Friday, May 29, 2009
New York Chiropractor visit www.drshoshany.com
Chiropractic Mentioned in AARP the Magazine
The July-August issue of /AARP the Magazine/ , the nation's largest
circulation magazine with more than 24 millions readers, includes a
story about back pain and mentions chiropractic as one of the "best
treatments for lasting relief."
Full Story read below
The Back Story
By Perry Garfinkel, July & August 2009
One of every five Americans is suffering back pain right now. Here are the best treatments for lasting relief
The first time I thought it was a quirk. The second time I thought it was a coincidence. The third time I would have sat up and taken notice—but I couldn't sit up. And the fourth time my back went out—leaving me supine for a week, except for when I crawled to the bathroom—I was forced to take action.
What undid me at last was the simple, perfunctory act of bending down to tie my shoe. I leaned down and wham, my whole left side crumbled like a graham cracker. I spent the next week in a fetal position on the bed, relieved only by visits to a physical therapist, a chiropractor, and an acupuncturist.
Low back pain should really be called spine pain because that's where it originates.
My story is not uncommon. Up to 85 percent of Americans will suffer back pain in their lifetime—and the number of people with chronic, debilitating low back pain is growing. The likely reason: rising rates of obesity and stress, says Timothy Carey, M.D., director of the Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, and the author of several recent studies on low back pain.
Despite the pervasiveness of the problem, there are few clear guidelines on how to properly diagnose and treat low back pain, leaving sufferers like me to try one therapy after another. Thankfully that disjointed approach is starting to change, as a slew of new research sheds light on what works and what doesn't. I've consolidated that research here—and consulted half a dozen experts in low back pain—to help you ease your agonizing aches.
The Anatomy of a Back
It's often hard to pin down the exact cause of a person's back pain—unless you have pain accompanied by a red-flag symptom such as numbness or weakness of the legs or feet, changes in bladder control, fever, or night sweats, or you have a history of cancer. In such cases, health care professionals agree, get to a doctor pronto.
Technically speaking, back pain may be the wrong nomenclature. It should really be called spine pain because that complex of bones is the center beam of the system that holds us erect.
The adult spine consists of 26 bones, called vertebrae, divided into three areas—the upper (cervical), the middle (thoracic), and the lower (lumbar). Picture a stack of pancakes, with butter between each pair, all loosely held together by maple syrup. The pancakes are the vertebrae, the butter pats are the water-absorbent discs between the bones, and the syrup is an intertwining collection of ligaments, joints, and muscles, all tangled with the cables carrying nervous system signals—among them, pain.
Even if you weren't born with a musculoskeletal irregularity, such as curvature of the spine (scoliosis), your discs wear out over time: they're the shock absorbers for your body weight. As you age, your bones become weaker, and you may develop osteoporosis (which can lead to fractures) or osteoarthritis (a breakdown of cartilage that may cause bones to rub together). Add a simple misstep—like my ill-fated bend to tie my shoes—and it can topple the stack.
So what should you do if you feel low back pain? First ask yourself: is the pain acute or chronic? Here's the difference: acute pain feels like a sudden stab followed by a burning sting, so painful it can immobilize you. People often say it feels like "something snapped." That snap may be a muscle stretching so far it tears like a frayed rubber band. Acute pain ends in a day to several weeks. Chronic pain may have started as acute but never went away. If pain lasts longer than three months, it's chronic.
Treating Acute Pain
The general rule for acute pain is to ice the injured area for 20-minute intervals to reduce inflammation and swelling, says Marilyn Moffat, D.P.T., Ph.D., professor of physical therapy at New York University. After 72 hours, switch to heat, which soothes muscles. Plus, heat works well on muscle spasms, involuntary contractions that send pain signals to the brain.
After the initial pain passes (and you've made it to the couch with an ice pack), the next question is: lie still or move? Until recently, doctors advised those with acute back pain to lie in bed until the pain passed. But a 2005 study found that people on bed rest have more pain and a slower recovery than those who stay active. "Muscles lose mass remarkably quickly when you don't exercise them," says Moffat. Just when you need those muscles to work harder to hold you up, they will be weaker than ever from lack of use. To aid movement in the early days of pain, she often has patients wear a lumbosacral corset, which supports the lower back.
