I Have to Drive 6 Hours for Pain Care

By Bailey Parker, Guest Columnist

I feel so alone and isolated. There have been times I wanted to die, but my 5-year old son keeps me going. I get up every day for him.

About two years after he was born, I had a car wreck. I hit a coyote at 60 mph and ripped the radiator off my car. The doctors told me I had the spine of an 80-year old and needed a double level fusion in my neck.

I was 34 then and in tremendous amounts of pain. But after reading online stories in spine health forums, I was skeptical about the surgery. Everything told me to wait. So I did, for a year. I saw three surgeons and a neurologist. They all told me to have the surgery.

I live in a small city in southwest Colorado. When it comes to opioid pain medication, all the doctors here seem to have taken the stance, “We just don’t do that here.” The nearest city is Albuquerque, New Mexico, which means a 4-hour drive for me across state lines, or a 6-hour drive to Denver over mountain passes.

Before my surgery, one of the doctors of orthopedic medicine prescribed my pain medication. For two months, I was able to work again and was beginning to get back on my feet. I remember thinking at the time that I didn’t want to take medication for the rest of my life, but the fusion sounded worse.

The third month in I called for a refill of my medication. They told me no, but wouldn’t say why or give me a follow up exam with the doctor. He was too busy and couldn’t see me for a month. I waited one excruciating month and went to see him, asking what happened.

BAILEY PARKER

He had looked at my prescription records and saw a prescription for narcotics from another doctor for when I had cystic fibroids on my ovaries. It was not the same pain medication as what he prescribed me, and I didn’t even know they were the same type of medicine.  

Even though I had a broken neck, he did not feel comfortable prescribing to me anymore. His office then took 6 months to get my medical records sent to my primary care doctor. I had to physically go in and yell at them that I was about to have major surgery. This was the first time I felt treated like an addict, but not the last.

I went to my primary care physician and explained what happened with this other doctor. We have a very good relationship. She knows all of my medical history. She handled my pain medication before my surgery but was very clear that she would not do it for an extended period.

I never take more medication than prescribed. I am not an addict. I do everything they tell me. I was walking and doing yoga every day, just as the doctors recommended. I took my vitamins and a fruit shake every day.

After the fusion surgery, things just didn’t feel right. I was in tremendous pain again and this time there was more of it in different places. I told the physician’s assistant at my surgeon’s office and he told me to just get off all the drugs. He said it would help. He told me I would be fine. I wasn’t.

I struggled for another month before I demanded to see the surgeon. He told me I would benefit from OxyContin and gave me a week’s supply. For the first time since my accident, I was able to work and properly care for my son. My depression lifted. But when I called to tell them that I was doing good on the medication, they said it was time to go back to my primary care doctor and any further medication would have to be prescribed by her.

I went to see her, but she still did not feel comfortable handling my care and referred me to a pain clinic 6 hours away. I was in despair, thinking that I had crippled myself for life and would lose my job, my son and my husband. All of these relationships were strained at this point.

The pain clinic helped me get my life back. They are compassionate and good to the people that come through their doors. It’s a common misconception that pain patients want to take medication. We don’t. We just want some of our lives back and pain medication helps us have that.

A year after my fusion, the surgeon met me again. The fusion had failed, and he wanted to do a revision that would be more painful than the first. He also told me he thought my pain might be caused by fibromyalgia. I’ve never been so angry. I have pain because of my broken neck. Pompous arrogant doctor with no aftercare.

Here is my dilemma, I’ve gotten better care in a big city, where they do not treat me like an addict. I’ve gotten my life back. At first, I was able to go there every three months to get my medication, but with the laws changing, they now say I have to go every month. Driving 6 hours both ways with a 5-year-old and a broken neck is hard. But quality of life and pain are great motivators.

My experience has left me with so much anger towards doctors in my area. It seems their Hippocratic oath has been trumped by the opioid crisis and fear of administrative action. I do not tell people about the medication that helps my quality of life for fear of judgement and stigma. Unless they have been through chronic pain, they simply don’t understand.

I wouldn’t wish this on my worst enemy.

Bailey Parker lives in Colorado.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

What Back Pain Sufferers Should Know

By Doug Beall, MD, Guest Columnist

Allow me to describe a common patient referred to my office. Their back pain has been around long enough to be chronic and anti-inflammatory pills no longer dilute the pain.  Good days are when the patient is able to leave the house and painfully make it through eight hours at work; bad days are when the only endurable position is to lay flat at home all day.

Learning to live with the pain is no longer an option, so his physician refers him to my office. Let's pause the story here.

This sequence has been the experience of countless patients suffering from back pain. After months — sometimes years — of what feels like a 10 on the pain scale, these patients are willing to do almost anything to make the pain go away.

By the time they come to the doctor, most have done their research and have already written their own prescription, concluding that invasive surgeries and painkillers are the only options strong enough to alleviate their pain. But how did we get to the point where the all-out attack option seems like the only option?

As a doctor who specializes in treating patients for back pain, here’s what I wish more patients suffering from chronic pain knew.

When it comes to strong painkillers and increasingly invasive surgeries, bigger is not better. While surgery is the right option for some, the culture of pain management in the United States has produced the myth that the more invasive and aggressive the technique, the more effective it is. This over-reliance on aggressive techniques, especially opioids and invasive surgeries, puts last resorts at the front of the line while ignoring a range of safer and frequently more effective treatments — injections, vertebral augmentation, stem cell therapy or radiofrequency ablation, to name a few.

Simply put, the more aggressive and invasive techniques have not demonstrated that they produce better results. People aren’t automobiles. Our bodies can’t be put back together quickly or without some downside from surgery. While the more invasive repair may be better for your car, when it comes to people, the less invasive the technique, the better the patient recovery will be.

The primary consequence of the bigger is better mentally has produced a dangerous dependence on opioids for treating non-cancer pain and post-surgical pain. Opioids may be necessary for a relatively comfortable recovery after surgery, but normally not for more than four to six weeks. Recent research published in the Journal of the American Medical Association (JAMA) estimates that six percent of patients prescribed opioids after surgery become persistent opioid users. Chronic opioid use has ruined countless lives, so any treatment relying on opioids should only be considered a last resort.

Furthermore, it’s not clear that invasive surgeries are effective for patients. As an example, one of the most common pain management procedures is lumbar spinal fusion surgery, which is often used to treat chronic lower back pain. A new study from the medical journal Spine indicates 20 percent of patients undergo another operation within four years of an initial spinal fusion. Patients can only hope they’re not the unlucky one out of five sitting in the doctor’s waiting room who will be back for a second operation.

Pain sufferers should know that the vast majority of their chronic pain could be helped with simple, less invasive procedures without having to make an incision. When patients are referred to my office, I start with the least invasive options before moving on to surgery and more definitive techniques.

