DiseasesSpinal pain — myths that keep us taking pills for years?
Sources: 11 · Article: 14 851 characters
- Jan Jaśkowski — Mity na temat bólu kręgosłupa i jak sobie z nim radzić. - OstMedic - osteopata Gdańsk, fitoterapia i fizjoterapia
- Jan Jaśkowski — 5 powodów dla których unikałbym operacji kręgosłupa. - OstMedic - osteopata Gdańsk, fitoterapia i fizjoterapia
- Jan Jaśkowski — Postępowanie w bólach kręgosłupa część 3. - OstMedic - osteopata Gdańsk, fitoterapia i fizjoterapia
- Jan Jaśkowski — Postępowanie w bólach kręgosłupa część 1. - OstMedic - osteopata Gdańsk, fitoterapia i fizjoterapia
- Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. · Br J Sports Med 2020
- Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. · Ann Intern Med 2017
- Effects of a tailored mat-Pilates exercise program for older adults on pain, functioning, and balance in women with chronic non-specific low back pain: a randomized controlled trial. · Aging Clin Exp Res 2023
- Immediate analgesic effect of transcutaneous electrical nerve stimulation (TENS) and interferential current (IFC) on chronic low back pain: Randomised placebo-controlled trial. · J Bodyw Mov Ther 2021
- The effectiveness of dry needling in patients with chronic low back pain: a prospective, randomized, single-blinded study. · Sci Rep 2022
- Orthomolecular Medicine News Service — Vitamin C, Shingles, and Vaccination
- Orthomolecular Medicine News Service — Born Defenseless: Why Infant Liver Maturity May Be the Missing Piece in Understanding Vaccine Safety, SIDS, and NDDs
Jan Jaśkowski explains that spinal pain can occur without significant damage, and that stress, fatigue, and lack of sleep can also affect it.
- The spine is not as fragile as commonly believed, and poor posture and weak muscles have not been confirmed as causes of pain.
- Changes visible on scans can also occur in people without pain, and routine imaging tests and surgery are usually unnecessary.
- Immobilisation and avoiding activity can lead to disability; exercises to strengthen muscles are no more effective than other activities.
What the authors write
Jan Jaśkowski
Spinal pain can occur without significant damage, and can also be affected by factors such as stress, fatigue, and lack of sleep.
„This means that you may feel more pain when you try to move or do something, even though there is no significant damage to your spine. Have you ever had a headache caused by stress or fatigue? Spinal pain is no different. In many cases, pain starts after only minimal mechanical strain, such as picking up a scrap of paper from the floor.”To oznacza, że możesz odczuwać większy ból, gdy próbujesz się poruszyć lub coś zrobić, mimo że nie dochodzi do większego uszkodzenia kręgosłupa. Czy kiedykolwiek miałaś/eś ból głowy ze stresu lub zmęczenia? Ból kręgosłupa niczym się nie różni. W wielu przypadkach ból pojawia się już po minimalnym mechanicznym uszkodzeniu jak podnoszenie papierka z podłogi.
Jan Jaśkowski
The spine is not as fragile as commonly believed, and immobilisation and avoiding activity can lead to disability.
„This is a mistaken belief that promotes fear-based behaviours and treatments, immobilisation, and avoidance of physical activity, and can lead to disability. Examples include statements such as: “You have a slipped disc” or “Your vertebra/pelvis is out of place.””Jest to mylne przeświadczenie, promujące zachowania i metody leczenia oparte na strachu, unieruchomieniu i unikaniu aktywności fizycznej, i prowadzące do niepełnosprawności. Przykładowe stwierdzenia to: wypadł ci dysk, kręg/miednica jest nie na miejscu.
Jan Jaśkowski
The belief that poor posture causes pain is not supported by the studies described.
„Although slouching is often blamed for causing pain, scientific research does not support this. Many people with spinal pain adopt a very upright, rigid posture. Next time someone suggests that spinal pain is caused by bad posture, look around and notice all the people sitting in odd or “incorrect” positions without any spinal pain.”Mimo że garbienie się często jest winione za powstawanie dolegliwości bólowych, badania naukowe tego nie potwierdzają. Wiele osób cierpiących na bóle kręgosłupa przyjmuje bardzo wyprostowaną, sztywną postawę. Następnym razem, kiedy ktoś zasugeruje, że ból kręgosłupa powstaje przez nieprawidłową postawę, rozejrzyj się dookoła i przyjrzyj się wszystkim siedzącym w dziwnych/ niewłaściwych pozycjach bez bólu kręgosłupa.
