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   Excess Weight and Back Pain

There is ample evidence to state that excess weight can cause acute and chronic back pain. This is particularly true for those who are considered obese. It is alarming to note that in 2009, more than one third of the adult population in the United States was considered obese. Compare this to 14 percent of this same population in 1980. It has long been known that there is a strong correlation between obesity and the onset of coronary heart disease, diabetes, high blood pressure, and colon cancer.

In addition, various studies have found a strong correlation between low back pain and being overweight or obese. Although painful spinal conditions such as spinal and knee joint arthritis, systemic inflammation of spinal muscles and ligaments, degenerative disc disease, etc. are prevalent among this group of people, they are not fatal. Perhaps this is the reason why research into the relationship between excessive weight and back health has been relatively limited.

Q: Is being overweight and being obese the same thing?
A: No. According to the National Institutes of Health overweight persons and obese persons fall into two separate categories as determined by the Body Mass Index (BMI).

Q: What is the Body Mass Index or BMI?
A: The BMI is simple number calculated by the relationship of two numbers – your height in feet and inches and your weight. The BMI categories are as follows:

• Underweight = <18.5
• Normal weight = 18.5–24.9
• Overweight = 25–29.9
• Obese = BMI of 30 or greater

(To find your BMI go to http://www.nhlbisupport.com/bmi/)

Q: How do I reduce my BMI?
A: The best way is to undertake a regimen that includes a proper diet, exercise and, if necessary, dietary supplements. In extreme cases, a person may also undergo behavioral therapy, surgery, or pharmacotherapy.

Q: Is there a relationship between diet, the BMI and back health?
A: Absolutely. Eating a proper diet not only reduces the BMI, it also serves to reduce and prevent back pain. By proper diet we mean one that includes:

• lean meat, fish and chicken
• plenty of fruit (apple, pear, peach, pineapple, grapes, oranges and papaya) and vegetables
• low fat dairy foods
• whole grains, including whole-wheat bread and pasta, cereals and brown rice
• nuts (e.g., almonds, walnuts and peanuts) and seeds
• plenty of water – be careful of flavored waters as they may contain unwanted calories

You should also limit or avoid:

• eating red meat as it can cause or exacerbate chronic back pain and joint inflammation
• processed meat
• high-fat dairy products
• coffee and tea
• fried foods
• white flour
• foods high in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars

More to come on the subject of diet and back health…

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   Intimacy and Back Pain

Each day millions of Americans suffer from back pain caused by muscle strain, sciatica, herniated disc, traumatic fracture, bone spurs, spinal arthritis, degenerative disc disease, or other forms of spinal pathology. Depending on the severity of the pain, most people will make physical and behavioral adjustments to their lifestyle in an effort to achieve some level of comfort or relief. One of the first aspects of daily living to be affected by back pain is that of intimacy.

For most people sex is the most important part of intimacy. A recent survey found that 56 percent of those with severe back pain would voluntarily discontinue sexual relations if it resulted in an end to their back pain. The same study revealed that 46 percent of the respondents had chosen to discontinue all sexual activity, while others in the survey had sex less often or had less satisfying sex when it did occur. When back pain negatively affects a previously healthy sex life, problems are likely to arise in the relationship.

If back pain has affected the intimacy that you and your partner previously enjoyed you may want to consider the following:

• Consulting a spine specialist to obtain an accurate diagnosis of the cause of your problem and a recommendation as to treatment alternatives. This information is critical to understanding what has happened to your back and what the future may hold. Keep in mind also that untreated pain can lead to proven relationship destroyers such as frustration, anger and depression
• Having a frank discussion with the spine specialist regarding back pain and sex. Your back pain is unique to you. Don’t make the mistake of thinking your partner understands how your pain affects you. For this reason, it is preferable that your partner be present to share their questions and concerns
• Asking the spine specialist for guidelines regarding positions and movements that will support your back and minimize pain during sex. As you experiment with different positions and movements keep in mind that you need to be gentle, and if it hurts, don’t do it.

Back pain doesn’t have to mean the end of sexual intimacy or the end of sexual satisfaction. It does mean, however, that you have to take affirmative steps to understand and manage it.

