Scoliosis and Its Common Impacts

October 3, 2008

types-of-scoliosis Scoliosis is a common orthopedic condition affecting millions of individuals. In fact, more than a half million doctors’ visits occur each year regarding the evaluation and treatment of scoliosis.

What is scoliosis? In medical terms, it describes lateral (side to side) curvatures of the spine (aka: the mid and/or lower back).

Occurring at any age, scoliosis most commonly develops between the ages of 10 and 15. Girls are more commonly affected than boys. The condition may be inherited or the cause may be unknown. In any case, scoliosis can be puzzling and should be evaluated and monitored properly to ensure the best outcome at any age.

Our bodies have specific spinal curvatures from front to back, as well as a straight line appearance from top to bottom. Because we stand and walk on two feet, we constantly use muscle control to keep us upright, while fighting external forces such as gravity. In most cases, "normal" spinal curves allow us to move and function correctly, and allow the body to be more resistant to injury.

On the other hand, abnormal curvatures can cause problems. In some individuals, lateral (or sideways) spinal curvatures can develop, which change the "normal" straight line appearance of the spine. If the curvature is measured larger than 10 degrees (side to side), it can be called a scoliosis. Curves less than 10 degrees are not classified as a scoliosis and may just be postural compensations. Some curvatures may be accompanied by increased front to back curves (kyphosis), may involve rotation of the spinal bones (vertebrae), or even contain more than one curve. Whether from daily activities, poor posture, specific injury, or even due to genetics, any change in "normal" curvature will affect spinal movement, position and function.

In most cases, the cause is unknown. In other cases, trauma, postural problems, developmental issues, neurological diseases, or other conditions may be causally related. Some scoliosis may be related to muscle spasm, biomechanical compensation, or leg-length inequality, which can often be addressed conservatively. Other scoliosis may be more complicated and may require more invasive treatments.

How is scoliosis evaluated? A thorough history and physical examination, including a postural analysis and spinal screening, is usually the first step in evaluating a spinal curvature or diagnosing scoliosis. Only if clinically appropriate and necessary, X-ray evaluation can determine the location and degree of the curvature, as well as monitor other associated factors. Depending on each case, additional diagnostic testing and/or repeat X-rays may be necessary as often as every 3 months to as little as once every few years to monitor abnormal findings.

Symptoms differ in each person. Fortunately, 4 out of 5 people with a scoliosis have curves less than 20 degrees, which are usually not detected by the untrained eye and have no symptoms. In most small curves, pain is not an issue and progression of the curve does not occur. In severe cases, pain and limited physical activity may be evident, in addition to possible harm to internal structures.

Will the scoliosis progress? In most cases, scoliosis remains mild, does not progress, and requires little treatment, if any. In other cases, growing children may have rapidly progressive curves which require more frequent check-ups and more aggressive treatment. One group of concern will be young females who have a scoliosis greater than 25 degrees and who have not had their first menstrual period. This concern is due to rapid growth during this developmental period. In addition, adults with pain and progressive curvatures must be monitored more closely.

Successful treatment doesn’t mean reversing the curve, but it means managing it and stopping it from getting worse. Curves under 20 degrees are usually "treated" with careful observation and conservative options, since most mild scolioses don’t progress or cause physical problems. Specific therapeutic exercises and stretching, electrical stimulation and spinal manipulation have been successfully utilized in the management of scoliosis. For curves between 25 and 45 degrees, in addition to those who are not at skeletal maturity, conservative care to include bracing may also be recommended. Bracing depends on the type and site of curvature. Surgery may be an option for curves greater than 45 degrees and progressive, and/or when internal organ function is affected.

Most people with scoliosis lead normal lives without complications. Physical activity is usually well-tolerated and encouraged. Since none of these therapies alone have been shown to consistently reduce scoliosis or to make the curves worse, an integrated approach to the treatment of scoliosis using your medical doctor as well as a chiropractic physician is a proven and effective treatment option.

Dr. Todd Joachim, a chiropractic physician, practices in Marion. He specializes in the conservative treatment, rehabilitation and management of musculoskeletal injuries and conditions including scoliosis, while using non-surgical chiropractic treatment options. Questions regarding chiropractic care or health concerns can be addressed to [email protected]


Arthritis of Spine Targets Young Men

October 2, 2008

back pain It’s a disease that affects between 150,000 and 300,000 Canadians, strikes males three times as often as females and is literally a pain in the backside.

