muscle pain posts Archives

Why does back pain appear to move or change intensity?

Tuesday, January 24th, 2012 at 7:52 PM  

There are three different mechanisms that affect your back pain when it is related to muscles- and that means most of the pain you will experience in your life.

1. Referred back pain patterns- Pain may be referred from one muscle to another when the nerves carrying painful sensations in a muscle stimulates the same area in the spinal cord as an adjacent muscle.

2. Central sensitization- When a painful area of the body stimulates the spinal cord and makes the cord more  active, other sensations coming in to the cord that would usually not be experienced as painful are now experienced as pain- like turning up the volume on your stereo and hearing things that you don’t hear when the volume is low. So when the original area of damage causing the pain is properly treated the other scattered areas of pain may disappear.
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Your bulging disc is not what’s hurting

Friday, January 6th, 2012 at 6:24 PM  

Two days ago I reported on a study that showed we are frequently doing a disservice to patients in inappropriately ordering imaging studies such as MRIs. Yesterday I saw a patient who could be the poster person for the study. This patient had a back injury one year ago when a fall onto the buttock produced lasting severe low back pain. The pain doesn’t radiate-it is only in a discrete area on the buttock. She felt a tender sensation when the area was pressed.

Despite the obvious findings suggesting the cause of her pain was muscle and not spine and nerves coming from the spine, an MRI was ordered and it showed a bulging disc and she was told this was the cause of her back pain. She has had a variety of physical therapy interventions and injections without relief.

Her physical examination showed that she could touch her toes and her straight leg raising was 90 degrees, rarely if ever seen with a patient whose pain was the result of a disc. She did have two muscles, the Gluteus Maximus and Piriformis, which were tender when stimulated by the Muscle Pain Detection Device. This showed that these muscles were the probable cause of her pain. A ketamine based cream was applied to the skin over these muscles and her pain was gone, further supporting the connection between the muscles identified and her long-standing back pain.
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Hip pain and surgery

Tuesday, November 15th, 2011 at 6:27 PM  

A bony abnormality of the hip called Femoral Acetabular Impingement Syndrome (FAIS), where the head of the femur (the thigh bone) is found to be irregularly shaped rather than its “normal” spherical shape, is sometimes treated with a surgical procedure to shave the head of the femur. FAIS can affect young individuals in contrast to osteoarthritis (OA) of the hip which usually occurs in older patients. It is thought that FAIS can cause pain in the hip, and can in addition if left untreated, result in OA. Read the rest of this entry

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How to decrease headache frequency

Thursday, June 9th, 2011 at 6:33 PM  

A recent study of a simple resistance exercise program for the neck and shoulders, in office workers who complained of weekly headaches (HAs), showed an approximately 50% reduction in HA frequency vs. a weekly health education control group. The exercise groups were 2 minutes or 12 minutes of daily exercise. The remaining HAs were no different in terms of intensity or duration of pain.

HAs are the most commonly reported pain problem. If brief exercise could have such a dramatic effect on HA frequency, it should be considered as a standard intervention for all office workers who appear to have muscle tension type headaches. However it is not clear why neck and shoulder exercise reduce HA frequency. It is understandable that exercising muscles that are tense and stiff from repetitive strain, for example bending your head and neck over a desk for hours at a time, could help relax stiff and tense muscles. which can cause back and neck pain.  But just performing an action to address HAs on a daily basis may make you more aware of the circumstances surrounding a headache episode. Since headaches are frequently brought on with emotional stress, being more aware of and addressing stress has been shown to reduce HA frequency through various interventions.
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Above all else, do no harm!

Tuesday, May 24th, 2011 at 6:34 PM  

In our desperate wish for pain relief, we sometimes receive treatment that is harmful. One of those treatments may be botulinum toxin, frequently provided as Botox injections to tender muscles. A recent article showed how Botox could produce permanent damage in muscles with normal muscle fibers being replaced with fat cells.
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Knee pain, back pain, and muscles

Thursday, May 12th, 2011 at 6:36 PM  

A large study of army recruits demonstrated the protective effect of exercise on the development of knee pain. Male and female recruits who performed 4 stretching and 4 strengthening exercises for 7 weeks, were 75% less likely to develop anterior knee pain.
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Follow-up to recent Failed Spinal Fusion post:

Friday, April 15th, 2011 at 6:41 PM  

The patient mentioned in the blog posted in March, 2011 copied me on an email he sent:

