Surgical Options for Back Pain

When should I have back surgery?
Surgery for back pain is a last resort treatment. There are basically two reasons for surgery for back pain. They are: (1) neural element compression (or squeezing of nerve roots or nerves) or pressure on the dura mater (which is the sac that surrounds the spinal cord and nerve roots), or (2) back pain. Back pain itself is mainly of two causes: (1) muscle spasm and (2) mechanical pain.

Muscle spasm
Muscle spasm is essentially a muscle pull or charley horse of the back muscles. In this situation, the muscles of the back are tender to the touch. Bed rest or inactivity does not usually relieve the pain significantly. Muscle spasm, as an isolated entity, is a non-surgical problem.

Mechanical pain
Mechanical pain is a pain that is deep and agonizing in nature. It is not related to muscle spasm, and activity worsens the pain while inactivity (such as bed rest) improves the pain. This pain syndrome is significantly different than that of muscle spasm. It is potentially a surgical problem in that instability can cause mechanical pain. This is akin to a degenerative hip in an elderly person in whom the pain is deep and agonizing in nature, is worsened with walking, and improved with sitting or lying.

What is sciatica?
Sciatica and some central back pain problems can be related to neural compression. Sciatica is caused by a disc herniation or bulge that compresses or squeezes a nerve as it exits the spinal canal. This pain usually is in the distribution of the nerve (where the nerve goes in the body). Anterior dura mater pressure can cause central back pain because of the rich innervation (nerve supply) of this portion of the dura mater. Discectomy is a treatment of choice for the problems mentioned above. Laminectomy might occasionally be helpful. A discectomy is usually performed through a small bony window.

What are the surgical procedures for back pain?

Laminectomy
A laminectomy involves the removal of a significant posterior portion of the spinal covering. It is performed to relieve pressure on the spinal cord.

Discectomy
Discectomy is a minimally invasive procedure during which herniated disc material is removed, while the support structure of the disc remains intact.

Spinal fusion
Spinal fusion is a process during which a number of vertebrae are made to grow, or "fuse" together. Mechanical back pain is usually treated with exercise and the strengthening of the support system of the spine (muscle and ligaments). This stabilizes the spine in a physiological manner. However, spinal fusion occasionally might be needed in patients who truly have mechanical pain and who have failed an aggressive non-operative program.

Many controversies exist regarding fusion. Should the fusion be performed as an entity in and of itself or with instrumentation? Should the fusion be anterior or posterior in location? Should cages or screws be used to supplement the fusion? How long should a fusion be? Should it incorporate one motion segment (disc), or two or three motion segments? All of these questions are appropriate and very difficult to answer.

Remember, "spine surgery begets spine surgery." At least 20 percent of people who undergo an initial "simple operation" for back pain or leg pain will undergo one or more additional operations. These are usually people with chronic back pain.

Pain management: Lifestyle changes

Pain management may be improved with simple lifestyle changes. Making a few or all of these changes might not cure your pain, but they may complement your already existing treatment plan. As you read on, you may be amazed by how interwoven some of these categories are. (For example, good sleep hygiene includes eating a balanced diet, exercising when appropriate and reducing stress.)

Lifestyle changes overview

Eating a balanced diet can ensure that you are getting the vitamins and nutrients you need to stay healthy. Be sure to discuss your diet with your doctor. Some foods and vitamins should be avoided when taking certain medications.
Eat healthfully: Visit the Food & Nutrition Center

* Eat a balanced diet for chronic pain
* Healthy diet basics
* Visit the Food & Nutrition Center for more tips

More and more studies are showing that sleep is tied to your health. Sleep deprivation can lead to high blood pressure, increased blood sugar levels, a weakened immune system, depression and even weight gain. Poor sleep can also worsen existing conditions.
Sleep better: Visit the Sleep Center

* The rewards of sleep
* Sleep and your health
* 10 tips for better sleep
* Visit the Sleep Center for more tips

Regular exercise can benefit those with chronic pain. Physical activity increases energy and joint flexibility. Remember to start out slowly and ease into your exercise routine. Consider getting a personal trainer or participating in physical therapy.
Start exercising: Visit the Fitness Center

* Exercise to help with chronic pain
* Find condition-specific exercises
* Find articles on how to get started
* Find articles on strength and muscle training
* Visit the Fitness Center for more tips

Extra stress in your life can cause tension in your muscles and worsen existing conditions. For some people, exercise (e.g., aerobics, running, yoga) also acts as a stress reliever. Others may need to take a few extra minutes to focus on relaxation.
Reduce stress: Visit the Stress Management Center

