Nature Creation ArticlesHealth, Pain, Therapy, Solution

The over­all qual­i­ties of warmth and heat have long been asso­ci­ated with com­fort and relax­ation, heat ther­apy goes a step fur­ther and can pro­vide both pain relief and heal­ing ben­e­fits for many types of back pain. In addi­tion, heat ther­apy for back pain is both inex­pen­sive and easy to do.

How heat ther­apy works
Many episodes of lower back pain result from strains and over-exertions, cre­at­ing ten­sion in the mus­cles and soft tis­sues around the lower spine. As a result, this restricts proper cir­cu­la­tion and sends pain sig­nals to the brain.

Mus­cle spasm in the lower back can cre­ate sen­sa­tions that may range from mild dis­com­fort to excru­ci­at­ing lower back pain. Heat ther­apy can help relieve pain from the mus­cle spasm and related tight­ness in the lower back.

Heat ther­apy appli­ca­tion can help pro­vide back pain relief through sev­eral mechanisms:

* Heat ther­apy dilates the blood ves­sels of the mus­cles sur­round­ing the lum­bar spine. This process increases the flow of oxy­gen and nutri­ents to the mus­cles, help­ing to heal the dam­aged tis­sue.
* Heat stim­u­lates the sen­sory recep­tors in the skin, which means that apply­ing heat to the lower back will decrease trans­mis­sions of pain sig­nals to the brain and par­tially relieve the dis­com­fort.
* Heat appli­ca­tion facil­i­tates stretch­ing the soft tis­sues around the spine, includ­ing mus­cles, con­nec­tive tis­sue, and adhe­sion. Con­se­quently, with heat ther­apy, there will be a decrease in stiff­ness as well as injury, with an increase in flex­i­bil­ity and over­all feel­ing of com­fort. Flex­i­bil­ity is very impor­tant for a healthy back.

There are sev­eral other sig­nif­i­cant ben­e­fits of heat ther­apy that make it so appeal­ing. Com­pared to most ther­a­pies, heat ther­apy is quite inex­pen­sive. Heat ther­apy is also easy to do — it can be done at home while relax­ing, and also make it an option while at work or in the car.

For many peo­ple, heat ther­apy works best when com­bined with other treat­ment modal­i­ties, such as phys­i­cal ther­apy and exer­cise. Rel­a­tive to most med­ical treat­ments avail­able, heat ther­apy is appeal­ing to many peo­ple because it is a non-invasive and non-pharmaceutical form of back pain relief

How to Apply Heat Therapy

The most effec­tive heat ther­apy prod­uct is Nature Cre­ation Herbal Pack. They can main­tain their heat at the proper tem­per­a­ture. “Warm” is the proper tem­per­a­ture. Patients should not have their heat source be hot to the point of burn­ing the skin. The desired effect is for the heat to pen­e­trate down into the mus­cles. Sim­ply increas­ing the tem­per­a­ture of the skin will do lit­tle to decrease discomfort.

In many instances, the longer the heat is applied, the bet­ter. The dura­tion that one needs to apply the heat, though, is based on the type of and/or mag­ni­tude of the injury. For very minor back ten­sion, short amounts of heat ther­apy may be suf­fi­cient (such as 15 to 20 min­utes). For more intense injuries, longer ses­sions of heat may be more ben­e­fi­cial (such as 30 min­utes to 2 hours, or more).

Two options of heat ther­apy include moist heat and dry heat.

* Dry heat, draw out mois­ture from the body and may leave the skin dehy­drated. How­ever, some peo­ple feel that dry heat is the eas­i­est to apply and feels the best.

* Moist heat, steamed or moist heat­ing packs can aid in the heat’s pen­e­tra­tion into the mus­cles, and some peo­ple feel that moist heat pro­vides bet­ter pain relief.

Nature Cre­ation prod­ucts can be used as dry heat and moist heat treatments.

Finally, it is impor­tant to use enough insu­la­tion between the heat source and the skin to avoid over­heat­ing or burn­ing the skin.

Please note that heat should not be used in cer­tain cir­cum­stances. For exam­ple, if the lower back is swollen or bruised, heat should not be used. Patients should con­sult doc­tors if they have heart dis­ease or hyper­ten­sion. Heat appli­ca­tion is also not suit­able in the fol­low­ing cases:

* Der­mati­tis
* Deep vein throm­bo­sis
* Dia­betes
* Periph­eral vas­cu­lar dis­ease
* Open wound
* Severe cog­ni­tive impairment

In gen­eral, if the injured area is swollen or bruised it is bet­ter to apply cold treat­ment to reduce the inflam­ma­tion or swelling.

In sum­mary, heat ther­apy is an easy and inex­pen­sive option to pro­vide relief from many forms of back pain. It may be used alone or in con­junc­tion with other ther­a­pies. Because it is so sim­ple, it is often over­looked and physi­cians may for­get to men­tion it, but heat ther­apy used in the right way can be a valu­able part of many back pain treat­ment programs.

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Arthri­tis is inflam­ma­tion of one or more joints, which results in pain, swelling, stiff­ness, and lim­ited move­ment. There are over 100 dif­fer­ent types of arthritis.

Causes, inci­dence, and risk factors

Arthri­tis involves the break­down of car­ti­lage. Car­ti­lage nor­mally pro­tects the joint, allow­ing for smooth move­ment. Car­ti­lage also absorbs shock when pres­sure is placed on the joint, like when you walk. With­out the usual amount of car­ti­lage, the bones rub together, caus­ing pain, swelling (inflam­ma­tion), and stiffness.

You may have joint inflam­ma­tion for a vari­ety of rea­sons, including:

* Bro­ken bone
* Infec­tion (usu­ally caused by bac­te­ria or viruses)
* An autoim­mune dis­ease (the body attacks itself because the immune sys­tem believes a body part is for­eign)
* Gen­eral “wear and tear” on joints

Often, the inflam­ma­tion goes away after the injury has healed, the dis­ease is treated, or the infec­tion has been cleared.

