Back Pain Relief and Treatment

MIGRAINE REBOUND FOR SURE

noreply@blogger.com (Dr. Tim Sams) — Tue, 24 Jul 2012 01:37:00 +0000

Do I address the fact that I haven't blogged in four years or ignore it. Hmmm. I believe that information is power and that people need to be told the truth. I didn't die, no grievous injuries. I have been busy with other stuff. Ouch. But, I am now committed to making this blog the best in the field of pain. And so, a recent study in the field of headache demonstrated taht migraine frequently follows a period of decreased stress. Thus, the weekend "rebound" theory of headache is strongly supported. May not seem like a big deal to some, but no one had actually researched this until now. Cool. Good to be back. Say something - I can hear you breathing.

SAVELLA

noreply@blogger.com (Dr. Tim Sams) — Sat, 03 Oct 2009 15:37:00 +0000

Can't believe it's been ten months since my last blog! Got caught up in things clinical. A new drug just came onto the market, Savella. An SNRI, that is FDA approved for pain relief for Fibromyalgia. The generic medication is Milnacipran, in the same class as Effexor and Cymbalta. The manufacturer says it targets norepinephrine over serotonin in a 3-1 ratio, more than any other SNRI, which is what makes it such an effective pain reliever. Several of my patients have tried Savella and found it to be effective with minimal side effects. It is being prescribed off label for any type of neuropathic pain and will probably become the sexy, new antidepressant. If you've tried everything else, including the anti-convulsants, you might want to ask your doctor to prescribed Savella. Dosing begins at 12.5 mgs and titrates to 25, 50, and 100 mgs every 2-3 days on a twice daily schedule. It's good to be back.

The Disappearing Pain Doctor

noreply@blogger.com (Dr. Tim Sams) — Mon, 29 Dec 2008 18:38:00 +0000

Hope everyone is having a great holiday! It's my plan to resume blogging at least weekly after taking a 7 month hiatus that was partly caused by my real world schedule ratcheting up and partly because no one was reading or at least commenting about the blog. However, following the "build it and they will come" philosophy, I plan on resuming posting regularly. But, I have decided that the postings will not be restricted to only pain topics. People in pain (PIPs) have lives apart from pain that I can also address and I will as the mood and events strike me and seem important. It was always my intentionfor this blog to be integrated into PIPs lives, and nonpaintopcis are part of that. We'll see how this works out in 2009.

Dr. Tim

BACK PAIN, MEDS, AND NONCOMPLIANCE

noreply@blogger.com (Dr. Tim Sams) — Mon, 07 Apr 2008 18:47:00 +0000

I listened to a phone call between a patient and our secretary last week. The patient wanted to come in a week before she was due for a refill of her Methodone and Dilaudid as she would be on vacation the next week. She was informed that this was fine, but that she would need to bring in her two bottles of narcotic to confirm that she had a week's worth left. She was told that this was standard policy. We did not refill patients early if they ran out of their narcotics early. The patient was outraged. She stated that this had never been required before and demanded to know why she was being singled out. She railed against the possibility that we did not believe her. She yelled at our secretary that we were being unfair, unreasonable, and unprofessional. She demanded that she be able to speak to the office manager, and aggressed against her as well - for almost 20 minutes. Eventually, she refused to come in early if we could not trust her, and stated she would see us after her vacation. Clearly, she expected to remain a patient even after her tirade.

These interactions happen all the time in a typical pain clinic, but patients almost never see them. Everybody is special, everybody is trustworthy, everyone should get special treatment. Patients should be able to structure their treatments, refills, etc., any way they want. Everybody thinks we should break the rules just for them. This patient demanded that we refill the two strongest narcotics in the history of the world 7 days early out of 28 simply because she wanted us to. The common sense, minimally important request to bring in her bottles outraged her. Objectively, this was not a big deal - if she had the last week of her meds. We'll never know since she felt too outraged and betrayed to bring her meds in and so will fill her script after her vacation - the clear implication being, it will be our fault when she goes through withdrawal.

