Category Archives: pain

Understanding Low Back Pain

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Lower back pain is one of the most common and most misunderstood health complaints worldwide. Stuart McGill, distinguished professor emeritus at the University of Waterloo and chief scientific officer at Backfitpro, has dedicated his career to unraveling its complexities. His work offers both scientific clarity and real-world hope to patients who have struggled for years without relief.

The Anatomy of Pain

McGill begins with fundamentals: the structure of the spine and how the lower back functions under stress. He explains that the spine is not a single moving part but a system of joints, muscles, and connective tissues that interact dynamically. Weakness or instability in any of these areas can set the stage for injury.

Challenging “Nonspecific Back Pain”

A central theme in McGill’s approach is his rejection of the label “nonspecific back pain.” Rather than accept pain without explanation, he emphasizes the importance of finding the causal link between an injury and its symptoms. According to McGill, clarity is not just possible—it’s essential for recovery.

Lessons from Complex Cases

Through case studies, McGill demonstrates how careful assessment and targeted treatment have resolved severe, long-standing pain. These stories show that with the right strategy, even patients who have been told there is “nothing more to do” can regain their mobility and quality of life.

Building Strength and Stability

Beyond diagnosis, McGill stresses prevention and resilience. His core message: strength and stability protect the spine. He shares his go-to exercises designed to reinforce spinal health and help patients move with less pain. These exercises aren’t about heavy lifting—they’re about building control, endurance, and protective strength.

Practical Advice for a Healthy Spine

McGill’s guidance goes beyond the clinic. He offers everyday strategies to keep the back strong: mindful movement, proper lifting techniques, and maintaining a balance between activity and rest. His conviction is simple yet powerful: nobody needs to suffer endlessly from back pain.

Outline

0:00:30 – Peter’s experience with debilitating back pain
0:14:11 – Anatomy of the back: spine, discs, facet joints, and common pain points
0:24:48 – Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more
0:31:30 – Why the majority of back injuries happen around the L4, L5, and S1 joints
0:37:20 – How the spine responds to forces like bending and loading, and how it adapts do different athletic activities
0:45:12 – The pathology of bulging discs
0:48:33 – The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more
0:59:36 – The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types
1:12:46-The significance of strength and stability in preventing injuries and preserving longevity
1:25:33-Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns
1:37:08-Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain
1:46:59-Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro
1:56:08-When surgical interventions may be appropriate, and “virtual surgery” as an alternative
2:05:48-Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more
2:11:21-Tarlov cysts: treatment and surgical considerations
2:13:34-The evolution of patient assessments and the limitations of MRI
2:18:40-Pain relief related to stiffness and muscle bulk through training
2:26:49-Advice for the young person on how to keep a healthy spine
2:39:24-Resources for individuals dealing with lower back pain

Placebo injection demonstrates ‘modest’ benefit in chronic back pain

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Key takeaways:

  • A non-deceptive placebo injection reduced chronic back pain with effect size similar to typical treatments.
  • Secondary outcome benefits and brain changes lasted up to 1 year.

A single saline injection, openly prescribed as a placebo, yielded approximately 1 month of chronic back pain improvement, along with longer-term benefits in depression and sleep, according to data published in JAMA Network Open.

“We have known that placebos can be powerful pain relievers, but it has been unclear how to use them ethically, without patient deception,” Yoni K. Ashar, PhD, assistant professor at the University of Colorado Anschutz Medical Campus, told Healio. “This spurred the development of the ‘open label,’ non-deceptive placebo treatment, which we studied here.”

https://www.healio.com/news/rheumatology/20241022/openlabel-placebo-injection-demonstrates-modest-benefit-in-chronic-back-pain

I’m a jaw expert, and you’ll never catch me doing these 5 things

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Kelly Burch 2024-07-04

For the 11 years I was practicing general dentistry, about five patients came into my practice each year with severe temporomandibular joint (TMJ) disorders that were impacting their daily lives. This type of jaw pain was debilitating, but I hadn’t learned anything about treating it in dental school. I felt like the medical and dental communities had failed these patients.

Priya Mistry is a jaw expert and treats patients with TMJ.

I wanted to do better for them, so I asked to shadow a TMJ expert. I watched as he evaluated patients’ posture and leg length. He taught me how the jaw — along with the feet, hips, and spine — is essential for posture. His patients told me he had saved their lives because they had so much jaw pain before seeing him.

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By the end of the first day, I knew I wanted to take over his practice. I had a 2-year-old and a 2-month-old at the time, so he was skeptical. But I worked under him for three years and brought the practice when he retired in 2021. Now, he’s like a second dad to me.

Since then, I’ve learned a lot about jaw health — including that seemingly harmless things can really impact your jaw. Here are five common things you should avoid if you want to foster good jaw health in yourself and your kids.

Avoid resting your head on your hands

Many people rest their heads against their fists when they’re looking at the computer during the day. This puts a lot of lateral pressure on the temporomandibular joint, which is designed mostly for back-and-forth movement. Even 20 minutes here and there adds up and can strain your jaw muscles or joints.

