Thoughts from a Low Back Pain Specialist - Dr. Kevin Venerus D.C.

http://articles.mercola.com/sites/articles/archive/2010/03/09/antidepressants-are-no-better-than-placebo.aspx

Pain and your brain

The perception and processing of pain information happens in your brain. Without your brain you could not have the opportunity to experience pain. Phantom pain is an interesting example of how the brain works. People who have lost a leg, for example, will complain of toe pain on that side, even though they have no toes. How is that possible? All we can say: the area of the brain that represents the pain perception of the toes is activated. Why, we cannot state, at least not in this context. This leads to the subjective experience of pain, even though there are no pain fibers from the toes to the brain.

All sensory information from the periphery, including pain, is channeled through the Thalamus to the cortex. The Thalamus is the main relay for all incoming sensory information.

Pain fibers are always "on" Our brain has two functions with respect to pain perception. One area of the brain receives the incoming pain fibers from the periphery via the Thalamus in order to facilitate the experience of pain. Another area of the brain fires down to the Thalamus to inhibit and dampen that transmission of pain. Here is an important thing to remember: pain fibers, similar to other neurons, fire at all times. This is essential to their survival. If they did not fire, they would degenerate and eventually die.

Brain inhibits pain perception

If it were not for the pain inhibition of the cortex, we would experience pain at all times. The problem arises when normal brain function declines in one or both brain hemispheres. The brain's capacity to inhibit pain perception would decline. This could lead to what we call intractable pain syndromes. The most difficult and frustrating cases for many of us in the health care field are those patients who present with these pain syndromes, with no history of trauma to explain them. These people simply hurt. Medication of varying strength has been used extensively, with less and less effectiveness.

The biggest mistake we all tend to make is to look only at the area of pain. There has to be an explanation for this person's suffering right there. When we cannot find a physical reason, we either give up, or we declare that it must be "psychological", that "it is all in your head". We give it fancy names such as "psychosomatic", etc.

Brain hemisphericity

Most of these names only cover up our helplessness and ignorance as to the true cause of their suffering. Actually, it may well be all "in their head". Besides looking at the area of pain, it is of vital importance to also investigate brain function. Once we understand that normal brain function is designed to inhibit pain perception, we must look for a way to evaluate the person's brain state. A neurological examination by a skilled chiropractic neurologist will easily reveal brain hemisphericity, the relative under-functioning of one brain hemisphere compared with the other.

Brain specific therapy

Once we have determined that there is no pathology in the area of pain, or anywhere else for that matter, we then have to decide how to best increase the function of the under stimulated brain hemisphere. The strongest sensory feedback from the periphery to the brain is via large diameter myelinated nerve fibers (Ia fibers), especially those from joint mechanoreceptors and muscle spindles. Brain hemisphere specific chiropractic adjustments on the side of the body opposite to the brain hemisphericity are exquisite ways to activate the brain function where it is needed. The brain can also be stimulated with light, sound, smell, taste, movement, etc.

For a successful outcome it is vital that all therapies are brain based. Their application must have a sound neurological basis. If you stimulate the "wrong" side, you may end up making the brain hemisphericity worse. This may lead to increased pain perception. From www.drz.org

Two new studies, from researchers at the University of California-San Francisco and the National Cancer Institute, suggest that hospitals may want to cut down on the volume of CT scans. One of the studies estimates that “about 29,000 future cancers could be related to CT scans performed in the United States in 2007 alone.” The researchers’ advice to patients: keep track of how many CT scans you receive, and discuss with your doctor if the CT scan is necessary.  Remember, CT scans are X-rays taken at multiple levels to give a better image of inside your body.  Some CT scans can give you as much radiation as 100 chest X-rays! 

An MRI does not have the radiation issues like a CT scan, but another recent study has shown when there is an increase MRI availability, there is a higher incidence of spinal surgery! This may be bad news for patients, since previous studies have found that increased surgery rates do not improve patient outcomes. “The worry is that many people will not benefit from the surgery, so heading in this direction is concerning,” said senior author Laurence Baker, Ph.D., professor of health research and policy at the Stanford University School of Medicine. 