With some injuries and dis­eases, the inflam­ma­tion does not go away or destruc­tion results in long-term pain and defor­mity. When this hap­pens, you have chronic arthri­tis. Osteoarthri­tis is the most com­mon type and is more likely to occur as you age. You may feel it in any of your joints, but most com­monly in your hips, knees or fin­gers. Risk fac­tors for osteoarthri­tis include:

* Being over­weight
* Pre­vi­ously injur­ing the affected joint
* Using the affected joint in a repet­i­tive action that puts stress on the joint (base­ball play­ers, bal­let dancers, and con­struc­tion work­ers are all at risk)

Arthri­tis can occur in men and women of all ages. About 37 mil­lion peo­ple in Amer­ica have arthri­tis of some kind, which is almost 1 out of every 7 people.

Other types or cause of arthri­tis include:

* Rheuma­toid arthri­tis (in adults)
* Juve­nile rheuma­toid arthri­tis (in chil­dren)
* Sys­temic lupus ery­the­mato­sus (SLE)
* Gout
* Scle­ro­derma
* Pso­ri­atic arthri­tis
* Anky­los­ing spondyli­tis
* Reiter’s syn­drome (reac­tive arthri­tis)
* Adult Still’s dis­ease
* Viral arthri­tis
* Gono­coc­cal arthri­tis
* Other bac­te­r­ial infec­tions (non-gonococcal bac­te­r­ial arthri­tis )
* Ter­tiary Lyme dis­ease (the late stage)
* Tuber­cu­lous arthri­tis
* Fun­gal infec­tions such as blastomycosis

Symptoms

If you have arthri­tis, you may experience:

* Joint pain
* Joint swelling
* Stiff­ness, espe­cially in the morn­ing
* Warmth around a joint
* Red­ness of the skin around a joint
* Reduced abil­ity to move the joint

Signs and tests

First, your doc­tor will take a detailed med­ical his­tory to see if arthri­tis or another mus­cu­loskele­tal prob­lem is the likely cause of your symptoms.

Next, a thor­ough phys­i­cal exam­i­na­tion may show that fluid is col­lect­ing around the joint. (This is called an “effu­sion.”) The joint may be ten­der when it is gen­tly pressed, and may be warm and red (espe­cially in infec­tious arthri­tis and autoim­mune arthri­tis). It may be painful or dif­fi­cult to rotate the joints in some direc­tions. This is known as “lim­ited range-of-motion.”

In some autoim­mune forms of arthri­tis, the joints may become deformed if the dis­ease is not treated. Such joint defor­mi­ties are the hall­marks of severe, untreated rheuma­toid arthritis.

Tests vary depend­ing on the sus­pected cause. They often include blood tests and joint x-rays. To check for infec­tion and other causes of arthri­tis (like gout caused by crys­tals), joint fluid is removed from the joint with a nee­dle and exam­ined under a micro­scope. See the spe­cific types of arthri­tis for fur­ther infor­ma­tion.
Treatment

Treat­ment of arthri­tis depends on the par­tic­u­lar cause, which joints are affected, sever­ity, and how the con­di­tion affects your daily activ­i­ties. Your age and occu­pa­tion will also be taken into con­sid­er­a­tion when your doc­tor works with you to cre­ate a treat­ment plan.

If pos­si­ble, treat­ment will focus on elim­i­nat­ing the under­ly­ing cause of the arthri­tis. How­ever, the cause is NOT nec­es­sar­ily cur­able, as with osteoarthri­tis and rheuma­toid arthri­tis. Treat­ment, there­fore, aims at reduc­ing your pain and dis­com­fort and pre­vent­ing fur­ther disability.

It is pos­si­ble to greatly improve your symp­toms from osteoarthri­tis and other long-term types of arthri­tis with­out med­ica­tions. In fact, mak­ing lifestyle changes with­out med­ica­tions is prefer­able for osteoarthri­tis and other forms of joint inflam­ma­tion. If needed, med­ica­tions should be used in addi­tion to lifestyle changes.

Exer­cise for arthri­tis is nec­es­sary to main­tain healthy joints, relieve stiff­ness, reduce pain and fatigue, and improve mus­cle and bone strength. Your exer­cise pro­gram should be tai­lored to you as an indi­vid­ual. Work with a phys­i­cal ther­a­pist to design an indi­vid­u­al­ized pro­gram, which should include:

* Range of motion exer­cises for flex­i­bil­ity
* Strength train­ing for mus­cle tone
* Low-impact aer­o­bic activ­ity (also called endurance exercise)

A phys­i­cal ther­a­pist can apply heat and cold treat­ments as needed and fit you for splints or orthotic (straight­en­ing) devices to sup­port and align joints. This may be par­tic­u­larly nec­es­sary for rheuma­toid arthri­tis. Your phys­i­cal ther­a­pist may also con­sider water ther­apy, ice mas­sage, or tran­scu­ta­neous nerve stim­u­la­tion (TENS).

Rest is just as impor­tant as exer­cise. Sleep­ing 8 to 10 hours per night and tak­ing naps dur­ing the day can help you recover from a flare-up more quickly and may even help pre­vent exac­er­ba­tions. You should also:

* Avoid posi­tions or move­ments that place extra stress on your affected joints.
* Avoid hold­ing one posi­tion for too long.
* Reduce stress, which can aggra­vate your symp­toms. Try med­i­ta­tion or guided imagery. And talk to your phys­i­cal ther­a­pist about yoga or tai chi.
* Mod­ify your home to make activ­i­ties eas­ier. For exam­ple, have grab bars in the shower, the tub, and near the toilet.

Other mea­sures to try include:

* Tak­ing glu­cosamine and chon­droitin — these form the build­ing blocks of car­ti­lage, the sub­stance that lines joints. These sup­ple­ments are avail­able at health food stores or super­mar­kets. While some stud­ies show such sup­ple­ments may reduce osteoarthri­tis symp­toms, oth­ers show no ben­e­fit. How­ever, since these prod­ucts are regarded as safe, they are rea­son­able to try and many patients find their symp­toms improve.
* Eat a diet rich in vit­a­mins and min­er­als, espe­cially antiox­i­dants like vit­a­min E. These are found in fruits and veg­eta­bles. Get sele­nium from Brewer’s yeast, wheat germ, gar­lic, whole grains, sun­flower seeds, and Brazil nuts. Get omega-3 fatty acids from cold water fish (like salmon, mack­erel, and her­ring), flaxseed, rape­seed (canola) oil, soy­beans, soy­bean oil, pump­kin seeds, and wal­nuts.
* Apply cap­saicin cream (derived from hot chili pep­pers) to the skin over your painful joints. You may feel improve­ment after apply­ing the cream for 3–7 days.