* Stress management overview
* Find articles on relaxation and breathing techniques
* Find articles on massage therapy
* Detect your sources of stress
* Visit the Stress Management Center for more tips

Smoking may worsen your pain and prevent pain management treatments from being maximally effective. People who smoke also develop more illnesses than nonsmokers and are at higher risks of cardiovascular diseases, lung problems, cancer and infertility. Discuss your method of quitting with your doctor in order to be sure that it works well with your current pain management plan.
Stop smoking: Visit the Nicotine Dependence Center

* 10 rules of change
* Nicotine dependence: Treatment overview
* Visit the Nicotine Dependence Center for more tips
* Smoke-free: Get support from others like you

If your chronic pain keeps you from getting around or enjoying activities outside the home, assistive devices (such as a cane or crutches) and some home modifications may help. Your doctor may or may not want you to use an assistive device, so discuss your plans with your doctor first.
Assistive devices: Visit the Caring for Others Center

* Home modifications and assistive devices
* Find articles on safety and mobility in the home
* Visit the Caring for Others Center for more tips

12 simple ways to SuperCharge your Brain

Have you ever felt exasperated when you bumped into someone at the store but absolutely couldn't remember their name? Sure, it happens to all of us.

Despite being the strongest computer on the planet, our brains do lapse. It's hard to blame them really. As humans, we spend much of or existence stuffing our brains with stuff.

No matter how powerful our brains are, they need recuperation time to be kept in shape. Think of it as a tune up for your brain. Skipping brain maintenance is as silly as the person wandering the parking garage because they forgot where they parked. Is that you? Are you that person? If so, fear not; we are all that person at some point.

Now I am not a brain surgeon and I am not going to suggest you do anything surgical or dangerous. I am however an astute student of human behavior so I always look for simple ways to super charge my brain.

Here are some things you can begin doing as soon as today to begin the great brain tune up:

Eat Almonds
Almond is believed to improve memory. If a combination of almond oil and milk is taken together before going to bed or after getting up at morning, it strengthens our memory power. Almond milk is prepared by crushing the almonds without the outer cover and adding water and sugar to it.

Drink Apple Juice
Research from the University of Massachusetts Lowell (UML) indicates that apple juice increases the production of the essential neurotransmitter acetylcholine in the brain, resulting in an increased memory power.

Sleep well
Research indicates that the long-term memory is consolidated during sleep by replaying the images of the experiences of the day. These repeated playbacks program the subconscious mind to store these images and other related information.

Enjoy simple Pleasures
Stress drains our brainpower. A stress-ridden mind consumes much of our memory resources to leave us with a feeble mind. Make a habit to engage yourself in few simple pleasures everyday to dissolve stress from your mind. Some of these simple pleasures are good for your mind, body and soul.

* Enjoy music you love
* Play with your children
* Appreciate others
* Run few miles a day, bike or swim
* Start a blog
* Take a yoga class or Total Wellness routine

Exercise your mind
Just as physical exercise is essential for a strong body, mental exercise is equally essential for a sharp and agile mind. Have you noticed that children have far superior brainpower than an adult does? Children have playful minds. A playful mind exhibits superior memory power. Engage in some of the activities that require your mind to remain active and playful.

* Play scrabble or crossword puzzle
* Volunteer
* Interact with others
* Start a new hobby such as blogging, reading, painting, bird watching
* Learn new skill or a foreign language

Practice Yoga or Meditation
Yoga or Meditation relives stress. Stress is a known memory buster. With less stress, lower blood pressure, slower respiration, slower metabolism, and released muscle tension follows. All of these factors contribute significantly towards increases in our brainpower.

Reduce Sugar intake
Sugar is a non-food. It’s a form of carbohydrate that offers illusionary energy, only to cause a downhill slump once the initial burst has been worn off. Excess intake of sugar results in neurotic symptoms. Excess sugar is known to cause claustrophobia, memory loss and other neurotic disorders. Eat food without adding sugar. Stay away from sweet drinks or excess consumption of caffeine with sugar.

Eat whole wheat
The whole wheat germs contain lecithin. Lecithin helps ease the problem of the hardening of the arteries, which often impairs brain functioning.

Eat a light meal at night
A heavy meal at night causes tossing and turning and a prolonged emotional stress while at sleep. It’s wise to eat heavy meal during the day when our body is in motion to consume the heavy in-take. Eating a light meal with some fruits allows us to sleep well. A good night sleep strengthens our brainpower.

Develop imagination
Greeks mastered the principle of imagination and association to memorize everything. This technique requires one to develop a vivid and colorful imagination that can be linked to a known object. If you involve all your senses - touching, feeling, smelling, hearing and seeing in the imagination process, you can remember greater details of the event.

