by Ryan P. Clark, D.C.
Many of us live with pain every day or at least deal with it on a frequent basis. Pain is one of the ways our body tells us that something is wrong. Pain is so common that some healthcare professions originated solely to helping patients deal with pain. Some pains are warning signs of significant pathology while others are more nuisance than red flag. So what kinds of pain are more deserving of swift and professional evaluation? Here are some things to consider when evaluating your own pain.
1. Severe Pain
This one is pretty straightforward. While intensity of pain and seriousness of the underlying condition don't always match up with each other, pain that is severe needs to be evaluated. Pain that you can describe as "the worst pain you have ever experienced" is of particular concern for your doctor.
2. Pain Location
Location, location, location. It's true in real estate and is often true with our bodies. Whether intense or not, you are better off having symptoms in particular areas (such as your head or chest) investigated due to the potential for significant underlying pathology. Chest pain is the classic example here as heart attacks can occur with little warning. Remember jaw pain and pain into your left arm are also frequently described by patients that suffer heart attacks.
3. Pain of Insidious Onset
Insidious pain is pain that builds slowly over time. Pain that begins quickly is frequently less serious of an issue than pain that just simply won't go away and slowly gets worse over time. This is obviously not true in every case though, so be sure to pay particular attention to pain that begins quickly and checks one or both of the boxes above (concerning location and severe intensity). Pain due to cancer is the classic example of pain of insidious onset.
4. Pain at Night
When the house is quiet and your lying in bed trying to fall asleep, you may notice pain that you weren't aware of during the day. While just noticing pain at night is itself not a red flag, pain that wakes you up at night is a red flag and should be evaluated.
5. Pain that Cannot be Relieved by Changing Position
This is one that I deal with a lot as a chiropractor as most of the patients that I see are complaining of musculoskeletal pain. No matter how intense their pain is or how significant of an injury they are dealing with, they can typically get into a position that relieves their pain. Pain that cannot be relieved by changing position or by moving around is a red flag and should be evaluated.
6. Constant Pain
Pain that is present all the time regardless of time of day should be evaluated. This includes pain that is very mild in intensity or easily treated with over-the-counter medication. OTC medications are not intended as a long-term treatment for pain and can often lead to new problems with overuse.
7. Deep Pain
It can often be hard to pinpoint the exact source of your pain and sometimes pain that feels superficial is actually pain being referred from somewhere else. Pain that seems to be coming from deeper within the
body, such as within the chest or abdomen, can be a sign of significant pathology.
8. Unexplained Pain
Sometimes pain may check off multiple red flag boxes but can be explained by keeping in mind your recent activity. For example, after an intense session at the gym you may have discomfort in your legs that is constant and does not respond to changing positions. It may be more noticeable at night and perhaps even severe in intensity. Since this can easily be explained by your recent workout, these signs would be less likely to be due to a concerning issue. By contrast, a blood clot in your lower leg will cause pain and swelling and perhaps redness/warmth in your lower leg that cannot be explained by a recent activity. Pain that cannot be explained is often worth getting evaluated, especially if it also falls into other categories listed above.
The main take away of this article is to be aware of some signs that suggest getting your pain evaluated is a priority. Of course, pain is not the only way that the body tells us something is wrong so pay attention to any other symptoms you might be experiencing such as night sweats, unexplained weight loss, fatigue, and prolonged or intense fever. Listen to your body and trust your instincts. A trip to the emergency room to find out that your possible heart attack is really just a bad case of gas may be embarrassing but its better than the alternative.
by Kathy Wang, D.C.
Pregnancy is an exciting time for an expectant mother but it can also be hard on her body. As the baby continues to grow, the mother's center of gravity changes and the curve in her lower back becomes deeper. Many women experience lower back pain, sciatica, neck pain, headaches, and/or swelling in their hands/feet that can lead to numbness/tingling as a result of the physical and hormonal changes. Sleep can often be affected as well due to issues with breathing and difficulty getting into a comfortable position. Expectant mothers are typically more determined than most to avoid the unwanted side effects of medication and often choose alternative therapies to help with their symptoms. Chiropractic is one of these therapies that aims to provide relief of symptoms while also helping to promote a healthy pregnancy and delivery. Many obstetricians are now referring their patients for chiropractic care to help minimize these complaints. A recent study found that chiropractic care not only lessened pain but also increased the quality of life in pregnant patients by decreasing fatigue and sleep disturbances.
Chiropractic adjustments help restore proper biomechanics to the spine and extremities and can decrease stress on the muscles, joints, and nervous system. This is important, not only for pain management, but also to allow for optimal positioning and easier movement of the baby, helping to promote a smooth delivery. At Aliso Family Chiropractic, we use the Webster technique which was specifically designed with pregnant patients in mind. This technique focuses not only on the movements of the joints of the pelvis and lower back but also targets muscles and ligaments in the area that are often tight and restrictive of movement. We use special pillows for our pregnant patients that allow them to lie face down for much of the visit. We also teach our patients stretches that are particularly helpful during pregnancy that they can do at home to get relief between visits.
Chiropractic can be a safe and effective way to treat many pregnancy-related symptoms. While all chiropractors are able to treat pregnant patients, some have additional training in this area. You can find a chiropractor near you that is certified in the Webster technique by searching on the ICPA (International Chiropractic Pediatric Association) website.
by Ryan P. Clark, D.C.
When patients come into our office with lower back pain they are often worried that they may have injured a disc. They typically don't know much about the intervertebral discs but they know that a problem with one is something they want to avoid. They are right to be concerned as disc injuries do typically require a longer recovery than strain/sprain injuries. Here's some information on herniated discs and why chiropractic is often an excellent choice for conservative care of a disc injury.
