Complications of Epidural Injections You Need To Know About

December 29th, 2011 AmeeL

People who experience pain after epidural injections or are considering the procedure often wonder if it can cause more harm than good. For some, there is no question about this; from new moms to veterans with neck and back pain, complications associated with epidural injections are a reality. These complications range from increased pain to paralysis and even death.

The Epidural

The epidural is so popular because it is convenient. The injection takes minutes and can relieve chronic pain for months at a time. Many with chronic pain do not receive a solid diagnosis, so treatment often begins and ends with pain medication.
Doctors also benefit from administering epidural injections; they receive hefty reimbursements from Medicare, and even heftier ones from private insurers.

An epidural procedure involves the injection of a steroid/anesthetic solution into the epidural space around the spinal cord. This reduces inflammation and also has a numbing effect, eliminating the transmission of pain signals.

The Dangers

The FDA is currently investigated the safety of two types of epidural procedures: transforaminal and particulate. The transforaminal form of epidural involves administering the shot with the needle inserted extremely close to arteries that supply blood to the spinal cord, increasing the chances of nerve damage. The chairman of the American Society of Interventional Pain Physicians, Laxmaiah Manchikanti, has stated that half of all epidural injections administered during 2010 were transforaminal.

Physicians consulting with the FDA also expressed concerns about the use of particulate steroids in epidurals. This form of steroid dissolves slowly in the body, and, if improperly administered, could block arteries and lead to strokes. While some companies that produce particulate steroids label the products as unsafe for use in epidural injections, some physicians continue to use them for that purpose according to lawsuits.

Other epidural complications include infection and abnormal bleeding in the epidural space, both of which can lead to nerve damage.

Difficulty of Risk Assessment

There is, unfortunately, no protocol for identifying damage caused by epidural injections. We have only the evidence of numerous lawsuits filed on behalf of people who have suffered strokes, paralysis and death after having the procedure done, along with some physician testimonies.

In 2007, results of an anonymous physician survey reporting patient complications following epidural injection were released. 287 physicians reported 78 known cases of complications overall, 13 of which were fatal. More on this survey can be found at http://www.ncbi.nlm.nih.gov/pubmed/17495784.

While epidural complications do not occur in the majority of cases, the apparent lack of protocol for assessing risk is alarming, especially given the extreme nature of reported complications. Also worth emphasizing is the fact that these injections do not cure anything. They provide short-term pain relief without addressing the cause of pain. Real neck and back pain treatment requires treating causes of pain and not just pain. While some doctors are more than happy to settle for numbing your symptoms, you as a patient are entitled to more. Unfortunately, the modern American health care system is more of an industry than a social service. That is why patients must act as informed consumers to ensure they get the best quality of care. The decision to receive epidural injections should be an informed one, given the potential risks. Only you can decide if resolving your pain in the short-term is worth the risks, and you deserve to know what those are.

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Flat Feet Can Cause Back Pain

December 27th, 2011 AmeeL

Flat feet are fairly common and, for some people, cause no pain. The cause and severity of flat footedness, and whether it causes a change in other joint angles, will likely determine whether or not this condition is painful. It is important to know that pain from flat feet can be felt not only in the foot, but in the ankles, knees and hips as well. There is also a connection between flat feet and back pain.

The arches of the foot are constructed of bones, joints, muscles, ligaments and tendons. The whole foot contains 26 bones, 33 joints and over a hundred muscles, ligaments and tendons. Muscles, ligaments and tendons strengthen the arch, assuring its structural integrity.

Flat feet can be congenital or acquired. People who are born with flat feet never develop arches. The condition can also be acquired if an injury to the foot weakens the soft tissues that support the joint. It can also occur due to loading over the years. Some people with flat feet have arches when there is no weight on their feet, but the arches are weak and flatten once weight is applied to the foot.

Why Arches Are Important

Arches serve two main functions in he foot. First, the gap between the ground and the inner foot has a shock-absorbing function that decreases the jolting force transferred from the ground to the body. Second, the arch help to ensure that the body’s weight will be carried and balanced on the outer edge, ball and heel of the foot. In this position, the ankle, knee and hip joints are properly aligned.

When the arch is absent, the foot may roll inward and take weight on the inner portion. This is called over-pronation. If you stand up and attempt to support yourself with your big toe and the inner part of your heel, you’ll feel a change take place in the alignment of your ankle, knee and hip joints. This misalignment can lead to chronic pain.

