Procedures:
Because chiropractors focus almost solely on the back, they are often a good choice for back pain. At your first chiropractic visit you will be thoroughly examined and may have an X-ray or an MRI, if a herniated disc (sometimes called a slipped disc) is suspected.
A spinal disc is said to herniate, or 'rupture', when its gristlelike tissue bulges into the spinal canal (left), due to excessive strian or age-related deterioration of supporting ligaments. Cross-sections of a herniated disc (below) show several minimally invasive surgeries.
Chiropractors are well aware that spinal manipulation can do more harm than good if your pain is the result of a disorder such as osteoporosis, a herniated disc, a vertebral fracture, or an infection or spine tumour. Give chiropractic treatment about four weeks to work. If you don't feel a difference by then, it's unlikely it will help you.
>I keep hearing about a back therapy called TENS. What is it and does it work?
Whether TENS (transcutaneous electrical nerve stimulation) can provide lasting benefit for chronic lower back pack is unclear, but it can redirect your attention away from the painful sensations and
provide some short-term relief. TENS involves delivering mild electric pulses from electrodes on your skin. Long-term benefits are still being studied. At the least, this therapy can't cause you harm.
To relieve symptoms and break a cycle of pain, some doctors recommend injections of anaes-thetics, nerve blocks or steroids into 'trigger' points along the spine. Experiments have also been done with injections of salt water and botulinum toxin (Botox), but the lasting benefits are still unclear. To manage chronic pain from failed back surgery or for severe leg pain (sciatica), many find relief with a spinal cord stimulation device. Such a unit blocks pain signals by stimulating the spinal cord with electrical pulses from a surgically implanted pulse generator. You control the pain by directing the outside generator to prompt the electrical pulsing.
When pain persists, many people think of back surgery. This is not a good choice for most sufferers, however, and is less commonly recommended that it once was. Fewer than 5 percent of back pain sufferers--typically only those with herniated discs, spinal stenosis (narrowing), sciatica or other structural problems-- are good candidates. In most cases, pain may subside with surgery, but long-term results are about the same as with nonsurgical treatments. So be sure to be fully informed of the risks and benefits before agreeing to a surgical procedure.
If your herniated disc is causing never damage, you may need a discectomy. In this procedure the surgeon takes the pressure off the pinched nerve by making an incision in the outer layers of the disc and removing the gel-like centre. Sometimes, part of the vertebra itself has to be removed (called laminectomy). Problems can develop following discectomy, however, due to the added strain on the other discs and the shift in the overall structure of the spine.
Several less invasive techniques to major back surgery have also been developed (see illustration).
IT'S A BIG AND VERY COSTLY PROBLEM: Most surveys of back pain show that at any one time 15-30% of the adult population are suffering from back pain. In Australia in the 12-month period 1999-2000, the victorian Workers Compensation system paid over $500 million for back pain claims.
In one, an enzyme called chymopapain, derived from papaya, is injected into a herniated disc to break it down. Chymopapain treatment is effective about 70 percent of the time, but is considered risky because of bad reactions (including severe allergic ones) to the enzyme; it's more commonly done abroad. In another, a probe is inserted through a tiny incision to remove part of a damaged disc. A third less invasive but controversial technique use lasers to burn out the disc. success rates vary widely, however.
Natural methods
If you're like most Australians with back pain, you've probably considered a 'natural' alternative--nearly 60 percent of us do. Acupuncture is a popular choice. Based on the ancient Asian theory that pain occurs when the body's natural flow of energy (qi) is off-balance, acupuncture involves a practitioner inserting 10 to 15 hair-thin needles in the back and other parts of the body to balance qi.
How actual pain relief occurs in uncertain. Conventional doctors believe the needles prompt nerves to emit natural, pain-blocking chemicals (endorphins). Many people get real--if transient--pain relief. To enhance the effect, the needles may be charged with electricity, heated or periodically rotated. In a related therapy called acupressure, three to five minutes of continuous pressure and massage is applied to an acupuncture point, which also stimulates qi.
With straightforward therapeutic massage, tension in your back can melt away as the muscles are manipulated. The muscle movement overwhelms--at least temporarily --the pain signals that would otherwise get transmitted. In 2001, Seattle researchers reported that therapeutic massage provided long-lasting benefits in reducing chronic lower back pain and disability. Always use a massage therapist who's professionally trained and licensed.
To break a pattern that seems to be leading to chronic back pain, try learning relaxation techniques, such as yoga, tai chi, guided imagery and meditation. Your metabolic, response to meditation-- the opposite of its response to stress--is believed to unravel the ravages of stress on your body. Another technique, biofeedback, can help you become aware of how you can relax your body most effectively. Electronic sensors measure different bodily functions---such as muscle tension, pulse rate and breathing pattern--while you practise various relaxation methods. In time, you'll learn to consciously regulate your body's stress levels without the sensors. Cognitive-behavioral therapy has proved quite useful for chronic back pain. This approach helps you again insight into your emotions and provides tools for managing stress and effectively dealing with feelings of helplessness and depression.
Because chiropractors focus almost solely on the back, they are often a good choice for back pain. At your first chiropractic visit you will be thoroughly examined and may have an X-ray or an MRI, if a herniated disc (sometimes called a slipped disc) is suspected.