Jan Jaśkowski
A weak core has not been confirmed as a cause of pain, and exercises to strengthen it are no more effective than other activities.
„The theory of a “weak core” has never been confirmed by scientific research. Unfortunately, this theory can cause unnecessary worry and needlessly complicate exercise programmes for people with spinal pain. Instead of strengthening your core, it is better to choose gentle physical activity that you enjoy and can do regularly.”Teoria o „słabym gorsecie mięśniowym” nigdy nie została potwierdzona przez badania naukowe. Niestety, teoria ta może powodować niepotrzebne obawy i zbytecznie komplikować program treningowy pacjentów z bólami kręgosłupa. Zamiast wzmacniania gorsetu mięśniowego lepiej wybrać spokojną aktywność fizyczną, którą będziemy z przyjemnością wykonywać regularnie.
Jan Jaśkowski
Spinal pain should not be considered a normal result of ageing and joint wear.
„That is why it should not be seen as a result of ageing and “wearing out” the joints. Most people recover relatively quickly, and many do not need medical help. Some people experience recurring episodes of spinal pain, which can be very troublesome but are rarely life-threatening.”Dlatego nie powinien być postrzegany jako rezultat starzenia się i „wycierania” stawów. Większość ludzi stosunkowo szybko dochodzi do siebie, a wielu nie potrzebuje pomocy medycznej. Część ludzi doświadcza powtarzających się epizodów bólu kręgosłupa, co może być bardzo uciążliwe jednak rzadko kiedy jest niebezpieczne dla życia.
Jan Jaśkowski
Spinal changes can occur in people who feel no pain, so the change itself does not necessarily cause pain.
„As scientific studies show (not just studies by American scientists), 20% of people in their twenties and as many as 40% of people in their eighties have a protruding intervertebral disc and do not have spinal pain. Nearly 50% of people in their twenties and 96% of people in their eighties have degenerative changes in the spine and do not have pain! We can therefore conclude that structural changes alone do not cause pain.”Jak pokazują badania naukowe ( nie tylko amerykańskich naukowców ), 20% dwudziestolatków i aż 40% osiemdziesięciolatków ma protruzję dysku międzykręgowego i nie odczuwa dolegliwości bólowych kręgosłupa. Blisko 50% dwudziestolatków i 96% osiemdziesięciolatków ma zmiany zwyrodnieniowe kręgosłupa i nie odczuwa dolegliwości bólowych! Można zatem wywnioskować, że sama zmiana strukturalna nie jest przyczyną powstawania bólu.
Jan Jaśkowski
A normal MRI result does not rule out problems with normal functioning, and imaging may not identify the cause of pain.
„I often treat patients in my practice whose MRI scans show no changes in the spine, yet they are unable to function normally.
Radiological tests do not reflect the patient’s actual condition.”W moim gabinecie często leczę pacjentów, których rezonans magnetyczny nie wykazał żadnych zmian w obrębie kręgosłupa, a mimo to pacjenci ci nie są w stanie normalnie funkcjonować.
Badania radiologiczne nie odzwierciedlają rzeczywistego stanu pacjenta.
Jan Jaśkowski
Routine imaging tests and surgery are usually unnecessary for spinal pain.
„In summary, radiological tests and surgery are generally not needed to treat spinal pain. In 80% of cases, radiological tests do not change the diagnosis or treatment. These tests are recommended only if a fracture, infection, or cancer is suspected.”Reasumując, badania radiologiczne ani leczenie operacyjne generalnie nie są potrzebne do wyleczenia dolegliwości bólowych kręgosłupa. W 80% przypadków badania radiologiczne nie zmieniają diagnozy i metody leczenia. Jedynie w przypadku podejrzenia złamania lub infekcji czy nowotworu wskazane jest wykonanie tych badań.
Jan Jaśkowski
Immobilisation does not improve spinal pain.
„However, immobilisation does not improve your condition at all. Spinal pain can be treated without resorting to drastic methods.