This patient's behavior was completely inappropriate, aggressive, and rude, and demonstrated grossly poor judgement. She yelled at the secretary and office manager for 30 minutes combined and expects to remain a patient of this clinic. She would probably threaten malpractice if we terminated her over this incident, which in fact we have every right to do.

Your doctor is not your mother, father, best friend, or priest. We don't have to care why you're being noncompliant, or inappropriate, or having a bd day - just that you are. The purpose of rules is to prevent us from having to figure out if you're telling the truth or not - that's for criminal courts and parents. We're neither. And we absolutely have the right to terminate your care if you act out. Always. The next time, you get angry because the doctor or staff won't bend the rules for you, remember this blog. And knock it off.

Dr. Tim

BACK PAIN AND PAIN MEDS

noreply@blogger.com (Dr. Tim Sams) — Mon, 31 Mar 2008 23:19:00 +0000

Every pain program I consult to, and there are dozens of them, is monitoring medications, especially narcotics, much more closely that ever before. You are expected to fill your meds on time, not early, and be responsible with them. Your doctor is neither the police, nor your parents. Having a good reason to be out of meds early is not the same as being on time. Whether you overconsumed, lost them, or they were stolen matters less than you think. Whether or not we believe your story matters less than you would think. Everybody gets one or two or even three free passes and then your doctor will probably confront you. No matter the reason, you are not a good candidate for strong pain meds if you cannot manage them. This morning a patient was outraged that she had to bring her meds with her to an appointment where she was filling her narcotics a week early so she could go on vacation. She was angry that we did not "trust her." The angrier she got, the more inappropriate. If she had the last week of her meds, why was it such a big deal to bring in her meds? Why does she think that the rules don't apply to her, that she is so special, she should be above everyone else? At best, she's being narcissistic, at worst she's using aggression to cover up being noncompliant with her narcotics. This happens all the time, the kind of interaction most patients never see but affects how pain doctors practice medicine. Be responsible with your meds, and if you run out, don't think your reason is important. It's not.

Dr. Tim

LIMBREL - A NEW ANTI - INFLAMMATORY

noreply@blogger.com (Dr. Tim Sams) — Thu, 20 Mar 2008 02:57:00 +0000

Limbrel is a relatively new prescription anti-inflammatory that is FDA approved for osteo-arthritis, but used off-label for a variety of inflammatory problems. Limbrel is not classified as a drug, but rather a medical food product. It inhibits the COX (cyclooxygenase) and LOX (lipoxygenase) enzyme systems. It is the first and only medical product that balances both COX-1 and COX-2 metabolism equally. It consists of flavocoxib, a blend of flavonoids from the two plants Scutellaria baicalensis and Acacia catechu, both well recognized for their aniti-inflammatory and anti-oxidant proerties. Anti-oxidants aborb free radicals in the joints that have been found to break down cartilage over time. Patients report effects within 4-10 days of taking the product. Side effects are minimal. Ask your doctor if he/she thinks Limrel might be effective for you.

BACK PAIN SURVEY OF TREATMENT SATISFACTION

noreply@blogger.com (Dr. Tim Sams) — Fri, 29 Feb 2008 16:53:00 +0000

A national, SpineUniverse survey of patient satisfaction with a range of back pain treatments yielded interesting results. Herbal remedies, over the counter pain medications, and acupuncture produced the greatest patient disatisfaction. Prescription pain medication, massage, exercise, and weight loss produced the greatest patient satisfaction. Less than half of the patients who underwent spine surgery were satisfied with the outcome of their surgery. If you are considering spine surgery, you may want to reread that last sentence. It is interesting to note that prescription pain medication and massage are treatments that are done to you. You have no real control over the outcome. Exercise and weight loss, both behavioral strategies are treatments that you do to and for you. You have complete control over them - but they are more work for you. You don't get to just passively lie there and be worked on. They are free, painless, and available to everybody. They also make every other treatment more effective. To read about the complete survey, go to:

http://www.spineuniverse.com/article/back-pain-3167.html

BACK SPASMS AND PAIN CONTROL

noreply@blogger.com (Dr. Tim Sams) — Thu, 07 Feb 2008 04:45:00 +0000

I had another back spasm earlier this week. The first in several years. It happened while I was typing an article about back pain. I don't care what Freud would say. My back locked up and I could hardly move. I'd say 8-9/10 pain. This time I laid on the floor and did the neutral spine exercise (Tim's Trick). The spasm eased in a minute or two but I stayed where I was for a half hour. I was left with the familiar, hot stiff ache that lasts for a few days to a few weeks.
I remembered:

How hard it is not to walk like the tin man
How serious I can get when I hurt
How much I avoid any jerky movements
How difficult it is to stand perfectly straight
How painful it can be to drive
How much I have to vary my activities
How to roll out of bed on my stomache - and how weird it looks
How easy it would be to take time off work

I'm mostly back to baseline aches and pains - my normal. I feel truly blessed that my spasms are infrequent. I have patients who go through this a couple times a week. That's a hard life. Perspective.

Good light,

Dr. Tim

BACK PAIN, NO INSURANCE, LITTLE MONEY

noreply@blogger.com (Dr. Tim Sams) — Tue, 15 Jan 2008 01:27:00 +0000

Back pain patients across the U.S. obtain phone consultations with me to achieve pain relief and a common reason is because they lost their health insurance, they hurt, and they can't afford to go to the doctor. What's the most cost effective way to get back pain relief with severe financial limitations and no insurance?

1) Take a low dose, over the counter, anti-inflammatory, like Advil. Inflammation is a pain trigger for almost everyone. Instant pain relief is not the goal, decreasing inflammation is.

2) Take a multivitamin, drink 6-8 glasses of water per day, eat multiple small meals.

3) Practice good sleep hygiene. Take a sleep aid from time to time. Go to bed and get up at the same time each day. Avoid long naps during the day. See # 6.

4) Consider taking St. John's wort, available at most grocery stores, which will increase your Serotonin levels and can improve your mood and your pain tolerance.

5) Do gentle back stretching exercises from daily to multiple times per day.

6) Get in the water (pool) and begin getting some non weight bearing, nonimpact exercise. If this is not possible, try a stationary bike - something to get your blood moving.

7) Vary your body mechanics from walking to sitting to standing to lying down every 10-30 minutes.

8) For $6.00, you can download a copy of my pain book, ABC's of Pain Relief and Treatment: Advances, Breakthroughs, and Choices with hundreds of treatment and self management suggestions.

9) For $19.95, you can consult with me for 15 minutes after completing an intake form. I can give you specific suggestions based on your unique situation.

10) Learn the back pain relief strategy of the neutral spine. Lie on the floor with your legs up on a chair facing you so your things and your calves form a 90 degree angle. this makes your low back straighten, similar to what happens with traction. try this several times per day for 5-15 minutes.

Back pain relief on the cheap!

Dr. Tim

BACK PAIN, EXERCISE, AND COMMON MISTAKES

noreply@blogger.com (Dr. Tim Sams) — Wed, 09 Jan 2008 23:18:00 +0000

The biggest mistake made by people with back pain is to not exercise at all, even after a course of physical therapy. Immediately after the therapy ends, so does any attempt at exercise. This is often the result of the underlying approach to exercise in which people with persistent back pain try to strengthen their back with exercise, increase their pain dramatically, and then stop exercising altogether, having learned that exercise hurts. The years pass with episodic attempts at exercising the injured back, usually in physical therapy, with only increased pain to show for their efforts.

The second biggest mistake people in pain make is to focus all their exercise efforts on their painful back or legs and ignore the rest of their body, which gets as weak as their back over time. With persistent pain, focus on your noninjured body parts first and only months later your injured back. Get some aerobic exercise through a stationary bike or in the pool - not so much that your pain increases. Then focus on strengthening your noninjured, non-back body parts so they can compensate for your injured back - not so much that your pain increases. Only then should you exercise your with the main goal of maintaining range of motion through gentle stretching - not so much that your pain increases. This is the most effective strategy for rehabilitating a persistently painful back. You should be doing some type of exercise 1-2 times every day. Are you?