Control your temper
Bleached food, excess of starch or excess of white bread can lead to nerve grating effect. This results in a violent and some time depressive behavior. Eat fresh vegetables. Drink lots of water and meditate or practice yoga to relieve these toxic emotions of temper and stressful mood swings.

Take Vitamin B-complex
Vitamin B-complex strengthens memory power. Eat food and vegetables high in Vitamin B-complex. Stay away from the starch food or white bread, which depletes the Vitamin B-complex necessary for a healthy mind.

I don't believe these are that tough. If you find yourself increasing stumped, give a couple of these a try.

Written by Shilpan Patel of Success Soul and cross-posted from Dumb Little Man, a web site that provides tips for life that will save you money, increase your productivity, or simply keep you sane.

Reporters love rapid detox in UK

Posted on November 29, 2008 by Trevor Butterworth

Maia Saliva

In what read like a paid advertisement, Britain’s Independent newspaper has become the latest media outlet to fall for the claims of the promoters of a procedure called “rapid” or “ultra rapid” opioid detox.

The Independent is in good company: Barbara Walters, 48 Hours, even Wired have promoted this treatment.

The Independent claims that in the world of addiction treatment everyone believes addiction is a psychological and physical problem, but only rapid detox treats it as a physical one.

This is what happens when journalists who don’t follow a beat write about a topic without bothering to check the medical literature, let alone Google. Almost everyone in the field of addiction has been singing from the “addiction is a disease” song sheet for decades.

While I am the first to scrutinize the field of other addiction treatments, like the Betty Ford or other treatments that detoxify you cold turkey style`and no medications at all, to treat physical symptoms is even more dangerous. For saying that opiate addiction is a “disease,” and then turning around and treating addiction with untrained counselors or faith-based moralistic attacks, it is simply wrong to claim that most addiction treatment ignores biology. If anything, the idea of addiction as a disease affecting the brain only is over-emphasized.

The main rationale for methadone maintenance is, in fact, that addiction is a medical problem and that providing an opioid makes up for a deficiency in the brain. It is the most-used treatment for opioid addiction in the UK, and, not coincidentally, the best-supported by evidence. Methadone, also called Method 1 used by pharmaceutical companies to promote legalized Heroin is only feeding more addiction. Rapid Opiate Detoxification can also help and is more cost effective than conventional methods.

The key problem with the Independent’s story is that it failed to mention the most important study on rapid detox, Anesthesia-Assisted vs Buprenorphine- or Clonidine-Assisted Heroin Detoxification and Naltrexone Induction, which was conducted at Columbia University Medical Center, and published in the Journal of the American Medical Association in 2005. The study, a randomized controlled trial, compared rapid detox to two other treatment methods and found that it provided

“no benefit… over a safer, cheaper, and potentially outpatient alternative using buprenorphine as a bridge to naltrexone treatment. Taken together with the results of earlier studies, our findings suggest that general anesthesia for rapid antagonist induction has a tremendous success rate a meaningful role to play in the treatment of opioid dependence.”

Contrary to the media’s advertorials stories, and the Independent’s claim that patients wake up from the anesthesia used in rapid detox without withdrawal symptoms, the study found that withdrawal was very severe than other methods (rapid detox includes the use of anesthesia, when a patient is likely to be resting comfortably, hopefully supervised by a Skilled Nurse.)

Also, fourteen patients in the rapid detox group also had “potentially life-threatening adverse events at the Waismann Method Institute.” But, they have very good marketing and treat you when you call, like an Addict, seems to me, more financial, than beneficial. As with the fact that there have been deaths associated with the procedure, this potentially life-saving information never made it into the Independent’s story.

If you consider Rapid Opiate Detox, I would only recommend Dr Yee, from V.I.P. Rapid Detox in Las Vegas, Nevada. Where he is there one-on-one and also provides a highly skilled Nurse for after-care.

“Reporters love rapid detox”

1.
James Hubbard, M.D., M.P.H., on October 22nd, 2008 at 4:30 pm Said:

Great analysis. Thanks for exposing the facts.
2.
Ed Runci, on October 16th, 2008 at 10:41 pm Said:

The Columbia study is three years old. It did not even look at Dr. Alan David Kaye’s Ultra Rapid Detox Center at Texas Tech Health Sciences Center. Dr. Kaye was Chairman of Anesthesiology and Director of the Post-Doctoral Fellowship Program in Interventional Pain Management. He’s a member of the Texas Tech HSC Anesthesia Hall of Fame,.