Ankylosing spondylitis (AS) is a mouthful to say, so some people call it "poker back." Having it can wreak havoc with your golf game, and make just getting around the house difficult.

New advances in diagnosis and treatment may help catch AS early and greatly ease the negative effects of this disease.

AS is a type of arthritis that usually affects the spine. According to a recent paper by Dr. Saeed A. Shaikh of McMaster University, "ankylosing spondylitis most commonly has its onset while a patient is in their 20s, although late teenage years are also relatively common for initial symptoms."

He adds that the disease "has a predilection to affect young males." It also has a strong genetic component, with a gene called HLA-B27 showing up in 93 per cent of the patients with AS, but is seen in only six per cent of the general population.

According to Shaikh, it can still be very difficult to diagnose, and "on average, there is a seven-to-10-year delay in the diagnosis of this disease from the onset of symptoms."

It doesn’t help that, he says, "the majority of back pain sufferers do not seek care from healthcare providers. Young men tend to be the segment of the population that are the least likely to do so."

So, you young guys, being tough and sucking it up when confronted with an aching back may work against you.

Magnetic Resonance Imaging (MRI) technology can reveal the earliest signs of this disease, especially inflammation in the sacroiliac joints, long before anything would show up on a conventional X-ray. (The sacroiliac joints connect the sacrum — the wedge-shaped bone at the bottom of the spine — to the pelvic bones.)

If left unchecked, AS can cause chronic back pain, stiffness, especially in the morning, as well as fatigue and pain in the joints. There can also be consequences elsewhere in the body, including eye infections, psoriasis and inflammatory bowel disease. In advanced cases, bony spurs can grow out from the edges of the vertebrae, fusing together parts of the spine and making movement even more difficult.

The Arthritis Society of Canada has plenty of good, objective information on this disease on its website, It says treatment usually starts with a non-steroidal anti-flammatory drug, like the ones you probably have in your medicine cabinet. Corticosteroids are sometimes given by injection into the affected join to provide short-term relief. For severe cases, there are disease modifying anti-rheumatic drugs such as methotrexate and sulfasalazine. Of course any medication can have side-effects so the benefits need to be weighed against the risks.

A new class of AS treatments involves biological response modifiers, sometimes just called biologics. These drugs work by plugging up the pathway that leads to inflammation. According to the Arthritis Society, they "recently have been shown to have the potential to slow or even halt the progression of AS in some people."

You can tell there’s big money in biologics, since the company behind one of them, Remicade® (infiximab), has sponsored a very high-quality website called On it, an unidentified, but very trustworthy looking guy in a white coat reviews the treatment options. While the information is medically vetted and factual, with links to other sources, it’s still useful to remember that the pharmaceutical company Schering-Plough Canada Inc. pays the bill for this website.

Most of the biologics are given by intravenous injection, at intervals of several weeks or months. Because of their cost, which the Arthritis Society estimates at $15,000 to $25,000 per year, most provincial health plans restrict them to patients whose disease cannot be controlled by conventional treatments. And because they depress the immune system, there are certainly people who should not be taking them at all.

Of course, there are some excellent non-pharmaceutical approaches to ease this disease. They range from stretching exercises to physical therapy to trying to maintain good posture. A physiotherapist can be very helpful in showing you how.

Moderate physical activity is desirable, but the Arthritis Society cautions against contact sports such as rugby or hockey, or falling down sports like skiing, because a person with AS may be at greater risk of spinal fracture.

Most experts agree that people with AS will always be aware of their disease, but advances in diagnosis and treatment can keep it under control. Famous people with AS reportedly include baseball player Rico Brogna and Mötley Crue guitarist Mick Mars.

Then again, former world chess champion Vladimir Borisovich Kramnik may be a more relevant example for most of us. The discomfort of sitting at a chessboard actually forced him out of the game.

But with medication for his AS, he was back for the 37th Chess Olympiad in June 2006. For now at least he seems to have his disease in check.

Tom Keenan, I.S.P., is an award-winning science writer, professional speaker and professor at the University of Calgary.


Watchung Chiropractor Works to Ease the Pain

October 1, 2008

chiropractor Whether suffering pain from an acute injury or a chronic condition, the walking wounded come to Dr. Ron Spiaggia’s rehabilitation facility seeking the same thing: pain relief and a return of physical mobility and function.