Flat Feet and Back Pain

When the pelvis is misaligned, it affects the upper body. There are a number of muscles that stretch between the lower back and the hips. A change in hip position will lead to alterations in the tension of these muscles, many of which connect to the spine. Back pain caused by muscle tension, spinal joint misalignment or both may occur.

Surgery is rarely required, as there are conservative flat feet treatments that help most people attain proper alignment. Many people use orthotic devices such as insoles in their footwear to ensure that weight is carried by and forces are transferred through the correct areas of the foot. They are similar to basic arch supports found in quality sneakers, but orthotics that are used to treat flat feet should be tailored to your exact foot size and shape by a specialist.

People who have flat feet caused by weak foot muscles can perform exercises to reactivate the muscles. A description of four flat feet exercises can be found at http://www.livestrong.com.

Pain in the feet, ankles, knees, hips and back may be caused by flat feet. If you see that your foot has little to no arch and notice that your shoe tread wears unevenly, seek out conservative treatment sooner than later; your joints will less likely suffer unneeded wear and tear if you resolve the problem early on.

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Back Pain: Pinched Nerves Could Be The Cause

December 24th, 2011 AmeeL

Learning how to narrow down the cause of your back pain will help you receive better treatment, both from yourself and from medical professionals. Since there are a number of back pain causes, finding yours will likely require some research into anatomy and medical conditions.

In today’s culture of specialization, we tend to defer the responsibility of diagnosis and the decision-making about treatment to professionals. While this makes sense on a cerebral level, it has left many chronic pain sufferers without answers. There are many excellent doctors who are in the business for the right reasons; that said, you can sadly expect anyone with chronic pain to have at least one story about a dismissive, negligent doctor whose prescription began and ended with pain medications.

Fortunately, there are alternatives to surgery, drugs and “just dealing” with chronic pain. You just have to know where to look. Part of educating yourself is gathering resources that will help you identify your pain and possible treatments. The first step is identifying what type of pain you have.

Signs of Nerve Impingement

There are many different types of pain, like burning, aching and stiffness. Pain associated with nerve impingement, or a “pinched nerve,” is sharp and often shoots to other parts of the body along the nerve path. Other sensations are associated with nerve impingement: tingling, numbness and weakness. If you have sharp back pain that is referred to other parts of the body and accompanied by these other sensations, it is highly probable that you have a nerve impingement near the area of your back that hurts.

Many people with back pain, especially lower back pain, complain of traveling pain. Impingement in the lower back, often of the sciatic nerve, can cause pain in the hips, buttocks and legs all the way down to the feet. Foot pain is not intuitively associated with pain in the back, but a little education into nerve pathways reveals that the two are likely related.

The Dermatome Map

An excellent resource for solidifying the link between back pain and pain in other parts of the body is the dermatome map, found here: http://www.apparelyzed.com. This provides a visual representation of where specific spinal nerves travel throughout the body.

Reading the map requires some basic education about the spine. The upper segment of the spine in the neck is referred to as the cervical spine, consisting of 8 vertebrae. The top vertebra is named C1; the next one down is C2, and so on to C8. The next segment of the spine connects to the ribs and is called the thoracic spine. Its vertebrae are named T1 through T12, with T1 as the topmost and T12 as the bottommost vertebra. Below this segment is the lumbar spine in the lower back, consisting of 5 vertebrae named like the other segments. Below the lumbar spine is the sacrum, a segment of fused vertebrae at the base of the spine.

The dermatome map provides an approximate but neat representation of the body’s nerve pathways. A person with pain in the lower back and heel pain could use this map to infer possible nerve impingement in the lumbar spine at L5. Likewise, numbness and tingling in the top of the hand could indicate a nerve problem stemming from the bottom vertebrae of the cervical spine. Using this tool to guide you and your doctor through diagnosis will speed up the process and increase your chances of receiving effective treatment.

Treating Causes of Pain, Not Just Pain

Determining the cause of your pain is a big step, but it’s not the finish line. If you suspect you have nerve impingement, it is important to seek out medical care. A variety of problems can lead to nerve impingement, and the exact cause and severity of your case will in part determine your treatment.

Seek out a doctor who will listen to your needs and desires. Pain medication may be required temporarily to allow you to function, but treating the cause of impingement will require further action. You may need physical therapy, chiropractic care or spinal decompression treatments. It is important that your doctors knows you understand that there are a variety of safe treatment options that can prevent prolonged pain medication use and surgery.

