Month: November 2013

Lumbar Sprains & Low Back Pain: Treatment Options

/ Thomas Cohn, MD

lumbar sprainLumbar sprains are often considered a generic term to explain low back pain that originates from the muscles or ligaments.  It is usually just in the low back and buttock area, and does not spread into the legs.  Lumbar strains and sprains are not serious injuries, they do not involve damage to lumbar discs, lumbar nerves, the vertebrae, or joints.  Pain is localized to the back and will resolve with conservative treatment.

What is a Lumbar Sprain?

Technically, sprains are tears of ligaments. In the lumbar area, these ligaments hold the bones in alignment with the help of muscles.  Strains occur to muscles when they are overstretched.  Most lumbar pain is related to injuries to the muscles, and thus are more correctly considered strains.

Mobility of the lumbar region is dependent on the action of both very large and very small muscles along the spine.  The lumbar spine can bend forward and back, rotate and twist.  Lifting and twisting can put excessive forces through the spine and muscles causing a strain. Pain usually appears after doing any of the following:

  • Performing too much lifting
  • Staying in a bent position
  • Performing repetitive lifting and twisting

Performing activities without the proper body mechanics, obesity, and poor conditioning are all contributing factors.

Treatment Options

Treatment of lumbar strains is typically conservative.  Ice initially for a day or two and then heat is often helpful.  Ice reduces initial swelling and pain, while heat facilitates muscle rest, blood flow, and healing.  Nonprescription medications including anti-inflammatories like ibuprofen and aspirin as well as analgesics like acetaminophen are helpful.  Rest should be limited to no more than two days.  Over 90% of these will resolve readily in less than a month.  Chiropractic therapy, massage, and physical therapy may all help improve function and diminish pain.

Full medical evaluation may be necessary if the pain continues longer than several weeks, or there are more serious problems like:

  • actual leg weakness,
  • numbness,
  • loss of control of the bowels or bladder,

Rarely will an injury to the spine, discs or nerves be present.  Even in cases of more severe back injuries, most of these also heal with conservative care.  Only in cases of neurologic compromise causing leg weakness or loss of control of the bowel or bladder would surgery be a definite consideration.

Low back pain is usually due to a muscle strain.  Learning proper body mechanics and maintaining good core strength helps prevent injury.  Almost everyone strains his or her back at some point.  Conservative care and time will heal almost everyone.

4 Pain Myths, Busted

/ Thomas Cohn, MD

pain mythsPain is a complex beast. Since it’s based on subjective factors, each person experiences pain differently than the next. If two people break their arms under exactly the same circumstances, their perception of pain will undoubtedly be different.

With this subjectivity comes a lot of misconceptions and myths about pain. These myths often lead to societal “rules” and mantras that, in reality, are not based in fact. Here are some common pain myths, and the truths behind them:

  1. No pain, no gain. This is a common mantra amongst athletes who believe that they must push their bodies to the point of pain in order to improve. This is incorrect. If your exercise routine is causing you pain beyond simple muscle soreness, it’s probably not a good thing. Listen to your body, and seek medical help if you hurt yourself during exercise.
  2. Going to the doctor won’t help. Some people who are in pain believe that their pain will never go away no matter what, and this sometimes prevents them from seeking medical assistance. The truth is a physician or pain management specialist can help you craft a plan for managing your pain and getting you on track to a better life.
  3. Pain meds are addictive and I shouldn’t take them. It’s true that pain medication can be addicting. However, that should not deter you from using meds to manage your pain. If used in a responsible manner, pain medication can be a great help in alleviating your pain.
  4. Every type of pain can be cured. This is not necessarily true. There are several forms of chronic pain (such as CRPS) that cannot be completely cured. Instead, the best course of action is to come up with a plan to manage the pain.

When it comes to pain, you can’t always trust what your mother says (unless she’s a pain doctor of course!). She may be wise beyond her years, but the way your body experiences pain is drastically different than anyone else. So don’t stick to these old mantras. If you’re in pain, or have a question about treatment options, reach out to a qualified medical professional who can analyze your unique situation and help relieve your pain.

Diabetic Neuropathy: Types, Causes, & Pain Management Options

/ Thomas Cohn, MD

diabetesDiabetes can cause multiple problems in the body.  High blood sugars can cause damage to nerves.  Diabetic neuropathy occurs in up to 70% of diabetics, and is painful in up to 30%. There are four common types of diabetic neuropathy: 

  1. Peripheral polyneuropathy
  2. Autonomic neuropathy
  3. Amyotrophy mimicking a radiculopathy
  4. Mononeuropathy

The small sensory pain fibers are the most commonly affected, causing pain in the feet and slowly progressing to the legs and often developing in the hands.  Loss of sensation in the legs can lead to open wounds, infections, amputations, and sometimes even death.

Causes of Diabetic Neuropathy

The causes of diabetic neuropathies are all thought to start with high blood sugars.  This is known to cause damage directly to the nerve, the insulation covering the nerves, and the blood vessels that provide nutrition.  There is also thought to be an auto-immune factor that diabetes provokes our immune system to fight the body itself like a foreign organism and cause damage.  Smoking and alcohol can also increase the likeliness of damage.  Lastly, diabetes makes the nerves more sensitive to damage, thus injury can cause significant increase in overall damage to nerves.

Peripheral Polyneuropathy

Peripheral polyneuropathy is the most common type of damage seen in diabetes.  It is noticed first affecting sensory nerves, but motor nerves can be equally damaged.  People often first notice numbness in the feet and toes, and changes in temperature.  Tingling, and burning is common, as well as pain and sensitivity even to the lightest of touches.   Motor changes include weakness in the feet and legs and difficulty with walking and balance.

Autonomic Neuropathy

Autonomic neuropathy is the next most common diabetic neuropathy.  The nerves that control the heart, bladder, stomach and intestines, sex organs, and eyes are from the autonomic nervous system.  Loss of control of the bladder may be from damage to these nerves.  In males, erectile dysfunction is a common issue.  Stomach problems include slow emptying, constipation, and sometimes diarrhea.  Heart problems include fluctuating blood pressures and heart rates.

Prevention & Treatment Options

Once diabetic neuropathies occur, they are often hard to manage and control, since the nerve damage is often permanent.  Good blood sugar control is the most important aspect in reducing the incidence and severity.  Painful neuropathies are best treated with neuropathic medications such as:

  • Gabapentin
  • Lyrica
  • Cymbalta

Narcotic/opioid medications are often only minimally helpful at best.  In the worst cases, implantable pain control devices such as spinal cord stimulation and intrathecal pain pumps are useful.  When pain is an ongoing problem, enlisting the help of an experience pain physician can be a lifesaver in symptom management.