Long before the chiropractor purchased the building in September 2001 to open his own practice, Spiaggia was familiar with the Watchung Avenue site. After earning his chiropractic degree, Spiaggia, 39, married 12 years and the father of three children, began his career in 1984 in the same building when it was the Back and Neck Care Center.

Since 2001, Spiaggia has overseen two expansions of the facility to accommodate patient volume and a business strategy to provide ""diversified, full treatment services,” he said.

The doctor said the practice sees from 80 to 100 patients a day, five days a week.

"The practice has grown 300 percent in patient volume, and the building was expanded from 1,500 square feet to its current 4,000 square feet,” Spiaggia said.

Filling all that space is a second chiropractor, Dr. Faisal Hussain, a psychiatrist; Dr. Paul Abend, a specialist in rehabilitation after nerve, muscle and bone injuries and illnesses; Andy Koser, a physical therapist; Anna Mantelli, a licensed massage therapist; and the support staff necessary to manage patients, billing and insurance companies.

"As a physiatarist, Dr. Abend provides neurodiagnostic testing and light pain management,” Spiaggia said, adding that chiropractors are not licensed to provide prescription medication.

Each specialist at Performance Rehabilitation & Sports Injury Center complements Spaiggia’s goal of providing comprehensive evaluation, treatment and maintenance following an injury.

Two new treatment therapies are available at the center: DRX 9000C Spinal Decompression Therapy and Micro Vas Therapy.

Spinal Decompression Therapy is a noninvasive course of treatment for chronic back pain, typically including herniated and bulging discs and degenerative-disc disease conditions of the neck or low back.

"I began using the DRX 9000C about 18 months ago. After getting very good results, recording less than a three percent chiropractor exacerbation of a patient’s condition following treatments, I now have two DRX machines. I’m proud to say I’m the only center in Central Jersey that offers this particular nonsurgical treatment,” Spiaggia said.

DRX machine therapy "reduces intradiscal pressure while sending water and nutrients back into the problem disc. This allows the disc to repair itself,” Spiaggia said.

On a recent visit, Dennis Kirk of Rahway was getting suited up for a long spinal stretch on the DRX 9000C. The girdle-like brace he donned isolates the area of the spine to be treated, which first was determined through a Magnetic Resonance Imaging scan.

Kirk laid on the DRX’s padded table and was positioned into a supine position to receive a slow, calibrated stretch of his lumbar area.

"I’ve had better than a 100 percent improvement of my pain since I started this treatment plan,” Kirk said.

He also receives traditional physical therapy modalities during his visits.

Thomas Calavano of the Martinsville section of Bridgewater received Micro Vas Therapy. Referred to Performance Rehabilitation by his podiatrist, he was seeking relief from the painful symptoms of neuropathy in his feet.

"I’ve been suffering pins and needle and electric-shock sensations for three years, with no relief. Four neurologists later, and also after acupuncture treatments, I am getting some results from this,” Calavano said.

His treatments require the application of eight pads on eight leg, which, when activated, give gentle electrical stimulation for 45 minutes.

Micro Vas Therapy ""increases circulation and oxygen levels to the affected extremity,” Spiaggia said.

chiropractor Growing up in Livingston, Spiaggia thought he would study to be a dentist. He turned to chiropractic after the only relief he got for a football injury was after chiropractic treatments.

"I decided then I wanted to help people suffering pain, especially someone who had been injured playing sports,” Spiaggia said.

Spiaggia still enjoys treating patients with sports injuries.

"I love dealing with athletes because they make good patients,” Spiaggia said, adding that athletes already are ""wired” to make a commitment to get excellent results from their treatment.

Even though Spiaggia has moved toward treating individuals who suffer chronic pain and who are 40-plus years old, his commitment to alleviate pain remains.

Laurie Levoy: 908-707-3118; [email protected]


Pain Isn’t Just a Symptom of Arthritis

October 1, 2008

back-pain-relief Pain is often thought to be a debilitating symptom of osteoarthritis. But new research suggests pain is more than a symptom, it’s a damaging part of the disease itself.

According to a new study, pain signals originate in arthritic joints and the biochemical processing of those signals as they reach the spinal cord actually worsen and expand arthritis. Furthermore, researchers found that nerve pathways that carry pain signals transfer inflammation from arthritic joints to the spine and back again to the joint — causing disease at both ends.

The process of pain signals being transmitted from the sight of origin to the processing centers in the spinal cord and back is called nociception — a type of “crosstalk” within the body. According to the study, it’s this crosstalk that enables joint arthritis and inflammation to be transmitted to the spinal cord and brain and consequently spread throughout the central nervous system.