Instead of having patients go under the knife and prescribing them opioids, many of my patients suffering from chronic lower back pain have experienced tremendous results with radiofrequency ablation, which uses radiofrequency energy to deactivate a nerve that transmits pain from a patient’s lumbar disc.  This procedure can be done with a needle during an outpatient visit, and it often provides instant relief that can last for years.

Other procedures include epidural steroid injections (ESIs) and vertebral augmentation surgery. Both are minimally invasive options that help relieve acute and chronic pain.

Epidural injections relieve a variety of conditions, including sciatica, herniated discs and spinal stenosis. During an ESI, a surgeon or interventional pain physician injects a local anesthetic and a steroid into the epidural space, providing swift pain relief for the region. While this relief only lasts for a few weeks or months, it provides patients with enough time to continue working on their physical therapy and for the underlying pathology to heal.

Vertebral augmentation is an injection of a cementing agent into a vertebra in order to stabilize a vertical compression fracture (VCF). VCFs can result in severe deformity and extreme pain, and vertebral augmentation can help fix this injury with minimal complication or risk.

For patients suffering the disabling effects of chronic back pain, it’s important to know there are alternatives to opioids and invasive surgeries; not only radiofrequency ablation, but a whole range of minimally-invasive techniques. In the end, surgery may be necessary — but for many, these other options will prove to be not only safer, but also more effective.

(Editor’s note: For another view on ESI’s and their risks, see Dr. Margaret Aranda’s column, “5 Things to Know About Epidural Steroid Injections.”)

Dr. Doug Beall is a Fellow of Interventional Pain Practice, a Diplomate of the American Academy of Pain Management and is the Chief of Services at Clinical Radiology of Oklahoma, specializing in interventional musculoskeletal care.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Learning About Back Pain Helps Reduce It

By Steve Weakley

A new study published in JAMA Neurology shows that learning about the neuroscience of pain may help relieve some of it. 

Researchers have long understood that pain sensitivity varies from patient to patient, and there is a complex relationship between the mind and the body that influences how we experience pain. To explore that connection, researchers in Belgium divided 120 patients with chronic back and neck pain into two groups. A control group was treated with commonly recommended physical therapy and exercises.

The second group went through a program of “neuroscience education therapy,” in which they were given a very detailed explanation of what happens to the nervous system during chronic pain. Patients learned how neurons and synapses work, and how pain signals travel through nerve fibers, to the spinal cord and then the brain.

They were also taught the importance of self-care, ergonomics, stretching and fitness.

The patients were then given a series of challenging movements and exercises that gradually became more difficult and painful. They were encouraged to push through their pain, continue exercising and concentrate on functionality, not pain relief.

Treatment in both groups lasted three months, and the patients were re-evaluated after six months and a year. 

Researchers say patients in the neuroscience therapy group showed markedly more progress than the control group.  They had significant improvement in their disability, a higher pain threshold, improved physical and mental functioning, and 50 percent less self-reported pain than the control group. That improvement continued even after one year.

“These positive effects can be attributed to the content of the experimental treatment as participants learn to put pain into the right perspective, to move regularly, and to be physically active. Consequently, participants probably feel empowered, whereas, previously, they viewed pain as a life-controlling factor,” researchers found.  

“The main message is: Don’t be afraid of the pain,” lead author Anneleen Malfliet told The New York Times. “We know that worrying and giving attention to pain ultimately increases it. Staying active and moving is better than rest when it comes to chronic back and neck pain.”

Low back pain is the most common cause of disability worldwide and it is the most often cited reason for missed work in the United States.  More than half of all working Americans experience back pain each year.

Positive Findings for New Osteoarthritis Drug

By Pat Anson, Editor

Pfizer and Eli Lilly have announced positive findings in treating osteoarthritis pain with an experimental non-opioid drug that has a history of safety concerns.  

Tanezumab is a humanized monoclonal antibody that targets nerve growth factor (NGF), a protein that increases in the body because of injury, inflammation or chronic pain. Tanezumab binds to NGF and inhibits pain signals from muscles, skin and organs from reaching the brain.

In the 16-week clinical study, osteoarthritis patients who were given two injections of tanezumab had significant improvement in their pain, physical function and assessment of their symptoms compared to a placebo. Osteoarthritis is a joint disorder that leads to thinning of cartilage and progressive joint damage.

“There is a substantial need for innovative new treatment options for osteoarthritis, as many patients are unable to find relief with currently available medicines and continue to suffer,” Ken Verburg of Pfizer Global Product Development said in a statement.

“We are encouraged by these results, which speak to the potential of tanezumab as a non-opioid treatment option for pain reduction and improvement in physical function.”

Preliminary safety data showed that tanezumab was generally well tolerated, with about 1% of patients discontinuing treatment due to adverse events. Rapidly progressive osteoarthritis was observed in about 1.5% tanezumab-treated patients, but none in the placebo arm.

The U.S. Food and Drug Administration granted “fast track” designation to tanezumab last year to help speed its development as a new treatment for osteoarthritis and chronic low back pain.

Ironically, it was the FDA that slowed the development of NGF inhibitors in 2010 after Pfizer reported some osteoarthritis patients receiving tanezumab experienced worsening of their disease and needed joint replacements. Another safety issue arose in 2012 because the drug caused “adverse changes in the sympathetic nervous system of mature animals.”  Most clinical studies of tanezumab did not resume until 2015.

“We look forward to continuing to advance tanezumab in our ongoing global Phase 3 development program, which includes six studies in approximately 7,000 patients with osteoarthritis, chronic low back pain and cancer pain,” said Christi Shaw, senior vice president of Eli Lilly. In studies to date, tanezumab has not demonstrated a risk of addiction, misuse or dependence.

Regeneron recently halted high-dose trials of fasinumab, another NGF inhibitor, because the risk of harm outweighed the benefits of the drug. There is some concern that NGF antibodies work too well and encourage osteoarthritis patients to become more active, which accelerates joint deterioration.

Betrayed by My Doctors and My Government

By Jeff Watt, Guest Columnist

I was a nurse and that career gave my life purpose.  I felt like I was making a difference in my patients’ lives.  However, in October of 2014, the healthcare system that employed me destroyed me.

I was experiencing stiffness in my neck and had some red spots on my legs.  I also had a fever that broke the night before.  That was it. 

Unfortunately, because I went to the ER to figure out what was going on, they decided to do a spinal tap.  The physician attempted 3 times and failed, so another provider was called in, who did another two attempts before finally placing the needle. 

JEFF WATT

The next day, I got the most agonizing headache of my life.  When I went back to the ER, they found the reason was a spinal fluid leak caused by all the failed attempts to collect spinal fluid.

The treatment for spinal headaches is to do an epidural blood patch, which includes another spinal puncture.  The first blood patch was placed in the wrong place, so the headache returned.  It took a second blood patch, and then ANOTHER spinal puncture to have it placed correctly and to make the headache go away.