BACK PAIN MISUNDERSTANDING AND POOR TREATMENT

noreply@blogger.com (Dr. Tim Sams) — Tue, 08 Jan 2008 03:33:00 +0000

Recently, I was asked why I created this blog with almost daily posts. The two main reasons are at the core of back pain relief and treatment and may be worth reading.

First, I know that the longer you've had back pain the more likely it is that what you do to help yourself is more important than what the doctors do to help you. This is a terrifying, frustrating, wonderful reality that places the responsibility for pain relief squarely in your hands. I know that numerous treatments for back pain will make the pain worse, not better. I know that the treatments for persistent back pain must be different than those for short term or acute back pain. I know that thoughts, feelings, and behaviors can open or close pain gates and make back pain bettter or worse. I know that people in pain must be educated about medical treatments for pain and communicate more effectively with their doctors in partnership. And I know that even if you are receiving the best possible medical treatment, you probably have more back pain than is necessary for the amount of tissue damage present. You can absolutely hurt less.

Second, after providing webcam and telephone assessment, treatment, and coaching across the U.S. and other English speaking contries for several years, I have learned how bad much of the medical care is for back pain patients across the U.S. and the world. I have learned that most people in pain are not treated in multidisciplinary pain management clinics, are not being treated by pain physicians and pain psychologists, have not been educated thoroughly about their back pain, and deal with the various conflicting agendas of their treating doctors.

Thus was born the need for this blog. My career has been dedicated for a quarter century to relieving medical pain and suffering. This blog is a logical, if unpaid, extension of that dedication for a worldwide audience. If you haven't been treated for several years in a multidisciplinary pain clinic including biofeedback and pain psychology, you can conclude that you have more pain than is necessary or inevitable. If you don't have a thorough understanding of "multifactoral back pain" with hundreds of strategies for self management, you have more pain than you should. If you are not in an agressive partnership with your pain doctor, you hurt more than you have to. If you don't understand that pain relief is largely your choice once you have the knowledge, then you can hurt less.

Some pain is inevitable; how much pain, and how much suffering, is something we can discover together. I promise to work hard for you. You have to work hard for you too.

Dr. Tim

BACK PAIN TREATMENT IS A NEGOTIATION BETWEEN PARTNERS

noreply@blogger.com (Dr. Tim Sams) — Thu, 03 Jan 2008 17:02:00 +0000

Back pain treatment is not and should not be a one sided dictation from the top of the mount. You and your doctor are partners in pain working together to achieve the greatest pain relief and increased function. Every treatment decision your doctor makes is based upon his medical expertise, his understanding of your back pain, and value judgements he makes about you related to costs, benefits, and risks of treatment. You must learn about the eleven step hierarchy of back pain treatment. You must learn from and educate your doctor about your back pain treatment, diagnoses, causes, and triggers. You must educate your physician at every appointment about the costs and benefits of the treatments you are receiving and the risks you are willing to take. You should make suggestions for treatment as you vigorously explore "cutting edge" options for treatment and pain management. Don't rely on your doctor to come up with new treatments, that's what the internet and other people in pain are for. Communicate effectively. Ask for what you want. Decline treatments you don't want. Take notes, write down questions and answers. Research topics you have discussed with your pain doctor. If your doctor has a problem with your partnership, or you have a problem with any other aspect of your doctor's treatment, you have the right to find a new doctor. Always. And your doctor has the right to terminate you as a patient. Always. Ultimately, both parties can walk away from a negotiation.

BACK PAIN AND NEW YEAR'S COMMITMENTS

noreply@blogger.com (Dr. Tim Sams) — Tue, 01 Jan 2008 18:19:00 +0000

Welcome to 2008! You can have less back pain at the end of this year than you do right now. What can you do to hurt less? What can you do to get more stuff done, to enjoy life more? What will you do?