MEDICATIONS

Your doc­tor will choose from a vari­ety of med­ica­tions as needed. Gen­er­ally, the first drugs to try are avail­able with­out a pre­scrip­tion. These include:

* Aceta­minophen (Tylenol) — rec­om­mended by the Amer­i­can Col­lege of Rheuma­tol­ogy and the Amer­i­can Geri­atrics Soci­ety as first-line treat­ment for osteoarthri­tis. Take up to 4 grams a day (2 extra-strength Tylenol every 6 hours). This can pro­vide sig­nif­i­cant relief of arthri­tis pain with­out many of the side effects of pre­scrip­tion drugs. DO NOT exceed the rec­om­mended doses of aceta­minophen or take the drug in com­bi­na­tion with large amounts of alco­hol. These actions may dam­age your liver.
* Aspirin, ibupro­fen, or naproxen — these non­s­teroidal anti-inflammatory (NSAID) drugs are often effec­tive in com­bat­ing arthri­tis pain. How­ever, they have many poten­tial risks, espe­cially if used for a long time. They should not be taken in any amount with­out con­sult­ing your doc­tor. Poten­tial side effects include heart attack, stroke, stom­ach ulcers, bleed­ing from the diges­tive tract, and kid­ney dam­age. In 2005, the U.S. Food and Drug Admin­is­tra­tion (FDA) asked mak­ers of NSAIDs to include a warn­ing label on their prod­uct that alerts users of an increased risk for heart attack, stroke, and gas­troin­testi­nal bleed­ing. If you have kid­ney or liver dis­ease, or a his­tory of gas­troin­testi­nal bleed­ing, you should not take these med­i­cines unless your doc­tor specif­i­cally rec­om­mends them.

Pre­scrip­tion med­i­cines include:

* Cyclooxygenase-2 (COX-2) inhibitors — These drugs block an inflammation-promoting enzyme called COX-2. This class of drugs was ini­tially believed to work as well as tra­di­tional NSAIDs, but with fewer stom­ach prob­lems. How­ever, numer­ous reports of heart attacks and stroke have prompted the FDA to re-evaluate the risks and ben­e­fits of the COX-2s. Cele­coxib (Cele­brex) is still avail­able, but labeled with strong warn­ings and a rec­om­men­da­tion that it be pre­scribed at the low­est pos­si­ble dose for the short­est dura­tion pos­si­ble. Talk to your doc­tor about whether COX-2s are right for you.
* Cor­ti­cos­teroids (“steroids”) — these are med­ica­tions that sup­press the immune sys­tem and symp­toms of inflam­ma­tion. They are com­monly used in severe cases of osteoarthri­tis, and they can be given orally or by injec­tion. Steroids are used to treat autoim­mune forms of arthri­tis but should be avoided in infec­tious arthri­tis. Steroids have mul­ti­ple side effects, includ­ing upset stom­ach and gas­troin­testi­nal bleed­ing, high blood pres­sure, thin­ning of bones, cataracts, and increased infec­tions. The risks are most pro­nounced when steroids are taken for long peri­ods of time or at high doses. Close super­vi­sion by a physi­cian is essen­tial.
* Disease-modifying anti-rheumatic drugs — these have been used tra­di­tion­ally to treat rheuma­toid arthri­tis and other autoim­mune causes of arthri­tis. These drugs include gold salts, peni­cil­lamine, sul­fasalazine, and hydrox­y­chloro­quine. More recently, methotrex­ate has been shown to slow the pro­gres­sion of rheuma­toid arthri­tis and improve your qual­ity of life. Methotrex­ate itself can be highly toxic and requires fre­quent blood tests for patients on the med­ica­tion.
* Bio­log­ics– these are the most recent break­through for the treat­ment of rheuma­toid arthri­tis. Such med­ica­tions, includ­ing etan­er­cept (Enbrel), inflix­imab (Rem­i­cade) and adal­i­mumab (Humira), are admin­is­tered by injec­tion and can dra­mat­i­cally improve your qual­ity of life. Newer bio­log­ics include Oren­cia (abat­a­cept) and Rit­uxan (rit­ux­imab).
* Immuno­sup­pres­sants — these drugs, like aza­thio­prine or cyclophos­phamide, are used for seri­ous cases of rheuma­toid arthri­tis when other med­ica­tions have failed.

It is very impor­tant to take your med­ica­tions as directed by your doc­tor. If you are hav­ing dif­fi­culty doing so (for exam­ple, due to intol­er­a­ble side effects), you should talk to your doctor.

SURGERY AND OTHER APPROACHES

In some cases, surgery to rebuild the joint (arthro­plasty) or to replace the joint (such as a total knee joint replace­ment) may help main­tain a more nor­mal lifestyle. The deci­sion to per­form joint replace­ment surgery is nor­mally made when other alter­na­tives, such as lifestyle changes and med­ica­tions, are no longer effective.

Nor­mal joints con­tain a lubri­cant called syn­ovial fluid. In joints with arthri­tis, this fluid is not pro­duced in ade­quate amounts. In some cases, a doc­tor may inject the arthritic joint with a man-made ver­sion of joint fluid. The syn­thetic fluid may post­pone the need for surgery at least tem­porar­ily and improve the qual­ity of life for per­sons with arthritis.

Expec­ta­tions (prognosis)

A few arthritis-related dis­or­ders can be com­pletely cured with treat­ment. Most are chronic (long-term) con­di­tions, how­ever, and the goal of treat­ment is to con­trol the pain and min­i­mize joint dam­age. Chronic arthri­tis fre­quently goes in and out of remis­sion.
Complications

* Chronic pain
* Lifestyle restric­tions or disability

Call­ing your health care provider

Call your doc­tor if:

* Your joint pain per­sists beyond 3 days.
* You have severe unex­plained joint pain.
* The affected joint is sig­nif­i­cantly swollen.
* You have a hard time mov­ing the joint.
* Your skin around the joint is red or hot to the touch.
* You have a fever or have lost weight unintentionally.

