caution and consult with your doctor and nutritionist before starting these medications. Safety in pregnant women or nursing mothers is often unknown. Willows bark, Devils claw and Ginger Extracts are three of the more popular anti-inflammatory supplements in some areas. Willow bark Devil’s Claw Ginger Extract Boswellia Bromelain Curcumin (Turmeric) Quercetin Cayenne Clematis Condurango Echinacea Kava Meadowsweet Pau d’arco Feverfew St John’s wort Valerian