11 Feb 2014 09:14 am

Blog Update

Hi Everyone,

Thanks for all your emails and suggestions.

Sorry for not posting anything here in the blog portion of the site lately. I know a lot of you regular readers have missed it and I do to. I’ve been very busy these past months and I just had to let blogging slide for a while.

I appreciate all of your suggestions for future articles and will try to get to as many of them as I can as soon as possible.

Warmest Regards,

Dean

*****************

17 Jun 2009 04:26 pm

Massage Therapy and Back Pain Relief

I’ve had several readers write to me over the years and ask my opinion on massage therapy and whether or not I thought it was effective for back pain relief.

Unfortunately, at the time I was unable to answer their questions as completely as I would have liked.

You see the problem with giving an opinion — or being able to recommend a therapy — is that there is quite often a lack of reliable information on the subject. Up until now, we’ve only had anecdotal evidence to suggest that massage therapy helped to reduce pain. And as you know, anecdotal evidence leaves plenty of room for doubt.

However, I recently ran across a study published in the Annals of Internal Medicine that finally lends some credibility to this very popular treatment method.

The study involved 380 adults with advanced cancer who were experiencing moderate-to-severe pain. The participants were divided into two groups. One group received six 30-minute massage treatments over two weeks from certified massage therapists, while the control group received an equal number of treatments utilizing simple touch performed by untrained individuals.

The Results

The good news is that both groups experienced immediate pain relief according to the report:

“Primary outcomes were immediate … and sustained … change in pain. Secondary outcomes were immediate change in mood …

[snip]

Both groups demonstrated immediate improvement in pain and mood …

[snip]

Massage was superior for both immediate pain and mood … ” [1]

Now, while this is good news, it should be noted that patients did not experience total pain relief from the treatments. Their pain was only reduced between 1 to 2 points on a 0 – 10 scale. This represents a significant improvement, but not total relief.

Also, this was not a blind study as noted here…

“Limitations: The immediate outcome measures were obtained by unblinded study therapists, possibly leading to reporting bias and the overestimation of a beneficial effect. The generalizability to all patients with advanced cancer is uncertain. The differential beneficial effect of massage therapy over simple touch is not conclusive without a usual care control group.” [1]

The report went on to conclude…

“Massage may have immediately beneficial effects on pain and mood among patients with advanced cancer. Given the lack of sustained effects and the observed improvements in both study groups, the potential benefits of attention and simple touch should also be considered in this patient population.” [1]

Herein Lies the Rub

Now perhaps you noticed that this study did not directly involve treatment for back pain. This is something that I happen to consider a plus rather than a negative.

After all, what’s significant about this study is that it was conducted on advanced cancer patients. These were people with real pain. There was little or no chance that their pain was psychosomatic in nature.

The same cannot be said about back pain or migraine headaches or any other form of pain where emotions or stress can influence the results. After all, the brain can play tricks on us.

And while one study is not enough to establish proof, and it was not a double-blind situation, and the patients did not receive total pain relief, the fact remains that the results were immediate and sustained for the short term.

Overall, I feel the positive outcomes from this study are encouraging.

Until next time,
Dean

References:

1. Kutner, JS. et all. Massage Therapy versus Simple Touch to Improve Pain and Mood in Patients with Advanced Cancer, A Randomized Trial. Annals of Internal Medicine. 16 September 2008 | Volume 149 Issue 6 | Pages 369-379

********************

18 May 2009 04:28 pm

Is Microdiscectomy Right For You?

I haven’t written much about surgery on this site mainly because most of the people who come here are already looking for an alternative and don’t need much convincing.

That’s my story anyway, and I’m sticking to it.

But as luck would have it, I receive email from time to time asking for my advice concerning microdiscectomy. They usually go something like this…

Dear Dumbass on the Internet,

I have just been diagnosed with a herniated disc at L4, L5 and my orthopaedic surgeon is recommending a microdiscectomy. What should I do?

Sincerely,
Fred

My Usual Response

Dear Fred,

Thanks for your email.

As far as your surgery question is concerned, keep in mind that I’m not a doctor and can’t diagnose, treat or give specific medical advice to individuals. As a journalist, all I can do is write in general terms. My advice is for educational purposes only and should not be construed as a specific recommendation for your situation.

However, having said that — if there is one thing (in terms of back treatment) I’m more opposed to than chiroquacktic adjustments, it’s back surgery. I believe real candidates for surgery to be a rare minority.

Granted, for some people, there is no alternative. Exercise just isn’t going to fix what’s wrong with their back. The good thing is, most orthopedic surgeons are honest and will tell you when they believe that to be the case. I suggest that you always follow their advice.

Sincerely,
Dumbass on the Internet

What I Really Think of Microdiscectomy

Regardless of what terms you put it in; it is essentially a partial amputation. There is no way to get around it. The part of your disc they’re going to remove is never going to grow back.

What you have to ask yourself is, would you agree to that procedure if it were another part of your body? Say a finger or hand, for example.

If you had an injured hand — and there was any chance that it could heal and be rehabilitated — would you take that chance or would you just give up and go for the amputation?

I can’t make that decision for someone else, but I know what my answer would be. They would have to drag me kicking and screaming into the O.R.

Keep in mind that the part of your disc they are going to trim off still has to heal. It will probably take just as long to heal as the bulge itself. It is going to leave the disc thinner and more vulnerable to bulging or rupture in the future. [1] And you’re still going to have to do physical therapy after the surgery.

The only difference is they hope that by removing the bulge, it will stop the sciatica symptoms. It is a symptomatic approach to treating the problem and that is seldom the best choice.

What I Would Do

My advice is to wait at least three to six months. And, according to Dr. Nelson of the Physician’s Neck and Back Clinic, this is also the recommendation of the American Academy of Orthopaedic Surgeons. [2]

In the mean time, try rebuilding your back through physical therapy and see if you can’t rehabilitate your spine and this wayward disc. [3]

Even if you’ve already tried some form of physical therapy and had disappointing results it doesn’t mean that PT isn’t going to work. Just as not all doctors are the same, physical therapists and physical therapy programs can vary widely.

Talk it over with your surgeon and see what he thinks. If he’s okay with it, I would put surgery off for as long as you can.

As always,
Dean

References:

1. Deyo, R.A., and Weinstein, J.N. (2001, February). “Low back pain.” New England Journal of Medicine 344(5), pp. 363-370.

Patients with suspected disk herniation should be treated nonsurgically for at least a month… Even with successful surgery, symptoms often recur after several years.

2. Nelson, B. Disc Syndromes. Physicians Neck & Back Clinics [2005]

Studies show that only about 1 in 10 disc syndromes eventually need surgery so non-operative care is often very successful… In fact, the American Academy of Orthopedic Surgeons recommends delaying surgery for 3-6 months [except for extremely rare conditions].

3. Orthogate, Lumbar Disc Herniation (eOrthopod) Friday, 28 July 2006

Most people with a herniated lumbar disc get better without surgery. As a result, doctors usually have their patients try nonoperative treatments for at least six weeks before considering surgery.

Next Page »