In recent years, as the numbers of patients with low back pain have increased, physicians have more frequently referred patients for medical imaging (MRIs, CTs, or radiography). This is troubling for several reasons, says Raj Rao, M.D., director of spine surgery in the Department of Orthopaedic Surgery at the Medical College of Wisconsin. For one, a study published in February in The Lancet found that low-back-pain sufferers who underwent medical imaging did no better than those who did not get imaging, despite the hefty price tag (an MRI can cost $2,000).
Unlike many other diagnoses, the discovery of an abnormality in your spine doesn't necessarily mean you've found the cause of your pain. For instance, 5 percent of those with a herniated disc—in which the disc's gelatinous center pops out of its fibrous covering into the spinal canal—feel no pain. For other people even a slight bulging of a disc causes intense discomfort.
Rao sees this all the time. "You can look at the MRIs of two people, both showing degenerative discs, but in one case there is little to no pain, while in the other, extreme pain," he says. "On the other hand, you can see a healthy spine but the patient has severe pain."
The doctor's first job, then, is not to find the cause of your pain, but to alleviate it. "Seeing images of bone spurs or crushed discs may only add worry, as those problems may not be related to the patient's pain," Carey says.
Rao and Carey usually wait a month to six weeks after the onset of a patient's back pain before ordering an MRI, unless there are red-flag symptoms. "I think of MRIs as a preoperative study," says Carey. "When the pain is bad enough and long-term enough that an invasive treatment becomes part of the conversation, then an MRI may be called for."
Treating Chronic Pain
Part of the frustration in treating low back pain—both for the physician and for the sufferer—is that outcomes vary so dramatically from one patient to the next. Although acupuncture might offer relief to one person, it may do nothing for another. Neurologists speculate that this may be due in part to the way pain signals travel up the spine to the brain. It also may be because most people who see a doctor for low back pain actually have several things wrong with their back. (In my case, an X-ray showed how a slight case of scoliosis was aggravating degenerating discs and bone spurs that were developing.) "At this point we have no way to test for—or treat—multiple back problems in isolation, so we have to resort to hit or miss," Rao explains.
That said, emerging research suggests we're getting closer to discovering what works best. A review in the February 2009 Journal of the American Academy of Orthopaedic Surgeons concluded that physical therapy combined with nonsteroidal anti-inflammatory drugs (such as ibuprofen or naproxen) is the most effective treatment for degenerating discs. According to the American Association of Neurological Surgeons, 90 percent of herniated discs can be effectively treated with conservative therapies such as limited bed rest, exercise, and anti-inflammatory medications. This would be heartening but for a study in the February Arthritis Care & Research, which found that fewer than half the participants who saw a health professional for back pain in the past year had been prescribed exercise.
I personally made some groundbreaking discoveries about physical therapy not long after becoming ambulatory again: staying healthy can be hard work, and it doesn't always feel so great. "You may feel some pain when you start physical therapy, even if it's just walking," says Carey. "This is normal." If the exercise consistently causes greater pain than the initial pain in your back, stop doing it and check with your physical therapist. But if the pain seems to lessen with each workout, you're on the right track.
If physical therapy isn't doing the trick, it's time to try other approaches, says Jack Stern, M.D., Ph.D., a neurosurgeon and senior member of Brain and Spine Surgeons of New York, in White Plains. Here are a few of the most commonly prescribed therapies for chronic low back pain—and the potential benefits of each.
• Chiropractic - To clarify a common misunderstanding: chiropractors don't "crack your back." That popping sound is a gas bubble being released from between two joints that have been coaxed into alignment. A study published in 2002 found that patients with low back pain treated by chiropractors showed greater improvement after one month than those treated by physicians.
Chiropractic care in Manhattan, NYC visit www.drshoshany.com
• Acupuncture - The needles used in acupuncture may work by stimulating the nerve fibers that transmit signals to the spinal cord and brain, which then release hormones that make us feel less pain.