Shortly after, I started experiencing sharp shooting pains down my right leg, causing extreme constant pain and causing me to collapse, unable to bear my own weight. 

I returned to the ER and they sent me to see a neurologist, who did an MRI and a number of other tests, in the end diagnosing me with a condition called arachnoiditis.  This is a progressive disease caused by scar tissue in the arachnoid space of the spinal cord clumping together and pinching the nerves, 24/7.  Arachnoiditis is progressive, a condition that only worsens and is incurable.  It has been described as pain as bad as that of cancer, but without the release of death.

Over the last 3 years since my injury, I have lost my job, friendships, and the ability to do sports and activities with my wife.  I have experienced increased shooting pains and weakness in my right leg, loss of bladder and bowel function causing me to wear adult briefs, balance issues, sexual dysfunction issues, and the list goes on.

Numerous specialists couldn’t provide a treatment to alleviate my pain.  I tried medication after medication with the same result -- until I was prescribed extended relief morphine and oxycodone.  These medications controlled my pain enough that I was able to get out to do events, to help out at home doing laundry and dishes, and gave me back a quality of life that I didn’t have.

In the last 6 months, I have been forced to completely taper off of these medications because of a set of guidelines released by the CDC. 

The so-called opioid “epidemic” has made persistent pain patients like myself collateral damage in the government’s attempts to stop deaths from overdosing.  The CDC even admitted it mistakenly included legal prescription opioids in the same data as overdoses caused by illicit fentanyl from China and other synthetic opioids.

I now spend my days in severe unrelenting pain.  Alternative medications prescribed by my doctor have done nothing.  I feel as though I have been abandoned and betrayed by my doctors, and my government.  My doctor is supposed to help and do no harm, and my government is supposed to do what is in the best interest of the people they represent, including patients who are dependent on opioids to give them a quality of life.

If the government is truly concerned about people’s deaths, perhaps it should look into the increase in suicides by patients who suffer from persistent pain.  We deserve effective and compassionate treatment of our pain.

Jeff Watt lives in Oregon.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Lyrica and Neurontin Ineffective for Low Back Pain

By Pat Anson, Editor

Lyrica, Neurontin and other anti-convulsant drugs are ineffective for treating low back pain and may even be harmful to patients, according to a new study published in the Canadian Medical Association Journal.

Prescriptions for anti-convulsant drugs have soared in recent years, as doctors seek “safer” alternatives to opioid pain medication.  Lyrica (pregabalin) and Neurontin (gabapentin) belong to a class of anti-convulsant nerve medications known as gabapentinoids. They are primarily used for treating nerve pain and fibromyalgia, but are increasingly being prescribed off-label to treat lower back and neck pain.

Australian researchers reviewed 9 placebo-controlled randomized trials and found high quality evidence that gabapentinoids did not reduce back pain or disability and often had side effects such as drowsiness, dizziness and nausea.

“The take-home message is that anti-convulsants are not effective and can lead to adverse effects in people with low back pain and radiating leg pain (eg, sciatica), so they should not be recommended to this patient population,” lead author Oliver Enke, MD, a researcher at the University of Sydney Medical School, told Helio Family Medicine.

Low back pain is the world’s leading cause of disability. Guidelines for treating low back pain usually recommend physical therapy, exercise and non-opioid pain relievers rather than stronger analgesics such as opioids or anti-convulsants.

A 2017 study published in PLOS Medicine also warned that pregabalin and gabapentin were ineffective for low back pain and have a “significant risk of adverse effects.” 

PNN readers often complain about side effects from Lyrica and Neurontin.

“I have used both medicines and neither help with lower back pain for me,” said Sheri. “I will say the mental confusion and memory loss on Lyrica is very real, but it takes a slight edge of pain away in my body as a whole from the fibromyalgia.”

“I can vouch that Lyrica does not help with back pain,” said Debra. “It helped with the nerve pain but I thought I was literally losing my mind. I couldn't remember simple words or synonyms for words.”

“I've been taking gabapentin for almost six months; it has helped my peripheral neuropathy, but I still suffer every day from arthritis in every joint of my body, including my lower back,” another reader wrote.

Lyrica and Neurontin are both made by Pfizer and are two of the company’s top selling drugs, generating billions of dollars in sales annually. Lyrica is approved by the FDA to treat diabetic nerve pain, fibromyalgia, post-herpetic neuralgia caused by shingles, and spinal cord injuries.

Neurontin is approved by the FDA to treat epilepsy and neuropathic pain caused by shingles, but is also widely prescribed off-label to treat depression, ADHD, migraine, fibromyalgia and bipolar disorder. According to one estimate, over 90% of Neurontin sales are for off-label uses. About 68 million prescriptions were written for gabapentin in the U.S. last year, compared to 44 million in in 2013.

There have been increasing reports of gabapentinoids being abused by drug addicts, who have learned they can use the medications to heighten the high from heroin, marijuana, cocaine and other substances. Gabapentin is not currently scheduled as a controlled substance by the DEA, while pregabalin is classified as a Schedule V controlled substance, meaning it has a low potential for addiction and abuse.  

Doctors Won’t Treat My Chronic Pain

By Leanne Gooch, Guest Columnist

I have never been addicted to anything.

I feel the need to preface any conversation about my chronic pain with that statement. I have degeneration in my neck, arthritis, spinal stenosis, failed back surgery syndrome, and some other names that have been thrown into my medical charts. 

A layperson without chronic pain would wonder why I feel the need to document every boring detail of my health history. It’s because I’ve had to explain every minute detail to each and every provider I’ve seen. For 20 years!  

Initially, when my pain started, I had a good primary care doctor who tried hard to find and treat the cause. He prescribed pain medications and sent me to many specialists. But after injections, physical therapy, rehabilitation, etc., he became the first in a long line of doctors who would not treat me as a pain patient. 

I wasn’t considered “chronic” until the 10th year. I learned during that time that women are viewed by the medical profession as weak for reporting their pain. I have seen the faces of both men (doctors) and women (nurses) who judged my pain story as being overly dramatic and embellished.  

I was eventually sent to a hotshot, top-of-his-game neurosurgeon. He said I had degeneration in my spine that they would normally see in elderly patients, 60 or 70 years of age. I was told a surgery would fix me all up. They would cut, put some donor bone in, some screws to hold it all together, and that constant aching pain would be gone!

I signed on the dotted line. I was only 25 years old. Of course, now we know those surgeries are a very bad idea, especially for someone so young, because even if they’re effective in the short term, all that hardware eventually leads to further degeneration with age. 

I had a spinal fusion, was patted on the head and sent my way. In follow-up exams with the surgeon, I was told everything was perfect and that my pain would subside when I healed. “Go live your life,” he said.

LEANNE GOOCH

Yeah, not so much. I spent the next four years in even more pain and was dismissed by no less than six doctors, who claimed that because my x-rays showed everything was fine, I must be fine. I didn’t need further treatment. I didn’t need pain medication. There’s no way I could be in the pain I claimed to be in. 