Spinal pain is very common. It can be very painful and cause a lot of worry, but it is rarely life-threatening.”Jednak unieruchomienie wcale nie poprawia twojego stanu. Ból kręgosłupa może być wyleczony bez uciekania się do drastycznych metod.
Bóle kręgosłupa są bardzo częste. Bóle kręgosłupa mogą być bardzo bolesne i przysparzają sporo zmartwień, są niezwykle często występującą dolegliwością, ale rzadko są niebezpieczne dla życia.
Jan Jaśkowski
It is not worth basing treatment on rumours or stories about miracle cures.
„Especially not on advice from non-specialists without an appropriate diagnosis. It is never possible to know with 100% certainty how a patient’s body will respond to a particular treatment. That is why treatment should be based on reliable medical knowledge and scientifically tested methods, not on stories from a neighbour or friends.”A tym bardziej laikom bez odpowiedniej diagnozy. Nigdy na 100% nie wiadomo jak organizm pacjenta zareaguje na dane leczenie. Dlatego należy opierać swoje leczenie na rzetelnej wiedzy medycznej i przebadanych naukowo metodach, a nie na opowieściach sąsiadki czy znajomych.
Research from PubMed · Europe PMC
We selected 5 studies with the best, positive results. This is a selection, not a full review of all research.
Total number of studies on this topic in PubMed: 6 189.
A meta-analysis found that Pilates was most likely to provide the greatest pain reduction in chronic, non-specific low back pain.
Aim of the study: Examine the effectiveness of specific modes of exercise training in non-specific chronic low back pain (NSCLBP).
Results: Among 9543 records, 89 studies (patients=5578) were eligible for qualitative synthesis and 70 (pain), 63 (physical function), 16 (mental health) and 4 (trunk muscle strength) for NMA. The NMA consistency model revealed that the following exercise training modalities had the highest probability (surface under the cumulative ranking (SUCRA)) of being best when compared with true control: Pilates for pain (SUCRA=100%; pooled standardised mean difference (95% CI): -1.86 (-2.54 to -1.19)), resistance (SUCRA=80%; -1.14 (-1.71 to -0.56)) and stabilisation/motor control (SUCRA=80%; -1.13 (-1.53 to -0.74)) for physical function and resistance (SUCRA=80%; -1.26 (-2.10 to -0.41)) and aerobic (SUCRA=80%; -1.18 (-2.20 to -0.15)) for mental health.
Money for the studyuniversity or foundation · Musculoskeletal Australia
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studycombined analysis of many studies (meta-analysis)
“Not stated” does not mean nobody paid — the database does not always record it.
Guidelines recommend considering non-drug treatments for low back pain, and exercise and multidisciplinary rehabilitation for chronic pain.
Aim of the study: RECOMMENDATION 1: Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence).
Results: (Grade: strong recommendation). RECOMMENDATION 3: In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence).
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studyreview of many studies
“Not stated” does not mean nobody paid — the database does not always record it.
In older women with chronic low back pain, Pilates reduced pain and disability, and the improvement lasted for six months.
Aim of the study: Mat-Pilates exercise is effective for chronic non-specific low back pain (NSLBP), but its application in older women is understudied. To examine the effects of a 10-week mat-Pilates program on pain, disability, and balance in older women with chronic NSLBP.
Results: IG significantly improved in VAS and RMDQ scores at 10 weeks and 6 months (p > 0.05). No significant differences were observed in TUG and BBS scores at any measurement point. No between-group differences were found in analgesic use or adherence to exercise during the 6-month follow-up. A 10-week mat-Pilates program reduced pain and improved disability in older women with chronic NSLBP, effects which persisted at 6 months. However, no impact on balance, analgesic use, or exercise adherence was observed.
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studystudy with random allocation to groups (RCT)
“Not stated” does not mean nobody paid — the database does not always record it.
The study found that TENS and interferential currents provided immediate relief from chronic low back pain.
Aim of the study: To compare the immediate analgesic effect of transcutaneous nerve stimulation (TENS) and interferential current (IFC), with different combinations of parameters, in individuals with chronic low back pain (CLBP).
