June 10, 2008

Acute Back Pain

Poindexter here may seem like a cute kid, but believe you me, when he wakes you up at three in the morning cause he’s having a snack attack, you’re more likely to think he’s a cute pain in the derriere.

And speaking of acute pain…

I spent over an hour the other day answering one fellow’s questions about his back problems and trying to translate into layman’s terms what his doctor had told him.

I won’t try to cover everything we talked about but one area where he was confused was the difference between acute and chronic pain.

It Ain’t What You Think

I’ve found that we, the general public, often confuse the term acute to mean severe or intense pain. Unfortunately, this is simply not what it means.

The word acute actually means the initial stage of an injury or disease. It is a reference to time scale only, not how much agony you may be in. Acute pain usually refers to a condition with rapid onset and short duration.

The word chronic, on the other hand, is a condition that persists over time. This can be months or even years. Chronic pain –- just as with acute pain — has nothing to do with the intensity or level of discomfort.

Also, the time scale can vary depending on the particular injury or disease. For example an acute heart attack may last as long as a week, while an acute headache may only last an hour or so.

It’s About Time

So just remember, when your doctor or nurse refers to the acute phase of a disease they are referring to time and really mean one or both of the following:

1. abrupt, or rapid onset
2. short duration

On the other hand when they refer to chronic pain, they are talking about a condition that is of longer duration.

If you keep these terms in mind, it will make communicating with your health care provider a little easier and less confusing.

Take care,
Dean

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June 6, 2008

Microdiscectomy for Herniated Discs

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 to surgery 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 emails 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 are 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 post op.

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 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.

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Comments Disabled for this Post

May 30, 2008

Sciatica Relapse Question

The guy on the right is thinking, “Why did I try lifting that quarter-pounder with cheese?”

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I received an email this week from a reader who was making progress with his rehabilitation program — thought his back was fine — but then made the mistake of overdoing it at a Memorial Day sporting event and incurred what he described as “a relapse” of his sciatica symptoms.

Since this is a fairly common occurrence, I referred him to the following forum discussion where someone else was experiencing a very similar situation. Here’s part of what that forum member wrote…

I train mainly for powerlifting, injured my back over 15 years ago, of late it seems to be recurring more often, I now get pain going down my leg when I sit for long periods in a car, however if I elevate my buttock it eases!

[snip]

I’ve just strained it again, don’t know how, very little pain, just a slight niggle, tried the gym but it felt worse.

How long should I steer clear of weights to let it heal? I tend to return to the gym within a week or two and try to work around it? Is this reason the injury just won’t go away?

My response to the above question was…

Hi plod,

The symptoms you’re describing can be caused by a pinched or irritated nerve. One thing to keep in mind is that an injured nerve can take as much as six months to fully heal even after all the symptoms disappear.

What often happens is that people start to feel better and think everything is healed… when it’s not. They then rush back into activities that can re-injure that nerve and bang… they think they’ve had a “relapse” when what they really have is unfinished business.

If you think of the rehabilitation exercises as filling a deflated tire — and you only fill the tire until it’s just off the rim and then go back to driving your car — you may think everything is okay because the rim appears safe from damage, but one hard bump and that rim is going to hit pavement.

My advice is to concentrate on rebuilding the back until it is truly 100% and not just barely off the rim.

I hope no doctors read my dumb “car guy” logic because I know it’s probably a bad example, but I came up with it off the top of my head just now.

Dean

Fortunately, #1 Dinosaur concurred with my rather crude example and didn’t think my explanation was too far off the mark.

The moral of this story is, don’t make the mistake of thinking that your back is completely recovered just because the pain or other sciatica symptoms have disappeared. Be patient a little while longer and continue to follow your physical therapist’s instructions until the affected tissues have had sufficient time to fully heal. Continue to rebuild your back until there is no doubt that it is fully recovered.

With sciatica, you’re looking at a time frame of about six months after all symptoms have resolved.

If you do this, I’m confident that you can avoid the dreaded relapse.

Take care,
Dean

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