“I’ve been waiting for clearance from my surgeon who finally declared my fusion as failed (FBSS) in early March and offered no additional hope for pain reduction. At one-year post surgery I could be evaluated for an implanted morphine pump or spinal cord stim. Pain management started experimenting with oxymorphone and hydromorphone, which both had bad side effects and were less effective than the oxycodone. I’ve had the first two weeks of treatments with Dr. Marcus. The first week he did my left side lower back and leg, this Monday he did the right side lower and mid back. Pain reduction is at least 90%! I have much more energy, am more active and I’m beginning to feel flexible. He is also working on my mid-back and legs. I’ve been able to reduce oxycodone from ~180mg+/day to 60-80mg/day.”
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Obesity and Understanding BMI with back pain

Tuesday, December 21st, 2010 at 6:46 PM  

People in all industrialized countries are being harmed by a world-wide obesity epidemic. We generally determine if we are the proper weight by calculating the BMI (Body Mass Index): dividing your weight in pounds x 703 by your height in inches squared. If you weigh 140 pounds and are 5 feet, 8 inches, your BMI would be 21.28-
(140 x 703/68 x 68). Normal is 18.5-24.9, overweight is 25-29.9 and obese is over 30. A study of patients in 30 European countries found that over 70,000 new cancer cases were attributable to excess BMI in 2002. Obesity is also associated with an increased incidence of diabetes, hypertension, arthritis, coronary artery disease and dementia.
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Painless back and muscle injections

Friday, December 10th, 2010 at 6:53 PM  

Pain is a deterrent to many patients when offered a therapeutic injection. There is some encouraging news on ways to make injections more comfortable.

A Cochrane review found that adjusting the pH, with bicarbonate, of a lidocaine injectate for local anesthesia, reduced the discomfort for patients without reducing analgesic effectiveness. The burning sensation produced by the acidic pH of lidocaine injectable is diminished by adjusting the pH upwards from the 3.5 -7.0 usually found in commercial preparations, to approximately 7.4.
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Pain relief, motion, and function after rotator cuff repair may not last

Friday, October 15th, 2010 at 7:10 PM  

An important study in Clinical Orthopaedics & Related Research [468(10):2678-89], reports that over time the function of the shoulder deteriorates in a significant number of patients who underwent rotator cuff repair, despite continued pain relief in many of the same patients.
The conclusions published in the abstract are found in the next paragraph:
“The early high functional scores after primary rotator cuff repair or reconstruction of the types we performed in the 1980s did not persist. The function achieved postoperatively was lost, as ROM and strength decreased to less than preoperative values. However, alleviation of pain was long-standing in most patients. Based on our data, we should warn patients to expect less
than permanent relief with those repairs. We cannot say whether the same will apply to currently performed types of repairs.”
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Source of your back, shoulder and neck pain

Thursday, August 12th, 2010 at 7:12 PM  

A 35 year old executive complained of neck and shoulder pain radiating into his fingers along with difficulty using his fingers. His MRI showed bone spurs in his neck which were causing compression of the nerves going into his arm. A neurosurgeon had suggested that he have surgery to remove the spurs and to fuse the vertebra in his neck.

He was given cervical spine epidural steroids and after the 2nd injection his pain and difficulties in his hand were eliminated, but the pain in the region of his shoulder blade persisted. He felt that it was time to revisit the neurosurgeon, but I told him that pain only in the shoulder isn’t typical for a problem in the spine.
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Measuring Low Back Pain Treatment Outcomes

Thursday, June 24th, 2010 at 7:14 PM  

The article in the European Spine Journal highlights a major difficulty in assessing the effectiveness of various back pain treatments. No two studies used the same criteria to measure improvement. The lack of uniformity appears to be present in every aspect of the enigma of low back pain. Recent studies demonstrated that the tests a family physician uses to establish probability of a disc herniation may not be valid. There are inconsistent criteria for fusion vs. a simple laminectomy or foraminotomy for back pain. Injection techniques vary widely for back pain thought to be from nerve or muscle.
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Is chronic back pain adequately treated?

Tuesday, May 25th, 2010 at 7:15 PM  

I just read an article on the under treatment of chronic pain with the most common associated disease states listed as osteoarthritis, rheumatoid arthritis, fibromyalgia, and sickle–cell anemia. Since physical deconditioning is fraught with many serious negative consequences, such as obesity, high blood pressure, stroke, heart disease and diabetes in addition to be being a cause of most common pain problems, it should probably rank as a form of disease.
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Activity and quality of life

Tuesday, May 18th, 2010 at 7:18 PM  

A recent article showed that even gentle but regular physical activity in middle aged women reduced the incidence of hip fractures. Lack of exercise contributes to many of the health problems with which we are confronted- obesity, heart disease, diabetes, hypertension, dementia, arthritis, and osteoporosis. At a time when the cost of health care is so important to each of us as Americans, awareness of inexpensive interventions and self responsibility for our well being should be foremost in our minds.

