Back Pain Relief in Mumbles, Swansea
The key to a healthy back, to back pain relief, paradoxically lies in preventing the problem in the first place. The key to back pain prevention is strengthening of the back and core muscles. Unfortunately, if you’re injured and trying to do these exercises you’re likely too late. In long standing back pain core muscles tend to shut off and movement is painful and restricted. It may feel hopeless but in the short term strength based rehab may not be your best course of action. Movement is important in rehab. The right kind of movement is critical.
At a gross level you need to work out functionally what triggers pain…. and then reduce these movements in the short term. If 10 minutes of walking triggers pain try walking for 9 minutes – to the point where the pain isn’t triggered. Operate below the pain triggering threshold, but exercise more frequently. Maybe twice a day rather than once a day. So if 10 minutes of walking triggers your back pain, try walking for 9 minutes, but walk 9 minutes multiple times in a day. Assess where this leaves you and try to always maintain activity levels below the pain threshold.
None of this should be taken for advice on how to treat your specific back pain. Rather its an indication of how the process may be addressed. In many cases this alone won’t solve back pain.
Getting Treatment For Your Back Pain
What if your pain is there all the time or triggered by all movements? Or you want to speed up recovery? Then you need to seek out therapy. Before you do this firstly assess if it’s an emergency. If you have…
- sudden loss of bowel or bladder function
- progressive weakness of legs with legs giving way
- back pain with severe abdominal pain
- signs of infection – listlessness, fever, vomitting…
If you can answer no to the points above you can breathe a sigh of relief and look for treatment.
The aim of therapy initially is to reduce pain and increase stability of the spine. Once that has been achieved then I assess range of movement and strength of relevant muscles to work out what needs working on to prevent future flair ups/ episodes.
The MRI Solution…
If you’ve suffered back pain that won’t go away you might have had an MRI scan already to ascertain what’s causing the damage. Whilst undoubtedly very useful, care must be taken to take MRI information in context…
Ninety eight healthy people with no back pain had their backs MRI’d in a 1995 study by the New England Journal Of Medicine. An astounding 52% had disk protrusions in their lower back but no pain. What you see on an MRI does not alway correspond with the pain you subjectively feel.
A more recent study in 2015 (American Journal of Neuroradiology April 2015, 36 (4) 811-816) looked at the MRI results of asymptomatic patients in varying age brackets. So these are people with no back pain. A table summarising some of the results from this study is shown below. [Disk signal loss is suggestive of a lack of hydration in the disc].
|Disk Signal Loss||17%||33%||54%||73%||86%||94%||97%|
|*Source: AJNR, Apr 2015, 36:811|
As you can see degenerative change starts to kick in for the majority of the population aged 30 plus. If you’re in your 60’s plus its highly unlikely an MRI would not show degenerative change. Unfortunately its just part of ageing. But this degeneration does not correlate exactly with pain. As this article states
Findings such as disk degeneration, facet hypertrophy, and disk protrusion are often interpreted as causes of back pain, triggering both medical and surgical interventions, which are sometimes unsuccessful in alleviating the patient’s symptoms
So the takeaway from this is that in extreme cases an MRI is very useful, but in the majority of cases the findings on your MRI may not correlate with pain.
If you’re finding this hard to swallow have a look at the British Association of Spine Surgeons article on MRI and back pain. Quoting them
Magnetic Resonance Imaging Scans (MRI scans) give a very clear picture of the structure of the spine. It does not tell the doctor why the spine is painful. In 85% of patients we are unable to say why back pain occurs
The Danger of Opioid Based Pain Killers
Opioid medication such as codeine, co-codamol, tramadol, oxycodone and fentanyl is derived from the opium poppy. It is thought to work by creating a surge of dopamine which induces relaxation. As the effects of the medication wear off it can make the patient feel terrible. Fight of flight response takes over from the feelings of relaxation so the patient is then eager for their next dose. This can make it difficult to ascertain whether the patient is feeling bad due to withdrawal symptoms or because the pain is returning.
Opioid based pain killers are addictive and must be aproached with care. Different people have different tolerances to the toxins in any medication. If you find this hard to believe, consider coffee. Why is it that one person can drink 8 cups of coffee and feel fine, yet another can drink 1 cup and end up feeling jittery and light-headed? The answer lies in the ability to metabolise toxins. Some people can metabolise them well, others can’t. Thats why when taking any medication you have to take care – you may be the one who can’t metabolise it well and suffer an adverse reaction. In excess opioid based medications depress respiration; breathing becomes shallow and slow. This is very dangerous. In particular if combined with other depressants such as alcohol, this can lead to respiratory failure.