Acupuncture in NYC visit www.livingwellnewyork.com
• Medication - NSAIDs, including ibuprofen (Advil) and naproxen (Aleve), help reduce swelling and inflammation. COX-2 inhibitors such as celecoxib (Celebrex) are a type of NSAID with fewer gastrointestinal side effects. Analgesics such as acetaminophen (Tylenol, Anacin Aspirin Free) are used to treat acute pain, as well as some forms of chronic pain. Opioids such as morphine and codeine can be habit forming, so they're usually prescribed only if pain is severe. Muscle relaxants such as cyclobenzaprine (Flexeril), diazepam (Valium), and carisoprodol (Soma) also are often prescribed for severe muscle spasm. Dr. Blank is a board certified pain management specialist call (212) 645-8151
If conservative approaches do not work, many physicians refer their patients for more invasive procedures—typically injections or surgery.
• Injections - A neurologist sometimes injects anesthetics, steroids, or narcotics into the soft tissues and joints around your spine to reduce inflammation and relieve pain. One of the most commonly injected medications is a synthetic version of cortisone, which is a natural steroid released by the adrenal glands when your body is under stress. However, a review of studies found insufficient evidence that injection therapy is more effective than other treatments.
• Surgery - The most invasive approach "is the last resort—even for surgeons," says James Weinstein, D.O., chair of the Orthopaedic Surgery departments at Dartmouth Medical School and Dartmouth-Hitchcock Medical Center. Three of the most common operations include:
Discectomy, or surgical removal of part of the damaged disc, is most often performed on herniated discs. A 2006 study, though, found that lumbar discectomy offered only modest short-term benefits.
Laminectomy is the removal of part of a vertebra, and is used in certain cases of spinal stenosis or spondylolisthesis to decompress the nerve.
Spinal fusion is the fusing together of vertebrae using bone grafts and metal rods. In a 2001 study of patients with severe long-term back pain, pain was reduced by 33 percent after two years for those who had spinal fusion, compared with 7 percent for those who received more conservative treatment.
There's an old Zen saying: "Before enlightenment, chop wood, carry water. After enlightenment, chop wood, carry water." It means no matter how much you know, you still have to take out the garbage. The difference is you take it out with more consciousness.
I feel the same way with my acquired wisdom about back pain. Even after voluminous research, I know that one false move, one stumble, and I could be flat on my back again. The difference is that I now know how to treat it. Now, I can say, I've got my own back's back.
Perry Garfinkel is the author of Buddha or Bust: In Search of Truth, Meaning, Happiness and the Man Who Found Them All (Three Rivers Press).
If you live in Manhattan NYC and are looking for a Pain Management Doctor,Chiropractor, Acupuncturist visit our website at www.livingwellnewyork.com
Tuesday, May 19, 2009
www.drshoshany.comGuideline for Low-Back Pain Interventions
Herniated disc protocol in our Manhattan NYC clinic is a Intensive interdisciplinary rehabilitation program. This Protocol involves Non-surgical spinal decompression on the DRX 9000, three dimensional rehabilitation using the Spine Force, Massage therapy, Acupuncture,Nutritional support.We custom fabricate corrective orthotics to correct improper gait biomechanics.
Research review by investigators in the Oregon Health & Science University Evidence-based Practice Center prompts America Pain Society to issue new clinical practise guideline
The American Pain Society (APS) has issued a new clinical practise guideline for low back pain that emphasises the use of noninvasive treatments over interventional procedures, as well as shared decision making between provider and patient. The findings are published in the current (May 1, 2009) issue of the journal Spine.
The new APS guideline, based on an extensive review of existing research, provides clinicians with eight recommendations to help determine the best way to treat patients with low-back pain. It also expands its current and previously published guideline for initial evaluation and management of this chronic condition.
"These recommendations are based on an even more complete body of evidence than was available just a few years ago. Consequently, we believe these recommendations will give physicians more confidence when treating patients with persistent back pain," said Roger Chou, M.D., lead author, director of the APS Clinical Practice Guideline Program, and associate professor of medicine (general internal medicine), Oregon Evidence-based Practice Center, Oregon Health & Science University.
"Unfortunately, randomised trials for a number of commonly used interventional procedures are still too limited to generate evidence-based recommendations, and our review also highlights the need for more research," Chou added.
