VCU Researchers Seek Relief for Back Pain

September 29, 2008

Study is first to look at a medicine’s ability to regenerate discs

1195078217-12533_full With the most common chronic pain in the back, Virginia Commonwealth University researchers are testing whetherp injections of a sort of "biological putty" can help people suffering chronic lower-back pain.

The substance, a growth factor called osteogenic protein 1 or OP-1, which can help regenerate or repair damaged discs, is approved by the U.S. Food and Drug Administration for investigational and humanitarian use.

"This is this first study of its kind where we are actually looking at a medication’s ability to repair a disc, help regenerate it and reduce painful symptoms," said Dr. Michael J. DePalma, medical director of the VCU Spine Center. DePalma is principal investigator for the study at VCU, one of seven sites where the industry-funded research is being conducted.

Candidates for the research study "are typically patients whose lifestyle has been really altered because they can’t function," DePalma said. "They can’t do things on a daily basis they really need to do. They are missing time from work. They can’t take care of chores. They can’t sleep at night because of the back pain."

Rebecca Tirs, 37, enrolled in the study this year. She was in a rollover car wreck in 1999.

"I had a lot of injuries; rehabilitation was two to three years," said Tirs, practice manager at a local dental office. "It changed my life completely."

Getting to work was sometimes a problem, so her boss allowed her to work from her home in Chesterfield County.

Chronic pain, she said, had become her "new norm." At times the pain would subside, going down to a level of one to three on a scale of 10. Around April last year, the pain started to become unbearable again.

A nurse practitioner treating her referred her to DePalma. Because she is still able to have children, there was reluctance to allow her into the study, she said. She wrote a letter pleading, and after agreeing to some restrictions, she was allowed to enroll.

"I thought, this could be the rest of my life, lying on the sofa, doing nothing, not even going to work," Tirs said. "I would have people come in to help with every function, even down to bathing."

She does not know whether she had the study treatment or the placebo but suspects it was the study treatment because of an allergic reaction she had for two days afterward.

She has noticed a slight improvement in her walk.

"This research . . . is a strategy to help repair an injured disc, and therefore it makes sense to help repair injured tissue and help it regenerate rather than doing something else like heating it up, deadening the nerve endings in it," DePalma said.

"Those procedures can be helpful . . . but the future is being able to understand why disc tissues are painful, how it’s injured, and directly repair that injury."

That can’t come soon enough, Tirs said.

"Folks in pain – we don’t always look it," she said. "We learn to deal with it, and we put on a good face. But it’s very isolating."

. . .

Not all pain is as debilitating, and for many, pain is temporary. It’s not always easy to tell initially which it will be.

"Pain is an indication that something’s not right," said Dr. Douglas Cutter, director of the CJW Medical Center (Chippenham) Sports Medicine Center. "If you have pain that limits the amount of activity, the intensity of activity, the range of motion of a joint, that’s significant. That is the body telling you that this is something that’s significant enough to seek medical attention."

Virginia Porter can’t remember what it feels like to be pain-free.

"It never goes away. There is no cure," said Porter, who has been battling pain since a bad car wreck 21 years ago. "People see us looking normal and don’t understand."

Porter, who lives in the Richmond area, and others like her suffering chronic pain often find that they go for years, and from doctor to doctor, trying to find help. After the devastating car wreck Porter was in, it was two years before a doctor put a name to her lingering pain – reflex sympathetic dystrophy.

"Three doctors before that said this was all in my head," Porter said.

Doctors don’t know what causes the pain disorder, also called complex regional pain syndrome, but research indicates it can develop after trauma and surgery. One characteristic is that it tends to worsen over time.

Treatments include medications, including pain relievers and muscle relaxants, or physical rehabilitation.

Cutter said various therapies can help relieve pain. Anti-convulsants, for instance, have been shown to help some people suffering with fibromyalgia, a chronic pain condition.

"That’s a tough patient to be – someone in chronic pain," Cutter said. "It’s a tough way to live."

Contact Tammie Smith at [email protected] or (804) 649-6572.


Dr. Ken Offers Relief for Lower Back Pain in Allen, TX

September 24, 2008

Before people reach for that bottle of muscle relaxants, anit-inflammatories or ibuprofin or prescription pain medicine, they should consider recent evidence that shows that chiropractic care is more effective than drugs for back pain. A study compared chiropractic adjustments vs. muscle relaxants for the treatment of low back pain.