I hate New Year’s resolutions, but I love using natural events in my life as metaphorical springboards for positive change. It seems a waste of a chance for growth not to use the turning of a new year as an opportunity to move forward in a positive way. Let's not make resolutions, let's make commitments, let's make a transformation in our personal pain paradigm. Let's take action. At this time, you can check yourself for the new year.

Are you being honest with yourself and those around you about your back pain and limitations? Are you being independent in seeing that your needs are met and that your life is progressing the way you want it to even with pain, or have you succumbed to physical and emotional dependence upon someone else? Are you exercising courage in challenging your back pain and all the idiosyncratic fears you have? Have you developed a Mastery Map for conquering your fears and pushing the envelope outward? Are you being creative in your approach to challenging pain, limitations, and life hassles, or have you surrendered to the familiar no matter how ineffective? Have you developed a plan for decreasing pain, increasing activity, and improving your quality of life? Do you want to develop a plan or are you settled into more of the same? Will you initiate the plan (s) you make for pain and suffering? Or will you stay on the couch? Will you persevere in the service of a carefully crafted plan, or will you succumb to “I do everything my doctors tell me to”?

There are no magic formulas for feeling better. Just a lot of risk and hard work. But it is possible and almost inevitable that you will feel better if you really try. If you do the same things this year you did last year, the best case is that you will feel the same at the end of the year. Take action. You can assess the efffectiveness of your pain coping. Take action. You can learn to decrease your pain. Take action. You can feel better. Take action. What are the three most important changes you know you should make to feel better? Take action.

We will be here for you all year. Go Blue.

Dr. Tim

BACK PAIN, MEDICATIONS, AND SIDE EFFECTS

noreply@blogger.com (Dr. Tim Sams) — Sun, 30 Dec 2007 16:13:00 +0000

There is no such thing as medication side effects; there are only effects, some of which are desired, some of which are undesired. Medications are almost always processed centrally, especially oral medications. They affect the blood stream, brain, kidneys, liver. Common medications for back pain are no exception. Anti-inflammatories don't simply affect inflammation; that's merely their targeted purpose. Muscle relaxants don't simply affect muscles, they relax everything - often making you tired, slowing your thoughts, and decreasing anxiety. Opioids (narcotics) have a wide range of effects only one of which is pain relief. They also make you sleepy, decrease diarrhea, relax muscles, decrease anxiety, and provide a great "buzz" when taken recreationally. Which effect (s) are you going for? The vast majority of meds have generalized effects which vary between patients based on hundreds of physical factors including: sex, age, race, weight, body fat, health problems, and metabolism. In a particular patient, physical effects can depend on: dose, blood serum level, tolerance, food consumption, water consumption, sleep, exercise, etc. Psychological factors can powerfully alter medication effects between and within patients including: anxiety, depression, expectation, body preoccupation, obsessiveness, compulsiveness, etc. Patients who have a history of reported intolerance to most medications tend to be anxious, hypersensitive to bodily changes, and strongly obsessive-compulsive. The desired efffects of medications for back pain must continually be measured against the undesired effects. Only you can do this; it's your body. But remember, it can take one to four weeks for some undesired effects to diminish or go away. With pain related medical problems, the goal is to increase your function, activity, and independence. If a medication for back pain makes you less functional, e.g., unable to drive, that medication or dose is a failure - period. You shouldn't be taking it. Don't tell your doctors you are allergic to most or all medicines unless you have frequent, specific allergic reactions, which involve an immune response with a surge of immunoglobulin and generalized histamine. Classic signs of allergic reaction are itchiness, rash, rapid heart rate, sense of heat, and shortness of breath. Other reactions are undesired but not allergic.

BACK PAIN, HOLIDAYS, AND THE GREATEST GIFT

noreply@blogger.com (Dr. Tim Sams) — Tue, 25 Dec 2007 16:45:00 +0000

Merry Christmas everyone! I love the holidays! People reach out to others and hold hands. I get a renewed sense that we're all in this together. I give myself permission to focus less on loss, and stress, and failure, and more on all the blessings I do have. I feel more connected to everything the last two weeks in December.