Researchers have identified likely drugs that can interfere with the crosstalk of arthritis pain through inflammatory receptors on sensory nerve cells. This could be an effective new approach to treating osteoarthritis — a condition that affects 21 million Americans.

“Until relatively recently, osteoarthritis was believed to be due solely to wear and tear, and inevitable part of aging,” Stephanos Kyrkanides, D.D.S., Ph.D., associate professor of Dentistry at the University of Rochester Medical Center, was quoted as saying. “Recent studies have revealed, however, that specific biochemical changes contribute to the disease, changes that might be reversed by precision-designed drugs. Our study provides the first solid proof that some of those changes are related to pain processing, and suggests the mechanisms behind the effect.”

Researchers also believe that if joint arthritis can have an effect on neuro-inflamation, it could have a role in conditions like Alzheimer’s disease, dementia and multiple sclerosis.

SOURCE: Arthritis and Rheumatism, 2008;58:3100-3109


You Don’t Have To Be Perfect To Be Free Of Back Pain

September 30, 2008

back pain Would you have back pain if every part of your body were perfect? The answer has to be… No, it’s pretty safe to say you wouldn’t have any pain if your body were perfectly aligned, perfectly balanced and in a perfect state of being.

But here’s the thing—you don’t have to be perfect to be pain-free. In fact, you can have serious conditions like Spinal Stenosis and even a Herniated disc and still have no pain—regardless of the type of job you have or how you think the condition developed or even the unique situation that you find yourself in today.

Don’t believe it? The prestigious New England Journal of Medicine just reported it.

They published a study in which researchers performed an MRI on 98 people who had no back pain. And the researchers found that nearly two thirds of them had some kind of abnormal disk condition.

The researchers conclude:

"Many people without back pain have disk bulges or protrusions… Given the high prevalence of these findings and of back pain, the discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental."

That’s right. They called having a bulging or protruded disc and having back pain a coincidence. Proof positive that you can have a condition and not have pain. Indeed, there are millions of people with existing back problems right now who do not even know that they have the condition and surly don’t have any pain at all.

How do you become one of those people?

Living with the condition and living pain free.

Let me say something that may be uncomfortable for you to hear. There is a good chance your condition will never go away. That may sound scary, but it is possible. Herniated disks don’t typically un-bulge themselves and then heal them self to the way they were when you were 15. Spinal Stenosis doesn’t come and go.

And yet, you can still live without pain. In fact, you probably already have.

If you have gone just one minute of one day since your last flare-up without pain, you’ve proved you can have your condition without pain.

How can this be? If the condition didn’t go away, what changes? It all has to do with the alignment of your body, the position of your pelvis, the curvature of your spine and the stability of your body as a whole as you go through your day.
Now, there are a couple of ways to try to relieve that irritation permanently. Sure, you could have surgery. That’s one option to treat your pain. But most surgeries fail within 3 to 5 years. Why? Because they don’t address the reason why the condition became symptomatic in the first place. In other words they don’t fix what’s really causing your condition to develop–they just remove the irritant that is causing the pain.

So what does? I understand you think you’ve tried everything—chiropractors, physical therapy, cortisone shots, acupuncture, massage, anti-Inflammatories and probably 20 others. But ask yourself one question. Answer it truthfully.
Has anyone ever looked at your body as a whole and told you specifically what your postural dysfunctions are and what specifically is causing your body to look like it does?

Furthermore has anyone spelled out for you why your pelvis is the way it is? Did they tell you specifically which muscles are tight, which muscles are weak and then give you a very specific and very targeted corrective program to achieve postural balance and stability, which is the single more important thing you can do to alleviate your pain and gain control of your life?

Stability is Everything when looking for pain relief

The only way to stop the irritation is to bring your body back to a more neutral, more balanced and more stable state. When you do that, everything works better—your back, your hips, your shoulders, your SI joint, everything. Once your body is balanced and stable you can do all the things you love to do and do them with the confidence that you are safe, strong and protected against further injury.

As the NEJM proved, you don’t have to be perfect to eliminate pain. You just need to work toward creating a more balanced and neutral state for your body. When you work toward pelvic stability, you help your spine maintain a neutral position. Then you can use your body as it was intended to be used.

That’s how you can have the condition and not have pain. You most likely won’t need surgery. You won’t wake up every morning stiff. You can return to your life and do all you want to do.