One hundred ninety-two patients with low back pain were assigned to one of two intervention groups (adjustments with placebo medicine or muscle relaxants with sham adjustments) or to a control group (sham adjustments with placebo medicine). Chiropractic adjustments were used to treat the low back area of the spine. Adjustments were performed with each subject in a facedown or side-lying position on a back pain treatment table. The adjustments were applied over the course of two weeks and followed by a final assessment visit two weeks later to see if the patients’ back pain had been resolved.

The results: After two weeks, chiropractic adjustments proved to be more effective than placebo in reducing low back pain and more effective than muscle relaxants and placebo in reducing low back pain.

“This study identified a sample population of subacute back pain sufferers for which chiropractic care provided an equally effective management to the conservative medical care of muscle relaxants,” wrote the researchers. Persons suffering from low back pain can receive this effective treatment by making an appointment with Dr. Kenneth Wilson, D.C. to help resolve low back pain condition.

Dr. Wilson’s efforts and patients’ testimonies speak for themselves.

“I suffered with low back pain for 20-plus years. It wasn’t until I decided to give chiropractic and try and chose Dr. Wilson as my Chiropractor that my back pain finally went away! I’m able to be more active with my family than any other time in the last 20 years! Thank you Dr. Wilson.” Dave R. Allen, Texas

For more information on low back pain treatment and other studies highlighting the benefits of chiropractic for back pain sufferers, please visit, call the office at (214) 547-7234.

Reference: Hoiriis KT, Pfleger B, McDuffie FC, et al. A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain. Journal of Manipulative and Physiological Therapeutics July-August 2004; 27(6): 388-98.


Opioid Painkillers Reduce Workers Low Back Pain

September 23, 2008

Opioid pain killersA new study has suggested opioid pain medications for workers with chronic low back pain, for it can significantly improve their ability to lift and perform other work-related physical tasks.

For the study, a team of Canadian researchers evaluated 30 patients with chronic low back pain of more than six months duration.

In the double-blinded, random-ordered, placebo-controlled trial, subjects performed a lifting test twice, once after receiving intravenous fentanyl and once after taking a placebo.

The objective of the study was to examine the impact of acute opioid administration on repetitive lifting and lowering exercise in workers with low-back pain.

The study showed that opioids improved lifting performance between 15 and 48 percent.

The researchers concluded that the performance improvement was due to reduced pain intensity.

Pain reduction, as measured by pain scales, was indicative of clinically relevant analgesia achieved by the medication.

However, the researchers suggest that longer trials are needed to measure the effectiveness of opioids as an adjunct to functional restoration programs for workers with low-back pain.

The study is published in The Journal of Pain, the peer review publication of the American Pain Society.

Battery-Operated Device Gives Hope To Chronic Back-Pain Sufferers

September 18, 2008

back pain sufferers picnicA relatively new device is helping to soften the blow of chronic back, neck and leg pain in patients of all ages, and folks from all over the Four-State region are coming to Hagerstown to try it out.

Chambersburg native Shirley Byers has suffered from chronic back pain for more than 20 years.

«I had spinal stenosis and a herniated disk, and vertebrae had gone,» she says.

After four unsuccessful surgeries, she says the scar tissue was pinching the nerves in her back so much, when she walked into Dr. John Olenczak’s office at Hagerstown’s Pain & Spine Institute, she could barely walk.

«I was walking with a walker,» she says.

Now, thanks to a device called a neuro-stimulator, getting around isn’t such a pain anymore.

«I’m not completely pain-free, but it’s nothing compared to what I had before,» says Byers.

Neuro stimulator back pain device«I implant a device into the spinal area and map out the area where the patient is having pain and then turn the pain into a nice, pleasant tingling sensation,» says Olenczak.

The stimulator is controlled by a battery and antenna, used by the patient to increase or decrease flow to their pain spot.  The surgery to implant the device is outpatient, and minimally invasive.

Doctors say traditionally neuro-stimulation is viewed as a last-ditch effort to ease pain. But they’re hoping with the help of support groups, like the picnic held at Halfway Park Monday, that patients will be able to get the word out about the procedure, as an alternative to invasive surgery.

