Excerpt from Book – End Back & Neck Pain


End Back & Neck Pain Book CoverDid you know 95% of the population gets spine pain, 30% have chronic spine pain and 48% get intermittent spine pain?

Do you fear that you have been misdiagnosed? In Dr. Fortanasce book “End Back & Neck Pain” he teaches you how to recognize what is causing back pain and if your healthcare professional has done a complete exam.

The major problem with spine pain prescriptions in the USA, according to a recent survey, is treatment often depends on the healthcare professional’s special interest or training. All treatment must be based on a proper diagnosis not on the healthcare professional’s special interest.

At the Fortanasce – Purino Neurology Center we are diagnosticians. We diagnose spine pain through the H.E.L.P. method. H.E.L.P. stands for: History, Exam, Lab test and Prescription treatment. Why is the H.E.L.P. method so important? Numerous studies show if one’s history, exam and lab test all fit together, the healthcare professional can pinpoint the source of your pain. Further studies indicate 86% of spine surgeries were successful if one’s history, exam and lab test all point to the same point of origin of the pain. If not, less than 30% of the surgeries are successful. Most important a proper diagnosis often leads to treatments where surgery is unnecessary.

You can begin by identifying what your spinal pain is telling you. Take the Spine Test:

The Spine Pain Test

  1. Is your spine pain severe, sharp, and stabbing? Yes or No
  2. Is your pain more in your arm or leg than in your spine? Yes or No
  3. Does your pain radiate from the spine down your arm or leg? Yes or No
  4. Is your pain most often associated with tingling, numbness, or burning? Yes or No
  5. Does looking up at the ceiling make your neck or arm pain worse? Yes or No
  6. Does bending, lifting, or twisting make your back pain worse? Yes or No
  7. Do you notice weakness in the painful extremity? Yes or No
  8. Does standing in one spot make the pain worse? Yes or No
  9. Do your legs get weak after walking a certain distance, such as one block? Yes or No
  10. Does rest make your pain better? Yes or No
  11. Does rest make your pain worse? Yes or No
  12. Is the pain worse in the morning? Yes or No
  13. Is your pain mainly a stiffness that gets better with exercise? Yes or No
  14. Has your pain persisted for more than three months without getting better? Yes or No
  15. Are you having difficulty doing your job because nobody appreciates how much you hurt? Yes or No
  16. Do you feel you take too much medication? Yes or No
  17. Do you sleep poorly and feel stressed most of the time? Yes or No
  18. Do you get severe calf cramps after walking a certain distance, such as one block? Yes or No
  19. Do you get up from bed and walk at night because your legs are restless? Yes or No
  20. Do you suffer from frequent cramps at night in bed? Yes or No

For questions 1 through 10, if you answered yes 5 or more times, you may have nerve-related pain and should see a doctor.

If you answered yes to questions 2, 4, 7, or 9, it is important to see a spine specialist.

If you answered yes to questions 11, 12, or 13, you may have joint back pain and should seek therapy.

If you answered yes to questions 14, 15, 16, or 17, you may have chronic pain syndrome and should be evaluated by a pain specialist or neurologist.

If you answered yes to question 18, have your doctor check your arteries for peripheral vascular disease, which is a serious condition.

If you answered yes to question 19, you may have restless leg syndrome, which is often inherited or due to other medications and is readily treated.

If you answered yes to question 20, you may have benign cramps due to several causes including vitamin D mineral deficiencies. Discuss with your doctor.

Chronic discomforts of the spine or neck may be annoying and severely limiting. If you have chronic spinal pain that has not been aggravated recently, here are some basic self-intervention activities to help you feel better.

By definition, if your symptoms last longer than three months, you have chronic pain. Those with chronic discomfort have a unique set of dynamics to deal with. Many with chronic pain do not report abrupt activity limitations in the way that those with acute injuries or flare-ups do. Often chronic discomfort is described as a nagging stiffness, a deep aching, or an annoying and intensely frustrating feeling. It may be constant or intermittent, and it is usually not described as sharp, severe, or lancing.

Is It Pain or Stiffness?

If the complaint is pain, the recommendation will always be to use a cold pack. Often, however, chronic discomfort is accompanied by reports of stiffness and tightness that just won’t go away. In these cases, heat may be appropriate. When muscle stiffness is the main complaint, a hot pack or heating pad likely will offer relief. Heat is the application of choice when stiffness and muscle soreness are the complaints.

Heat is advantageous because it comfortably promotes circulation to the area, thereby helping to flush the muscles of metabolic by-products that have built up over time from long-term muscle spasm. Reducing the chemical buildup in the muscle tissue can have a large effect on how you feel. True, a cold pack can accomplish this, too. But some people cannot fully relax onto a cold pack, thereby preventing the spasm from subsiding. In these cases heat is appropriate.

A typical time to stay on a heating pad or reusable hot pack is 20 minutes. You can use the heat as often as it is comfortable, so long as the skin has a chance to return to its normal color and temperature for at least 45 minutes before the next application. Obviously, the negative side effects are burns, some of which can be several layers deep if you’re not careful. As a rule, avoid using the hot pad directly at bedtime and set a timer or alarm to alert you when 20 minutes has passed. Often the heat is soothing, and dozing off is not uncommon. Unfortunately, this is how burns occur.

Analyze Your Activities

For acute discomfort, maintain a level of activity that you can tolerate. For chronic discomfort, begin by analyzing your home and work environments to identify activities and positions that are aggravating. Poor posture or movement habits may exacerbate the mechanism of your discomfort and keep the discomfort percolating. Immobilization over the long term is never the best answer. With chronic pain you will need to modify your activities and minimize those that exacerbate or increase the symptoms.

Exercise and Conditioning

There is no magic pill, but properly prescribed and consistently done exercise comes close. Remember that not all exercises are right for every condition. A little common sense mixed with professional instruction can go a long way toward developing a program that is therapeutic rather than harmful. For now, suffice it to say in most chronic pain cases, performing a stretch and exercise regimen can at least ease discomfort. A regular program can go a long way toward helping you feel better and tolerate more during the week. Perhaps the best way to begin is by choosing activities that address your overall level of fitness. Walking, swimming, and using a stationary bike are three simple activities that begin the process of improving your fitness level and easing discomfort.

Sleep Well

Most chronic pain patients have some form of sleep loss which results in an escalation of their pain perception. The chemical serotonin acts as a pain dampener and is secreted in the deeper stages of sleep. Cortisol is serotonin’s opposite, working to ramp up the perception of discomfort. Cortisol is secreted when you are anxious, tired, or angry, three common traits that chronic pain patients express. Coincidental? Not likely.

One way to promote a restful night’s sleep is to avoid stimulants such as caffeine and chocolate late in the day. Turkey and dairy products such as milk and cheese tend to be useful late night snacks for promoting a good night’s sleep.

Stretching is another way to help calm the body into a restful mode. Long and soft stretches tend to be quieting to the nervous system, ramping down neurological input to help ease spasm and restrictive muscle pain. Stretches should be held for 60 seconds or longer and done two or three times each. The pull should be steady but conservative, well below symptom threshold. In most cases, stretching is the self-intervention that provides the most benefit for chronic pain sufferers. You can do all the stretches in designated sessions over the course of the day, or you can focus on the one or two that provide specific relief to your back or neck as often as necessary. In either case, you’ll be surprised at how much relief some simple stretching can provide.

Whether you take over-the-counter medication, change your body mechanics, modify your activity, use a lumbar belt or cervical soft collar for a brief period, begin some stretching activities, or use a hefty dose of ice for a time, you can get some immediate symptom relief through your own actions.