Press Release Summary: Article written by Alfredo Arango Medical Editor for Health Miami Ezine (Salud Miami)
Press Release Body: Jul 16, 2008 - Those distressing back pains, which are not caused by problems of the discs or the vertebrae, can now be solved thanks to a new medical subspecialty and technological advances. Millions of people can benefit from this. According to statistics published by the American Academy of Orthopaedic Surgeons, "low back pain is one of the most frequent problems treated by orthopaedic surgeons," so much so that four out of five adults in the United States "will experience significant low back pain sometime during their life."
"Nowadays there are incredible alternatives, all based on the philosophy of performing the least invasive procedure as possible," says Dr. Julian F. Naranjo, who subspecializes in Interventional Medicine for Pain, and is affiliated with Aventura Hospital and Medical Center of Miami.
The physician explains that his subspecialty was born of the need to find relief for chronic pain problems that previously had no solution, and pain in the spine is among the most common of these. "There were only two options available to patients: physical therapy or surgery. If neither was effective, or if they were not eligible for those procedures, they were forced to continue suffering pain for the rest of their lives, taking painkillers that could cause addiction and other problems," adds Dr. Naranjo, a board certified anesthesiologist and diplomate of the American Board of Anesthesiology and the American Board of Pain Medicine.
Some of the newest procedures are denervation or Facet Joint Radiofrequency Rhizotomy, of the cervical, thoracic or lumbosacral areas, which eliminates pain and allows the patient to recover and carry on a normal life.
According to the specialist, in the past, not much attention was paid to certain structures in the spine called facet joints; these joints make it possible to bend forward, backward, to the sides and to stretch. With the passing of time, these joints, just as any other, can become inflamed and trigger an anthritic-type condition, which in its early stages is not visible in x-rays, MRIs or scans, and can only be detected by the clinical history of pain and by the results of physical exams.
When the facets become painful the patient cannot bear to stand up for very long; when lying down, he or she needs to shift positions; and feels pain whenever bending or stretching; this is relieved by taking anti-inflammatory medication; however, once the medication's effect wears off, the pain comes back with the same intensity.
It is now possible to desensitize or denerve these joints, which eliminates sensation in the joint, thus relieving the pain; during the period there is no pain, a rehabilitation program is implemented in order to strengthen the muscles in the back and those used in walking which have become debilitated and contribute to the continuing problem.
This is an outpatient procedure performed by viewing the spine under x-rays. The patient is administered intravenous sedation and local anesthetic. The procedure is safe even for individuals suffering from cardiac or pulmonary problems, or any other serious health condition, because the patient remains conscious throughout the procedure.
"There is an area through which the nerve enters the joint. The tip of the radiofrequency needle is inserted into that spot producing sensory stimulation, which causes the same tingling, pressure or pain the patient normally feels in the area where the usual pain occurs. Subsequently, motor stimulation is performed, making it possible to assess paraspinal muscle movement and prevent affecting the nerves that extend to the extremities. All this makes it possible to determine the exact placement of the radiofrequency needle, in order to achieve an effective ablation of the facet joint nerve, thus relieving the chronic back pain," the doctor explains, and adds that once the pain is under control, the patient must begin a physical rehabilitation program to be able to optimize long-term results.
The expert states that the advantages of this type of intervention are many: there is no need for an incision or surgery, no structures are destroyed, physiology is not altered, and this enhances the body's ability to perform its natural healing process. "This option is much more natural, more logical, and should always be evaluated before considering much more aggressive spinal procedures, such as surgery," he recommends.
Many patients never need another procedure done. To obtain these excellent results, patient education is of the utmost importance, as well as a change of lifestyle in certain cases.
"If the patient is obese, he or she must lose weight; if the individual's lifestyle is completely sedentary, he must become more active, and must stretch and strengthen the muscles. These measures increase the success rate of the procedure, and the patients thus obtain long-term improvement," the specialist says.
This procedure, which is also successful in eliminating the pain caused by spinal arthritis, can be repeated as often as needed, because it has no side effects nor does it cause any long-term damage. In the case of older patients, it can be performed once or twice a year.
Dr. Naranjo explains that it is not always necessary to perform this procedure or other similar ones. "Some of my patients have come to me with unbearable back pain, which they had suffered for years, and have benefited from a simple exercise plan suited to their particular situation. We can determine exactly who needs an invasive procedure and who doesn't. It would not be ethical to perform a procedure on a patient who could be cured by using methods that are simpler and less costly," he warns.
The American Academy of Orthopaedic Surgeons makes the following suggestions for back pain prevention:
· Exercise regularly, to keep the muscles that support your back strong and flexible. · Use the correct lifting and moving techniques; get help if an object is too heavy or of an awkward size. · Maintain your proper body weight; being overweight puts a strain on your back muscles. · Avoid smoking. · Maintain a proper posture when standing and sitting; don't slouch.
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