I caution my patients against chewing pens, gum, or fingernails

Humans aren’t meant to be chewing constantly. Chewing on items throughout the day — like pens, fingernails, or gum — means you’re overusing your jaw muscles. You wouldn’t do bicep curls all day, right? Chewing on gum or other items is like doing that for your jaw and can lead to overuse injuries.

Don’t even get me started on popular jaw strengtheners, which people chew on to try to get a more defined jawline. Those things scare me and I would recommend everyone steer clear.

Don’t use your teeth to open things

Lots of people grind their teeth at night without realizing it, which can weaken the teeth. When you use your teeth to tear open a plastic package or anything else, it puts a lot of pressure on the teeth. Sometimes, it’s the straw that breaks the camel’s back, and your tooth can crack or chip.

It’s easier said than done, but try to reduce stress

Lots of TMJ problems happen because people clench or grind their jaws. When we’re emotionally stressed, we clench even more than normal. During the pandemic, referrals to my practice skyrocketed, and my mentor and I fully believed it was because of stress. If possible, try to find ways to reduce and manage your stress and relax your jaw.

I advise parents to wean babies off pacifiers by 6 months

Pacifiers and thumb sticking can cause the mouth, palette, and jaw to grow in all sorts of wrong directions. That’s why I like to see babies stop using pacifiers by 6 months. Pacifiers interrupt healthy tongue posture (in which the tongue is touching the roof of the mouth). That can lead to mouth breathing and other health concerns that could be avoided by kicking the pacifier early.

Jaw health and tongue position can play a huge role in overall health. Taking small actions to take care of your oral health now — and getting help if you experience issues like clicking, popping, or mouth breathing — can help you stay healthy.

https://www.businessinsider.com/jaw-expert-dentist-tmj-pain-reduction-tips-2024-7

Medical Mysteries: A new mother is felled by ferocious back pain

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While breastfeeding her new baby, she developed intense, unexplained pain that kept getting worse.

Several days after her parents’ departure Lucido stumbled into the bathroom early one morning and unintentionally sat down hard on the toilet. Instantly she felt a sickening shudder in her lower back followed by the sensation of an electric current shooting up her spine. Intense nausea came next. Worried she might pass out from the pain, Lucido lay on the bathroom floor.

Aimee Lucido with her baby, Lyra

In 2018 Columbia University’s Irving Medical Center had launched a program headed by endocrinologist Adi Cohen to recruit, study and treat women with a rare condition called pregnancy- and lactation-associated osteoporosis (PLO).

A severe form of early-onset osteoporosis — osteoporosis that occurs before age 50 — PLO can occur in the late stages of pregnancy or during breastfeeding when the loss of maternal calcium leads to a temporary decrease in bone mineral density. Unlike postmenopausal osteoporosis, which is common and affects about 10 million Americans, PLO is rare, although no one knows how rare.

Little is known about the condition, which was described more than 70 years ago. Misdiagnosis is common and many doctors have never seen a case.

https://www.washingtonpost.com/health/2024/06/22/pregnancy-backpain-breastfeeding-medical-mysteries/

Botox for Trigeminal Neuralgia

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There is a growing body of evidence suggesting that Botox is a safe and effective treatment for trigeminal neuralgia.

Trigeminal neuralgia (TN) is a chronic facial pain disorder characterized by sudden, severe, electric shock-like pain in one or more branches of the trigeminal nerve. This condition is relatively rare, with about 4.3 new cases per 100,000 people each year in the US.

TN can significantly impact quality of life, often leading to higher rates of depression, anxiety, and sleep disorders compared to the general population. Common triggers like brushing teeth, chewing, and swallowing can be so painful that individuals may neglect oral hygiene, lose weight, become dehydrated, and develop anxiety about these activities. TN can be highly disabling, with up to 45% of sufferers missing daily activities for at least 15 days in six months, and over 50% experiencing severe anxiety and depression related to their pain.

Trigeminal Neuralgia Treatment

The first line of treatment for TN usually includes anticonvulsant medications such as carbamazepine, oxcarbazepine, lamotrigine, gabapentin, lacosamide, or the muscle relaxant baclofen. However, these drugs often have side effects like fatigue, cognitive issues, dizziness, tremors, and electrolyte imbalances, which can limit their use. For acute pain flares, treatments like infusion therapy and trigeminal nerve blocks are used.

Surgical options for classic TN include microvascular decompression, gamma knife radiosurgery, and balloon compression, but these come with concerns about tolerability, long-term efficacy, and safety.

Botox for Trigeminal Neuralgia Treatment

Botox, also known as OnabotulinumtoxinA, FDA-approved for chronic migraine, is used off-label by neurologists for TN. Small studies have shown that it can be a safe and effective treatment, particularly for those who cannot tolerate medications or are not candidates for surgery. This treatment has been shown to reduce pain intensity and attack frequency and improve quality of life compared to a placebo.

Speak with your CNMRI neurologist about this treatment if you are having break through facial pain from TN in spite of multiple medication trials.

https://practicalneurology.com/articles/2024-may-june/onabotulinumtoxina-for-trigeminal-neuralgia-treatment