Why is Muscle Balance Therapy so different?

First, you should understand that there is no single set of exercises that can specifically help a Herniated disk or Spinal Stenosis or any condition for that matter. So I urge you not to search the Internet for back pain exercises and just do any old stretch or exercise without knowing the underlying reason you are doing it for.

You must also understand that the Corrective Exercise Program you will get form Muscle Balance Therapy is not based on your diagnosis but rather on corroborating evidence from both physical and visual assessments that are used to ensure you are doing the correct and safest program possible for you and your current condition.

Muscle Balance Therapy is based on the biomechanical principle—the more balanced and stable your body is the better your body will work and the less pain you will be in. So before we start we must first know which muscles are out of balance, meaning we need to know specifically which muscles are tight and which are weak. Once we know those, then we can create a very specific and targeted stretch and exercise program to restore balance. And again that only comes from doing the specific assessments…

Let me just review this point one more time, there is no such thing as a single exercise for and medical diagnosed form of back pain like a herniated disc or Spinal Stenosis. So when you ask me will, I just had and MRI and was just diagnosed with 4 Herniated Discs, Degenerative Disc Disease all levels, Spinal Stenosis and oh I was born with Scoliosis and 17 years ago I was in a major auto accident, will your system work for me the answer is will always be yes…

In fact, I tell everyone it great to know your specific diagnosis but now forget about it, you can not change the facts and you can not change the past. Rather, focus your energy on the things you know you can change and as you restore balance you will restore function.

That brings us to the third unique aspect of Muscle Balances Therapy and that is that we have to perform what we call the Unbalanced Workout. This means that you will not benefit from just blindly strengthening or stretching all your core muscles. That is not the way to do it.

The reason is that you could be stretching or strengthening muscle groups that do not need to be stretched or strengthened and you can make your condition worse. Here is the secret: The difference between having pain and not having pain is in millimeters of movement and the more specific the physical approach the faster and safer the results will be.

The fourth difference is not in our exercises, because there are no new exercises in the world. Rather, it’s the confidence you get knowing that the exercises that you are doing are working the muscles in the best way possible for you and your situation.

The Secret

Everyone understands that one approach can not be the answer to every possible circumstance, and we know that, so here is the secret, as you work with Muscle Balance Therapy and address root cause issues like physical balance and postural stability, please understand that we encourage you to seek out those same modalities that failed you before, they all have value in the process of healing but not until you address the important stuff first.

You know the list of things that you have tried; I contend that this time Massage, Inversion, Supplements, Trigger Point Therapy, Heating Pads to name a few will all work to speed your healing and help you achieve optimal health for the rest of your life.

Is Muscle Balance Therapy perfect? It’s close. Does everyone get 100% pain relief? Most do.

I can say with all honesty that there is 100% chance you will improve from your current state. We have a list of 50 ways that your body and life will benefit and 100% pain relief is by all measures a bonus. So it boils down to this: Would you be happy with 80%, 60%, even 50% reduction in pain yet able to do all the things you love to do? Would that improve your quality of life?

I have dedicated the last 15 years of my life and endured both personal and professional sacrifice to create a safe, systematic approach to addressing all forms of back pain that can be used by young and old alike. And I have never been closer then I am right now with the concept of Muscle Balance Therapy to be able to say that you have just learned one of the best lessons anyone with back pain can hear.

I’m not promising miracles, but I do promise a complete and thorough as well as safe approach to managing, treating and even eliminating your pain.

I have seen amazing results again and again for those people that put in the effort and believe in them self knowing that they are doing the right thing.

Let me leave you with this last thought and one that I believe holds the most power.  The human body is intrinsically designed to heal its self, we as individuals just need to give our bodies what is needed and remove what is not needed, Muscle Balance Therapy puts that power to heal yourself back in your control.

If I could barrow a line from my good friend Bob Proctor, the cure to ignorance is knowledge and the answer to fear, worry and doubt is study, understanding and faith. Faith builds enthusiasm and enthusiasm accelerates healing. How good it that!

So if you don’t believe me that you can have your condition and not have pain let me teach you what is possible. If you worry and are filled with doubt I urge you to study what is already available to you and the more you know the better off you will become.

That is true for all things and will be true till the end of time.

1. Jensen, M.C., et. al. Magnetic Resonance Imaging of the Lumbar Spine in People without Back Pain. N Engl J Med 1994; 331:69-73
2. Bob Proctor, The Winners Image, ©1995 –2008



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.