Wesley Wilken opted for the device after having seven foot surgeries, and then finding out the pain in his feet was the result of a problem with his back.

«I feel like it was the right thing to do because I didn’t want to have back surgery.  That was the main thing – opening my back up and introducing more pain,» he says.

«This is really a totally reversible device.  If it doesn’t work or there’s an issue, I can withdraw it,» says Olenczak.

Olenczak has implanted neuro-stimulators in more than 60 patients from all over the Mid-Atlantic region over the last two years.

The Pain and Spine Institute, which is run out the Mid-Atlantic Orthopedic Group, is third in the state for number of neuro-stimulators installed, to date.

You can watch short video about this back pain device.


Suffered From Back Pain Woman Sues Her Insurance Company

September 15, 2008

Debra Voss is in constant pain because of a back problem. She believes she needs an operation. Fortunately, she has health insurance. Unfortunately, the health insurance company won’t pay for the operation.

«I don’t know what to do,» she said.

Voss is 41. She is divorced. She has three children, the youngest of whom is 10. She attended secretarial school after graduating from Bishop DuBourg High School. She has spent most of her working life in the advertising business, most recently as an executive assistant.

The problem with her back began on the Saturday before Christmas.

«My leg started hurting,» – she said. «I’d been on my feet all day, and I thought maybe I had twisted my ankle. Then the pain went into my back. But I wasn’t really worried. The agency I worked for is off between Christmas and New Year’s, so I figured I’d just take it easy and I’d be all right.»

But the pain did not subside. She went to a chiropractor. That did not help. She went to her doctor, who prescribed painkillers and physical therapy. She also ordered an MRI. The MRI revealed degenerative disc disease. At least that is one reading of it. She went to a neurosurgeon. He referred her to a pain specialist who gave her a series of injections. That didn’t help. She had a discogram in which needles were used to probe her discs. That didn’t work. The neurosurgeon then suggested an operation, a lumbar spinal fusion.

This happened over a period of several months. Voss was still working, but she said the situation was becoming unbearable. She was in pain and also groggy from the medication. She said she was nervous about surgery, but she felt she had to do something. She visited another neurosurgeon for a second opinion. She said he agreed that surgery was her best option.

The surgery was scheduled for June at St. Anthony’s Medical Center. She decided to take a leave from work to recuperate. The day before the surgery was scheduled, she got a call from her neurosurgeon’s office. The insurance company had refused to authorize surgery.

The insurance company is Anthem Blue Cross and Blue Shield. It explained the decision to deny surgery in a letter to Voss. “The clinical information provided does not support the medical necessity of Lumbar Spinal Fusion as this procedure is considered not medically necessary as a treatment of low back pain and/or leg pain due to degeneration of lumbar discs unless there is evidence of spondylolisthesis (lack of proper spine alignment) on preoperative X-rays.”

Voss went through the appeal process at Anthem. Her appeals were denied. She has also filed a complaint with the Missouri Department of Insurance.

Her neurosurgeon is Dr. Charles Wetherington. I asked him if other insurance companies approve lumbar spinal fusion when there is no evidence of spondylolisthesis.

«Most do. Some are getting kind of difficult, but generally, if you talk to somebody, they’ll be reasonable,» – he said. In this instance, he spoke with Anthem’s medical director, Dr. Wayne Meyer, but without success.

«We adhere to certain guidelines,» – Meyer said. «They’re clear on this, and they have nothing to do with cost.»

He said the evidence does not show that lumbar spinal fusion is successful or appropriate for most people with lower back pain. «I was in surgical practice myself until two and a half years ago,» – he said. «I still believe in evidence-based medicine.»

I asked about a study that Wetherington referred to from Sweden. «That’s only one study and as I understand it, there are flaws in that study,» – said Meyer.

Meyer also spoke about the appeal process. He said two neurosurgeons from outside the organization reviewed the case and upheld the decision to deny the surgery.

Voss, meanwhile, is beside herself. She has been on unpaid leave from her job since June. «I don’t know what I’m going to do. I can’t work. I’m never comfortable or without pain,» – she said. She said she has nearly exhausted her savings. «I think I might be able to make it though October, but then I don’t know what I’ll do.»

Wetherington said that he performs about 10 of these surgeries a month and he estimated that about a third of them don’t have the conditions that Anthem requires.