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  Neck Pain Relief

  Epidural Nerve Block

If you are experiencing neck pain due to whiplash, spinal stenosis, disc herniation or arthritis in the facet joints of the cervical spine, your back and neck specialist will seek to determine the source of the pain. By knowing the exact source of the pain the most effective and long-lasting treatment alternative can be selected. One of the most useful tools in the specialist’s diagnostic armamentarium when dealing with neck pain is the nerve block. The purpose of the diagnostic nerve block is to identify the area causing the pain as precisely as possible. The procedure entails injecting an anesthetic (usually lidocaine to numb the pain) and a contrast agent (to identify the spinal structure) into the affected area. Lidocaine is a fast-acting anesthetic that usually wears off in about two hours. Other slower-acting anesthetics are sometimes used for longer lasting pain relief.

A nerve block can also be very useful in the management of chronic neck pain. The primary difference between a diagnostic and therapeutic nerve block is that the latter contains an anesthetic and a steroid such as cortisone (to reduce swelling). The pain reducing effects of cortisone can last for months. In some cases the specialist may mix morphine or fentanyl (a synthetic narcotic analgesic) with cortisone to obtain increased pain relief. If the nerve block is successful, surgery is not necessary.

Epidural Spine Block

Depending on the objective data, the back and neck specialist may choose to inject an anesthetic and a steroid into the epidural space that exists between the covering of the spinal cord and the inside of the bony spinal canal. An epidural spinal injection is a non-surgical treatment option that may provide long-term relief from neck pain radiating to the arm. The injected medication coats the targeted nerve roots and the outside lining of the facet joints near the area of injection. In some instances the epidural spinal injection can provide permanent relief.

The epidural spine block procedure is performed on an out-patient basis with the assistance of fluoroscopy (x-ray) to monitor the placement of the needle into the epidural space. A small amount of contrast dye is injected to confirm that the needle is placed properly and that the medication is in the area where it’s needed. The procedure usually takes between 15 and 30 minutes.

There is no guarantee that a therapeutic nerve block will work in every instance and there is no way to predict what a particular individual’s outcome will be. Experience has shown that they work about 50% of the time. When they work, a second block is not needed nor is there a need for other treatment (e.g., surgery). In some cases the block is successful but its effectiveness wears out. It is recommended that no more than three blocks be performed per year.

As is the case with all invasive treatment procedures the possibility of side effects exists. Your specialist will describe what these are and provide you with specific after-care instructions for you to follow. In rare instances the specialist may determine it is unsafe to perform a spinal block if certain medical conditions exist.

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  Texting and Neck/Arm Pain

Neck and arm pain related to texting is a growing phenomenon. Initially referred to as “BlackBerry thumb,” the repetitive stress that comes from excessive use of a wireless device’s tiny keyboard to send text messages has been found to strain muscles, tendons, and ligaments in the hand, arm and neck. In addition, prolonged flexed-neck posture, or “hunching over,” as the keyboard is manipulated can cause cervical nerve disruption accompanied by acute or chronic neck pain. This non-traumatic pain often radiates down the arm causing a combined pain that is greater that arm or neck pain alone. Similar outcomes have long been associated with using a computer keyboard.

It is predicted that if excessive texting behavior continues unabated, the number of nerve-related disorders such as osteoarthritis and degenerative disc disease will increase and lead to a debilitating pain syndrome that negatively impacts school and/or work performance. A more immediate concern is that inflammation of the basal joint at the base of the thumb due to excessive texting will result in thumb arthritis. This condition manifests itself in hand pain, swelling, decreased strength and limited range of motion.

Simple steps to take to prevent the development of a texting-related pain include:

• Stopping texting at the first sign of discomfort or pain – if you can’t stop, cut back on the number of messages sent each day
• Try to avoid hunching over – position the keyboard in such a manner as to limit pressure on your neck and upper back muscles as they work to keep your head from falling forward
• Don’t sit in the same position for long periods of time
• Use both thumbs – and give your thumbs a rest when typing long messages.

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