Prevention

If arthri­tis is diag­nosed and treated early, you can pre­vent joint dam­age. Find out if you have a fam­ily his­tory of arthri­tis and share this infor­ma­tion with your doc­tor, even if you have no joint symptoms.

Osteoarthri­tis may be more likely to develop if you abuse your joints (injure them many times or over-use them while injured). Take care not to over­work a dam­aged or sore joint. Sim­i­larly, avoid exces­sive repet­i­tive motions.

Excess weight also increases the risk for devel­op­ing osteoarthri­tis in the knees, and pos­si­bly in the hips and hands. See the arti­cle on body mass index to learn whether your weight is healthy.

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A heart attack (also known as a myocar­dial infarc­tion) is the death of heart mus­cle from the sud­den block­age of a coro­nary artery by a blood clot. Coro­nary arter­ies are blood ves­sels that sup­ply the heart mus­cle with blood and oxy­gen. Block­age of a coro­nary artery deprives the heart mus­cle of blood and oxy­gen, caus­ing injury to the heart mus­cle. Injury to the heart mus­cle causes chest pain and chest pres­sure sen­sa­tion. If blood flow is not restored to the heart mus­cle within 20 to 40 min­utes, irre­versible death of the heart mus­cle will begin to occur. Mus­cle con­tin­ues to die for six to eight hours at which time the heart attack usu­ally is “com­plete.” The dead heart mus­cle is even­tu­ally replaced by scar tissue.

Approx­i­mately one mil­lion Amer­i­cans suf­fer a heart attack each year. Four hun­dred thou­sand of them die as a result of their heart attack.

What causes a heart attack?

Ath­er­o­scle­ro­sis

Ath­er­o­scle­ro­sis is a grad­ual process by which plaques (col­lec­tions) of cho­les­terol are deposited in the walls of arter­ies. Cho­les­terol plaques cause hard­en­ing of the arte­r­ial walls and nar­row­ing of the inner chan­nel (lumen) of the artery. Arter­ies that are nar­rowed by ath­er­o­scle­ro­sis can­not deliver enough blood to main­tain nor­mal func­tion of the parts of the body they sup­ply. For exam­ple, ath­er­o­scle­ro­sis of the arter­ies in the legs causes reduced blood flow to the legs. Reduced blood flow to the legs can lead to pain in the legs while walk­ing or exer­cis­ing, leg ulcers, or a delay in the heal­ing of wounds to the legs. Ath­er­o­scle­ro­sis of the arter­ies that fur­nish blood to the brain can lead to vas­cu­lar demen­tia (men­tal dete­ri­o­ra­tion due to grad­ual death of brain tis­sue over many years) or stroke (sud­den death of brain tissue).

In many peo­ple, ath­er­o­scle­ro­sis can remain silent (caus­ing no symp­toms or health prob­lems) for years or decades. Ath­er­o­scle­ro­sis can begin as early as the teenage years, but symp­toms or health prob­lems usu­ally do not arise until later in adult­hood when the arte­r­ial nar­row­ing becomes severe. Smok­ing cig­a­rettes, high blood pres­sure, ele­vated cho­les­terol, and dia­betes mel­li­tus can accel­er­ate ath­er­o­scle­ro­sis and lead to the ear­lier onset of symp­toms and com­pli­ca­tions, par­tic­u­larly in those peo­ple who have a fam­ily his­tory of early atherosclerosis.

Coro­nary ath­er­o­scle­ro­sis (or coro­nary artery dis­ease) refers to the ath­er­o­scle­ro­sis that causes hard­en­ing and nar­row­ing of the coro­nary arter­ies. Dis­eases caused by the reduced blood sup­ply to the heart mus­cle from coro­nary ath­er­o­scle­ro­sis are called coro­nary heart dis­eases (CHD). Coro­nary heart dis­eases include heart attacks, sud­den unex­pected death, chest pain (angina), abnor­mal heart rhythms, and heart fail­ure due to weak­en­ing of the heart muscle.

Ath­er­o­scle­ro­sis and angina pectoris

Angina pec­toris (also referred to as angina) is chest pain or pres­sure that occurs when the blood and oxy­gen sup­ply to the heart mus­cle can­not keep up with the needs of the mus­cle. When coro­nary arter­ies are nar­rowed by more than 50 to 70 per­cent, the arter­ies may not be able to increase the sup­ply of blood to the heart mus­cle dur­ing exer­cise or other peri­ods of high demand for oxy­gen. An insuf­fi­cient sup­ply of oxy­gen to the heart mus­cle causes angina. Angina that occurs with exer­cise or exer­tion is called exer­tional angina. In some patients, espe­cially dia­bet­ics, the pro­gres­sive decrease in blood flow to the heart may occur with­out any pain or with just short­ness of breath or unusu­ally early fatigue.

Exer­tional angina usu­ally feels like a pres­sure, heav­i­ness, squeez­ing, or aching across the chest. This pain may travel to the neck, jaw, arms, back, or even the teeth, and may be accom­pa­nied by short­ness of breath, nau­sea, or a cold sweat. Exer­tional angina typ­i­cally lasts from one to 15 min­utes and is relieved by rest or by tak­ing nitro­glyc­erin by plac­ing a tablet under the tongue. Both rest­ing and nitro­glyc­erin decrease the heart muscle’s demand for oxy­gen, thus reliev­ing angina. Exer­tional angina may be the first warn­ing sign of advanced coro­nary artery dis­ease. Chest pains that just last a few sec­onds rarely are due to coro­nary artery disease.

Angina also can occur at rest. Angina at rest more com­monly indi­cates that a coro­nary artery has nar­rowed to such a crit­i­cal degree that the heart is not receiv­ing enough oxy­gen even at rest. Angina at rest infre­quently may be due to spasm of a coro­nary artery (a con­di­tion called Prinzmetal’s or vari­ant angina). Unlike a heart attack, there is no per­ma­nent mus­cle dam­age with either exer­tional or rest angina.

