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How To Diagnose Lower Back Pain

January 29th, 2010

Lower back pain is a common affliction, with millions each year visiting physicians for relief. Not only will they seek relief, they will want a diagnosis.



It is not always easy to diagnose lower back pain. Many body structures can cause it. There are muscles, ligaments, and tendons; spinal column bones; joints, discs and nerves. In addition to these structures, there may be underlying medical conditions your physician needs to evaluate.

Whether you initially diagnose lower back pain yourself, or leave that to your physician, the diagnosis will need to consider both the location and symptoms of your pain.

Step 1 – Location

The first step is to decide the location. “Where does it hurt?”

1. Axial lower back pain: This lower back pain hurts only in the low back. Pain does not travel into any other area.



2. Radicular lower back pain: This lower back pain hurts in the low back, and also radiates down the backs of the thighs into one or both legs.

3. Lower back pain with referred pain: Diagnose lower back pain with referred pain if it hurts in the low back area, and tends to radiate into the groin, buttocks, and upper thighs. The pain will rarely radiate below the knee, but may seem to move around.

Step 2 – Symptoms

Once you diagnose lower back pain as to location, you will consider symptoms. “How does it feel?”

1. Worsens with certain activities: If you play football, for example, the pain is worse.

2. Worsens in certain positions: Perhaps it gets worse if you stand for too long. Or it is more painful after you sit in a car.

3. Feels better after rest: Resting from the activity or position usually reduces the lower back pain.

4. Deep and steady: Not a sharp muscle catch, this pain is constant and deep within the affected areas.

5. Severe: The pain is excruciating, possibly more so in the calf than the lower back.

6. Numbness and tingling: There may be “pins and needles” within the area.

7. Fleeting pain: Pain may seem to come and go, leaving you unsure at times just how it feels.

8. Achy and dull: Like the flu, this pain is sore and dull, though sometimes intensifying.

9. Migratory: It hurts in one spot, then another.

Diagnosis

AXIAL: If location is best described by number 1 above, and symptoms are a combination of 1, 2, and 3, you can probably diagnose lower back pain as being axial – the most common type. This is also called “mechanical” lower back pain. A variety of back structures can cause axial lower back pain, and it is difficult to identify which is the cause. Axial pain gets better on its own, and about 90% of patients recover within six weeks.

RADICULAR: If location is best described by number 2 above, and symptoms are a combination of 4, 5, and 6, you can probably diagnose lower back pain as being radicular – commonly called sciatica. This lower back pain is caused by compression of a lower spinal nerve, usually the sciatica nerve that runs from the spinal column, down the back of the thighs to the feet. Doctors usually recommend conservative treatment such as physical therapy exercises, medications, and possibly spinal injections, for six to eight weeks.

REFERRED: If location is best described by number 3 above, and symptoms are a combination of 7, 8, and 9, you can probably diagnose your pain as being lower back pain with referred pain – the least common type. This lower back pain is treated the same as axial back pain and frequently goes away as the problem resolves on its own.



How do you diagnose lower back pain?

Diagnose lower back pain with care. You need an accurate diagnosis, which your physician can best make, to be sure no underlying causes need attention. It is not enough to know you have sciatica. You need to know the underlying cause of the sciatica to determine treatment options.

If you do diagnose lower back pain, check the diagnosis with your physician.



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Acetaminophen Overdose – What Do I Need To Know?

January 29th, 2010

Acetaminophen overdose has been in the news and a subject of concern lately. What is it, what does it do to my liver, and how can I protect myself? Find out here.

Acetaminophen (or paracetamol in Great Britain) is used by many people today as an over-the-counter drug for pain relief and to reduce fever. Acetaminophen is also an active ingredient in many over the counter cold, flu, and sleeping remedies. It is the active ingredient in many recognized pain relievers such as over the counter drugs Tylenol, Excedrin, and prescription brands Vicoden and Percocet.

Acetaminophen quickly gained popularity when it was introduced into the market in the 1950’s since it doesn’t contain the warnings for gastrointestinal bleeding and stomach upset that aspirin does. As a result, people may tend to down them quite regularly with little thought. This is not without serious risk.

On June 29 and 30, 2009, the Food and Drug Administration advisory panel held meetings to discuss the safety of acetaminophen and possible new guidelines for safe consumption of this drug. Why the worries? Acetaminophen, when taken according to labels, has been considered generally safe. It is widely used by millions at safe levels with minimal side effects. However, when these guidelines are exceeded, this is called acetaminophen overdose.

What are the dangers of acetaminophen? Most people think of alcohol abuse or hepatitis as being the most common causes of liver failure. They are not. Acetaminophen overdose is the leading cause of liver damage in the United States. This can be manifested in abnormal liver function, elevated liver enzymes, or even liver failure and death. Acetaminophen leaves toxic residues in the liver, and the liver requires assistance to remove them from your body. These residues can build up over time if your liver doesn’t have what it needs to do the job. Research has shown us that acetaminophen was the leading cause of acute liver failure in the U.S. from 1998 to 2003.

In the United Kingdom, where acetaminophen is known as paracetamol, it is common practice for those wanting to commit suicide to mix alcohol and acetaminophen, which is one of the dangers of acetaminophen, and this can lead to liver failure. This may prove fatal if not treated right away. As a result, the packaging has been changed on products in that country, and limits have been put on its purchase. The warnings are very clear on the label, and as a result, there have been fewer incidences of suicide attempts with paracetamol overdose. The most common way to treat acetaminophen overdose in Europe if the patient gets to a hospital in time is to administer large doses of a drug called N-acetyl-cysteine or NAC. This quickly raises a protein called glutathione in the patient’s system, and they may get sick from the high dosage, but it keeps their liver from failing completely and can save their life in this extreme circumstance.