The greatest gift you can give your family this holiday season is to function at your best throughout each day. Your family and friends want your time, your conversation, your good spirits. Faking it is absolutely just as good as the real thing. They're not as observant as you think. Faking it means less pain behavior, defined as all the things you do verbally, facially, and behaviorally that communicate to others that you hurt. This includes moaning, groaning, wincing, limping, taking meds, complaining, being grouchy, etc. This holiday season, make every effort to minimize these behaviors, especially in front of other people. It will help if you vigorously pace yourself and set limits with activities that can increase your pain. Sit some, stand some, lie down some, move around some. Alternate frequently, every 15-30 minutes. Don't use pain meds to overdo; you will pay for it later and so will your family. The more you overdo, the more pain behvior you will engage in and the more likely you are to crash. Your family and friends don't need you to cook for 20 people; don't need a hundred presents; don't need lights everywhere; don't need everything to be perfect. So you can't play football, or fill the house with baked goods. So what?

You may need to lower your expectations for the holidays - de-emphasize the fantasy holidays you see in books, on television, or maybe had or wanted as a kid. Finances are tight for most of us. Major gifts and good health can be hard to come by. Some element of your holiday will be weird and surreal. Holidays can powerfully drive you to be miserable. Get over it. Life is happening all around you. Cut to the chase, to what's important - let go of "It's not fair" or "They deserve more." Perhaps more than any other time, from the third week in December to the beginning of the new year is a time of rebirth, of re-commitment, of making plans. On this day, in this year, just enjoy what your have.

On Christmas Eve, my small family had dinner and watched "White Christmas" and "The Santa Clause." Today, we will open some gifts and spend the day in front of the fire place playing Scrabble, drinking hot cocoa, and talking to each other. Nothing big, nothing impressive. Just our small little family; just like my daughter wants it. Me too.

As part of your blessing today, you might think about our soldiers in Iraq; so far from home, so scared, and wanting nothing more than what you have right now. Say a prayer for them.

Be good to yourself.

Dr. Tim

BACK PAIN, HOLIDAYS, AND COPING

noreply@blogger.com (Dr. Tim Sams) — Sat, 22 Dec 2007 23:08:00 +0000

The holiday season is a special challenge when you hurt. Holidays can be difficult anyway as the fantasy and the reality clang together. The fantasy - loving family, tender moments, grateful appreciation for hard work and thoughtfulness, petty differences put aside, people coming together united in family or friendship. The reality – hurt feelings, lack of appreciation, petty differences on display. Worse yet, too much stress, too much alcohol, too many demands, too little money, old wounds surfacing; the pain of recognizing the difference between the Hallmark holiday and your dysfunctional family.

One way or another, holidays are immediately stressful times. Increased physical demands, i.e., house cleaning, cooking, grocery shopping, traveling, etc will increase pain. The emotional and mental aspects of holidays can also increase pain. It is taxing to gear up emotionally to socialize with family and friends and be charming even if you are the one being fed and watered. Difficult interactions, avoiding landmine topics of conversation, dealing with toxic relatives, discussing your medical condition, etc. can all increase pain.

The holiday season is almost inevitably a time for some reflection, looking back at the past year and forward to the next. It is natural to become aware of all the difficult, painful, challenging aspects of your life. When you hurt all time, this reflection can either cause the holiday blues or worsen depression, especially if you compare how you wish things were with the way they are. When you hurt you may find your self focusing on the negative until it seems all there is.

What can you do to help yourself survive and even enjoy the holidays? I have developed a list below to help you get the most of this holiday season.