Ath­er­o­scle­ro­sis and heart attack

Occa­sion­ally the sur­face of a cho­les­terol plaque in a coro­nary artery may rup­ture, and a blood clot forms on the sur­face of the plaque. The clot blocks the flow of blood through the artery and results in a heart attack (see pic­ture below). The cause of rup­ture that leads to the for­ma­tion of a clot is largely unknown, but con­tribut­ing fac­tors may include cig­a­rette smok­ing or other nico­tine expo­sure, ele­vated LDL cho­les­terol, ele­vated lev­els of blood cat­e­cholamines (adren­a­line), high blood pres­sure, and other mechan­i­cal and bio­chem­i­cal forces.

Unlike exer­tional or rest angina, heart mus­cle dies dur­ing a heart attack and loss of the mus­cle is per­ma­nent, unless blood flow can be promptly restored, usu­ally within one to six hours. While heart attacks can occur at any time, more heart attacks occur between 4:00 A.M. and 10:00 A.M. because of the higher blood lev­els of adren­a­line released from the adrenal glands dur­ing the morn­ing hours. Increased adren­a­line, as pre­vi­ously dis­cussed, may con­tribute to rup­ture of cho­les­terol plaques.

Approx­i­mately 50% of patients who develop heart attacks have warn­ing symp­toms such as exer­tional angina or rest angina prior to their heart attacks, but these symp­toms may be mild and discounted.

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Back pain is a com­mon com­plaint. Four out of five peo­ple in the United States will expe­ri­ence low back pain at least once dur­ing their lives. It’s one of the most com­mon rea­sons peo­ple go to the doc­tor or miss work.

On the bright side, you can pre­vent most back pain. If pre­ven­tion fails, sim­ple home treat­ment and proper body mechan­ics will often heal your back within a few weeks and keep it func­tional for the long haul. Surgery is rarely needed to treat back pain.

Causes

Your back is an intri­cate struc­ture com­posed of bones, mus­cles, lig­a­ments, ten­dons and disks — the cartilage-like pads that act as cush­ions between the seg­ments of your spine. Back pain can arise from prob­lems with any of these com­po­nent parts. In some peo­ple, no spe­cific cause for their back pain can be found.

Strains

Back pain most often occurs from strained mus­cles and lig­a­ments, from improper or heavy lift­ing, or after a sud­den awk­ward move­ment. Some­times a mus­cle spasm can cause back pain.

Struc­tural problems

In some cases, back pain may be caused by struc­tural prob­lems, such as:

* Bulging or rup­tured disks. Disks act as cush­ions between the ver­te­brae in your spine. Some­times, the soft mate­r­ial inside a disk may bulge out of place or rup­ture and press on a nerve. But many peo­ple who have bulging or her­ni­ated disks expe­ri­ence no pain from the condition.

* Sci­at­ica. If a bulging or her­ni­ated disk presses on the main nerve that trav­els down your leg, it can cause sci­at­ica — sharp, shoot­ing pain through the but­tock and back of the leg.

* Arthri­tis. The joints most com­monly affected by osteoarthri­tis are the hips, hands, knees and lower back. In some cases arthri­tis in the spine can lead to a nar­row­ing of the space around the spinal cord, a con­di­tion called spinal stenosis.

* Skele­tal irreg­u­lar­i­ties. Back pain can occur if your spine curves in an abnor­mal way. If the nat­ural curves in your spine become exag­ger­ated, your upper back may look abnor­mally rounded or your lower back may arch exces­sively. Sco­l­io­sis, a con­di­tion in which your spine curves to the side, also may lead to back pain.

* Osteo­poro­sis. Com­pres­sion frac­tures of your spine’s ver­te­brae can occur if your bones become porous and brittle.

Rare but seri­ous conditions

In rare cases, back pain may be related to:

* Cauda equina syn­drome. This is a seri­ous neu­ro­log­i­cal prob­lem affect­ing a bun­dle of nerve roots that serve your lower back and legs. It can cause weak­ness in the legs, numb­ness in the “sad­dle” or groin area, and loss of bowel or blad­der control.

* Can­cer in the spine. A tumor on the spine can press on a nerve, caus­ing back pain.

* Infec­tion of the spine. If a fever and a ten­der, warm area accom­pany back pain, the cause could be an infection.

Fac­tors that increase your risk of devel­op­ing low back pain include:

* Smoking

* Obesity

* Older age

* Female gender

* Phys­i­cally stren­u­ous work

* Seden­tary work

* Stress­ful job

* Anxiety

* Depression

Most back pain grad­u­ally improves with home treat­ment and self-care. Although the pain may take sev­eral weeks to dis­ap­pear com­pletely, you should notice some improve­ment within the first 72 hours of self-care. If not, see your doctor.

In rare cases, back pain can sig­nal a seri­ous med­ical prob­lem. See a doc­tor imme­di­ately if your back pain:

* Is con­stant or intense, espe­cially at night or when you lie down

* Spreads down one or both legs, espe­cially if the pain extends below the knee

* Causes weak­ness, numb­ness or tin­gling in one or both legs

* Causes new bowel or blad­der problems

* Is asso­ci­ated with pain or pul­sa­tion (throb­bing) in the abdomen, or fever

* Fol­lows a fall, blow to your back or other injury

* Is accom­pa­nied by unex­plained weight loss

Also, see your doc­tor if you start hav­ing back pain for the first time after age 50, or if you have a his­tory of can­cer, osteo­poro­sis, steroid use, or drug or alco­hol abuse.

Diag­nos­tic tests aren’t usu­ally nec­es­sary to con­firm the cause of your back pain. How­ever, if you do see your doc­tor for back pain, he or she will exam­ine your back and assess your abil­ity to sit, stand, walk and lift your legs. He or she may also test your reflexes with a rub­ber reflex ham­mer. These assess­ments help deter­mine where the pain comes from, how much you can move before pain forces you to stop and whether you have mus­cle spasms. They will also help rule out more seri­ous causes of back pain.

If there is rea­son to sus­pect that you have a tumor, frac­ture, infec­tion or other spe­cific con­di­tion that may be caus­ing your back pain, your doc­tor may order one or more tests:

* X-ray. These images show the align­ment of your bones and whether you have arthri­tis or bro­ken bones. X-ray images won’t directly show prob­lems with your spinal cord, mus­cles, nerves or disks.