Spinal problems that cause nerve impingement should be treated as serious medical conditions. You can take steps to diagnose and resolve your pain, but don’t substitute self-care for medical treatment when the latter is needed. Establish yourself as a partner in your treatment and avoid getting the run-around from a doctor who won’t take you seriously.

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3 Myths About Yoga and Back Pain

December 21st, 2011 AmeeL

Many people with pain and stress turn to yoga for relief. The effectiveness of this ancient form of movement therapy is well established historically, and has recently become supported by a growing body of scientific evidence. Yet popular misconceptions still persist about yoga, and the results of two recent studies into yoga for back pain may help perpetuate these misconceptions. A little critical thinking and research can help you to separate yoga myths from facts and make a wise decision about your treatment path.

Myth #1: Yoga is Bad For Your Back

When many people think of yoga, they envision a contortionist. Some yogis, it is true, are hyperflexible due to their years of intense body work. However, the common practice of yoga does not require or aim to achieve this amount of flexibility. It is hard to talk about yoga as one thing, as there are a number of types. All yoga types use poses to stretch muscles and build strength. The forms are highly adaptable to individual needs, and stretching yourself beyond comfort is never recommended.

Helping to spread Myth #1 are recent headlines stating that yoga can ruin your back. A recent study from the University of York is sited as determining that, in some, yoga practice leads to severe pain. It is hard to argue with a study’s results, but you can question the conditions of a study and the interpretation of the results. On further digging, we find that, of 300 chronic back pain patients, 12 suffered worse back and neck pain after yoga practice, with others reporting increased ability to carry out daily tasks. While the number of people with worse pain after yoga is not insignificant, it hardly suggests that yoga will give you a bad back.

The article in question, found at www.iol.co.za, quotes a Dublin physiotherapist as saying that the yoga-related injuries he sees often involve overstretching of the neck and lower back as well as hip and knee joint complications. These injuries are the result of performing yoga improperly. Pressure to “do well” in a class, lack of instruction or poor instruction can all lead to improperly performing yoga poses. Sometimes, the blame is with the execution of the treatment and not the treatment itself.

Myth #2: Yoga is Natural, So It’s Harmless

On the flip-side of Myth #1 is the misconception that yoga, along with herbal remedies and other natural forms of treatment, can do no harm. Like any form of medicine, yoga has contraindications. As discussed above, it can be performed improperly, leading to injury. Also, specific back problems may be exacerbated by certain forms and poses of yoga. People with SI joint dysfunction, for example, should not do poses balancing on one leg. Forward-bending poses can be harmful to those with tight hamstrings and a flattened-out lower back.

Natural does not mean harmless, because natural forms of treatment can be just as powerful as those fabricated in a lab. Respect the medicine, whatever one you choose, and avoid abusing it.

Myth #3: Yoga is Just Expensive Stretching

What’s so special about moving your body into particular poses? Yoga has been blacklisted by some as a fad, a celebrity trend and a placebo. But the practice has a lot to offer our bodies and minds. Yoga is not simply stretching; its poses also build strength. Most forms of yoga emphasize the importance of efficient breathing. This can increase your sense of relaxation, which reduces the amount of muscle tension you may experience. Some forms of yoga foster deep meditation; others emphasize proper body alignment. Each type of yoga varies in aim and intensity, but no type of yoga is can be reduced to fancy stretching.

Myth #3 will likely be perpetuated by headlines concerning a recent study conducted to assess yoga’s efficacy as a treatment for back pain compared to simple stretching. One such headline is found at www.telegraph.co.uk. The results of the study showed that both participants in the yoga group and the stretching group experienced equal relief. However, interpretation of the conditions and the results must conducted.

The above article reports that the stretching group held their stretches for lengthy periods of time and spent more time overall with their routines than the yoga group. The article ever-so-briefly mentions that the stretching group were also given strengthening exercises to do. Finally, toward the end of the article, one of the researchers conceded that the stretching program assigned was a lot like yoga. Yet the misleading headline would be enough for some to conclude that Myth #3 is a confirmed fact.

Dispelling myths surrounding back pain treatments like yoga is necessary; otherwise, people who could benefit from the practice would never try. Depending on the cause of your back pain, yoga may be a viable and safe treatment option for you. Approach the practice with respect, and don’t settle for a headline; critical thinking will help you weed out the myths surrounding back pain.

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