1) Recognize that your life has changed. You have persistent pain along with your own unique sequella – impaired finances, troubled relationships, etc. Acknowledge that change and organize yourself around that reality. You may need to grieve the losses associated with these changes.
2) Lower your expectations for the holidays. Don’t expect to or commit to creating a magical time for yourself and others. Lower your family’s expectations for the holidays by discussing necessary changes in advance. Don’t let “tradition” trap you into unhealthy behavior. Grieve this loss if need be.
3) Don’t try to accomplish everything you did before you had pain. Respect your challenges. Give yourself permission to do less if need be.
4) Be creative about pacing yourself and setting limits with activity. Make the holiday meal potluck. Agree to exchange a single gift with family members or family units with a price limit. Enlist the help of someone with meal preparation or household chores.
5) Consider focusing on or a return to a traditional (old fashioned) holiday in terms of gifts, trees, family visits, etc. This allows you to focus more on family and friends and less on material stuff.
6) Give a gift (s) to the less fortunate. Donate to a needy family, give something to your church or temple. Donate some time to a mission. Volunteer at hospital or nursing home. The saddest thing over the holidays is to feel lonely. Help someone else not be lonely, and in the process, help yourself.
7) Make a deliberate attempt to count your blessings. Focus on the good things in your life. Each day, post one positive thing you are thankful for.
8) Reconcile with an estranged friend or relative.
9) Make a commitment to changing certain behaviors in the coming year. Set specific
goals for yourself. Forgive yourself or another person for a transgression. Accept what happened and let go the pain. The APEX strategy for forgiving can help.

Back Pain, Blessings, and Liberty

noreply@blogger.com (Dr. Tim Sams) — Sat, 22 Dec 2007 22:39:00 +0000

This is a blog about back pain, but people with back pain are people first, patients second. There will always be issues and events that transcend and envelop people and patients everywhere. This post is from a newsletter I have sent out each holiday season since 2002.

Death is not a tragedy. A wasted life is. Don’t get me wrong. Life has value all by itself. This isn’t about abortion, capital punishment, stem cell research, or vegetarianism. From single cell bacteria to your own children, life has value. It means something. It wants to keep on living, even if it hurts. It gets one chance to participate in the circle; one chance to shout at the moon and echo through the ages.
Though we are born with value, we give life real meaning and purpose by the way we live. At the end, we get to look back and see where and how we made a difference. Erik Erikson labeled the final stage of life maturation "ego integrity vs. despair". We need to believe that we did some good; that we accomplished something meaningful, perhaps even more important than our own lives--something that will transcend our deaths and mark our place in the universe; or we feel an existential despair from which we cannot return. For people like Einstein or Bill Gates, this is easy. For the rest of us, it’s a little more subtle.
I don’t know that I am a Christian, a Muslim, or a Jew. I attend a Presbyterian church a half dozen times a year. But I always attend at Easter and Christmas. There is something enriching, universal, and powerful about the cycle of birth and death along with the primitive, archetypal belief that in some way we can transcend death. I believe that life has transcendent meaning when there is something more important than death, and by extension our own lives.
And so we come to Iraq. It matters not what you think of the war in Iraq. I think it’s a horribly misguided enterprise driven by the “war on terror” and a president who looked America in the eye and lied to us, not the first or the last to do so. George Bush will end up just a blip in American History, but not so for our armed forces. They transcend Tweedle Dum. The red, white, and blue of the American flag doesn’t simply stand for freedom, but the willingness to fight for freedom, to die for freedom, so our children’s, children’s children will have the opportunity for life, liberty, and a fair chance at happiness. The armed forces stand proud and resolute as perfect symbols of the strength in freedom, democracy, and individual rights.
What the armed forces do is at the pleasure of the current president, the commander-in-chief. But their underlying purpose is forever. Whether in the glorious rightness of World War’s I and II or the mire of moral paralysis that was Vietnam, the armed forces embody the best in all of us; honor, fidelity, commitment to a just cause, and true bravery defined as “integrity in action.” They make their lives and so their deaths meaningful. They live a principle and by a code that transcends the petty machinations of politicians, so that we can make our dreams real.
This holiday season, as with all others, we will spend some time reflecting on our lives, making plans for the coming year, and maybe getting back in touch with what’s really important, things like health and family. You can look back on the blur of the past year and wonder how it passed so quickly. You can think about your core values and whether or not you’re living up to them. Therein lies one path to meaning and purpose; having the integrity to live in accordance with moral beliefs.
America’s strength and national integrity survives in and through our armed forces. They have an absolute code of honor, and by God and country they live in accordance. From Corporal Roberto Abad to Private First Class Casey Zylman there are 3897 heroes who must now live on in our memories. Sometime this holiday, during one of our toasts, let’s honor the men and women who will never again be home with their families as well as those who will. Please go to www.cnn.com/specials/2007/iraq/forces/casualties and maybe toast one particular hero by name. You might also donate a prepaid phone card so that a soldier can call home.
Corporal Abad stood on a wall in the dark and cold beside a fallen comrade and said “I won’t let them hurt you. Not tonight. Not on my watch. You can sleep safe, now. All secure sir.”
God bless America and God bless our Armed forces. May their holidays and yours be safe and warm.