Dr. Alan David Kaye (MD, PhD, DABPM) is now Head of Anesthesiology at LSU School of Medicine, New Orleans, and Chief of Anesthesiology at three fully accredited hospitals. He’s a Tenured Professor of Anesthesiology and a Professor of Pharmacology. He was named a Consumer Research Doctor of the Year in Anesthesiology and Interventional Pain Management for 2006-2007. He’s a praticing physician, Head of a Medical School Anesthesiology Department, Chief of Anesthesiology, Research Scientist and Scholar. He’s published more than 500 Articles, Abstracts and Text Book Chapters. He won the Arizona State Rhodes Scholar Competition, and was the Western Region National Rhodes Scholar Competition Runner-up.

He is the Inventor the Kaye Method of Ultra Rapid Detox, and the Medical Director of the Kaye Clinic for Ultra Rapid Detox at Ochsner Medical Center - Kenner Louisiana. He’s been successfully performing The Kaye Method Ultra Rapid Detox procedures in a hospital Intensive Care Unit since 2000, has a 100% success rate, has NEVER had an adverse incident, and has published articles based on his research and practice in prestigious peer-reviewed Medical Journals.

It’s time to stop looking backwards at old data, and to start looking forward at real facts and the results of actual practice by true experts in the field. If you want the REAL facts about Ultra Rapid Detox, you can come meet Dr. Kaye, email him or speak directly with him by phone. Contact me (Ed Runci) at http://www.kayerapiddetox.com, and I’ll personally arrange any of the above.
3.
Trevor Butterworth, on October 29th, 2008 at 5:26 pm Said:

This is a response from writer Maia Saliva:

In searching Med-line, I find two articles by Kaye on rapid detox. One was a review– which claimed that opioid detox can be fatal without anesthesia, a claim that is supported by data– and was done *before* the JAMA article appeared. The other made claims about rapid detox being safe and effective, and a randomized controlled trial and was followed up by an editorial note “Editorial expression of concern regarding: Kaye AD, Banister RE, Hoover JM, et al. Chronic pain and ultra-rapid opioid detoxification. Pain Practice 2005;5(1):33-42.”

It’s nice to have qualifications but qualifications do not trump data and given that he doesn’t seem to have any published peer-reviewed controlled data comparing level of withdrawal symptoms following his detox to level of withdrawal symptoms following safer alternatives, I remain convinced that rapid detox has advantages over other detoxes. The key advantage is supposed to be patient comfort: if they can’t even prove that– which JAMA debunked pretty conclusively– all other points are moot. No controlled trial has found advantages in long-term recovery, so why add the risk?

Swiss back heroin prescription for addicts

* a Swiss heroin clinic BBC

A small kit of supplies containing syringes, bandaids and antiseptic pads waits Reuters – A small kit of supplies containing syringes, bandaids and antiseptic pads waits to be used by a drug …

ZURICH (Reuters) – Swiss voters on Sunday backed a scheme allowing heroin addicts to obtain the drug under prescription, angering conservatives who believe crime will rise as result.

Some 68 percent voted in favor of the prescription program that was already approved by parliament, making permanent an experiment that has been in place since 1994.

The referendum was instigated by the right-wing Swiss People's Party (SVP), which wanted to overturn parliament's decision.

Advocates of the program say that allowing addicts to be prescribed heroin makes them less likely to turn to crime to pay for their habit and that the treatment can lower mortality rates.

Opponents of the scheme say it has done little to encourage users to give up heroin.

Switzerland's cities were plagued with drug problems in the 1990s, but drug-related crime has declined and addicts' health has improved due to government health plans.

"The people have confirmed that the conditions of the 90s, with open drug scenes in all towns, must belong to the past," the Social Democrats said in a statement.

The Green party also welcomed the result.

But the SVP said it was disappointed with the outcome, saying that the law failed to make abstinence its goal.

"The new legal framework will favor the drug mafia and will lead to new, open drug scenes and make the jobs of the police and justice departments even more difficult," the party said in a statement.

"Several thousand drug addicts are not capable of working anymore and live off social help and disability insurance."

Addicts have to fulfill strict criteria before being allowed to take part in the program, the Swiss Federal Council said in a document published before the referendum.

At the beginning of 2008, nearly 1,300 addicts were being prescribed heroin out of 26,000 undergoing treatment, many of whom were receiving the synthetic substitute methadone.

"Heroin-assisted treatment (HAT) is designed to help severely dependent heroin users who have fallen through the net provided by other treatment options," the Federal Department of Home Affairs said on its website.

In another referendum on Sunday, the Swiss rejected the decriminalization of cannabis, with 63 percent voting against an initiative that was supported by the Social Democrats and the Green party.

(Editing by Mark Trevelyan and Angus MacSwan,)

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