While volunteering for the Salvation Army Bell Ringing yesterday, I was reminded of a common sign of lumbar stenosis.  I was standing outside of our local Kroger grocery store (it was very cold by the way!) and I noticed a few shoppers walking into the store with an empty shopping cart.  If you look carefully, you will notice their posture while pushing the carts.  They are flexed forward, and leaning on the cart.  This posture, flexion of the lumber spine opens up the spinal canal and allows the nerves that control the lower extremity to work better. 

Ironically, most shoppers that do this, do not even notice that it is their change in posture is what improves their gait.  They assume the cart acts as a "crutch" to help them walk.  

In new patient consults that I suspect lumbar stenosis, I always ask if they walk better with a shopping cart.  I usually get a surprised look of - yes it does, or they have to think about it before they realize that pushing the cart actually does help their gait. 

What we use in our office is a technique called Flexion Distraction which helps open up the spinal canal which is compressed by lumbar stenosis.  Studies have shown an increase of spinal canal area increase by 28%. 

Notice in the photo above, the shopper is not just pushing the shopping cart, she is leaning forward and putting some of her body weight on the cart.  This creates an increased flexion posture in the lumbar spine, allowing the nerves to work better in her legs.  This is a common sign of lumbar stenosis that can be helped with chiropractic care using Flexion Distraction technique. 

On a bipartisan, 30-4 vote, the Michigan Senate today approved Senate Bill 968, and its associated bills, legislation that would restore Michigan’s chiropractic scope of practice to the level enjoyed by doctors of chiropractic and their patients prior to the rewrite of the Public Health Code in the late 1970s.

The bill package now moves to the Michigan House of Representatives, which passed similar legislation last year. We are now closer than ever before to a scope that will allow Michigan DCs to practice as they are educated and trained.

Michigan currently has the most restrictive chiropractic scope of practice in the nation. Chiropractors in every other state are allowed to perform the services outlined in the bills. This restrictive scope doesn’t just affect DCs and their patients; it negatively affects Michigan’s economy, as well. There are numerous studies that make a compelling case for chiropractic as an effective and efficient way to control the skyrocketing costs of our healthcare system, by reducing the rates of surgery, inpatient hospital care, and advanced imaging, coupled with reduced lost work days and speedier patient recovery times. With the state’s growing fiscal crisis, any method of controlling these costs must be explored.

I just came across a study in the Journal of the American Medical Assoication from a few years ago showing that taking Acetaminophen daily causes liver damage in just two weeks! Most people understand that taking pain relievers for extended periods of time (years for example) would cause liver, and other organ damage. But I don't think anyone realized how soon liver damage can occur. So when ever you are having any type of back pain for more then just a couple of days, you need to have it checked by a chiropractor, and get the source of the pain fixed. Remember, the pain medication only masks the pain, and does nothing to solve the source of the problem. Do not take Acetaminophen for any extended periods of time to resolve your back pain - think of your liver! http://jama.ama-assn.org/cgi/content/abstract/296/1/87

My patient continues to improve. His pain has decreased to about a 5/10, and his reflexes and muscle strength continue to improve. (Signs that the nerve function is improving). He has been getting treatments daily this week, and hopefully next week we can reduce the treatment frequency as he improves.

I just had a patient come into my office telling me about their failure with Spinal Decompression. They responded to one of those "Free Report" advertisements in the local newspaper. He told me he tried the therapy for about 8 weeks and had some improvement in his pain, but not enough to justify the $5000 he paid. He was diagnosed with a L5 herniated disc with radiculopathy down the left leg. The MRI findings are consistent with my physical exam findings. I explained to him a technique I use in my office called Cox Flexion Distraction. I have had great success in treating patients with many low back pain conditions, including herniated discs. Since this technique is spinal manipulation, it is covered by most insurances, unlike spinal decompression. A gentle and specific contact is made in the lumbar spine as the lower portion of the table slowly drops which decreases the pressure within the disc. This motion also restores the normal biomechanics of the spinal segment. I just started his treatments today. He noticed some relief after the first visit, but has a ways to go before he is pain free. I plan to keep updates on his progress with a non-surgical treatment for his herniated disc! For more information on Cox Flexion Distraction visit www.AdvancedBackSolutions.com/hnp