Eventually, I got in with another hotshot surgeon, but this time it was at a hotshot hospital! They finally unearthed the fact that my fusion never did fuse. I had another surgery, but there were complications. They said my body rejected the donor bone. The bone would have to come from me, from my hip. They would need to cut the front and back of my neck, and my hip. They’d also put in more screws, metal plates and a metal bracket. 

The second surgery was not successful in ridding me of any pain. 

I was back on the merry-go-round of trying to find another doctor. In the interim, I’d gain and lose jobs due to whatever had taken up residence in my once amazingly functional body. I’d gain and lose medical insurance as well. Needless to say, I also went into deep and terrifying medical debt, while also being denied pain treatment. I was ineligible for individual policies because I had a pre-existing condition. 

I was forced into taking antidepressants when I didn’t need them. I wasn’t depressed, I was in pain. I was also forced to undergo counseling twice; both times I was dismissed after one visit because it wasn’t a mental issue I was dealing with. I was too embarrassed to properly express my pain levels. Forced to downplay how desperate I was for pain relief. 

I was even turned away by receptionists, who flatly and rudely said, “We don’t see or treat pain patients.”

That’s a short synopsis of why I am where I am 20 years later, essentially bedridden. The pain doesn’t allow for restful sleep. I can feel my health disappearing. I now have weight issues from hypothyroidism, no appetite most of the time, insomnia that doctors won’t treat, and very high blood pressure. 

After 18 years, I finally got to a pain clinic, as they call them now. The doctor has two physician assistants, one who believes everyone is a drug addict and one who wants to do a good job, but whose hands are tied by government guidelines and overreach. 

I am under-treated by a long shot, yet I am harassed by the pharmacist every single month. I use one pharmacy and one doctor, but still run into denial or delay getting a prescription filled. I had to explain and essentially beg the pharmacist to get a small script filled after my most recent invasive surgery for a spinal cord stimulator. 

Four months later, I’m still in tremendous pain and have a nearly constant tremor in my right arm. The stimulator seems to hit on a nerve and my muscles seize up, the pain rising to levels that I didn’t know a human could withstand. It’s awful. It’s painful. And I am under-medicated because of criminals I never had a thing to do with. 

I have been told that my pain will never get better and can never be cured. It will only get worse as the degeneration continues. Wishing for it to be over is a pervasive daily thought. I have to work diligently to chase those thoughts away, so as not to fall prey to giving up.

My doctors can’t or won’t treat me because my chronic pain contributed to all the addicts all over the world. I’ll admit that’s a ridiculous statement when they admit they’ve gone too far in denying me proper medical care. 

I am 43 years old.

Leanne Gooch lives in Missouri.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Women Most at Risk for ‘iPad Neck’

By Pat Anson, Editor

If you have neck and shoulder pain and regularly use an iPad or tablet device, there’s a good chance the two are connected. Especially if you’re a young woman.

A recent study of over 400 university students, alumni and staff found that 60 percent have persistent pain in the neck and upper shoulders – often caused by slouching or bending to watch their iPads or tablet computers. Over two-thirds (68%) said they experienced symptoms while using their tablets.

"Such high prevalence of neck and shoulder symptoms, especially among the younger populations, presents a substantial burden to society," said lead author Szu-Ping Lee, PhD, a physical therapy professor at the University of Nevada Las Vegas. His study was published last week in the Journal of Physical Therapy Science.

The top risk factor for “iPad neck” was surprising. Women were twice as likely as men to experience neck and shoulder pain during tablet use.

“Our study revealed that females and individuals with current musculoskeletal symptoms were more likely to be at risk for neck and shoulder symptoms,” Lee wrote.

“Certain postures during use were also identified as important risk factors, specifically sitting without back support and with the tablet in lap were significantly associated with symptoms during use.”

UNLV IMAGE

The most frequently reported symptoms were stiffness, soreness or aching pain in the neck, upper back, shoulder, arms, hands or head. Most of those surveyed (55%) reported moderate discomfort, but 10 percent said their symptoms were severe and 15 percent said it affected their sleep. Less than half (46%) said they stopped using the devices when they felt discomfort.

Lee says the findings concern him, especially given the growing popularity of tablets, e-book readers, and other devices for personal, school and business purposes. At PNN, we know that about 10 percent of our readers use iPads or tablets.

Almost half of the tablet users surveyed use their devices for three or more hours each day. Flexing the neck forward for long periods of time puts pressure on your spine, causing neck and shoulder pain. Sedentary behavior and bad posture while reading are also contributing factors.

Researchers say many students sit cross-legged on the floor when studying on their tablets. Interestingly, women were far more likely (77%) to use their tablets while sitting on the floor than men (23%).

Lee offered these tips to avoid iPad neck:

• Sit in a chair with back support.
• Use a posture reminder device -- small, wearable devices that beep to alert you when you're slouching.
• Place your iPad on a stand (rather than a flat surface) and attach a keyboard to achieve a more upright posture.
• Exercise to strengthen your neck and shoulder muscles.

"Using these electronic devices is becoming a part of our modern lives," Lee said. "In order to reduce the risk of developing long-term neck and shoulder problems, we need to think about how technology like tablet computer affects human ergonomics and posture."

Wear, Tear & Care: Second Thoughts About SpineGym

By Jennifer Kilgore, PNN Columnist

I wrote a story last year about an IndieGoGo campaign for the SpineGym, an exercise device that helps people alleviate lower back pain by developing their back and abdominal muscles.

The device sells for $198 and, according to the SpineGym website, is the most successful Finnish product ever to use international crowdfunding sources.

INDIEGOGO

I received a complimentary version of the SpineGym to review, and I really, really liked it. The product itself is helpful, and I feel that it performs as advertised.

I haven’t developed a six-pack or anything, but it does seem to target some problem areas in my back that don’t get exercised enough by traditional means.

Then I started noticing some Tweets in which I’d been tagged. Thousands of people who invested in SpineGym or reserved it for loved ones are still waiting for their devices.

“Ordered a ‘spine gym’ via @Indiegogo in 2016, still have not received my ‘gym’ nor any answer. They have been anything but forthcoming, to the point of evasive. I am trying to just get an answer, but nothing but erroneous updates. Terrible,” said one Tweet.

“Bought mine for my dad. It will be two years in July. It would have helped him. Now too late,” said another Tweet.

SpineGym received an astonishing 928% in funding, almost $1.8 million. The campaign closed two years ago, and yet to date only about 200 of the 5,546 backers on IndieGogo and 2,255 on Kickstarter have received a SpineGym.

The company’s website still offers the product for sale and says that “SpineGym is used widely around the world to strengthen the core and to improve physical ability and well-being.”

‘Not Going to Put Up With This’

Meanwhile, angry backers have not received the product they were promised.