Intervertebral discs are located between most of our vertebras (not just in the lower back) and act as a shock absorbers and spacers. They are tough and fibrous around their outer circumference with a soft, gelatinous center. I tell patients to think of a jelly doughnut as an example to describe the consistency of a disc. That tougher, outer fibrous layer is innervated with nerve fibers and tearing this portion does cause pain. The softer, internal core is not innervated so damage to this portion of the disc does not directly lead to pain.
Discs can be injured in many different ways but the classic mechanism for an acute disc injury involves lifting, especially when combined with twisting. Poor biomechanics with activity, being overweight, and deconditioning of core musculature can all increase the likelihood of suffering a disc injury. With disc injuries, the main concern is typically where the disc material has gone. A large disc herniation in one person may actually cause less problems than a small disc herniation in someone else as symptoms are so dependent on location of the herniation. Disc material that travels posteriorly (towards the back) and compresses or irritates the spinal cord can cause pain and other symptoms into both sides of the body while disc material that travels more to either side and compresses or irritates a spinal nerve root will cause symptoms only on one side. Those that compress the spinal cord can cause symptoms such as pain in the neck/back/arms/legs, numbness/tingling/weakness, difficulty walking, loss of urinary/bowel control, and issues with balance/coordination/dexterity. X-rays do not show discs but can give a general idea of disc health by how well spaced the vertebra appear. Advanced imaging, such as MRI or CT studies, can identify disc injuries.
In our office, patients with disc injuries are first treated with a focus on decreasing pain and inflammation. We typically use flexion/distraction (f/d) technique beginning at the first visit to not only help with pain and inflammation but also to improve mobility and restore function. F/D technique consists of the patient lying face down on a specific table that can lengthen and bend. This allows the doctor to slowly stretch the patient's spine pulling disc material away from the spinal canal and/or nerve roots. The doctor can use his or her hand to block the spinal level above the herniation which focuses the decompressive force directly at the level with the herniated disc. Patients often feel an instantaneous improvement in their symptoms while on the table. This technique is repeated at subsequent visits and may be combined with other types of spinal adjusting. Once a patient's condition has improved enough, we will then focus on increasing core strength and teaching proper biomechanics to decrease likelihood of re-injury.
Many disc injuries respond well to conservative care though some do require surgery. Physical therapy, acupuncture, and massage therapy all may prove helpful with disc injuries and are excellent adjuncts to chiropractic care. What uniquely positions chiropractic as the best option for conservative care of disc injuries, though, is the ability to directly affect movement and function at the specific spinal level(s) involved rather than simply treating the area more broadly. If you know someone that is dealing with a disc injury, tell them to look for a chiropractor that uses the flexion/distraction technique. It is a valuable tool that can provide symptom relief and may help someone get back to their life quicker and without surgery.
by Ryan P. Clark, D.C.
Most of us have had the flu at one time or another or have at least seen a family member experience it. You feel terrible. You probably have a fever and aching throughout your body. You're fatigued. Maybe you also experience chills and a headache or a runny nose and sore throat. You have symptoms for a week or two but then they go away and you feel back to normal. That's how the flu is supposed to go, right? Then, why are so many healthy people dying from the flu this year?
Influenza (the flu) is caused by viruses and can spread from person to person through fluid droplets that are expelled by coughing, sneezing, or talking. These droplets can be directly transmitted to another person or indirectly through contact with a contaminated surface. Recent research suggests that flu particles can even be present in the exhaled breath of an infected individual. There are different strains of flu virus and each individual strain can affect us to different extents. This year, the strain H3N2 is the predominant source of cases of the flu in the U.S. H3N2, associated with more flu hospitalizations and deaths than other strains, is particularly hard on the elderly. A 2016 study conducted at Yale found that older individuals did not produce a sufficient amount of antiviral proteins in response to infection with the flu when compared to younger individuals. When a mouse model was used to mimic this lack of a specific response to flu virus, researchers found that infected mice were dying from lung tissue damage caused by the response to the infection rather than the infection itself. This suggests that the less-specific response in elderly flu patients may be playing a role in the higher mortality rate observed in this population. This does not explain the deaths in younger individuals who should be able to mount a more specific response to the flu.
When your body is infected with the flu virus, your immune system mounts a response. White blood cells that fight invading pathogens such as viruses or bacteria encounter the flu virus and release small proteins called cytokines. Cytokines act as signalers and have a direct impact on the intensity and duration of a person's immune response. Immune cells that are recruited to the area then attack tissue that hosts the virus. An excessive response (or cytokine storm) is thought to play a central role in flu-related deaths of individuals considered to be at low-risk of succumbing to the flu. In these individuals, the immune response is so fierce that too much tissue is destroyed. Similar outcomes have been observed in patients with other conditions such as SARS (sudden acute respiratory syndrome) and ARDS (acute respiratory distress syndrome).
As of today, doctors cannot identify patients who are prone to these excessive responses. These patients often develop pneumonia or sepsis as an end result which can progress quickly and lead to death. Difficulty breathing, chest pain, and a spiking fever are all important symptoms to know that could signal that your case of the flu is progressing to pneumonia. Symptoms of sepsis can include confusion, shortness of breath, elevated pulse, fever/chills, and intense pain. Research is being done to identify ways to modulate the immune response to prevent an excessive response from occurring. Cytokine storms have been successfully stopped in mouse models but further research must be done to find a therapy that is both safe and effective in humans. For now, our best way of preventing flu-related deaths in healthy individuals is to be vigilant about the signs of pneumonia and sepsis and to seek care promptly when present.