* Mag­netic res­o­nance imag­ing (MRI) or com­put­er­ized tomog­ra­phy (CT) scans. These scans can gen­er­ate images that may reveal her­ni­ated disks or prob­lems with bones, mus­cles, tis­sue, ten­dons, nerves, lig­a­ments and blood vessels.

* Bone scan. In rare cases, your doc­tor may use a bone scan to look for bone tumors or com­pres­sion frac­tures caused by osteo­poro­sis. In this pro­ce­dure, you’ll receive an injec­tion of a small amount of a radioac­tive sub­stance (tracer) into one of your veins. The sub­stance col­lects in your bones and allows your doc­tor to detect bone prob­lems using a spe­cial camera.

* Nerve stud­ies (elec­tromyo­g­ra­phy, or EMG). This test mea­sures the elec­tri­cal impulses pro­duced by the nerves and the responses of your mus­cles. Stud­ies of your nerve-conduction path­ways can con­firm nerve com­pres­sion caused by her­ni­ated disks or nar­row­ing of your spinal canal (spinal stenosis).

Most back pain gets bet­ter with a few weeks of home treat­ment and care­ful atten­tion. A reg­u­lar sched­ule of over-the-counter pain reliev­ers may be all that you need to improve your pain. A short period of bed rest is okay, but more than a cou­ple of days actu­ally does more harm than good. If home treat­ments aren’t work­ing, your doc­tor may sug­gest stronger med­ica­tions or other therapy.

Med­ica­tions

Your doc­tor may pre­scribe non­s­teroidal anti-inflammatory drugs or in some cases, a mus­cle relax­ant, to relieve mild to mod­er­ate back pain that doesn’t get bet­ter with over-the-counter pain reliev­ers. Nar­cotics, such as codeine or hydrocodone, may be used for a short period of time with close super­vi­sion by your doctor.

Low doses of cer­tain types of anti­de­pres­sants — par­tic­u­larly tri­cyclic anti­de­pres­sants, such as amitripty­line — have been shown to relieve chronic back pain, inde­pen­dent of their effect on depression.

Phys­i­cal ther­apy and exercise

A phys­i­cal ther­a­pist can apply a vari­ety of treat­ments, such as heat, ice, ultra­sound, elec­tri­cal stim­u­la­tion and muscle-release tech­niques, to your back mus­cles and soft tis­sues to reduce pain. As pain improves, the ther­a­pist can teach you spe­cific exer­cises to increase your flex­i­bil­ity, strengthen your back and abdom­i­nal mus­cles, and improve your pos­ture. Reg­u­lar use of these tech­niques will help pre­vent pain from com­ing back.

Injec­tions

If other mea­sures don’t relieve your pain and if your pain radi­ates down your leg, your doc­tor may inject cor­ti­sone — an anti-inflammatory med­ica­tion — into the space around your spinal cord (epidural space). A cor­ti­sone injec­tion helps decrease inflam­ma­tion around the nerve roots, but the pain relief usu­ally lasts less than six weeks.

In some cases, your doc­tor may inject numb­ing med­ica­tion into or near the struc­tures believed to be caus­ing your back pain. Early stud­ies indi­cate that bot­u­lism toxin (Botox) also may help relieve back pain, per­haps by par­a­lyz­ing strained mus­cles in spasm. Botox injec­tions typ­i­cally wear off within three to four months.

Surgery

Few peo­ple ever need surgery for back pain. There are no effec­tive sur­gi­cal tech­niques for mus­cle– and soft-tissue-related back pain. Surgery is usu­ally reserved for pain caused by a her­ni­ated disk. If you have unre­lent­ing pain or pro­gres­sive mus­cle weak­ness caused by nerve com­pres­sion, you may ben­e­fit from surgery. Types of back surgery include:

* Fusion. This surgery involves join­ing two ver­te­brae to elim­i­nate painful move­ment. A bone graft is inserted between the two ver­te­brae, which may then be splinted together with metal plates, screws or cages. A draw­back to the pro­ce­dure is that it increases the chances of arthri­tis devel­op­ing in adjoin­ing vertebrae.

* Disk replace­ment. An alter­na­tive to fusion, this surgery inserts an arti­fi­cial disk as a replace­ment cush­ion between two vertebrae.

* Par­tial removal of disk. If disk mate­r­ial is press­ing or squeez­ing a nerve, your doc­tor may be able to remove just the por­tion of the disk that’s caus­ing the problem.

* Par­tial removal of a ver­te­bra. If your spine has devel­oped bony growths that are pinch­ing your spinal cord or nerves, sur­geons can remove a small sec­tion of the offend­ing ver­te­bra, to open up the passage.

You may be able to avoid back pain by improv­ing your phys­i­cal con­di­tion and learn­ing and prac­tic­ing proper body mechanics.

To keep your back healthy and strong:

* Exer­cise. Reg­u­lar low-impact aer­o­bic activ­i­ties — those that don’t strain or jolt your back — can increase strength and endurance in your back and allow your mus­cles to func­tion bet­ter. Walk­ing and swim­ming are good choices. Talk with your doc­tor about which activ­i­ties are best for you.

* Build mus­cle strength and flex­i­bil­ity. Abdom­i­nal and back mus­cle exer­cises (core-strengthening exer­cises) help con­di­tion these mus­cles so that they work together like a nat­ural corset for your back. Flex­i­bil­ity in your hips and upper legs aligns your pelvic bones to improve how your back feels.

* Quit smok­ing. Smok­ers have dimin­ished oxy­gen lev­els in their spinal tis­sues, which can hin­der the heal­ing process.

* Main­tain a healthy weight. Being over­weight puts strain on your back mus­cles. If you’re over­weight, trim­ming down can pre­vent back pain.

Use proper body mechanics:

* Stand smart. Main­tain a neu­tral pelvic posi­tion. If you must stand for long peri­ods of time, alter­nate plac­ing your feet on a low foot­stool to take some of the load off your lower back.

* Sit smart. Choose a seat with good lower back sup­port, arm rests and a swivel base. Con­sider plac­ing a pil­low or rolled towel in the small of your back to main­tain its nor­mal curve. Keep your knees and hips level.