In order to prevent these dangers of acetaminophen, the most important step you can take is to read all of the information on the label, and follow dosing instructions carefully. Do not take more than the recommended dose, even if you think you might need it. One difference between acetaminophen and other painkillers is that the window between therapeutic and toxic doses is much narrower than other drugs. With acetaminophen, there is not much room for error. On the label it will indicate how long or for how many days you should take the medicine. Follow this precaution carefully as well. Generally, you should not be taking this for more than 10 days in a row. Seek medical attention if your problem persists.

And read the labels of all of the medicines you are taking to make sure that you are not “doubling up” on safe dosages to prevent dangers of acetaminophen and acetaminophen overdose. Do not mix acetaminophen with alcohol. This increases the toxic load on the liver.

Know what to look for. Some of the signs of acetaminophen overdose mimc flu symptoms. In this case, you may think you have the flu, but if you have been taking acetaminophen for several days, it is a good idea to seek medical attention immediately. It may save your life! Of course, a common sense approach would be to stay well below the established guidelines if possible to protect your liver even further. An ounce of prevention is better than a pound of cure!

The best way to avoid acetaminophen and liver damage is to take care of your liver and make sure it is not overloaded with toxins in the first place. Additionally, pay close attention to all toxins that your liver is exposed to, whether this be in the form of over the counter or prescription drugs, alcohol, or other toxins in your environment. It is also important to note that use of acetaminophen depletes the levels of protective glutathione in your system. The Food and Drug Administration has a Power Point Presentation that includes a list of glutathione depleting substances. This list includes acetaminophen , alcohol, smoking and caffeine. So when you are taking this medicine, it would be good to make sure you are raising your glutathione levels as well to help your liver to remove it from your body and prevent liver damage.

For a long term preventive approach for acetaminophen and liver damage, you need a dual strategy. Don’t overload your liver with toxins, and then give your liver what it needs to cope with the chemicals and toxins that you are exposed to.

In conclusion, what is acetaminophen overdose? It is the leading cause of liver damage in the US, and is the result of taking more acetaminophen than the recommended safe dose. To prevent acetaminophen toxicity, please read the labels on all medications you take carefully. To protect your liver from acetaminophen overdose, do not exceed the safe dose, limit your drug and toxin exposure, and keep your glutathione levels high. This will prevent liver damage and keep your liver healthy. And if your liver is healthy, you are healthy!



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Neuropathic Pain

January 29th, 2010

The brain’s sensory cortex, which receives and interprets incoming information, maintains a representation of the body physically within itself. The homunculus is the name given to the diagram obtained when each part of the body is plotted against its place on the sensory cortex, with more important areas of the body being illustrated as larger areas of the brain. Various areas, such as the hands and the lips, take up much more brain area due to their importance in normal function, and it is these most important areas to control which need greater sensory awareness and greater processing power to work out responses.

When we suffer an injury the pain comes directly from that part, streaming in from the highly irritated nerve ends and the normally silent nerves woken up by the chemical soup of the injury. As the barrage of impulses comes in to the spinal cord it meets the second stage nerves which will take the messages on into the central nervous system. These second stage nerves become highly excited by the incoming torrents of impulses and amplify the signal significantly, passing on much higher pain levels to the higher brain centres.

We don’t feel pain until it reaches the higher brain centres and intrudes upon our consciousness. In a sense, all our pain is in our minds, as it does not exist unless it gets up to our conscious brain.  Our pain is not imaginary, our brains are constantly creating a virtual reality for us to understand the world, a virtual visual reality, a virtual touch reality and also a virtual pain reality when it’s appropriate. This concept is important in that it is the brain which constructs our pain reality and not the broken ankle, the slipped disc or the burnt hand.

When a limb in amputated it is obvious the muscles, ligaments and bones are all cut, but what is less clear, and much more important for the future, is that the nerves travelling down the part are also cut through. Cutting the part of the nervous system off from the centre means a sudden loss of incoming signals from the amputated part, with serious side effects for the individual. When the nervous system is deprived of its incoming information the consequences can be unpleasant.

The second stage nerves react badly to being deprived of their incoming streams of impulses, not by going off-line but by doing the opposite, by increasing their reactivity and responsiveness. Because the nerve has been cut and there are not messages coming through they can begin to fire off impulses for no reason, spontaneously. These overexcited nerves can produce a significant pain problem as while the leg does not exist any more the nerves which serve the leg areas are still present in the central nervous system. The brain’s sensory areas responsible for the leg are still capable of manufacturing leg pain.

Pain which appears in an area of the body which is now absent is known as phantom pain and is a common side effect of amputation which develops in the weeks and months after the trauma. Phantom pain can be very unpleasant in nature, very deep and cold, or sharp and stabbing and so can be a particularly difficult pain to treat or to cope with. Neuropathic pain is the term for a pain like this which is generated internally by the central nervous system and not as normal pains which are secondary to tissue damage.

Drug treatment of phantom pain is difficult as the morphine chemicals such as morphine, fentanyl, tramadol and codeine are often not very effective. The nerve treatment agents such as amitriptyline, gabapentin and pregabalin are used against neuropathic pain with some effectiveness. Other treatments include transcutaneous electrical nerve stimulation (TENS), an electrode based stimulation treatment which can be self-managed. Cognitive therapy may also be useful to start to cope with what can be a long term problem.

Phantom pain can be an intractable, serious problem for anyone with an amputation, and having significant pain before the amputation may make the likelihood of phantom pain greater. A multidisciplinary approach involving a pain clinic is most likely to be helpful.



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