Results: In the intergroup comparison of NPRS, all intervention groups showed greater pain reduction compared to GTP (p < 0.05). In the total MPQ score, the groups that obtained significant results (p < 0.05) when compared to GTP were GT100Hz and GT2Hz, while the groups GT100Hz and GI4KHz/100Hz were significant when compared to GIP. In the PA, GI4KHz/100Hz showed an increase in the PPT in all points compared to GTP and GI2KHz/100Hz. Both TENS and IFC presented immediate analgesic effect in CLBP, with emphasis on the interferential current of 4 KHz modulated at 100Hz.
Money for the studynot stated
Do the authors have ties to companies?not stated
Did a manufacturer help with the study?unknown
Type of studystudy with random allocation to groups (RCT)
Participants280
“Not stated” does not mean nobody paid — the database does not always record it.
In the study, dry needling was associated with greater pain reduction and improved function compared with sham therapy.
Aim of the study: Dry needling (DN) is a standard procedure for treating musculoskeletal disorders. However, there are no clear recommendations for using DN in low back pain (LBP).
Results: Intergroup differences were observed in the functional efficiency in ODI in all measurement time-points (p < 0.001). There were significant differences in the range of motion (Schober test) in the DN group (main effect: p < 0.001). For all measurements, differences (p < 0.001) were observed in favor of DN compared to the control. In conclusion, DN program according to the FRS concept stands for the novel treatment method supplemented by an exercise program, effectively reducing pain and improving functional efficiency in LBP patients.
Money for the studygovernment, public institutions · University of Opole in Poland, Academy of Physical Education in Katowice, Ministry of Health
Do the authors have ties to companies?no — the authors say so
Did a manufacturer help with the study?NO
Type of studystudy with random allocation to groups (RCT)
Participants40
“Not stated” does not mean nobody paid — the database does not always record it.
Perspectives and opinion materials
The content below presents the authors’ opinions, interpretations and hypotheses. It is not treated as equal to scientific studies and systematic reviews.
Orthomolecular Medicine News Service Opinion material
„The pain is generally lessened little by analgesics. Some unfortunate individuals can experience postherpetic neuralgia, a syndrome of residual nerve pain that can continue for months or years following a shingles outbreak. Treatment of Shingles with Vitamin C The clinical response of shingles to vitamin C therapy is decidedly different from its response to traditional therapies. While there are not many reports in the literature on vitamin C and shingles, the studies that do exist are striking.”The pain is generally lessened little by analgesics. Some unfortunate individuals can experience postherpetic neuralgia, a syndrome of residual nerve pain that can continue for months or years following a shingles outbreak. Treatment of Shingles with Vitamin C The clinical response of shingles to vitamin C therapy is decidedly different from its response to traditional therapies. While there are not many reports in the literature on vitamin C and shingles, the studies that do exist are striking.
Orthomolecular Medicine News Service Opinion material
„Pharmacogenetic Testing for Analgesic Adverse Effects: Pediatric Case Series. Clin J Pain 32, 109-115 (2016). 6. Thomas, C. & Moridani, M. Interindividual variations in the efficacy and toxicity of vaccines. Toxicology 278, 204-210 (2010). 7. Kearns, G. L. Pharmacogenetics and development: are infants and children at increased risk for adverse outcomes? Curr Opin Pediatr 7, 220-233 (1995). 8. Tomljenovic, L. & Shaw, C. Mechanisms of aluminum adjuvant toxicity and autoimmunity in pediatric populations. Lupus 21, 223-230 (2012). 9. Boretti, A. Reviewing the association between aluminum adjuvants in the vaccines and autism spectrum disorder.”Pharmacogenetic Testing for Analgesic Adverse Effects: Pediatric Case Series. Clin J Pain 32, 109-115 (2016). 6. Thomas, C. & Moridani, M. Interindividual variations in the efficacy and toxicity of vaccines. Toxicology 278, 204-210 (2010). 7. Kearns, G. L. Pharmacogenetics and development: are infants and children at increased risk for adverse outcomes? Curr Opin Pediatr 7, 220-233 (1995). 8. Tomljenovic, L. & Shaw, C. Mechanisms of aluminum adjuvant toxicity and autoimmunity in pediatric populations. Lupus 21, 223-230 (2012). 9. Boretti, A. Reviewing the association between aluminum adjuvants in the vaccines and autism spectrum disorder.
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