The Mystery Continues

It has long been a mystery why some individuals are especially prone to develop chronic back pain while others are not.  The answer now appears to be genetic.

A common cause of low back pain is degenerative disc disease (DDD) – an age-related condition in which the discs dry out, become brittle and are easily torn or fractured.  As the disc deteriorates, sensory nerves within the disc become painfully exposed. 

A British study, published in the Annals of Rheumatic Diseases, looked at 4,600 people and found that the PARK2 gene was linked to age-related disc problems.

Investigators found that variants of the PARK2 gene appeared to have an effect in people with DDD.   The gene seemed to increase the speed at which their condition deteriorated.  The important question then becomes, can the gene be turned off?   Investigators say more research is needed to find the answer.

Dr. Frances Williams, of the Department of Genetic Epidemiology at King's College London, who worked on the study, said: "Further work to define the role of the PARK2 gene will, we hope, shed light on one of most important causes of lower back pain.  It is feasible that if we can build on this finding and improve our knowledge of the condition, we may one day be able to develop new, more effective treatments for back pain caused by this common condition."

Too Much of a Good Thing

The constant, exasperating pain in the low back may drive you to use a lot of acetaminophen (e.g.,Tylenol, Anacin, Liquiprin, Percocet).  The drug is commonly used to treat musculoskeletal pain, osteoarthritis, headache, back pain and other inflammatory conditions.  Make sure you’re not taking too much of it.

 The following is an excerpt from 

Back Surgery – Avoid the Nightmare

New Warnings About Acetaminophen

Be mindful of the amount of acetaminophen you’re taking. This is especially true if you’re taking other prescribed analgesics containing mixtures of acetaminophen and opiates. An overdose (more than 2,000 mg per day) of acetaminophen can damage your liver. Also, if you have diabetes or are prediabetic, remember that acetaminophen may produce false results in urine glucose tests.

“The risk of liver injury primarily occurs when patients take multiple products containing acetaminophen at one time and exceed the current, maximum dose of 4,000 mg within a 24-hour period.”

Prescribed analgesics often contain acetaminophen combined with opioids such as codeine, oxycodone, or hydrocodone. The amounts of acetaminophen in these combination products can be quite high. A tablet of Anexsia, for example, contains 750 mg of acetaminophen. Lortab, Tylox, and Vicodin have 500 mg, while Percocet has 650 mg.

The FDA has recently asked manufacturers to reduce the acetaminophen content in these products to safer levels. The important thing to remember is not to consume more than 4,000 mg of acetaminophen within a twenty-four-hour period. Taking more than that is flirting with disaster.

A Better Golf Swing With a Strong Core

When you do your core exercises, these are the muscles that are strengthened:

(Muscles of the pelvic floor, lower back and diaphragm are also part of the core musculature – they’re not shown in the illustration.)

A.  Serratus anterior

B.  Transverse abdominal

C.  Internal oblique

D.  External oblique

E.  Aponeurosis of external oblique

F.  Linea alba

G.  Tendinous insertion

H.  Rectus abdominis

The transverse abdominal (i.e., the deep muscle of the core) wraps around the trunk like a corset.  It attaches the lower ribs, diaphragm and lumbar spine to the hips.  In effect, it ties the rib cage and upper body to the pelvis and lower body.  It keeps you “connected.”

The core stabilizes the body, protects the spinal column and provides a firm support for the various physical activities we perform.

 

The upper body turn is the key to a full, natural release of the club.  Using the large muscle groups (internal and external obliques) to move the torso together with the arms and shoulders will ensure a proper release at the proper time.

Not only does a strong core facilitate a full and proper swing, it also protects the low back from excess strain.  Read about the supportive role of the core in avoidance of back pain in Back Surgery – Avoid the Nightmare

Back & Leg Pain Relief Without the Buzz

One of the most debilitating and intolerable effects of Failed Back Surgery Syndrome (FBSS) is the chronic pain in the low back and leg, lasting long after surgery.  Additionally, any conventional spinal cord stimulation treatment (SCS) used to relieve this pain very often leaves the patient with the undesirable side effects of paresthesia (i.e., numbness, tingling, buzzing and shock-like sensations).

Conventional SCS devices are commonly used to alleviate chronic pain.  However, they have been only moderately effective in alleviating leg pain (i.e., sciatica, nerve root compression symptoms) and even less effective in relieving associated low back pain.  Moreover, conventional SCS treatment produces a variety of uncomfortable tingling, buzzing and shock-like side effects (paresthesia).

The bioengineers at the Nevro Corp have high expectations.  They’ve developed a medical device designed to alleviate the chronic, debilitating pain in patients suffering from Failed Back Surgery Syndrome, with the added benefit of eliminating the paresthesia effects.

The Nevro device (Senza – RCT) is a high-frequency spinal cord stimulation (SCS) system implanted near the pain-generating site.  Small electrodes with batteries, implanted alongside the spinal cord, emit high-frequency electromagnetic pulses to the spinal cord to mask the transmission of pain signals to the brain.

 The Nevro System operates like conventional devices but delivers electromagnetic pulses at a much higher, more effective frequency. The Senza-RCT claims a two-fold advantage over conventional systems:  1. It provides prolonged pain relief in the low back and legs, and 2. It has none of the undesirable paresthesia side effects (I.E., numbness, tingling, buzzing sensations).

The FDA has approved the Nevro System for investigational use only.  Controlled studies are now being done to evaluate its safety and efficacy. 

Read about Failed Back Surgery Syndrome and its causes in Back Surgery – Avoid the Nightmare

 

The Osteoporosis Factor

A fall on the outstretched hand and resulting wrist fracture is often the first indication of osteoporosis in a postmenopausal woman.   If you’ve had such an injury recently and your X- ray image looks like the one shown below, it can be a helpful warning sign.

It’s an important notification that preventive measures need to be taken immediately to avoid much more debilitating injuries later on – fracture of the hip or spine, which can have devastating effects. Remember, by the time osteoporosis shows up on a plain x-ray image, you’ve already lost as much as 30% of bone mass.  Weak, osteoporotic bone becomes a risk factor in the treatment of other conditions that may require surgical treatment.  Diet, medication (including calcium and vitamin D supplements) and weight-bearing exercise can  halt or  retard further deterioration of bone mass and bone density.

 If you’ve had no fracture but are concerned about developing osteoporosis, a DXA scan (dual

x-ray absorptiometry) is the way to go.  It’s a more sensitive test that can detect osteoporosis much earlier. The scan (of spine or hip) may show that you have osteopenia – an early stage of bone loss that can lead to osteoporosis if not treated.   Read the details about the diagnosis of osteoporosis in my new book,  Back Surgery – Avoid the Nightmare.  

 The X-ray image shows the most frequent injury sustained after a fall on the outstretched hand.