* Lift smart. Let your legs do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lift­ing and twist­ing simul­ta­ne­ously. Find a lift­ing part­ner if the object is heavy or awkward.

Many peo­ple choose hands-on ther­a­pies to ease their back pain:

* Chi­ro­prac­tic care. Back pain is one of the most com­mon rea­sons that peo­ple see a chi­ro­prac­tor. If you’re con­sid­er­ing chi­ro­prac­tic care, talk to your doc­tor about the most appro­pri­ate spe­cial­ist for your type of prob­lem. In addi­tion to chi­ro­prac­tors, many osteo­pathic doc­tors and some phys­i­cal ther­a­pists have train­ing in spinal manipulation.

* Acupunc­ture. Some peo­ple with low back pain report that acupunc­ture helps relieve their symp­toms. The National Insti­tutes of Health has found that acupunc­ture can be an effec­tive treat­ment for some types of chronic pain. In acupunc­ture, the prac­ti­tioner inserts ster­il­ized stain­less steel nee­dles into the skin at spe­cific points on the body.

* Mas­sage. If your back pain is caused by tense or over­worked mus­cles, mas­sage ther­apy may help loosen knot­ted mus­cles and pro­mote relaxation.

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What Is Pain?

Pain has been defined sci­en­tif­i­cally as an unpleas­ant, emo­tional and sen­sory expe­ri­ence asso­ci­ated with actual or poten­tial tis­sue damage.

Most types of arthri­tis are asso­ci­ated with pain that can be divided into two gen­eral cat­e­gories: acute and chronic. Acute pain is tem­po­rary. Chronic pain ranges from mild to severe, and can last weeks, months, years, or even a lifetime.

Chronic pain is dis­tress­ing because it affects the suf­ferer on many lev­els. It affects them:

• phys­i­cally — with sen­sa­tions of discomfort
• emo­tion­ally — with feel­ings of despon­dency and hopelessness
• psy­cho­log­i­cally — with depres­sion and dis­solv­ing self-esteem
• socially — as they descend into isolation
• occu­pa­tion­ally — as tasks become more dif­fi­cult to perform

It is there­fore imper­a­tive to man­age your pain the best way pos­si­ble to pre­serve qual­ity of life. Despite the fact that chronic pain adversely affects the qual­ity of life of patients, it is often poorly managed.

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There are a vari­ety of the­o­ries about the causes of stress related back pain. Impor­tantly, the over­rid­ing tenet in all of these the­o­ries is that psy­cho­log­i­cal and emo­tional fac­tors cause some type of phys­i­cal change result­ing in the back pain.

In most the­o­ries of stress related back pain, the pain cycle con­tin­ues and is exac­er­bated as the pain leads to the patient becom­ing timid and anx­ious about daily activ­i­ties. The pain cycle is char­ac­ter­ized by:

• The patient becomes unnec­es­sar­ily lim­ited in many func­tions of daily life, as well as leisure activities
• This decrease in activ­i­ties is due to the patient’s fear of the pain and injury
• This fear may be made worse by admo­ni­tions from doc­tors (and/or fam­ily and friends) to “take it easy” due to some struc­tural diag­no­sis (which may actu­ally have noth­ing to do with the back pain)
• The lim­i­ta­tions in move­ment and activ­ity lead to phys­i­cal de-conditioning and mus­cle weak­en­ing, which in turn leads to more back pain

Of course, this cycle results in more pain, more fear, and more phys­i­cal de-conditioning along with other reac­tions such as social iso­la­tion, depres­sion and anxiety.

Doc­tor Sarno’s theory

In Dr. Sarno’s for­mu­la­tion of TMS, the back pain is not attrib­uted to mechan­i­cal or phys­i­cal fac­tors, but rather due to the patient’s feel­ings, per­son­al­ity, and uncon­scious issues. Key emo­tions include uncon­scious anger and rage. In addi­tion he describes peo­ple who are likely to get TMS as being sim­i­lar to the type A per­son­al­ity, with char­ac­ter­is­tics such as:

• Hav­ing a strong inner drive to succeed
• Hav­ing a great sense of responsibility
• Being self-motivated and disciplined
• Being their own sever­est critics
• Being per­fec­tion­is­tic and compulsive

Dr. Sarno’s the­ory is that these per­son­al­ity char­ac­ter­is­tics inter­act with stress­ful life sit­u­a­tions to cause the back pain. He points out that the source of psy­cho­log­i­cal and emo­tional ten­sion is not always obvious.

Dr. Sarno’s the­ory of TMS describes a mech­a­nism whereby emo­tional ten­sion is pushed out of aware­ness by the mind into the uncon­scious. This uncon­scious ten­sion causes changes in the body’s ner­vous sys­tem. These changes include con­stric­tion in blood ves­sels and reduc­tion of blood flow to the var­i­ous soft tis­sues, includ­ing mus­cles, ten­dons, lig­a­ments, and nerves in the back. This causes a decrease in oxy­gen to the area as well as a buildup of bio­chem­i­cal waste prod­ucts in the mus­cles. In turn, this results in mus­cle ten­sion, spasm and back pain expe­ri­enced by the patient.

The diag­no­sis of stress-related back pain is often made by a thor­ough med­ical his­tory and phys­i­cal exam. Patients must be cau­tious in try­ing to self-diagnose stress related back pain, as there may be a seri­ous med­ical con­di­tion (such as a tumor or infec­tion) caus­ing the pain. A good med­ical exam­i­na­tion can usu­ally rule out the more seri­ous struc­tural causes of back pain in a great major­ity of patients.

For cases of stress-related back pain, the his­tory of onset of back pain is often quite vari­able. The pain may start with an iden­ti­fi­able inci­dent, or it may start insid­i­ously. For instance, it is not uncom­mon for the pain to start with an inci­dent such as a lower back sprain or strain, only to have it con­tinue as the result of emo­tional fac­tors long after the injury has healed.

In many cases there may be MRI find­ings such as a “disc bulge” or “degen­er­a­tive disc dis­ease” when stress-related back pain is the actual cul­prit. In these instances, the MRI find­ings are not clin­i­cally sig­nif­i­cant and ulti­mately deter­mined not to be the cause of the pain.