Low-back pain is the fifth most common reason for doctor's visits and accounts for more than $26 billion in direct health care costs nationwide each year. While a number of interventional diagnostic tests and therapies, and surgery are available, and their use is increasing, in some cases their usefulness remains uncertain.
"We have advocated strongly in many of our recommendations for physicians to use shared decision making because of the relatively close trade-offs between potential benefits relative to harms, as well as costs and burdens of these various treatment options," Chou explained. Shared decision making involves a patient's full participation in medical choices after receiving comprehensive information about the impact of all options on his or her particular life situation.
To develop the guideline, a multidisciplinary APS panel, augmented by experts on interventional therapies, reviewed 3,348 abstracts and analysed 161 relevant clinical trials. The panel found that the evidence for the use of these interventions was mixed, sparse or not available. Based on the data the panel gathered, the APS now recommends:
1. Against the use of provocative discography (injection of fluid into the disc in order to determine if it is the source of back pain) for patients with chronic nonradicular low-back pain.
2. The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioural emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies.
3. Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies.
4. A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms.
5. Insufficient evidence to guide recommendations for vertebral disc replacement.
6. A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc.
7. A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients with persistent and disabling radiculopathy due to herniated lumbar disc or persistent and disabling leg pain.
8. Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root.
Chou and his colleagues also reaffirm their previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. "In general, noninvasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery," said Chou.
Recommendations from the first APS Clinical Practise Guideline on Low-Back Pain are intended for primary care physicians and appeared in the Oct, 2, 2007, issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimise routine use of X-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders
About the American Pain Society
Based in Glenview, Ill., the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practise to reduce pain-related suffering.APS was founded in 1978 with 510 charter members. From the outset, the group was conceived as a multidisciplinary organisation. APS has enjoyed solid growth since its early days and today has approximately 3,200 members. The Board of Directors includes physicians, nurses, psychologists, basic scientists, pharmacists, policy analysts and more.
This is an exciting new study because it confirms what Chiropractors have been saying for many years, Surgery and drugs to manage Low back pain is not the best treatment option.
In our New York City office we combine the best of the latest non-surgical technology like Spinal decompression,3D Spinal rehab, Physical therapy, Medical care and of course Chiropractic care to offer patients the most comprehensive care for back pain treatment.
Visit our website at www.livingwellnewyork.com
or my personal website which has an impressive amount of research on the benifits of non surgical spinal decompression
Sunday, May 10, 2009
What Is Spinal Decompression Therapy? Proven Non-Surgical Treatment for Back Pain in Manhattan,New York visit the Spinal decompression specialist Dr. Steven Shoshany D.C.,C.C.E.P. Spinal Decompression Therapy (also known simply as Spinal Decompression or SD), is a non-surgical therapy proven to treat back pain and sciatica caused by bulging, herniated, and degenerative discs or facet syndrome. Even post-surgical patients and those suffering from stenosis (a narrowing of the spinal canal) have reported significant pain relief from SD treatments. Over a series of relaxing treatment sessions, patients experience powerful pain reduction and healing. Some patients even notice an improvement in their symptoms after the first few treatments! Spinal Decompression, not to be confused with traction, gently lengthens and decompresses the spines, creating negative pressures within the discs. This reversal of pressure creates an intradiscal vacuum that not only takes pressures off of pinched nerves, but helps to reposition bulging discs and pull extruded disc material back into place. Simultaneously, spinal experts believe nutrients, oxygen and fluids are drawn into the disc to create a revitalized environment conducive to healing. By bringing disc pressures to negative levels, many experts surmise that SD stimulates the body?s repair mechanism, providing the building blocks needed to mend injured and degenerated discs. Dr. Steven Shoshany D.C, C.C.E.P., C.K.T.P. Manhattan herniated disc specialist visit website www.drshoshany.com or call (212) 645-8151
We offer the most comprehensive non-surgical treatment for herniated discs in New York City.
Utulizing state of the art diagnostics, the DRX-9000, The SpineForce 3D spinal Rehab system, Cold laser therapy, Kinesio tape.
We offer the most comprehensive non-surgical treatment for herniated discs in New York City.
Utulizing state of the art diagnostics, the DRX-9000, The SpineForce 3D spinal Rehab system, Cold laser therapy, Kinesio tape.