“If I hear nothing by Friday as I said, I’m putting a formal complaint in with my credit card company to get my money back,” a backer wrote on IndieGogo last week. “Not going to put up with this.”

While sites like IndieGogo are fundraising sites, not sale sites, the question must be asked: What happened to the $1.7 million raised on IndieGogo and the $460,000 on Kickstarter?

Why is SpineGym available for commercial sale but not available to backers, who’d provided money for the venture in the first place?

I sent an email to SpineGym’s customer service, asking what the problem is. Many of the individuals with whom I’ve corresponded on Twitter said they’ve tried emailing customer service and filing complaints, only to receive silence in response.

INDIEGOGO

I received a response that same day. SpineGym's explanation (with no name attached to their email) was that the initial interest far overpowered their tiny team, and that this meant “re-designing the product, re-designing the manufacturing [sic] re-planning the chain of sub-contractors processes as well as the logistic chain.” 

They also said they are currently looking for an additional customer service representative to handle the “huge amount of questions” from backers. They do state, however, they are “100% sure” that backers will receive their products, though it is taking far longer than they’d anticipated.

There is little explanation as to why such overwhelming interest warranted the entire redesign of their product. SpineGym noted delays regarding additional manufacturing issues, namely the baseplates, which were substituted with a new laminate more resistant to scratching and dirt. The company says new production samples are under final tests “at this very moment” and, if they pass review, will be shipped to backers this month.

At present, backers have little recourse aside from contacting SpineGym’s customer service and opening a claim. IndieGogo and Kickstarter have no options available, given that the campaigns have ended and all the money raised have been disbursed to the company. Technically, the campaigns were successful -- very successful -- so it’s not a matter of capital. It’s a matter of principle.

Despite my best intentions, I recommended a product that swindled backers out of hundreds of dollars. There is no reason why a plastic mat with two swiveling arms should take this long to create, regardless of redesigns, revamps, or whatever else SpineGym claims.

I will keep an eye on this situation and will hopefully have a better report soon. I recommend that backers keep up the pressure.  

Jennifer Kain Kilgore is an attorney editor for both Enjuris.com and the Association of International Law Firm Networks. She has chronic back and neck pain after two car accidents.

You can read more about Jennifer on her blog, Wear, Tear, & Care.  

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Why I’m Leaving My Spine Surgery Practice

By David Hanscom, MD, PNN Columnist

From the day I entered medical school, I wanted to be an orthopedic surgeon. I was planning on practicing internal medicine, but on a whim I applied for an orthopedic residency and, much to my surprise, was accepted.

I came out of my residency and fellowship in 1985 on fire, ready to solve the world’s spine problems with my surgical skills.

About six months ago, something shifted deep within me. In the three decades I’ve practiced spine surgery in the Seattle area, I’ve tried to address the whole patient. But I didn’t yet have a clear idea about all the factors that affect a person’s physical and mental health.

In fact, for the first eight years of my practice, I was part of Seattle’s movement to surgically solve low back pain with lumbar fusions. A new device had been introduced that ensured a much higher chance of a successful fusion. Our fusion rate for low back pain was nine times that of New England’s. I felt badly if I couldn’t find a reason to perform a fusion.

Then a paper came out in 1993 documenting that the success rate for fusion in the Washington Workers Compensation population was only between 15 to 25 percent. I had been under the impression that it was over 90 percent. A lumbar fusion is a major intervention with a significant short and long-term complication rate. I immediately stopped performing them.  

I also plunged into a deep abyss of chronic pain that many would call a burnout. I had no idea what happened or why. I had become a top-level surgeon by embracing stress with a “bring it on” attitude. I was fearless and didn’t know what anxiety was.

What I didn’t realize was that my drive for success was fueled by my need to escape an abusive and anxiety-ridden childhood. I was a supreme master of suppressing anxiety until 1990, when I experienced a severe panic attack while driving on a bridge over Lake Washington late one night.

Although I was skilled at consciously suppressing my anxiety, my body wasn’t going to let me get away with it. Anxiety and anger create a flood of stress hormones in your body. Sustained levels of these hormones translate into over 30 possible physical symptoms. I descended into a 13-year tailspin that almost resulted in my suicide.  

DAVID HANSCOM, MD

I can’t express in words how dark my world became. I experienced migraines, tension headaches, migratory skin rashes, severe anxiety in the form of an obsessive-compulsive disorder, burning feet, PTSD, tinnitus, pain in my neck, back and chest, insomnia, stomach issues, and intermittent itching over my scalp.

In 2002, I accidentally began my journey out of that dark hole by picking up a book that recommended writing down thoughts in a structured way.  For the first time I felt a shift and a slight decrease in my anxiety. I learned some additional treatments and six months later, I was free of pain. All of my other symptoms disappeared.

I began to share what I learned with my patients and watched many of them improve. Addressing sleep was the first step. Slowly I expanded it to add medication management, education about pain, stress management skills, physical conditioning, and an improved life outlook.

I still didn’t know what happened to me or why. Then in 2009, I heard a lecture by Dr. Howard Schubiner, who had trained with Dr. John Sarno, a physiatrist who championed the idea that emotional pain translates into physical symptoms.

Within five minutes of the beginning of Dr. Shubiner’s lecture, the pieces of my puzzle snapped into place. I realized that sustained levels of stress hormones can and will create physical symptoms. I also learned how the nervous system works by linking current circumstances with past events. If a given situation reminds you of past emotional trauma, you may experience similar symptoms that occurred around the prior event.

I felt like I had been let out of jail. I’ll never forget that moment of awareness.

What’s puzzling is that these concepts are what we learned in high school science class. When you’re threatened for any reason, your body secretes stress chemicals such as adrenaline and cortisol. You’ll then experience a flight, fight or freeze response, with an increased heart rate, rapid breathing, sweating, muscle tension and anxiety. When this chemical surge is sustained, you become ill. It’s been well documented that stress shortens your life span and is a precursor of chronic diseases.

Modern medicine is ignoring this. We are not only failing to treat chronic pain, but creating it.

Spine surgeons are throwing random treatments at symptoms without taking the time to know a patient’s whole story.  It takes just five minutes for a doctor to ask a simple question, “What’s going on in your life over the last year?” Answers may include the loss of a job, loved one, divorce, or random accident. The severity of their suffering is sometimes beyond words. But once we help them past this trauma, their physical symptoms usually resolve.

What has become more disturbing is that I see patients every week who have major spine surgery done or recommended for their normal spines. It often occurs on the first visit. Patients tell me they often feel pressured to get placed on the surgical schedule quickly. At the same time, I am watching dozens of patients with severe structural surgical problems cancel their surgery because their pain disappears using the simple measures I’ve learned.

I love my work. I enjoy my partners as we help and challenge each other. My surgical skills are the best they’ve been in 30 years. My clinic staff is superb in listening and helping patients heal. I’m also walking away from it.