New Relief for Back Pain

September 3, 2008

Doctors may soon have another way to help people relieve chronic back pain without the side effects of many traditional pain killers.

Original new back pain medicationA medication that’s been used in Europe since 2006 is now part of national clinical trials in the United States.

Despite surgery and multiple treatments Roy Bradley lives with chronic lower back pain. He’s also tried multiple medications, which lead to taking multiple pills each day, and multiple frustrating side effects.

But lately, he said it’s been a little easier. He’s part of a clinical trail where researchers are testing a medication which can be taken once a day, and which might help ease some after effects.

Dr. Greg Gottschlich, one of the lead researchers in this national trial, said the once-a-day pill is a powerful morphine-like drug in a sustained release formula that enters the body slowly a little at a time.

He said, «We can see a steady state of level medication, rather than a big high, followed by a drop; we don’t have as many side effects».

The reports so far on this new delivery system are pretty promising:

Gottschlich said the team is seeing, «Better control of pain, better quality of life, better sleep, better functioning in patients.»

Bradley said he’s noticed many of these positive effects too even though he’s not sure he’s getting the drug with the new delivery system. 
Early results of this trial should come some time next year.

You can watch video on

Implant Can Help Disguise Back Pain, Doctors Say

August 27, 2008

New technology is giving an old treatment for back pain new life.

Spinal cord stimulation has been used for decades to help patients with chronic lower back pain, but the expensive devices had too many drawbacks, including the need to be replaced frequently and limited battery life.

Now the Food and Drug Administration has approved a new stimulator which lasts ten years and is rechargable.

Doctors at Suburban Hospital inserted the first of these devices in the D.C. area into 48-year-old Joyce Thomas, who has been plagued by lower back pain for more than three years.

“I worked at a convenience store; I was lifting up tote of grocery and went to turn to move it and the pain hit me really bad and I just couldn’t move at all,” recalled Thomas, who has undergone three back surgeries, including two spinal fusions, without significant pain relief.

Dr. John Dombrowski recommended the spinal cord stimulator, which masks pain with a tingling sensation.

“To me it’s just like a tingling feeling,” said Thomas, “like if your hand’s numb and went to sleep and tingling — that’s what feels like.”

During the procedure, two wires, called leads, were inserted around Thomas’ spinal cord. They connect to a small battery containing a computer placed in her lower back. Unlike earlier versions, the new model contains more computer programming options and can be recharged every three months.

“This battery and computer conducts electrical signals to the spinal cord – the signal drowns out the pain patient is experiencing,” said Dr. Dombrowski, an anesthesiologist.

During surgery, Thomas helped the doctors ensure she felt tingling in all areas where she normally experiences pain.

After the procedure, she’ll decide when to use the device with a remote control.

“You can turn it on, you can turn it off, you can change programs — just like you would do watching TV,” he said.

Thomas is optimistic the new device will make all the difference.

“I just want to get back on my feet and be able to do stuff and go back to work,” she said.

Doctors say the device may also be used for chronic arm and neck pain, heart disease, and cancer.

Eli Lilly’s Depression Drug May Cut Chronic Low Back Pain

August 26, 2008

Washington D.C. (AHN) – Eli Lilly and Co.’s Cymbalta depression treatment significantly reduced back pain in comparison with a placebo, new studies suggest. The drug is prescribed to treat depression, generalized anxiety disorder, diabetic nerve pain, and fibromyalgia.

The pharmaceutical company carried out a study on 236 adults with chronic low back pain who weren’t depressed. They took Cymbalta or a placebo drug daily for 13 weeks. The study found that 31 per cent of patients receiving the treatment experienced a 50 percent reduction in pain, compared with 19 percent of individuals who were in the placebo group.

Researchers said that a 60-120 milligram dose of Cymbalta produced the desired effects, a 60 -120 milligram. However, a large number of patients from the medicine group discontinued use due to adverse events, the most common of which were nausea, dry mouth, fatigue, diarrhea, excessive sweating, dizziness and constipation.

Indianapolis-based Lilly filed an application in May with the Food and Drug Administration to allow Cymbalta to be prescribed for managing chronic pain. Both studies were funded by the company.

The study was presented in Madrid at the 12th Congress of the European Federation of the Neurological Sciences.