According to a study at the Royal Liverpool University Hospital (RLUH) over 6 months in 2005 14% percent of patients suffered an adverse reaction to their medication. Of these half were potentially avoidable through better practice, the other half were not. The likelihood of an adverse reaction increased as the number of medications taken increased. The study listed opioid medication as one of the top 3 most likely to cause an adverse reaction (the other two were diuretics and anticoagulants).
Opioids & The Pharmaceutical Industry
Before 1990’s opioids were only prescribed for acute pain, palliative care and for cancer patients. It was not indicated for chronic pain. Following extensive marketing by pharmaceutical companies to convince doctors that opioids were safe, non-addictive and suitable for chronic pain, prescriptions quadrupled from 1999 to 2010 in USA. Pharmaceutical companies promoted opioids with scant proof of their claims. One of the culprits, Purdue Pharma was fined $600m for misleading the public about the addictive nature of the drug.
Former Medical Director at New York City Health Department, Andrew Kolodny, raised the alarm on over-prescription of opioids in 2004. At considerable personal cost he fought the might of the pharmaceuticals and the estimated $1bn they have spent on lobbying in the US. (If you’d like to read more – there’s a great article about Andrew Kolodny’s fight against opioid prescriptions in New Scientist, 13 Jan 2018)
What To expect From Acupuncture Treatment
Outcomes for treatment can vary wildly. Acupuncture is a treatment tailored to the individual and an individuals circumstance affects the duration and outcome of treatment. I have treated some patients with recent onset (acute) back pain and resolved it within 3 treatments. At the other end of the spectrum I have treated patients with significant nerve damage. With these patients, acupuncture is often an ongoing weekly treatment which manages the pain, rather than eliminating it. These two patient profiles are outliers. Most patients I see typically need 5-8 sessions, depending on age, fitness, length of time with back pain and severity of symptoms. The general rule of thumb is that the younger, healthier and less time you have been suffering the quicker it is to treat.
Myself and my daughter have been treated by Tim for a number of years for several issues including back pain, sleep problems and tinnitus. Acupuncture has cleared my tinnitus and definitely helps with pain management. I know that without acupuncture, I would struggle to function, stay in work and cope with pain. I feel Tim’s approach is truly holistic and my daughter and I always benefit from treatments.
Highly recommended. I have been struggling with lower back pain for the last 4 years. Every time I have been advised painkillers and physio! Thought I give acupuncture a go as I was fed up and it was affecting my every day activities. I can honestly say it been the best decision I made. After 2 sessions with Tim the pain had eased and after the 3 sessions the pain had gone I could get back to light excerise. Very happy with Tim and treatment he gave me.
If I could rate Tim at Gower acupuncture higher than a 5 star I would. I’ve spent the last 14 months trying to get a diagnosis for a muscle problem that I have, I’ve spent money going to private consultants, numerous trips to the doctors, hospital and physiotherapists and nobody could give me even a hint at what it could be. I thought I would give acupuncture a try as I didn’t know what else I could try and within one consultation and treatment with Tim he had managed to give me a diagnosis that described my problem to a tee. I would highly recommend him.
– James Davies
I enjoyed my first session with Tim and also found it very interesting, never having experienced acupuncture before. I got the impression of a competent, caring professional and felt very much at ease. Over the years, I had been told by several practitioners that my thoracic spine was “like a rock” – a phrase that Tim echoed. In the days following the treatment, there was an appreciable difference and the area felt looser and more mobile than it had for a very long time. The discomfort that has been present recently has gone. I will definitely be visiting again.
– Johh Pritchard
I have been struggling for a while with back pain and migrene. After the first two sessions, my migrene and muscle pain have significantly reduced, plus my overall mood has improved. Tim is very professional and patient.
About Tim Wright Acupuncturist, Swansea
I have treated over 4,000 patient visits since 2011 and have a particular interest in musculoskeletal pain management for the simple reason I consider acupuncture to be the best treatment.
If you’d like to see how I may be able to help your back pain or sciatica click below to book a free 15 minute consultation in my Mumbles Clinic.
* According to September 2020 draft NICE guidelines. Click here to view full text