I can’t keep watching patients being harmed at such a staggering pace. I have loved seeing medicine evolve over the last 40 years, but now I feel like I am attempting to pull it out of a deep hole. I never thought it would end this way. Wish me luck.

Dr. David Hanscom has helped hundreds of back pain sufferers by teaching them how to calm their central nervous systems without the use of drugs or surgery. In his book Back in Control, Hanscom shares the latest developments in neuroscience research and his own personal history with pain.

More information can be found on his website.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

New Treatments on Horizon for Chronic Pain

By Steve Weakley

Patients and doctors have long complained that there are few new treatments for chronic pain. And those that do come along are often reformulations of old medications or have unwelcome side effects.

Two developments this week suggest that trend may be changing. A new drug application has been submitted to the Food and Drug Administration for an “opioid of the future” that is less addictive, and research has uncovered a new way to treat neuropathic pain long term with a single injection.

In experiments on laboratory mice, researchers at the University of California at San Diego discovered a new method to block the root cause of pain with the injection of a naturally occurring protein, apolipoprotein A-I binding protein (AIBP). 

AIBP “turns off” a receptor called TLR4 that sits on the surface of nerve cells and searches for signs of infection or tissue damage.  Researchers say turning off the receptor prevents and even reverses inflammation and other cellular processes that create the sensation of pain.

A single spinal injection of AIBP relieved neuropathic pain associated with chemotherapy in the mice for two months with no side effects, according to findings published in the journal Cell.

“What’s so special about our new approach, inhibiting the TLR4 receptor with AIBP, is that it actually modifies the pain processing systems themselves," says study co-author Tony Yaksh, PhD, a professor and vice chair for research in the Department of Anesthesiology at UCSD School of Medicine.

"So, if you think of neuropathic pain as a disease, then we see this as truly disease-modifying. We’re blocking the underlying mechanism that causes pain, not just masking the symptoms.”

Neuropathic pain is a common side effect of chemotherapy treatments for cancer. Chemotherapy not only inhibits the growth of cancer cells, it can permanently damage nerve cells and make people sensitive to even the slightest touch. Opioids and other medications such as gabapentin (Neurontin) are commonly prescribed for neuropathy, but both have unwelcome side effects.

“If it comes down to a choice between living with chronic pain or getting a spinal injection once every few months, we think most people would take the injection," said co-author Yury Miller, MD, a professor in the UCSD Department of Medicine. “As it stands now, AIBP could be developed as therapy for unremitting severe pain that only responds to high dose morphine. AIBP would remove the need for opioids, and reduce the potential for drug abuse.

"We're not saying we shouldn't use opiates to treat chronic pain, or in particular cancer pain—that would be a tragedy.” Yaksh said. "But it would also be a greater tragedy if we didn't support work to find a substitute for systemic opiates.”

“Opioid of the Future”

While AIBP is still in its experimental phase and could be years away from being available for treatment, Nektar Therapeutics’ so-called “opioid of the future” is one step closer to market.  Nektar has completed over a dozen clinical trials on NKTR-181 and applied to the FDA for approval of the drug as a treatment for chronic low back pain.

PNN has previously reported on NKTR-181, a new type of opioid that shows promise in relieving moderate to severe pain with less risk of abuse and addiction of traditional opioids like oxycodone or hydrocodone.

Because of its slow rate of entry into the central nervous system, NKTR-181 significantly reduces the “high” or euphoric effect that recreational drug users crave. Many pain sufferers don't feel that high when taking opioid medication, they just get pain relief.

In trials, NKTR-181 showed a 65% reduction in low back pain vs. placebo in tablets taken twice a day. Safety studies found recreational drug users had significantly less “drug liking” of NKTR-181 -- even at high doses -- when compared to oxycodone. Participants also had less daytime sleepiness and fewer withdrawal symptoms.

nektar therapeutics

If it receives FDA approval, Nektar hopes to launch the drug commercially as early as next year. The company has yet to announce a partnership with a larger pharmaceutical company to help produce and commercialize NKTR-181 -- which is when the no-name "opioid of the future" will get a makeover with a branded name to make it more marketable.

Don’t Take Away Our Medicine

By Lynn Joyce, Guest Columnist

I am a 62-year-old woman who -- aside from my intensely painful back --- enjoyed a full life of work, swimming, going to the gym, outings to various places with my husband and friends, and running my household.

A few years ago, my back pain became so severe I had to move from my primary care doctor to pain management after all the solutions we tried, including physical therapy, various pain treatments, x-rays and MRIs could not diagnose or in the end treat me. I went to a doctor in Sarasota who gave me pain medicine. which helped a little. I also had several procedures under anesthetic, which again did not totally relieve the pain.

I was desperate, as I spent much of the day and night with ice packs on my back to ease the pain. My ordinary life went down the drain, my husband got fed up with me not being able to accompany him and looking after my home went downhill.

I cried as I went to bed early with a sleeping pill to take away the pain -- though this did not always work as the pain woke me up. I tried various types of pain medicine and the one that worked best was oxycodone.

Nearly a year ago my doctors finally found a combination of drugs that made me pain free and able to resume my normal life. I was ecstatic to be able to do all the things I enjoyed again and to be able to run my home and look after my family.

I then had a shock a month ago when my doctor told me that my medicine would have to be reduced. I had two tearful visits to his office, where he told me that starting July 1st I would receive only one oxycodone a day.  

LYNN JOYCE

My doctor knows that this is not even a therapeutic dose and yet is being forced to break his sacred oath to "First do no harm." After getting my life back, I was so upset that I would have to go back to my previous existence, where every day is full of pain and there is very little joy.

I am not a drug addict. I am a person that needs medication for a condition that curtails my enjoyment of life, just as much as another person who needs a drug to alleviate their condition or keep them alive. My doctor should be allowed and supported in the care of his patients, not vilified by government and media alike.

There are legitimate people who are truly suffering and need the medication that is being taken from them. I am one of these people -- the other side of this so-called crisis – and we are being ignored and used as scapegoats by the government.

I do not understand how such arbitrary, draconian laws can be passed in a modern society. This government’s heavy-handed solution to the "opioid crisis" is targeting the wrong people. We are not the ones selling drugs like fentanyl and heroin, we are just people with an illness. We are not lawbreakers, although some of us may be driven to escape the pain with illegal drugs or, in some tragic cases, suicide.

There are studies that totally refute the reasoning behind these opioid laws and guidelines, doctors who have tried to stop this from happening to their patients, and those who know the science and social reasons that show we are not the cause. We are not out there selling our drugs or "doctor shopping."

I see and read daily about politicians and stores that are jumping onto the false bandwagon to further their own careers and profits. Pharmacies that are too afraid or are taking a false moral stance about the prescriptions they will or won't fill.

There has been mishandling of prescriptions in the past, but systems have been put in place to remedy that. Yet the media screams about this person or that who has overdosed and stores like Walmart that will limit a person’s medication to seven days. I hope there are the few that get opioids for short term use if they need it, but they are not long-term pain sufferers who need their therapeutic doses daily to ameliorate their pain.

