Thursday, June 16, 2011

Insomnia and Pain.

The sleep cycle is composed of 4 stages. Stage 1 is light sleep, Stage 4 is a deep sleep. Stage 4 is the most restful/restorative sleep. After Stage 4 we enter REM Sleep (Rapid eye Movement). This is the stage in which we dream. At night we go through this roughly 90 minute cycle multiple times spending less time in stages 3-4 and more time in REM sleep. How often one wakes up throughout the night varies by person and is not harmful unless it causes daytime sleepiness.

Pain can cause difficulty falling asleep and frequent awakenings throughout the night. This often limits the depth of the sleep cycle preventing the restful/restorative sleep and causing someone to wake up feeling tired despite having "slept" all night. Pain leads to decreased activity during the day which also hampers stage 3 and 4 restful sleep. For the patient in pain, less restful sleep causes more pain/anxiety/stress/depressed mood and less ability to cope with their pain.

Treatment for insomnia due to pain involves treating the pain, but also limiting factors that can make sleeping difficult for someone without pain. See "Rules for Sleep" and "Eating for Insomniacs" in future blog posts.

Monday, June 6, 2011

Depression and Anxiety.

Depression/Anxiety and pain often go hand-in-hand.  This is because pain will make you feel sad.  Sadness may also manifest physically as pain.  When you are hurting, you are not going to want to be active and do the things you enjoy.  If this is repeated continually, it will cause you to feel depressed.  As the depression worsens, prolonged immobility will cause your pain to flare up with the slightest activity.  The increased pain will make the depression worse and the depression, both directly and indirectly, will make the pain worse. That is why it is paramount to address and treat psychological disturbances when pain becomes chronic.
Lifestyle modifications are important to consider in the management of pain.  As already stated, stopping smoking is always a good first step.  A well balanced diet will also ensure that your nutritional and caloric demands are optimized.   Finally, minimizing caffeine and alcohol intake will also aide in your nutritional recovery.
Exercise has a crucial role in the treatment of pain.  It is important to differentiate regular exercise from therapeutic exercise.  Often people engage in sport-specific play, warm-up, stretch, and have a cool down periods.  Weight lifting and cardio focused programs also help in aerobic conditioning, toning & strengthening.  Albeit important for a healthy overall lifestyle, this differs from formal therapy programs that focus on back/neck exercises, postural training, and core strengthening.  In a formal PT program, your therapist may also utilize modalities that further facilitate pain relief.  This includes things such as massage, cold/hot packs, TENS units, and many more.  Your doctor and therapist will work together also to educate you on body mechanics and a proper home exercise program.

Monday, May 9, 2011


Back pain is a billion dollar problem. Treatment of back pain is a billion dollar industry. Patients have a myriad of choices. There are countless medications, devices, therapies and doctors or therapists of all stripes willing to take your money in an effort to make you better-- or at least make your wallet lighter. Patients often don't know where to begin. It’s very difficult to find answers because there is not a "standard" for treating back pain. Treatment depends on what the problem is, who is giving the advice and who is paying for treatment. What do I mean?  Well, the back is made up of muscles, ligaments, tendons, bones, joints, nerves and discs. Any of these can cause pain. The type of pain and location of this pain are often the same for different pain generators. This explains why so many MRI's are ordered in the U.S. We are always trying to find the source of the problem. Unfortunately, that is not always easy to find when everything looks arthritic or degenerated. The treating provider is important, because everyone has an interest in treating back pain the way they were trained to treat it. Chiropractors think manipulation works best. Physical therapists think therapy works best. Interventionalists think injections/minimally invasive surgeries work best. Surgeons think fusions/decompressions work best. Everyone has studies and evidence to back up their claims. Everyone has a car/house payment to meet.

Where does that leave the average Joe/Jo Ann with new or chronic back pain? Confused.  Let’s see if I can clarify things with some rules to live by.

1. New back pain should be treated very carefully so it doesn't become chronic. Don't ignore the pain. If lifting makes it worse, STOP! You have an injury and need to treat it accordingly.  If you have to lift more than 20 lbs. as part of your job, understand that you are probably making your problem worse by ignoring it and continuing to work. Eventually it will force you to stop working and the problem will be more difficult to treat.

2. First work on the problems you can fix. This means lose weight if you are overweight. Use good posture at work or at the computer. Strengthen your core muscles, but don't do sit ups/crunches. Stop smoking. Don't stay in bed, get out and try to walk if you can.

3. If the pain is still there after a couple of weeks see your doctor or spine pain specialist. Who is a spine pain specialist? They come in various makes and models. Chiropractors, Interventionalists (like me), Surgeons and some Therapists.  Chiropractors or Therapists are often a good place to start because back pain will usually go away on its own and these providers can help it to resolve faster. When to seek additional care?  When the problem is not going away after several weeks/months or the pain is so severe you can't participate in therapy. If this is the case, see a Spine Interventionalist who uses the least invasive methods possible, but is still adept at knowing when to send something on to a surgeon if required. Surgery is needed for the most severe problems that are not responding to more conservative treatment. The good news is that less invasive treatments than traditional spine surgery are coming out all the time and fewer surgeries need to be done.

Monday, April 4, 2011

The Root of the Problem

How does your back feel? Does it hurt yet? Give it time. Other than headaches, back pain is the most common malady in the United States. Why? Partly because we don't take good care of our spines. We are too fat, we don't exercise and when we do it makes our backs worse; we smoke, and we lift things that are too heavy for our spines then wonder why we hurt so much.  Then, we get angry when Humpty Dumpty can't be put back together again. But, besides all this, our backs hurt because of the way God made us. Our discs break down, our nerves get pinched, arthritis creeps in and sometimes this starts before we reach the age of 20. So what to do? First, recognize that back pain for some people is an inevitable part of living life. Second, do everything you can within reason to prevent injury and minimize risk of injury.

Wednesday, February 16, 2011

Posts Coming Soon!

Welcome to the Capstone Pain & Spine Blog!  Please be patient and come back very soon-- we will have a first "official" post by this weekend.