Proper exercise should take into account your level of conditioning before you begin any program. Many new exercisers will strain their weak or stiff muscles causing pain and disillusionment with their new found passion and quit. Remember the most important thing about your exercise plan is that you are able to and actually return for your next scheduled session.
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If I get back pain will it go away?

Tuesday, May 11th, 2010 at 7:22 PM  

Although Low Back Pain (LBP) is thought to affect around 80% of individuals, it is also thought to be self limiting and get better quickly (within weeks). Studies of patient populations however suggest that it is actually a more serious problem. Although most patients who experience back pain do not see a doctor, 60-80% of those that do are still reporting pain one year later and in those whose pain has disappeared, 20% will have a recurrence within months.
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Chronic Low Back Pain and Fibromayalgia

Friday, April 23rd, 2010 at 7:25 PM  

A recent article discussed the number of patients with Chronic Low Back Pain (CLBP) who also had Fibromyalgia syndrome (FMS). This article is an example of the confusion in medicine about both conditions. Believe it or not although the most common diagnosis for low back pain is non-specific low back pain, referring to sprains and strains of muscles and other soft tissue, there is no agreed method to look for and treat muscle generated low back pain. Patients with
Fibromyalgia on the other hand, although complaining of pain in muscles, are for the most part not considered to have muscles as the cause of their pain but rather problems in their nerves that are experienced as pain in muscles.
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Back Pain Treatment

Thursday, April 22nd, 2010 at 7:27 PM  

Please refer back to the past two blogs to find the background material for todays blog. Although the number of CARF approved pain centers in the US halved, the number of outpatient pain centers mushroomed. The services provided however focused on two areas:

  1. Medication management
  2. Nerve blocks and other invasive procedures.

Although many patients could be helped with one or both of these approaches, many patients in need of physical therapy and psychological services that were integrated with the overall treatment plan, would no longer receive optimal treatment. Reimbursement would be the driver of care rather than the needs of the patient. Centers could not stay in business and provide care that insurance companies would not cover. The shift toward procedures became an accepted standard of care and new organizations of pain physicians were formed whose membership focused predominantly on invasive procedures.
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History of Back Pain- Don’t believe that the newest approach is the best!

Sunday, April 11th, 2010 at 7:31 PM  

Spinal fusion surgery for back pain was reviewed in three articles in the Journal of the American Medical Association this week http://cot.ag/bjDgWW . The sobering conclusions were that we are spending up to 10 times more for complicated new surgical procedures and frequently getting worse outcomes and up to twice as many complications.

 

Unfortunately, this is nothing new in the history of back pain treatment. An article in Spine http://cot.ag/dASfWh analyzed the cost of the treatment of back and low back pain in the United States.  It found that the cost of care from 1997 to 2005 went up from $62 billion to $86 billion and at the same time the number of patients reporting difficulty in functioning because of their pain also went up by 25%. Spending 65% more ($34 billion) resulted in worse outcomes.
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History of Muscle Pain

Monday, March 22nd, 2010 at 7:34 PM  

A review of comprehensive pain treatment textbooks finds no chapters dealing with muscle pain aside from sections on “Myofascial Pain Syndrome” discussing “trigger points” as the defining characteristic of syndromes with painful muscles. This points up a fundamental problem in discussing and understanding clinical muscle pain- the lack of agreed terminology to describe what is found when a painful muscle is examined. All muscle pain logically cannot be the result of trigger points. Treating every patient with tender muscles with injections will frequently result in failure to eliminate the pain. To better appreciate this lack of understanding, the history of muscle pain should be reviewed.
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What causes my back pain?

Sunday, May 3rd, 2009 at 12:49 AM  

With severe back pain we frequently worry about having a herniated disc. If you have back pain and get an MRI chances are you’ll find something. At NY Hospital/Weill-Cornell, 90% of the MRIs of the low back are read as abnormal. But most back pain is diagnosed as “Idiopathic /Non-specific”, referring to sprains and strains of soft tissue such as muscle. But common soft tissue problems are not seen on the MRI so we often incorrectly assume that what we see on the image, such as disc herniaton/bulge, degenerated discs, spinal stenosis, facet arthritis, spondylolisthesis, is the cause of the pain. When we treat these “causes” we have many failures. Actually in some studies more than 50% of the back surgeries are unsuccessful leading to a new diagnosis, Failed Back Surgery Syndrome. Some clinicians recognize that muscles could be a source of the back pain and have attempted to treat the muscle that they have identified by applying pressure (palpation) to the suspected painful muscle. There are a variety of treatments that are offered. I will discuss some of them next time.

~Norman J. Marcus, MD
Norman Marcus Pain Institute, New York NY 
 
“Your New York City Pain Relief Doctor”
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