Back & Neck Pain

Spinal stenosis is closely associated with degenerative arthritis of the spine, and can be very difficult to live with.  As with many other back and neck conditions, diagnosing it early can help manage it successfully over time.

But the diagnosis process is not always straightforward.  According to Dr. Mark Ebell, Senior Editor of Essential Evidence Plus, a website that helps clinicians make evidence-based decisions, spinal stenosis "is a tough diagnosis to make".

In an Essential Evidence Plus POEM, Dr. Ebell summarized and commented on a 2010 systematic review of medical literature that looked to what degree specific symptoms (age, bilateral leg or butt pain, pain in certain positions, etc.) correlated with a diagnosis of spinal stenosis.

Interestingly, the reviewers were only able to locate 4 studies (involving 741  patients total).  Based on the fact that spinal arthritis is one of the most common types of arthritis (and arthritis is the leading cause of disability in the US), you would think the PTB would have arranged for more studies on diagnosing the stenosis that often results from it....

Anyway, the reviewers found that age (greater than 70 years), pain with walking, neurogenic claudication, bilateral butt or leg pain, unexpected urinary problems, no pain when sitting and pain relief when bending forward all correlated with a diagnosis of spinal stenosis, and most of them quite highly.  These signs and symptoms were obtained from the patients in the studies during the medical histories.  Their physical exams revealed that people who use a wide stance as their regular posture were more likely to have stenosis, as well.

This review also found that being younger than 60 and the absence of neurogenic claudication were correlated with not having spinal stenosis.

_Sources:

_{Ebell and Wilkes. Useful signs and symptoms of lumbar spinal stenosis. Poem of the Week Podcast #154 Essential Evidence Plus. Accessed 5/15/12.}

_{Pradeep Suri, MD; James Rainville, MD; Leonid Kalichman, PT, PhD; et al.  Does This Older Adult With Lower Extremity Pain Have the Clinical Syndrome of Lumbar Spinal Stenosis?  The Rational Clinical Examination JAMA. 2010;304(23):2628-2636}

Sadly, the American Pain Foundation closed its doors last week.  I received the following in an email, and it seems that pretty much all the content on their website has been replaced with it as well:

With deep regret and heavy hearts, we sadly inform you that due to irreparable economic circumstances, APF must cease to exist, effective immediately. On May 3, 2012, the Board of Directors formally voted to dissolve the organization.

The Board and staff have worked tirelessly over many months to address a significant gap between available financial resources and funds needed to remain operational. Unfortunately, the economic situation has not changed in any meaningful way, despite our best efforts.

APF hopes to be able to transfer content from various information, education, and support programs to other organizations so that you may continue to benefit from the value these programs have provided to thousands of individuals and families across the country.

Your personal experiences in living with pain and seeking compassion, empathy and medical care often against the odds -- have driven our efforts over these many years. This includes enactment of key provisions of the National Pain Care Policy Act in the Health Reform Bill that led to a landmark report issued in 2011 by the Institutes of Medicine. This report documents the shocking numbers of US citizens that live with pain and calls for immediate changes to address gaps in care. Despite this, the current climate towards improving the plight of people with pain in the US continues to be precarious and hostile.

As you unfortunately know, the need for public outcry around the needs of Americans struggling with pain conditions is greater today than ever before in light of the multi-front assault occurring daily on our right to dignified care. Misguided state and federal policies are impeding access to appropriate and reasonable medical care for people struggling with pain, and deterring even the most compassionate medical providers from treating anyone with pain conditions.

It is therefore critical that each of you raise your voices singularly and together to demand the care you deserve. It is only by continuing to demand attention to the ever-worsening barriers and unacceptable suffering that change will occur.

Elected officials, policy makers, and the media need to keep hearing from each and every one of you so they are not allowed to walk away from the consequences of this over-looked public health and medical problem.

Please know that although APF will cease to exist, the resolve and commitment among individuals on the Board and staff remain strong.

Check out the latest articles here on the Back and Neck Pain site:

• All About Adjacent Segment Degeneration
• Total Disc Replacement or Spinal Fusion?
• Your Psoas Muscle
• The Latissimus Dorsi Muscle
• Vocabulary: Encroachment
• Anatomy: Bony Process

While a crick in the neck generally doesn't require a doctor's appointment, few people can deny the intense discomfort they feel when they have one. So what do you do? For starters, you might try some at home therapies. If that doesn't work, maybe it is time to see a doc.

I'd like to be sure you are aware there's a (small, but growing) category on the Back and Neck Pain site dedicated to helping you figure out what your symptoms mean.  So, for example, if you have shooting pain down your leg, it could be radiculopathy, and you can find a write up of this problem in that category.  The category is called What to Do If You Have.... Check it out.

Every time I do my back exercises I am amazed at what muscles can really do.  This is because, in my opinion, each muscle, by means of it's shape, the location of its ends and other things contributes something unique to the way the spine moves.  Making them stronger increases support for and movement of the spine. Here are a couple of significant muscles that play big roles in the healing of back pain:

• Psoas
• Latissimus Dorsi

If you are one of those spine patients who needs help deciphering your diagnosis into plain English, you are not alone. One of my initiatives here on the Back and Neck Pain site on About.com, is to clarify commonly used terms. Below are a few I've recently added to the list. Check them out:

• Encroachment
• Bony Process
• The Daily Spine - Back Pain Vocabulary Terms

Total disc replacement is a motion sparing surgery that, in recent years, has been developed as an alternative to spinal fusion.  To a large extent, this is in response to adjacent segment degeneration, or degeneration in the spine located at the levels above and below the fusion site.

Should you opt for a total disc replacement surgery instead of a spinal fusion (video)?  Now you can explore the possibility, and review the results of medical research asking this and related questions in my new article How Does Total Disc Replacement Stack Up Against Spinal Fusion?

You may remember back in February, I asked you to vote in our About.com Reader's Choice Award contest for the best back pain blog. Ladies and gentlemen, we have a winner!

The winner is the The Back Pain Blog. I love this blog because it's written by someone in the know - a person who experiences chronic back and neck pain.   Congratulations!.

As of late, I've been busy on the Back and Neck Pain site here on About.com.  Check out some of the things I've been up to:

• TIPs and IDETs
• Should You Have A Revision Back Surgery?
• Dural Tears and Cerebrospinal Fluid Leaks
• Common Reasons Revision Surgeries Are Given
• What Is Incidence?
• What Is Hook Lying?
• Positioning Your Neck For Safety and Comfort
• When You Extend Your Legs, Your Spine May Be Effected