The over­all char­ac­ter­is­tics of stress-related back pain include symp­toms such as:

• Back pain and/or neck pain
• Dif­fuse mus­cle aches
• Mus­cle ten­der points
• Sleep dis­tur­bance and fatigue
• In many stress-related back pain cases, patients com­plain of the pain “mov­ing around”

In gen­eral, symp­toms of stress related back pain are sim­i­lar to those of fibromyalgia.

Accord­ing to Dr. Sarno, the diag­no­sis of TMS is made not only by rul­ing out other organic causes for the pain but also by pos­i­tively iden­ti­fy­ing the fea­tures of TMS.

Just as there are a vari­ety of the­o­ries about how stress and other emo­tional or psy­cho­log­i­cal fac­tors can cause back pain, there are a vari­ety of treat­ment approaches. The fol­low­ing out­lines two approaches:

Dr. Sarno’s approach to treat­ment of chronic pain

Dr. Sarno’s approach to patients with stress related back pain or TMS, is one of empha­siz­ing the psy­cho­log­i­cal and emo­tional fac­tors as causative and reas­sur­ing the patient as to t he impor­tance of a return to full phys­i­cal functioning.

Dr. Sarno’s approach focuses almost entirely on the repressed emo­tions of anger or rage as the causative fac­tors for the back pain. Once the diag­no­sis of TMS is made it is strongly rec­om­mended to the patient to “think psy­cho­log­i­cal, not phys­i­cal” when the pain occurs. In addi­tion, this treat­ment approach is gen­er­ally lim­ited to accept­ing the stress related back pain for what it is (through a series of edu­ca­tional lec­tures) and/or get­ting psy­chother­apy to address the uncon­scious issues.

This the­ory and approach is very dif­fer­ent than the way most physi­cians man­age patients with these back symptoms.

Multi-disciplinary treat­ment of stress related back pain

The multi-disciplinary (or inte­grated) approach defines and treats stress related back pain in some­what broader terms than Dr. Sarno’s con­cept of TMS. With the multi-disciplinary approach, the health care pro­fes­sion­als do not always see the well-defined per­son­al­ity char­ac­ter­is­tics that Dr. Sarno dis­cusses and do not focus on uncon­scious anger as the focal psy­cho­log­i­cal issue.

The multi-disciplinary approach to treat­ing stress related back pain includes eval­u­a­tion of phys­i­cal, emo­tional, cog­ni­tive and envi­ron­men­tal fac­tors in all types of back pain prob­lems and devel­ops treat­ments for each aspect. Thus, the multi-disciplinary for­mu­la­tion will look at the rel­a­tive con­tri­bu­tion of the fol­low­ing factors:

• Physical—including de-conditioned and weak mus­cles, nerve irri­ta­tion, etc.
• Emotional—including depres­sion, anx­i­ety, anger, etc.
• Cognitive—such as neg­a­tive thoughts, pes­simism, hope­less­ness, etc.
• Environmental—such as loss of job, finan­cial prob­lems, etc

This approach then devel­ops a treat­ment pro­gram based upon how much each fac­tor is thought to be influ­enc­ing the pain. A multi-disciplinary pro­gram may include such treat­ments as:

• Treat­ing the phys­i­cal fac­tors through re-activation ori­ented phys­i­cal ther­apy and/or pain medications
• Treat­ing the phys­i­cal and emo­tional fac­tors through appro­pri­ate med­ica­tions (often includ­ing anti-depressants or mus­cle relaxants)
• Treat­ing the emo­tional and cog­ni­tive fac­tors through psy­cho­log­i­cal pain man­age­ment tech­niques and biofeedback
• Treat­ing the envi­ron­men­tal fac­tors through coun­sel­ing or therapy

The idea of mul­ti­dis­ci­pli­nary treat­ment of back pain has been around for at least 25 years. It has been shown to be quite suc­cess­ful; although, the key fac­tor in treat­ment out­come is the moti­va­tion of the patient to com­plete a reha­bil­i­ta­tion approach.

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The ques­tion often comes up as to when it is best to use cold or hot treat­ment in injuries. Per­haps this can help. When to use ice or heat depends on how long ago the injury occurred.

After you strain a lig­a­ment or mus­cle, it is gen­er­ally best to use cold (ice or a cold pack) imme­di­ately and then for the next day and 1/2. It’s usu­ally wise not to use heat, such as a heat­ing pad, until swelling and bruis­ing has stopped.

Cold is usu­ally used first because it reduces swelling and inflam­ma­tion. Use Ice for the first 48 hours after an injury. Apply for 20 min­utes, remove for 20 min­utes, then repeat. Do not apply directly to the skin — put a thin towel over the skin for pro­tec­tion, or freeze a cup full of water, tear off the top rim and move the ice over the injury. This helps con­trol bleed­ing by con­strict­ing blood ves­sels. Cold acts as a local anes­thetic and so relieves pain. Usu­ally the bruis­ing asso­ci­ated with acute inflam­ma­tion stops within 1 to 3 days. To relieve mus­cle spasms, minor sprains and strains, it’s usu­ally best to apply cold for 20 min­utes inter­vals at a time every 4 to 6 hours for the first day and a half. Com­mer­cial cold packs may be safer than using ice. Pro­longed expo­sure to cold, espe­cially ice, can result in frost­bite to tis­sues. Later in the process, you may relieve pain by apply­ing heat, rather than cold, to your injury.

Use heat 20 min­utes at a time at least 24 hours after a minor injury or 48 hours after a more seri­ous one. Place a heat pack directly on the injured area — do not add pres­sure. Do not apply to bro­ken skin.

Cold reduces inflam­ma­tion. Apply cold to acute injuries, such as a newly sprained ankle or a pulled muscle.

Heat improves cir­cu­la­tion. It’s best for chronic pain, such as from tight mus­cles or a sore back.

Alter­nate Heat and Cold if you have soft tis­sue dam­age and/or stretched lig­a­ments, such as an ankle sprain. Heat aids in restor­ing range of motion. Apply cold for 20 min­utes per hour as desired for the first 24 hours. The next day, apply warmth for 20 min­utes per hour as desired.

Cau­tion: Don’t apply cold for more that 24 to 36 hours or warmth for more than 72 hours, see a doctor.

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