I have read that companies are being forced by the DEA to reduce their drug production so much that there are worries about hospitals not having enough to treat patients or with surgeries being delayed.

Those of us that need long term drug treatment are your family member, a friend, or a familiar stranger like the postal worker who you see every day. We are not the archetypal addict that people think of when the words “drug user” comes up. Think of a time in your life when you or someone you care about was in pain and were helped by medication to make it go away.

We have that pain every day and it doesn't go away without our medicine. The government or anyone else in a position of power who keeps on pushing this inhumane agenda should walk in our shoes for a day.

Lynn Joyce lives in Florida.

Pain News Network invites other readers to share their stories with us. Send them to editor@painnewsnetwork.org.

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.

Spinal Injection Bill Would Raise Healthcare Costs

By Pat Anson, Editor

Republicans and Democrats often claim that reducing the cost of healthcare is one of their major goals. But a bipartisan bill that is sailing through Congress with little debate will do just the opposite, raising the cost of some epidural, facet joint and other spinal injections used to treat pain by as much as 25 percent for Medicare beneficiaries.

Critics say the legislation is little more than a money grab by doctors who perform the procedures, under the guise of preventing opioid addiction.

The “Post-Surgical Injections as an Opioid Alternative Act” (HR 5804) is one of nearly 60 bills to combat the opioid crisis approved last week by the House Energy and Commerce Committee. It moves to the full House for a vote.

The bill would partially reverse a decision made by the Centers for Medicare and Medicaid Services (CMS) in 2016 to cut the Medicare reimbursement rate for epidurals and other injections.  The interventional procedures – which do not involve opioids -- can cost several hundred dollars per injection.

The American Society of Interventional Pain Physicians (ASIPP) lobbied unsuccessfully to get the reimbursement cuts overturned – until it found two Illinois Republican congressmen willing to sponsor HR 5804, Rep. John Shimkus and Rep. Raja Krishnamoorthi.

“We first went to the CMS, then HHS, with no success in reversing draconian cuts for interventional techniques. CMS and the administration told us that it requires an Act of Congress,” ASIPP says on its website. “As a first step toward this, Shimkus and Krishnamoorthi have introduced H.R. 5804, which reverses some of the cuts for Ambulatory Surgery Center procedures. This is only the beginning. We have many other cuts to be reversed.”

According to OpenSecrets.org, Shimkus and Krishnamoorthi have both received $10,000 in campaign donations from ASIPP. The organization has spent over $500,000 on lobbying and donations so far in the 2017-2018 election cycle.

‘I Find It Hard to Trust CMS’

Shimkus introduced the ASIPP bill on May 15th and two days later helped shepherd it through its first and only hearing before the House Energy and Commerce Committee.

During the hearing, Shimkus claimed that by cutting the cost of spinal injections, CMS created a disincentive for doctors to perform the procedures and encouraged them to prescribe opioids instead.

“A lot of us were surprised to see CMS reduce the reimbursement rate for non-opioid pain treatments like epidurals for post-surgery pain,” Shimkus said. “I find it hard to trust CMS when those of us in this arena think their cut has led to more opioid use.

“A lot of us believe the inability to use epidurals to treat pain and prescribe opioids is not healthy for our country.”

To be clear, the CMS reimbursement cuts do not prevent any doctor from performing injections – it only made the shots less profitable. And Shimkus offered no evidence that the lower reimbursement rates encourage more opioid use – although he convinced many of his colleagues that they did.  

“I do think it's important in this crisis to be specific with CMS to make sure that we are not discouraging the use of non-opioid alternatives based on reimbursement-related issues,” said Rep. Larry Bucshon, MD (R-IN), who is a cardiologist. “In my experience over the years, CMS makes reimbursement decisions based on the financial incentives to do so, not necessarily, in my opinion, based on what is the appropriate therapy.”

“I don't agree that epidurals are not an alternative (to opioids) already. They are. They are. I just had a conversation with a surgeon about that. So that's not so,” said Rep. Anna Eshoo (R-CA).  “Imagine being able to manage pain without taking an opioid. We could do 20 other things together and it wouldn't equal that."

Rep. Frank Pallone (D-NJ) wasn’t buying any of it.

“I don’t think we have gotten any objective criteria to suggest that what CMS did is going to lead to more people taking opiates,” Pallone said. “I don't think there is any evidence to suggest that this legislation will lead to decreased opioid prescribing or a decreased prevalence of addiction.

“I think we are setting a bad precedent with the bill. I don't think that we, as Congress, are in a good position to pick and choose winners amongst therapies and procedures. I just don't think we know enough to understand the consequences of doing that to understand the relative value and the efficacy of different therapies and procedures on the market.”

Despite those concerns -- and after just 30 minutes of debate that included no public testimony -- committee members overwhelmingly supported the bill by a vote of 36 to 14. Nine Democrats joined with all Republicans on the committee in voting yes.

“What we are doing is temporarily reversing cuts to non-opioid treatment that we all agree save money and lives, then collecting to help ensure we are reimbursing providers at the most appropriate levels possible,” Shimkus said.

“That’s ASIPP talking,” says Terri Lewis, PhD, a researcher and longtime advocate for the pain community. “What does Shimkus know? Shimkus doesn’t know anything. There is no data to support that.”

Health Risks of Spinal Injections

There was no discussion by the committee about the effectiveness of epidurals and other spinal injections -- or of the health risks associated with their use.

Epidural injections have long been used to relieve pain during childbirth, but they are also increasingly being used to treat back pain, despite reports there is little evidence the shots are effective.

The FDA has also warned that the use of steroids in spinal injections – a procedure that’s never been approved by the agency -- “may result in rare but serious adverse events, including loss of vision, stroke, paralysis, and death.”

“Here we have a procedure that they’re trying to slip under the swimming pool fence that is not FDA approved, that relies on materials that are not regulated and/or contraindicated, and they’re trying to pull a fast one. And they could very easily do it in this climate of opioid hysteria,” said Lewis.

As PNN has reported, some pain management experts believe spinal injections are overused – in part because they’re more profitable for doctors than using opioids or other procedures.  

“Probably everything that gets compensated well is over-utilized because it’s the compensation system. It’s a reimbursement system that pays more for treatment procedures than outcomes,” said Lynn Webster, MD, a past president of the American Academy of Pain Medicine.

A 2012 report by the General Accounting Office – a report requested by Rep. Pallone – found that unsanitary injection practices in ambulatory care clinics expose thousands of patients every year to blood borne pathogens such as hepatitis and HIV.  A perfectly sanitary needle can also go astray and puncture sensitive membranes in the spinal cord, leaving patients with serious and sometimes permanent injuries.      