A spinal disc is said to herniate, or 'rupture', when its gristlelike tissue bulges into the spinal canal (left), due to excessive strian or age-related deterioration of supporting ligaments. Cross-sections of a herniated disc (below) show several minimally invasive surgeries.
- Chemonucleolysis, in which a needle injects an enzyme, chymopapain, into the bulging disc to dissolve portions of it.
- Percutaneous (through the skin) discectomy, in which a probe of it.
- Laser discectomy, in which a laser vaporises part of the disc.
Chiropractors are well aware that spinal manipulation can do more harm than good if your pain is the result of a disorder such as osteoporosis, a herniated disc, a vertebral fracture, or an infection or spine tumour. Give chiropractic treatment about four weeks to work. If you don't feel a difference by then, it's unlikely it will help you.
>I keep hearing about a back therapy called TENS. What is it and does it work?
Whether TENS (transcutaneous electrical nerve stimulation) can provide lasting benefit for chronic lower back pack is unclear, but it can redirect your attention away from the painful sensations and
provide some short-term relief. TENS involves delivering mild electric pulses from electrodes on your skin. Long-term benefits are still being studied. At the least, this therapy can't cause you harm.
To relieve symptoms and break a cycle of pain, some doctors recommend injections of anaes-thetics, nerve blocks or steroids into 'trigger' points along the spine. Experiments have also been done with injections of salt water and botulinum toxin (Botox), but the lasting benefits are still unclear. To manage chronic pain from failed back surgery or for severe leg pain (sciatica), many find relief with a spinal cord stimulation device. Such a unit blocks pain signals by stimulating the spinal cord with electrical pulses from a surgically implanted pulse generator. You control the pain by directing the outside generator to prompt the electrical pulsing.
When pain persists, many people think of back surgery. This is not a good choice for most sufferers, however, and is less commonly recommended that it once was. Fewer than 5 percent of back pain sufferers--typically only those with herniated discs, spinal stenosis (narrowing), sciatica or other structural problems-- are good candidates. In most cases, pain may subside with surgery, but long-term results are about the same as with nonsurgical treatments. So be sure to be fully informed of the risks and benefits before agreeing to a surgical procedure.
If your herniated disc is causing never damage, you may need a discectomy. In this procedure the surgeon takes the pressure off the pinched nerve by making an incision in the outer layers of the disc and removing the gel-like centre. Sometimes, part of the vertebra itself has to be removed (called laminectomy). Problems can develop following discectomy, however, due to the added strain on the other discs and the shift in the overall structure of the spine.
Several less invasive techniques to major back surgery have also been developed (see illustration).
IT'S A BIG AND VERY COSTLY PROBLEM: Most surveys of back pain show that at any one time 15-30% of the adult population are suffering from back pain. In Australia in the 12-month period 1999-2000, the victorian Workers Compensation system paid over $500 million for back pain claims.
In one, an enzyme called chymopapain, derived from papaya, is injected into a herniated disc to break it down. Chymopapain treatment is effective about 70 percent of the time, but is considered risky because of bad reactions (including severe allergic ones) to the enzyme; it's more commonly done abroad. In another, a probe is inserted through a tiny incision to remove part of a damaged disc. A third less invasive but controversial technique use lasers to burn out the disc. success rates vary widely, however.
Natural methods
If you're like most Australians with back pain, you've probably considered a 'natural' alternative--nearly 60 percent of us do. Acupuncture is a popular choice. Based on the ancient Asian theory that pain occurs when the body's natural flow of energy (qi) is off-balance, acupuncture involves a practitioner inserting 10 to 15 hair-thin needles in the back and other parts of the body to balance qi.
How actual pain relief occurs in uncertain. Conventional doctors believe the needles prompt nerves to emit natural, pain-blocking chemicals (endorphins). Many people get real--if transient--pain relief. To enhance the effect, the needles may be charged with electricity, heated or periodically rotated. In a related therapy called acupressure, three to five minutes of continuous pressure and massage is applied to an acupuncture point, which also stimulates qi.
With straightforward therapeutic massage, tension in your back can melt away as the muscles are manipulated. The muscle movement overwhelms--at least temporarily --the pain signals that would otherwise get transmitted. In 2001, Seattle researchers reported that therapeutic massage provided long-lasting benefits in reducing chronic lower back pain and disability. Always use a massage therapist who's professionally trained and licensed.
To break a pattern that seems to be leading to chronic back pain, try learning relaxation techniques, such as yoga, tai chi, guided imagery and meditation. Your metabolic, response to meditation-- the opposite of its response to stress--is believed to unravel the ravages of stress on your body. Another technique, biofeedback, can help you become aware of how you can relax your body most effectively. Electronic sensors measure different bodily functions---such as muscle tension, pulse rate and breathing pattern--while you practise various relaxation methods. In time, you'll learn to consciously regulate your body's stress levels without the sensors. Cognitive-behavioral therapy has proved quite useful for chronic back pain. This approach helps you again insight into your emotions and provides tools for managing stress and effectively dealing with feelings of helplessness and depression.
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