Dr. Tim

The Number One Cause of Back Pain

noreply@blogger.com (Dr. Tim Sams) — Sun, 16 Dec 2007 17:26:00 +0000

People with back pain often spend years in a wasted search for the "true" diagnosis of their back pain, usually in the belief that once discovered, an "accurate" diagnosis will lead to cure. The years go by and they rail at the incompetence of doctors who can't give them a diagnosis or simply add another to the growing list. Degenerative disc disease, spinal stenosis, bulging disc, herniated disc, foraminal narrowing, facet arthropathy, spondylosis, spondylolisthesis, compressed nerve root, arachnoiditis, arthritis, myofascial pain, radiculopathy, and scoliosis are just a few of the diagoses you may be given. But the reality is that the longer you have experienced back pain, the less likely that there is one overarching diagnosis. Your pain is almost inevitably "multifactoral", i.e., there are multiple factors causing, maintaining, and exacerbating your pain. Effective treatment requires attacking all the various factors contributing to your pain. From a tissue perspective, pain triggers can come from muscles, discs, nerves, tendons and ligaments, joints, bone, or scar tissue. The inflammatory process is a major culprit in maintaining back pain. Even your immune system can be a pain trigger. Another complicating factor is that as time passes, your pain triggers morph, with some disappearing, some appearing, and others waxing or waning in intensity. Back pain is an erratically but constantly moving target. Thus, there is a tremendous amount of trial and error with medical treatments and medications. Today's effective treatment may not work tomorrow and vice versa. This can be frustrating, but is as it should be. Don't shoot the messenger, whether it's me, your pain doc, or an ancillary provider.

BACK PAIN, LUMBAR FUSION, AND COGNITIVE BEHAVIORAL TREATMENT

noreply@blogger.com (Dr. Tim Sams) — Sun, 16 Dec 2007 01:16:00 +0000

A recent study in the Journal of Pain (122, 2006, pp 145-155) compared the effectiveness of lumbar fusion with a course of cognitive education and exercise in patients who had undergone previous, less invasive surgeries (failed back). This was a prospective study with sixty patients cleared for fusion surgery, randomized either to lumbar fusion or cognitive education and exercise. One year post treatment, there was no statistical difference between fusion and cognitive/exercise groups in the primary outcome of back specific pain and disability as measured by their score on the Oswestry Disability Index. The success rate was 50% in the fusion group and 48% in the cognitive/exercise group. Specific secondary measures at one year were also assessed including mean pain severity, general function, emotional distress, fear avoidance, work status, and fingertip to floor distance. There was no significant difference between groups except that the cognitive education and exercise group had less fear avoidance and greater fingertip to floor distance. The authors concluded there was no evidence of greater benefit from lumbar fusion following a failed back surgery over cognitive education and exercise. This is an extraordinary finding for those people with failed back surgery who are considering lumbar fusion, especially given the risks of fusion and the grueling post op period. There are situations where lumbar fusion after failed back surgery is medically necessary, but the authors express great concern about the high rate of unnecessary fusions after back surgery.