“When it comes to spinal injections after surgery the risk to the patient, related to adverse events, increases substantially because spine surgery comes with risks of dural tears and accidental cuts,” says Terri Anderson, a Montana woman whose spine was damaged after receiving steroid injections for a ruptured disc in her back.  She now suffers from adhesive arachnoiditis, a chronic inflammation in the spinal membrane that causes severe pain.

“It is unconscionable that harmful injections would be pushed on unsuspecting pain patients,” Anderson said in an email to PNN. “It looks like the large hospital corporations and interventional pain professional societies have been busy lobbying our congressional representatives.  Apparently our healthcare system has become a profitable venture that indirectly contributes to many election campaigns in the U.S.”

No date has been set for a full House vote on HR 5804. To become law, it must pass both the House and Senate and then be signed by President Trump.  There is little opposition to the bill because many critics only recently learned that it was even being considered by Congress. 

“If this is allowed to stand, we have a problem,” says Lewis. “Another thing is Congress directing the practice of medicine. We’ve had just about enough of that.”

Physical Therapy for Back Pain Lowers Healthcare Costs

By Pat Anson, Editor

If you have lower back pain and get it treated with physical therapy first, you are significantly less likely to later need opioid medication or high cost medical services, according to a new study in Health Services Research.

Researchers at the University of Washington and George Washington University analyzed health insurance claims for over 50 million people from 2009 to 2013, tracking patients who had a new diagnosis of lower back pain.

Compared with patients who saw a physical therapist later or not at all, those who saw a physical therapist first had an 89% lower probability of having an opioid prescription, a 28% lower probability of having an MRI or advanced imaging, and a 15% lower probability of having an emergency department visit. Their healthcare costs were also significantly lower for out-patient care, pharmacy and out-of-pocket expenses.

“We found important relationships among physical therapy intervention, utilization, and cost of services and the effect on opioid prescriptions," said co-author Ken Harwood, PT, a professor of physical therapy at George Washington University.

One unexpected finding is that patients who had physical therapy first had a 19% greater chance of being hospitalized.

“Having an in-patient hospitalization is not necessarily a bad outcome for a patient. PTs (physical therapists) provide care that aims to resolve LBP (lower back pain) by addressing musculoskeletal causes first, but if the problem does not get resolved, PTs may refer patients appropriately for more specialized care,” the study found.

One out of every four Americans will experience at least one day of lower back pain every three months. Researchers say about half will be treated with opioid medication, while physical therapy (12%), exercise (19%) and psychological therapy (8%) will be recommended far less often.    

"Given our findings in light of the national opioid crisis, state policymakers, insurers, and providers may want to review current policies and reduce barriers to early and frequent access to physical therapists as well as to educate patients about the potential benefits of seeing a physical therapist first," said lead author Bianca Frogner, PhD, a professor and health economist at the University of Washington Center for Health Workforce Studies.

Lower back pain is the world’s leading cause of disability, affecting about 540 million people at any given time. But there is little consensus on the best way to treat it.

A recent series of reviews appearing in The Lancet medical journal found that lower back pain is usually treated with inappropriate tests, risky surgeries and painkillers.

“The majority of cases of low back pain respond to simple physical and psychological therapies that keep people active and enable them to stay at work,” said lead author Professor Rachelle Buchbinder of Monash University in Australia. “Often, however, it is more aggressive treatments of dubious benefit that are promoted and reimbursed.”

TV Host Tries Stem Cell Therapy for Chronic Back Pain

Reality TV star Tarek El Moussa – host of HGTV’S “Flip or Flop” – recently posted photos on Instagram detailing his experience with stem cell therapy. 

El Moussa has a history of back injuries causing severe pain. He lost 50 pounds while recovering from one back injury and was taking “large amounts of pain meds to try and help the pain.” 

“Truthfully those meds really affected my mental and physical state and changed who I was,” El Moussa posted.

When he recently injured his back again and could “barely walk,” El Moussa decided stem cell therapy was a better option. In one photo of the stem cell procedure, El Moussa shows a 12-inch needle being inserted into his lower back to remove fat cells, a procedure similar to liposuction.

TAREK EL MOUSSA

“I believe they put over 1,000,000 stem cells back in my body after the lipo. It's wild seeing the technology and future of medicine,” he wrote.

A post shared by Tarek El Moussa (@therealtarekelmoussa) on May 9, 2018 at 7:24pm PDT

A post-operative photo shows El Moussa’s discolored and bruised lower back three days later. He said he was still “a little sore” but that his back was “actually feeling better!” He’s hoping for a “major improvement” from the procedure in a few weeks.

El Moussa’s therapy involved a controversial stem cell product known as stromal vascular fraction (SVF).  It’s the same product at the center of two lawsuits recently filed by the Department of Justice on behalf of the FDA against stem cell clinics in Florida and California.

What is Stromal Vascular Fraction?

SVF uses autologous stem cells derived from a patient’s own body, including adipose (fat) cells obtained through liposuction.  When injected back into the body, these stem cells stimulate the immune system, have anti-inflammatory properties, and promote the development of new blood vessels. All help to heal injured tissues.

For clinicians, the attraction of SVF is that the procedure is “point of care” or delivered at the time of care.  In theory, this would exempt the therapy from FDA rules for stem cell products under the “same surgical procedure” exception.  The FDA, however, doesn’t agree with that interpretation and has yet to approve SVF use. It considers the procedure unproven and experimental. But that hasn’t stopped dozens of stem cell clinics from offering SVF therapy.

SVF generally has a good safety profile.  Potential risks of SVF therapy include lack of standardization of SVF products and terminology, unwanted tissue differentiation, poor cell handling and insufficient data on dose versus effect. 

Evidence regarding the clinical efficacy of SVF in treating painful conditions is limited.  Jaewoo Pak, MD successfully treated patients with knee osteoarthritis.  Their pain scores, functional ability and cartilage regeneration were all improved through SVF therapy.  Pak also achieved success in treating meniscus tears and osteoarthritis of the hip.  

In 2015, three researchers for the Cell Surgical Network (who are defendants in the FDA lawsuits) reported on their treatment of 1,524 patients with SVF who lived with painful conditions such as osteoarthritis.  About 25% of the patients showed evidence of new cartilage formation in their joints and 80% had a significant reduction in pain.  The beneficial effects of SVF were sustained for well over six months and some for several years.  The researchers also reported success in treating neurodegenerative diseases, with 80% of the patients with interstitial cystitis showing pain reduction.

Despite the controversy and lawsuits, El Moussa and thousands of other patients are willing to give SVF therapy a try. We’ll keep you updated on his progress.

A. Rahman Ford, PhD, is a lawyer and research professional. He is a graduate of Rutgers University and the Howard University School of Law, where he served as Editor-in-Chief of the Howard Law Journal. He earned his PhD at the University of Pennsylvania.

Rahman lives with chronic inflammation in his digestive tract and is unable to eat solid food. He has received stem cell treatment in China. 

The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represent the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.